Potential interruptions in HIV prevention and treatment services for gay, bisexual, and other men who have sex with men associated with COVID-19

Abstract

Background Globally, the coronavirus pandemic has necessitated a range of population-based measures in order to stem the spread of infection and reduce COVID-19-related morbidity and mortality. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 mitigation strategies and interruptions to HIV prevention and treatment services for MSM. Methods Data for this study were collected as part of a COVID-19 Disparities Survey implemented by the gay social networking app Hornet, with data collected between April 16th, 2020 and May 24th, 2020. Data were assessed for countries where at least 50 participants completed the survey, to best evaluate country-level heterogeneity. We used a modified Poisson regression model, with clustering at the country-level, to assess the association between stringency of pandemic control measures and access to HIV services. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index; each country received a score (0-100) based on the number and strictness of nine indicators related to school and workplace closures and travel bans. Results A total of 10,654 MSM across 20 countries were included in these analyses. The mean age was 34.2 (standard deviation: 10.8), and 12% (1264/10540) of participants reported living with HIV. The median stringency score was 82.31 (Range:[19.44, Belarus]-[92.59, Ukraine]). For every ten-point increase in stringency, there was a 3% reduction in the prevalence of access to in-person testing (aPR: 0.97, 95% CI:[0.96, 0.98]), a 6% reduction in the prevalence of access to self-testing (aPR: 0.94, 95% CI:[0.93, 0.95]), and a 5% reduction in access to PrEP (aPR: 0.95, 95% CI:[0.95, 0.97]). Among those living with HIV, close to one in five (n=218/1105) participants reported being unable to access their provider either in-person or via telemedicine during the COVID-19 pandemic, with a greater proportion of interruptions to treatment services reported in Belarus and Mexico. Almost half (n=820/1254) reported being unable to refill their HIV medicine prescription remotely. Conclusions More stringent government responses were associated with decreased access to HIV diagnostic, prevention, and treatment services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to facilitate minimize service interruptions to MSM communities during this and potential future waves of COVID-19.

Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review

“…Twenty primary research studies and 33 editorials/commentaries were identified. Sixteen studies were conducted within three countries: the USA, Australia and Turkey, one study was conducted across Belgium and Brazil and the final three studies were conducted across multiple nations [19][20][21][22] (see Table 4 for included countries). Sixteen studies were quantitative, with an additional survey involving open-ended questions, two involved semi-structured qualitative interviews and one detailed a case series (see Table 4).…”

“…The research investigated a range of topics including, mental health and stress [20,21,23,24], access to health care [22,25], experiences of stigma [26], factors impacting medication adherence [27] and social precarity [28]. One US study involved a case series of PLHIV who had been diagnosed with COVID-19 [9] and three studies focused on unique subgroups of PLHIV, including African American and Latinx PLHIV [29], PLHIV with substance use disorders [30] and transgender women living with and without HIV [28].…”

“…Participant recruitment and data collection is a time intensive task, but many studies drew on internet-based surveys or worked with existing cohorts to gather early information on the impact of COVID-19. For example, four studies involved cross sectional surveys conducted online or via social networking apps Grindr and Hornet [19,22,31,32]. One study involved semi-structured qualitative interviews with 15 racially diverse PLHIV who had been part of an HIV care intervention [29].…”

Sexual health (excluding reproductive health, intimate partner violence and gender-based violence) and COVID-19: a scoping review

“…Eight studies evaluated HIV care outcomes among SGM. [76][77][78][79][80] Two cross-sectional observational quantitative studies, one in Australia and the other global, reported a decline in pre-exposure prophylaxis (PrEP) use among sexual minority individuals during lockdown. 77 80 A global study found that MSM experienced greater difficulty in accessing condoms during lockdown.…”

Estimating the potential impact of COVID-19-related disruptions on HIV incidence and mortality among men who have sex with men in the United States: a modelling study

“…The COVID-19 pandemic and responses to it have disrupted HIV prevention and treatment services around the world, and influenced sexual behaviour, with consequences for HIV transmission and mortality. 1-4…”