The authors reply

Abstract

Dear researchers,We appreciate the interest in our publication and the comments on the content of the article, which we received with great esteem and consideration. Generally, the authors agree and reinforce the importance of our findings, but question two central points: (1) why our research, against the most recent literature, points to an increase in random sexual relations, and (2) whether the COVID-19 pandemic can truly affect the incidence of sexually transmitted infections (STIs) in high-risk/vulnerable groups.Regarding the first question, we believe that the authors misunderstood our findings. In our study published in CSP 1 , we showed results regarding only individuals involved in chemsex, i.e., 920 people (38.9%) of the 2,361 men who have sex with men (MSM) included in the original survey. Although 95% of these individuals sought casual sex regardless of stay-at-home measures, frequency of sexual encounters as well as number of partners decreased, as we detailed in another publication 2 . The data from the general sample of that study show that the majority of MSM (75.9% in Brazil and 72.5% in Portugal) reported a decrease in the number of sexual partners during the pandemic. Thus, the problem itself is not just quantitative (increase or decrease in random encounters), but the fact that when the encounters occur, they seem to be permeated by unsafe sexual practices, increasing the vulnerability to exposure to STIs and SARS-CoV-2 simultaneously (due to unknown partners, use of drugs, orgies, and use of ineffective prevention methods). The finding that 95% of chemical sex cases occurred with a casual partner reinforces the maintenance of behaviors and practices similar to the non-pandemic period, which are associated with higher turnover or number of sexual partners 3 .Concerning the second question, we believe that the impact of the COVID-19 pandemic on STI incidence in high-risk or most vulnerable groups is notorious, as is the case of chemsex-practicing MSM. In a non-pandemic context, the practice of chemsex already increases exposure to STIs 4 , due to aspects such as diminished capacity for negotiating preventive methods, multiple partners, use of psychoactive substances, or even unorthodox contexts. A pandemic context, on the other hand, imposes physical and social distancing for preventing and controlling the new disease, such measures move bodies away and create barriers to sexual practice, which can increase access to psychoactive substances and also associated sexual practices, e.g., orgies that take place in "hidden" places. CARTA LETTER

Sexual Practices and Predisposition to PrEP Use Among Men Ages 50 Years and Older Who Have Sex With Men: A Cross-Sectional Study

“…The time frame during which the study was conducted should also be taken into consideration because it coincided with the COVID-19 pandemic when isolation and social distancing measures were in place. These circumstances may have influenced the behavior of participants, although several studies (Chone et al, 2021; Sousa et al, 2020; Sousa, Oliveira et al, 2021) conducted in these countries have indicated an increase in unprotected sexual activity among MSM during the COVID-19 pandemic.…”

“…To access the initial 30 participants without the need for the researchers to travel to all regions of Brazil and Portugal, two of our experienced researchers, who were duly trained and calibrated, created a public profile on two geolocation-based dating apps (Grindr and Hornet) to identify the “seeds.” In these apps, the researchers approached the first individuals available online in each of the two applications (Chone et al, 2021; Sousa et al, 2020). After approaching each seed, we sent them a link to participate in the survey and instructed them to invite other MSM from their social network until the necessary sample size was obtained.…”

“…Despite many of these individuals having been diagnosed with HIV during their youth, the percentage of MSM acquiring HIV annually is consistently growing (CDC, 2020; Crenitte et al, 2021). Several research findings and studies have emphasized the need for increased attention to the issue of HIV among MSM ages 50 years and older (Brooks et al, 2012; McMillan et al, 2018; Sousa et al, 2020; The Lancet Healthy Longevity, 2022). For instance, it is estimated worldwide that individuals ages 50 years and older represent 17% of new HIV infections.…”