Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men’s HIV-Related Behaviour in Australia

Abstract

COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants’ HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017–June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020–June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.

A National, County-Level Evaluation of the Association Between COVID-19 and Sexually Transmitted Infections Within the United States in 2020

“…However, this hypothesis may be challenged by the near-universal shift in resources that occurred within the United States to refocus STI personnel (including disease intervention specialists) to COVID-19 24 . Alternatively, these variations may be result of regional differences in how individuals changed their sexual behavior in response to lockdowns and other physical distancing policies 27 . For instance, a study in Australia found that suburban areas with a smaller gay population reported fewer partners and less HIV testing compared with larger populations.…”

“…For instance, respiratory diseases, injection drug use–associated diseases, and food-water-and-vector-borne diseases all significantly decreased between 2019 and 2020, and the 2020–2021 influenza season was one of the most mild on record 1,26 . All of this may be directly due to behavioral and policy changes that occurred during the first phase of the pandemic (including masking, hand hygiene, and physical distancing), and it is possible that these policies also impacted sexual health behaviors by decreasing the number and frequency of contact with casual partners 6,27–29 . 31s,32s However, not all changes are necessarily positive.…”

“…31s,32s However, not all changes are necessarily positive. For example, disruptions in healthcare service may have exacerbated chronic illnesses, social isolation brought on physical distancing compounded depression, and a possible decline in preexposure prophylaxis usage 27 . 33s,34s Furthermore, behavioral changes made during the first phase of the pandemic were not always sustainable, and some studies suggest a rebound of STI cases that correspond with the end to lockdown policies 6,27 .…”

Mpox (monkeypox) knowledge, concern, willingness to change behaviour, and seek vaccination: Results of a national cross-sectional survey

“…Previous research has found that GBMSM are unwilling to avoid kissing to reduce the risk of gonorrhoea (23). However, COVID-19 research showed that GBMSM modified their sexual practices to reduce transmission risk, particularly in the absence of vaccine protection (15, 17), gradually increasing levels of sexual activity after they were vaccinated (24). It is difficult for people to sustain behaviour that has a personal or social cost over time (25), so public health messages should consider what behaviour change may be achievable and acceptable for GBMSM during mpox outbreaks, in order for messaging to be effective.…”

Impact of COVID-19 on HIV Prevention Access: A Multi-platform Social Media Infodemiology Study

“…Further, as more individuals at risk for HIV become sexually active due to removal of COVID-19 restrictions, the possibility of HIV transmission during a post-pandemic period may increase, necessitating more comprehensive understanding of barriers associated with PrEP access [ 10 , 12 ]. This may also coincide with a time period where an increased number of HIV-negative individuals are reportedly engaging in riskier sexual and unsafe behaviors [ 13 ]. Hence, research examining the impacts of the COVID-19 pandemic on HIV prevention behavior is needed to address post-pandemic challenges, but interventions will also need to be tailored to specific vulnerable populations and diverse experiences.…”