Open Access Research article

Substance use and sexual behaviours of Japanese men who have sex with men: A nationwide internet survey conducted in Japan

Yasuharu Hidaka12*, Seiichi Ichikawa3, Junko Koyano4, Michiko Urao5, Toshihiko Yasuo26, Hirokazu Kimura7, Masako Ono-Kihara1 and Masahiro Kihara1

Author Affiliations

1 Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan

2 Japanese Foundation for AIDS Prevention 5th floor, 1-3-12, Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan

3 Nagoya City University School of Nursing 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan

4 Matsuhama Hospital 3396 Matsuhama-cho, Niigata, 950-3121, Japan

5 Genetic Counselling and Clinical Research Unit, Kyoto University School of Public Health Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan

6 AIDS Medical Center, Osaka National Hospital 2-1-14, Hoenzaka, Chuo-ku, Osaka, Japan

7 Minami Public Health and Welfare Center, City of Yokohama 3-48-1 Hananogi-cho, Minami-ku, Yokohama, 232-0018, Japan

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BMC Public Health 2006, 6:239  doi:10.1186/1471-2458-6-239

Published: 26 September 2006



Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM.


Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet.


In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N, N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge.


This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.