Gender differences among MA users have been reported by some studies. Female MA users were more likely to be younger, have lower educational level, have never been married, and be an MA-using sex partner [21
]. Our findings show significant differences between the demographic characteristics of male and female MA users, and some new findings in this study differed from those in other studies. Most male MA users in this study were married and local or self-employed businessmen; most female MA users were young, single, and mobile CSWs. These findings are interesting because they suggest that gender-specific intervention measures should be implemented in risk reduction programs for MA user populations.
The reasons for MA use were investigated in this survey. The major reason for MA use is its benefit in enhancing sexuality; most male and female respondents neglected its addictiveness. Furthermore, both males and females had several wrong perceptions of MA. MA was usually regarded as a daily life necessity, very much like cigarettes, especially by male respondents. This finding indicates that more information on the risks and harm of MA should be provided in intervention programs in the future. MA use is a complicated social problem in many countries. The reasons why more and more people fall into MA addiction require more studies from the physiological, psychological, and social perspectives. Individual, social, and environmental factors have been reported to be associated with initiating MA injection [24
]. In this study, among those who recognised its addictiveness, fewer females than males wanted to try to abstain from MA. The reasons underlying this behaviour require further investigation.
Gender differences were observed in terms of MA use behaviours. Most female MA users initiated MA use at an early age, had shorter abuse durations, used MA more frequently, and were more likely use MA with heterosexual partners. MA enhances sexual performance, sensitivity, and pleasure, increasing the risk of trauma from prolonged intercourse and failure to use condoms [25
], and is associated with having multiple sex partners and unprotected sex [9
]. Results from this paper support previous findings showing that MA use can greatly increase the risk of STD/HIV transmission. Although most respondents in this study had enough knowledge of STD/AIDS, some misunderstandings were observed. Most male and female respondents recognised the risk of multiple sex partners; however, many MA users did not know how to prevent STDs/AIDS using condoms. High-risk sexual behaviours related to MA use among these respondents were very common, including having sex with multiple partners and exchanging sex partners. More males had been engaged in group sex and sex partner exchanges than females because most male respondents had had sex with CSWs during MA use. It indicates the truth that many sex episodes involved one man and more than one woman including those women who are not MA users during MA use, suggesting that some form of intervention specific to these kinds of sex encounters should be conducted. Furthermore, many males had also been engaged in other high-risk sexual practices, such as never using condoms and never changing condoms when changing CSW partners, which may endanger their female partners as well.
Several limitations are present in this study, including the sample population and the data collection methods. First, the study utilised non-random sampling recruitment methods and had inclusion criteria confined to non-injected heterosexual MA users; thus, the generalisability of the study results could be limited. Second, behavioural data were collected through self-reporting and memory or recall of behaviours during sexual or MA use events may be problematic. Third, most female MA users recruited into the study report behaviors that would lead them to be classified as sex workers. Therefore, the sample tells us little about MA use and related knowledge, attitudes, and risk behaviors in the broader population of women who use MA without injection. Finally, although STD/HIV testing was conducted for each participant in this cross-sectional study, detailed information about actual STD/HIV infection rates in this article was not provided. A multi-factor analysis on STD/HIV prevalence among non-injecting heterosexual MA users will be conducted in another study.
The study was characterised by a number of strengths. First, this study provides the first report in China addressing the characteristics of and high-risk behaviours among non-injecting heterosexual MA users. Second, the findings enrich our knowledge of gender differences in demographic characteristics, perception of MA and STDs/HIV, and high-risk behaviours among non-injecting heterosexual MA users. Third, this study discussed the reasons for MA use, although further investigation is needed.