Objective  To analyze the serologic detection results and risk behaviors in different types of drug users in human immunodeficiency virus （HIV） sentinel surveillance in Guangxi during 2012−2021 and provide evidence for HIV infection and spread risk assessment in drug users.

  Methods  Sentinel surveillance was conducted annually in the drug users during 2012−2021 through questionnaire survey and serological testing.

  Results  A total of 136 384 drug users were included in the study during this10-year period. The proportion of traditional drug users decreased from 81.21% to 59.56% and the proportion of club users increased from 10.24% to 22.21%. The positive rates of HIV infection, syphilis and hepatitis C virus infection decreased in traditional drug users, but not in club drug users. The proportion of injecting drug users decreased from 76.13% to 58.91% in all drug users, in which the proportion of traditional drug users decreased from 84.15% to 72.30%, but the proportion of club drug users fluctuated between 5.30% and 12.91%. In injecting drug users, the proportions of those who injected drugs in the past month, shared needles with others and shared needles in the latest month all decreased. In all the drug users, the proportion of those who had sex in the latest month increased from 37.14% in 2013 to 58.52% in 2020, and the proportion of those who had commercial sex in the past year fluctuated between 19.80% and 32.95%. The awareness rates of HIV-related knowledge were all ≥90.00% and the proportion of those receiving any kind of HIV-related services was ≥80.00% in the past year.

  Conclusion  HIV spread risk through injection decreased but the sexually transmission risk increased in traditional drug users, and HIV spread risk increased in club drug users.