Impact of the early 2020 COVID-19 crisis and lockdown on PrEP use among men who have sex with men (MSM) in France

Abstract

ObjectiveTo describe changes in pre-exposure prophylaxis (PrEP) use during and following the COVID-19 lockdown in France (March–May 2020) and identify the factors associated with PrEP discontinuation among men who have sex with men (MSM) after the lockdown.MethodsData from the, an anonymous, cross-sectional internet survey among MSM in July 2020, were analysed. Among respondents who were using PrEP prior to the lockdown, a binary logistic regression model was used to compare participants who were still taking PrEP (current PrEP users) with those who were not taking PrEP at the time of the survey (former PrEP users).ResultsAmong 8345 respondents, 946 were PrEP users before the lockdown, of whom 58.8% (n=556) reported stopping PrEP during the lockdown and 15.4% (n=146) were not using PrEP at the time of the survey. Among the 556 who stopped PrEP during lockdown, 86.5% (n=481) reported no sexual activity; 76.8% (n=427) restarted PrEP after lockdown. Former PrEP users were more likely to be younger, not living with a stable male sexual partner, report moderate anxiety, report increased psychoactive drug use during the lockdown, and report not having tested for HIV or STI since the end of the lockdown because they did not know where to go, preferred to wait or for another reason. Reporting fewer male sexual partners in the last 6 months was also significantly associated with being a former PrEP user.ConclusionsMSM adapted PrEP use to their sexual activity during and after the French lockdown. After the lockdown, discontinued PrEP occurred more often among MSM who had fewer sexual partners and had mental health vulnerabilities. These factors could also be predictive of PrEP discontinuation in a more general context. PrEP users should be informed on how to safely stop/start PrEP and on the use of other prevention tools to reduce potential risk exposure during PrEP discontinuation.

Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021

“…By then, PrEP initiations fell by up to 75%, probably as a result of a decreased accessibility to healthcare services, especially those offering PrEP, but also a lower level of exposure to sexual risk of HIV acquisition during lockdown. 10 , 20 , 21 , 22 PrEP initiations progressively resumed following the end of the first lockdown (from June 2020), but stagnated at the level observed before the start of the pandemic during the rest of year 2020. A trend toward a recovery in increase in PrEP initiations emerged from February 2021 and more particularly in June 2021, marked by the end of the third wave of the COVID-19 pandemic.…”

Potential Impact on Sexual Behaviors, Access to HIV Care and Health for Men Who Have Sex with Men (MSM) during the COVID-19 Pandemic

“…58.8% of the approximately 1000 PrEP-using French MSM users reported stopping their use of the medication during the lock-in period. Less sexual partners and mental fragility were factors that were significantly linked [17]. The availability of PrEP services did not appear to discourage drug use, though.…”

Seroconversion rate of SARS-CoV-2 IgG antibodies and dating behaviour in HIV-PrEP users in a German metropolis during the COVID-19 pandemic

“…Recently, several studies have been published regarding PrEP use and numbers of STIs during the beginning of the pandemic. [6][7][8][9][10][11][12] Only little has been published on whether sexually active MSM are under increased risk for SARS-CoV-2 infection and the effects of lockdown on MSM. [13][14][15][16][17][18] Intrinsic perception of threat imposed by infection with SARS-CoV-2 might have impact on social behavior and therefore was longitudinally observed.…”