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

Abstract

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.

Overview of SARS-CoV-2 infection in adults living with HIV

“… 104 , 105 Other studies (but not all) have described substantial reductions in sex with non-steady partners during the first weeks of lockdown among men who have sex with men (MSM). 106 , 107 , 108 , 109 These studies describe MSM as indicating fewer sexual partners or fewer opportunities for having sex. Reduced sexual activity with sexual partners external to the household is more likely to result in reduced sexual transmitted infections among HIV-positive MSM.…”

“…Reduced sexual activity with sexual partners external to the household is more likely to result in reduced sexual transmitted infections among HIV-positive MSM. 106 A Belgian study described MSM who had sex with nonsteady partners were significantly more likely to be HIV positive, to use pre-exposure prophylaxis (PrEP), or to have engaged in sexual practices such as group sex, chemsex, and sex work, before the first national lockdown, compared with their counterparts. 106 Lockdown restrictions and reducing in-person visits during the COVID-19 pandemic might have interrupted both pre-exposure prophylaxis for adults at high-risk of HIV infection and antiretroviral treatment for people living with HIV.…”

“…106 A Belgian study described MSM who had sex with nonsteady partners were significantly more likely to be HIV positive, to use pre-exposure prophylaxis (PrEP), or to have engaged in sexual practices such as group sex, chemsex, and sex work, before the first national lockdown, compared with their counterparts. 106 Lockdown restrictions and reducing in-person visits during the COVID-19 pandemic might have interrupted both pre-exposure prophylaxis for adults at high-risk of HIV infection and antiretroviral treatment for people living with HIV. Hence outreach programmes for treatment and prevention of HIV have become increasingly relevant and should be rapidly implemented in case of further waves.…”

The impact of physical restriction measures imposed during the two waves of COVID-19 on chlamydia and gonorrhea diagnoses in Belgium. Results of an sexually transmitted infection clinic

“…Indeed, in LD1, an online survey indicated that Belgian MSM reduced their sexual activity with nonsteady partners with 85%. 7 Although no Belgian sexual activity data are available for LD2, personal communication with patients indicate regular sexual activity through internet dating and in private encounters during this period, despite the social measures and the threat of being fined by the authorities.…”

“…6 Furthermore, a reduction in casual sex was noted in several countries, including Belgium, during the first lockdown. 5,[7][8][9] However, few studies are available which investigate the trend of STIs after a lockdown period, and to our knowledge, none of them explored the effect of the mitigating efforts of the second COVID-19 wave in Europe.…”