How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey

  1. Amanda Gabster
  2. Jennifer Toller Erausquin
  3. Kristien Michielsen
  4. Philippe Mayaud
  5. Juan Miguel Pascale
  6. Carles Pericas
  7. Michael Marks
  8. Jennifer Katz
  9. Gonzalo Cabezas Talavero
  10. Marilu de Argote
  11. Anet Murillo
  12. Joseph D Tucker

Reviewed by

Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

To describe reported changes in sexual behaviours, including virtual sex (sexting and cybersex), and access to HIV/STI testing and care during COVID-19 measures in Panama.

Methods

We conducted an online cross-sectional survey from 8 August to 12 September 2020 among adults (≥18 years) residing in Panama. Participants were recruited through social media. Questions included demographics, access to HIV/STI testing and HIV care, and sexual behaviours 3 months before COVID-19 social distancing measures and during social distancing measures (COVID-19 measures). Logistic regression was used to identify associations between variables and behavioural changes.

Results

We recruited 960 participants; 526 (54.8%) identified as cis-women, 366 (38.1%) cis-men and 68 (7.1%) non-binary or another gender. The median age was 28 years (IQR: 23–37 years), and 531 of 957 (55.5%) were of mixed ethnicity (mixed Indigenous/European/Afro-descendant ancestry). Before COVID-19 measures, virtual sex was reported by 38.5% (181 of 470) of cis-women, 58.4% (184 of 315) cis-men and 45.0% (27 of 60) non-binary participants. During COVID-19 measures, virtual sex increased among 17.2% of cis-women, 24.7% cis-men and 8.9% non-binary participants. During COVID-19 measures, 230 of 800 (28.8%) participants reported decreased casual sex compared with pre-COVID-19 measures. Compared with pre-COVID-19 measures, decreased casual sex was reported more frequently during COVID-19 measures by cis-men compared with cis-women (39.2% vs 22.9%, urban/rural adjusted OR (AOR)=2.17, 95% CI 1.57 to 3.01), and by Afro-descendant compared with participants of mixed ethnicity (40.0% vs 29.8%, AOR=1.78, 95% CI 1.07 to 2.94). Compared with no change in virtual sex (16.8%), increased virtual sex (38.5%, AOR=1.78, 95% CI 1.10 to 2.88) and decreased virtual sex (86.7%, AOR=16.53, 95% CI 7.74 to 35.27) were associated with decreased casual sex encounters. During COVID-19 measures, HIV/STI testing could not be obtained by 58.0% (58 of 100) of the participants who needed a test, and interrupted HIV care was reported by 53.3% (8 of 15) of participants living with HIV.

Conclusions

COVID-19 measures in Panama were associated with a decrease in casual sex among cis-men and Afro-descendant people, while access to HIV/STI testing and care was seriously disrupted.

Article activity feed

  1. Version published to 10.1136/sextrans-2021-054985
  2. ScreenIT

    SciScore for 10.1101/2021.02.03.21251095: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Ethical considerations: We obtained ethical approval from the Comité Nacional de Bioética de Panama (EC-CNBI-2020-06-73), Ghent University (BC-07988) and the University of North Carolina at Chapel Hill for secondary data analysis.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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 several limitations. First, online questionnaires are likely to suffer selection bias as they are only able to include participants who have seen the announcement and are both motivated and able to use online tools and connect. However, our study used best practices to decrease selection bias [29]. Second, the convenience approach in sample selection limits the generalisability of findings. However, we found that our sample had a fairly similar structure to the 2020 census data in terms of ethnicity, urban/rural spread, and province of residence (Supplementary Table 1), except that our sample had more female participants compared to census data. This finding is common in online health surveys, especially those examining sexual and reproductive health topics [30]. Lastly, this analysis is unable to correlate behaviour with biological outcomes, therefore we do not know the impact of behaviour changes on HIV or STI rates. Our data have implications for STI and HIV research and policy. From a research perspective, our data suggest the need and usefulness of more rigorous behavioural research during national medical crises and pandemics that have the capacity to disturb normal services. While we were able to recruit a convenience sample during the pandemic, national panels or other methods can be used to obtain less biased observations [29]. These data will be important as lockdown conditions are relaxed and reinforced. From a policy perspective, our data underline t...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.02.03.21251095 on medRxiv