‘Stay at home …’: exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK

Abstract

ObjectivesThe first UK national lockdown began on 23 March 2020, in response to the COVID-19 pandemic, and led to reduced STI/HIV service provision in the UK. We investigated sexual behaviour, use and need for sexual healthcare during the pandemic.MethodsParticipants (N=2018), including men (cis/transgender), transwomen and gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth, completed an online cross-sectional survey (23 June 2020–14 July 2020), in response to adverts on social media and dating apps.Sexual behaviour, service use and unmet need for STI testing (any new male and/or multiple condomless anal sex (CAS) partners without STI testing) in the 3 months since lockdown began were examined and compared using multivariable analyses with an equivalent 3-month period in a 2017 survey (N=1918), conducted by the same research team.ResultsSince lockdown began, 36.7% of participants reported one or more new partners, 17.3% reported CAS with multiple partners, 29.7% HIV testing (among 1815 of unknown/negative status), 24.9% STI testing and 15.4% using pre-exposure prophylaxis (PrEP).Since lockdown began, 25.3% of participants had unmet need for STI testing. This was more likely among Asian versus white participants (adjusted OR (aOR)=1.76, (1.14 to 2.72), p=0.01); for participants living in Scotland (aOR=2.02, (1.40 to 2.91), p<0.001) or Northern Ireland (aOR=1.93, (1.02–3.63), p=0.04) versus England; and for those living with HIV (aOR=1.83, (1.32 to 2.53), p<0.001).Compared to 2017, the equivalent 2020 subsample were less likely to report new male partners (46.8% vs 71.1%, p<0.001), multiple CAS partners (20.3% vs 30.8%, p<0.001) and have unmet need for STI testing (32.8% vs 42.5%, p<0.001) in the past 3 months.ConclusionsWe found potential for ongoing STI/HIV transmission among men who have sex with men during the initial UK lockdown, despite reduced sexual activity, and inequalities in service access. These findings will support public health planning to mitigate health risks during and after the COVID-19 response.

Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences

“…The study highlighted unmet need for SRH services, with one in 10 survey participants reporting unsuccessful attempts to access SRH services and one in five men needing but being unable to access condoms 12. Other UK studies found that men who have sex with men and young people experienced an unmet need for STI testing, contraception and condom access 13–15. This paper describes the results from qualitative follow-up interviews with Natsal-COVID participants exploring the experiences of unmet or delayed SRH need in the general population.…”

Changes in STI and HIV testing and testing need among men who have sex with men during the UK’s COVID-19 pandemic response

“…2 Consequently, sexual health services (SHS) rapidly reconfigured: in-person asymptomatic screening and walk-in appointments were suspended and patients directed online. 3 While the introduction of social restrictions during the first national lockdown 4 5 led to reductions in sexual risk behaviours for MSM (eg, one UK study of MSM found 47% reported new recent sex partners March-June/July 2020, a substantial decrease from 71% in a comparative 2017 sample), 6 they continued to be reported by a high proportion. [6][7][8] Social restrictions eased July-September 2020, 9 and sexual risk behaviour among MSM seemed to increase compared with the first national lockdown.…”

Choice of antibiotics for prophylaxis of bacterial STIs among individuals currently self-sourcing

“…1 During the COVID-19 pandemic, online surveys of MSM were carried out in the UK within the Reducing Inequalities and Improving Sexual Health (RiiSH-COVID) study. 2 The second survey ( 23November -12 December 2020) included questions on STI prophylaxis. The survey had 1,522 respondents, of which 1,520 completed the STI prophylaxis questions.…”

“…During the COVID-19 pandemic, online surveys of men-who-have-sex-with-men(MSM) were carried out in the UK within the Reducing Inequalities and Improving Sexual Health Study 2. The second survey (23 November–12 December 2020) included questions on STI prophylaxis.…”