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Given the distinct social and cultural context of same\u2010sex relationships and drug\u2010using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta\u2010analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta\u2010analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta\u2010analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10\u201316%; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 97.6) but higher when studies utilized self\u2010administered surveys (15%; 95% CI = 12\u201319%; <jats:italic>p<\/jats:italic>&lt;0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82\u20135.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27\u20138.21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between\u2010study comparisons. Responses to SDU\u2010related harms should consider local contexts, including specific drug types used and their relative risks.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26054","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T05:26:14Z","timestamp":1672896374000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7012-6467","authenticated-orcid":false,"given":"Laura","family":"Nevendorff","sequence":"first","affiliation":[{"name":"Disease Elimination Program Burnet Institute  Melbourne Victoria Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Victoria Australia"},{"name":"HIV AIDS Research 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