How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID)
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Abstract
To investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic.
Methods
British participants (18–59 years) completed a cross-sectional web survey 1 year (March–April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16–74 years) conducted in 2010–2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18–44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors.
Results
In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18–24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers.
Conclusions
Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010–2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.
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SciScore for 10.1101/2022.04.29.22274486: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: We obtained ethical approval from University of Glasgow MVLS College Ethics Committee (reference 20019174) and London School of Hygiene and Tropical Medicine Research Ethics Committee (reference 22565). Sex as a biological variable Data from Natsal-COVID are presented for all participants and separately for men (including trans men) and women (including trans women). Randomization 16 Interviewers visited all sampled addresses, identified residents in the eligible age range (16–74 years), and randomly selected one individual to participate in the survey. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing …
SciScore for 10.1101/2022.04.29.22274486: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: We obtained ethical approval from University of Glasgow MVLS College Ethics Committee (reference 20019174) and London School of Hygiene and Tropical Medicine Research Ethics Committee (reference 22565). Sex as a biological variable Data from Natsal-COVID are presented for all participants and separately for men (including trans men) and women (including trans women). Randomization 16 Interviewers visited all sampled addresses, identified residents in the eligible age range (16–74 years), and randomly selected one individual to participate in the survey. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: No previous study has examined whether differential access to key interventions to prevent STI or HIV and their sequelae might have changed at a population level due to the COVID-19 pandemic.20 However, our study also has limitations.13 Whilst it benefited from a questionnaire developed by the Natsal team to obtain high-quality data while navigating pandemic-related circumstances and used a large national sample, with quota sampling and weighting to improve generalisability, the Natsal-COVID study is not a probability sample. Specific prevalence estimates should be treated with particular caution given expected selection and response biases. Due to the lack of population-level data on access to key STI/HIV prevention interventions by sociodemographic and behavioural characteristics collected immediately prior to the pandemic, we used data from Natsal-3 to compare trends in differential uptake of interventions. Natsal-3 data provided the best comparison for these population-level sexual health interventions—with four key caveats. First, Natsal-3 data were collected ten years ago, and sexual behaviours and service provision have likely undergone secular changes in this timeframe. Second, Natsal-3 was a household-based probability sample, and there are different sampling biases between the surveys that weighting can only partially correct.13 Third, where we saw differences in associations, it was not possible to determine whether this was because of a ...
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.
Results from scite Reference Check: We found no unreliable references.
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