Changes in Sexual Behavior, PrEP Adherence, and Access to Sexual Health Services Because of the COVID-19 Pandemic Among a Cohort of PrEP-Using MSM in the South

  1. Sanjana Pampati
  2. Kayla Emrick
  3. Aaron J. Siegler
  4. Jeb Jones

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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has had unforeseen consequences on the delivery of HIV and sexually transmitted disease (STD) prevention services. However, little is known about how the pandemic has impacted pre-exposure prophylaxis (PrEP)-using men who have sex with men (MSM).

Methods:

Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered 10 surveys in total, including 1 ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n = 56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effect regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months.

Results:

A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally—number of male sexual partners, anal sex acts, condomless anal sex, and oral sex (all measured in the past 2 weeks)—there was a decrease from February to April followed by an increase from April to June.

Discussion:

Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.

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  1. Version published to 10.1097/qai.0000000000002640
  2. ScreenIT

    SciScore for 10.1101/2020.11.09.20228494: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableEligible participants were cisgender male, 18-34 years old, lived in the Southern United States and planned to stay there for at least 16 weeks, English proficient, reported anal sex with a man in the past 6 months, were HIV-negative, and were current users of oral HIV PrEP.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted in SAS 9.4 (SAS Institute, Cary, NC).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. Given limited sample size, we were unable to test for demographic and geographic differences in our findings. Further because participants are from several states in the South, we were unable to link our findings to specific state-level policies to control COVID-19. All data are self-reported and are subject to social desirability biases. Findings may not be generalizable to other populations or settings. Our findings underscore the need to maintain STD and HIV prevention efforts during the COVID-19 pandemic, as recent calls for action have stressed.13,14 Finding unique ways to deliver these essential services is needed. Guidance from the US Centers for Disease Control and Prevention and other sources offer a host of options to ensure appropriate care during the pandemic,15,16 including lab-only visits for indicated HIV/STD tests, at-home HIV/STD testing, self-testing for HIV via an oral swab-based test, extending the prescription of PrEP to a 90-day supply to decrease trips to the pharmacy, utilizing telemedicine when possible, and finally referring patients elsewhere if needed services cannot be provided. Moreover, a critical component of PrEP check-up visits is risk reduction counselling and incorporating discussions of COVID-19 risk into these discussions may be needed. For all sexual activities examined except kissing, there was substantial variability in the perceived level of COVID-19 acquisition risk, suggesting a need for clearer risk reduc...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.09.20228494v1 on medRxiv