Background
Men who have sex with men (MSM) use cannabis more frequently than heterosexuals. Cannabis use has various adverse psychological and health outcomes. In the pretext of elevated sexual pleasure and stress relieving potential of cannabis, it is used worldwide, including in Nepal. However, there is a lack of research regarding the existing status and factors associated with cannabis use among men who have sex with men (MSM) in Nepal. This study aimed to find out the prevalence and factors associated with cannabis use among MSM in Nepal.

Methods
A cross-sectional survey was conducted among MSM in Nepal (N=250) between October and November 2022. Participants were recruited using respondent-driven sampling (RDS) in Kathmandu Valley, Nepal. We collected socio-demographic characteristics, HIV risk-related behaviors, and questions on recreational drugs such as cannabis, poppers, cocaine, heroin, and drugs associated with chemsex (i.e., crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Using multivariable ordinal logistic analysis, the association of demographics, sexual risk-related behaviors, and health-related behaviors with cannabis use were examined. Overall proportions were weighted in RDS Analyst software, and 95% confidence intervals were calculated.

Results
In a study involving 250 participants, the mean age was 27.6 (SD=8.9) years. We found that 27.3% of participants ever used cannabis in their lifetime, and 15.6% had used it within the past six months. With increasing age, MSM were less likely to use cannabis use in the past six months (aOR: 0.8; 95% CI: 0.7-0.9). Participants who were single (aOR: 21.5; 95% CI: 2.6-175.6), ever being detained by the police (aOR: 11.4; 95% CI: 2.2-58.4), smoking tobacco daily (aOR: 4.6; 95% CI: 1.2-17.9), seen a doctor within the last six months (aOR: 0.2; 95% CI: 0.1-0.6), and having a trusted healthcare provider (aOR: 0.1; 95% CI: 0.01-0.2) were associated with cannabis use in past six months.

Conclusion
This study found that the prevalence of cannabis use among MSM is more common. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to younger, single, and daily smoker MSM in the form of screening, risk stratification, and treatment. Further investigation is warranted to elucidate the underlying mechanisms relating to cannabis use among MSM. Tailored interventions to mitigate drug-related harm in this population should be implemented.