Changing the Use of HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men During the COVID-19 Pandemic in Melbourne, Australia

Chow, Eric P F; Hocking, Jane; Ong, Jason J.; Schmidt, Tina; Buchanan, Andrew; Rodrı́guez, Elena Rodrı́guez; Maddaford, Kate; Patel, Prital; Fairley, Christopher K

doi:10.1093/ofid/ofaa275

Cited by 75 publications

(87 citation statements)

References 11 publications

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“…Among the MSM using PrEP before the lockdown period, 47.0% had stopped using PrEP, which is in line with a study among MSM in Australia. 19 While it cannot be excluded that they stopped using PrEP to ensure sufficient pill supplies, only 8.0% in our study reported being concerned about not having sufficient pills. Moreover, considering that almost two-thirds had been on a PrEP care appointment within 90 days before completion of the survey and that only 22.6% had their appointment postponed, it is unlikely that they stopped using PrEP due to not having access to PrEP care.…”

Section: Discussioncontrasting

confidence: 59%

“…This is in line with studies in the USA and Australia where MSM indicated fewer sexual partners or having less opportunities for having sex. [17][18][19] The reduced sexual activities with sexual partners outside the household is likely to result in reduced HIV and STI transmission among MSM. Among those who had sex with non-steady partners during the lockdown in our study, more than two-third were using PrEP or were HIV positive.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the majority of those using daily before the lockdown (57.4%) remained to use PrEP daily during the lockdown, in line with an Australian study. 19 Potential reasons for continuing daily PrEP use could be that such daily users prefer to keep their routine or that they do not exclude the possibility of unplanned sexual encounters. Another reason may be the lack of awareness, available knowledge or support on how to stop and restart PrEP use.…”

Section: Discussionmentioning

confidence: 99%

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Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

et al. 2020

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ObjectivesTo examine changes in the occurrence of physical sex with non-steady partners among men who have sex with men (MSM) in Belgium during the first weeks of the COVID-19 lockdown and associations with sociodemographic factors, sexual practices, drug, alcohol and pre-exposure prophylaxis (PrEP) use. A secondary objective was to explore changes in PrEP use and the need for PrEP follow-up.MethodsA cross-sectional online survey. The questionnaire was available in Dutch, French and English, between April 10 and 27 (2020), and disseminated via sexual health and lesbian, gay, bisexual, trans, queer or intersex organisations throughout Belgium. Eligibility criteria included being 18 years or older, not being exclusively heterosexual and living or being born in Belgium.ResultsThe sample included 694 MSM. Physical sex with non-steady partners decreased from 59.1% to 8.9% during the first weeks of the lockdown. Those who had sex with non-steady partners were significantly more likely to be HIV positive, to use PrEP or to have engaged in sexual practices such as group sex, chemsex and sex work before the lockdown, compared with their counterparts. Among those who used PrEP before the lockdown, 47.0% stopped using PrEP, 19.7% used event-driven PrEP and 33.3% used daily PrEP during the lockdown. Almost two-thirds of PrEP users had a PrEP care appointment in the weeks before the lockdown and a minority received follow-up elsewhere or online. Some PrEP users had concerns regarding their follow-up.ConclusionsMSM in our survey substantially reduced sexual contact with non-steady partners during the first weeks of the COVID-19 lockdown, suggesting that the risk for HIV and STI transmission in this period was low. We recommend ensuring access to sexual health services, such as HIV testing and follow-up for PrEP for the small group having multiple sex partners and engaging in sexual practices such as chemsex, or group sex, even in times of a pandemic threat.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

et al. 2020

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“…21 For some men, stopping sex with nonprimary partners may obviate the need for PrEP. 15 , 22 Conversely, some GBM may prefer to continue their PrEP use as discontinuation may undermine the habit of pill-taking, the reassurance of being protected from HIV, or inhibit their motivation to reinitiate. Some men also seem to believe that PrEP may offer some protection against COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men

Hammoud

Grulich

Holt

et al. 2021

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV preexposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM). Methods: Participants in an ongoing online cohort study previously reported PrEP use from 2014 to 2019. In April 2020, 847 HIV-negative and untested participants completed questionnaires assessing changes in PrEP use as a result of COVID-19 public health measures. Binary logistic multiple regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to compare changes in PrEP use behaviors. Results: Among 847 men, mean age was 44.1 years (SD: 12.7). PrEP use rose from 4.9% in 2015 to 47.2% in 2020. Among those, 41.8% (n = 167) discontinued PrEP use during COVID-19 restrictions. Discontinuing PrEP during COVID-19 restrictions was independently associated with being less likely to have recently tested for HIV (aOR: 0.17; 95% CI: 0.09 to 0.34; P < 0.001) and less likely to report sex with casual partners (aOR: 0.28; 95% CI: 0.14 to 0.54; P < 0.001). Conclusions: By April 2020, following the introduction of COVID-19 restrictions, GBM dramatically reduced PrEP use, coinciding with a reduction in sexual activity. Longer-term impacts of COVID-19 restrictions on sexual behaviors among GBM need to be monitored because they may foreshadow fluctuations in prevention coverage and risk of HIV infection. Our findings indicate a potential need for clear, targeted information about resumption of PrEP and on-demand optimal dosing regimens in response to ongoing changes in restrictions.

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“…The reduction in PEP prescriptions we saw was slightly lower than that seen at 56 Dean Street, which might be because the COVID-19 epidemic in England (5585 cases as of March 22) 2 was larger than in Australia (1765 cases as of March 22). 3 The reduction observed at MSHC might have been due to reduced sexual risk during the COVID lockdown period rather than reduced access to services, 4 given our walk-in service remained open and accessible throughout the period.…”

mentioning

confidence: 99%

Postexposure prophylaxis during COVID-19 lockdown in Melbourne, Australia

et al. 2020

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Changing the Use of HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men During the COVID-19 Pandemic in Melbourne, Australia

Cited by 75 publications

References 11 publications

Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

Reduced sexual contacts with non-steady partners and less PrEP use among MSM in Belgium during the first weeks of the COVID-19 lockdown: results of an online survey

Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men

Postexposure prophylaxis during COVID-19 lockdown in Melbourne, Australia

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