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Starks TJ, Hillesheim JR, Castiblanco J, Cain D, Stephenson R. Drug use during the second year of the COVID-19 pandemic: observations from repeated cross-sectional surveys of sexual minority men in the US active on social networking applications. AIDS Care 2024; 36:145-153. [PMID: 38289592 PMCID: PMC11283985 DOI: 10.1080/09540121.2024.2308738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/10/2024] [Indexed: 07/28/2024]
Abstract
Studies conducted early in the COVID-19 pandemic - before vaccines were widely available - indicated that drug use may have declined among sexual minority men (SMM). This study evaluated drug use trends in the second year of the pandemic. Cross-sectional responses from cisgender SMM living in the US and recruited online (n = 15,897) were grouped for analyses: Time 1: 3/1/2021-5/30/2021; Time 2: 6/1/2021-8/31/2021; Time 3: 9/1/2021-11/30/2021; and Time 4: 12/1 2021-2/28/2022. Results of multivariable models indicated that illicit drug use (excluding cannabis) increased at Times 2 (OR = 1.249, p < .001), 3 (OR = 1.668, p < .001), and 4 (OR = 1.674, p < .001) compared to Time 1. In contrast, cannabis use was relatively stable over time. Rates did not differ significantly among Times 1, 2, and 4. While rates of COVID-19 vaccination increased over time, illicit drug use was negatively associated with the odds of vaccination (OR = 0.361, p < .001). These findings highlight the need for ongoing attention to the risks drug use poses among SMM. Illicit drug use - a long-standing health disparity among SMM - increased significantly across the second year of the pandemic. Because they are less likely to be vaccinated, SMM who use illicit drugs may be at greater risk of COVID-19 infection or complications.
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Affiliation(s)
- Tyrel J. Starks
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of the City University of New York, New York, NY, USA
| | - Joseph R. Hillesheim
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Juan Castiblanco
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Demetria Cain
- Department of Psychology, Hunter College of the City University of New York, New York, NY, USA
| | - Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Khan F, Loerinc LB, Scheel A, Gillespie SE, Camacho-Gonzalez AF. Incidence of Sexually Transmitted Infections in Youth with HIV During Pre-COVID and COVID Era. AIDS Patient Care STDS 2024; 38:252-258. [PMID: 38935346 DOI: 10.1089/apc.2024.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Adolescents and young adults (AYAs) living with HIV have high rates of co-sexually transmitted infections (STIs). During the coronavirus disease (COVID) pandemic, STI prevention strategies, including access to testing/treatment facilities, availability of health care workers, and condom availability, may have decreased. This study aimed to determine if differences in STI incidence for first infection and reinfection existed between the pre-COVID and COVID eras in a cohort of AYAs living with HIV in Atlanta, GA. Retrospective chart review was conducted for all patients between ages 13 and 24 at the Grady Ponce Clinic. Two eras were identified: a pre-COVID era (January 1, 2009-December31, 2019) and a COVID era (January 1, 2020-June 30, 2021). STIs recorded included gonorrhea, chlamydia, human papillomavirus, syphilis, trichomonas, herpes simplex virus, lymphogranuloma venereum, hepatitis C, bacterial vaginosis, and chancroid. First and recurrent incidence rates for any STIs were reported. Our sample included 766 sexually active AYAs with HIV. A total of 721 patients were included in the pre-COVID era and 583 (80.9%) had at least one STI. A total of 337 patients were included in the COVID era, and 158 had at least one STI (46.9%). The overall first STI incidence rate increased from 42.47 to 58.67 per 100 person-years (PY) and the recurrent STI incidence rate increased from 121.50 to 169.85 per 100 PY from the pre-COVID to the COVID era (p < 0.001). Our study demonstrated significantly higher incidence rates of first and recurrent STIs in AYAs living with HIV in the COVID era. We urge continuation of existing STI prevention programs to avoid secondary clinical and economic adverse effects of increased infections.
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Affiliation(s)
- Firdous Khan
- Augusta University, Medical College of Georgia, Augusta, Georgia, USA
| | - Leah B Loerinc
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy Scheel
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott E Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andres F Camacho-Gonzalez
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Grady Health Systems, Grady Infectious Diseases Program, Ponce Family and Youth Clinic, Atlanta, Georgia, USA
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Guiriguet C, Alberny M, Mora N, Rebagliato O, Roca C, Fina F, Fàbregas M, Benítez M, de la Poza M, Medina M, Flayeh S, Pedrazas D, Sabatés M, Coma E. Sexually transmitted infections, the epidemic that persists after the COVID-19 pandemic: an analysis of the primary care electronic health records covering about 5 million people in Catalonia. BMC PRIMARY CARE 2024; 25:150. [PMID: 38704552 PMCID: PMC11069189 DOI: 10.1186/s12875-024-02395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The aim of our study is to analyse the trends in the diagnosis of sexually transmitted infections (STIs) during the COVID-19 pandemic. METHODS We conducted an observational retrospective population-based study using data from primary care electronic health records spanning from January 2016 to December 2022 (involving 5.1 million people older than 14 years). We described the daily number of new STI diagnoses from 2016 to 2022; as well as the monthly accumulation of new STI diagnoses for each year. We compared the monthly averages of new diagnoses in 2019, 2020, 2021 and 2022 using the T-test. Finally, we performed a segmented regression analysis of the daily number of STI diagnoses. RESULTS We analysed 200,676 new STI diagnoses. The number of diagnoses abruptly decreased coinciding with the lockdown. Overall in 2020, we observed a reduction of 15%, with higher reductions for specific STIs such as gonorrhoea (-21%), chlamydia (-24%), and HIV (-31%) compared to 2019. Following this drastic drop, which was temporarily associated with the lockdown, we observed a rapid rebound. In 2021, the number of STI diagnoses was similar to that of 2019. Notably, we found a considerable increase in 2022, particularly for non-specific STI, which lack laboratory confirmation (67% increase). HIV was the only STI with a reduction of up to -38% in diagnoses at the end of 2022 compared to 2019. CONCLUSIONS After a significant reduction in 2020, the number of STIs recorded in primary care rapidly rebounded, and the current trend is similar to that of 2019, except for HIV. These findings underscore the dynamic impact of the COVID-19 pandemic on STI diagnoses and highlight the importance of ongoing monitoring and public health interventions in the post-pandemic period.
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Affiliation(s)
- Carolina Guiriguet
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain.
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
| | - Mireia Alberny
- Medical Management of Primary Care Services, STI/HIV Area, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Núria Mora
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Oriol Rebagliato
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Carme Roca
- El Clot Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Mireia Fàbregas
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Mència Benítez
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Mariam de la Poza
- University of Barcelona, Barcelona, Spain
- Doctor Carles Riba Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Manuel Medina
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - Souhel Flayeh
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
| | - David Pedrazas
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Montserrat Sabatés
- Gotic Primary Care Centre, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- Primary Care Services Information Systems (SISAP), Institut Català de La Salut (ICS), Gran Via de Les Corts Catalanes, 587. 08007, Barcelona, Spain
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de Lima Medeiros Y, Guimarães IC, de Melo FA, de Souza Chandretti PC, Leite ICG, Vilela EM. Oral manifestations of syphilis: Knowledge and skills of senior dental students and newly graduated dentists. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:497-503. [PMID: 37950520 DOI: 10.1111/eje.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To evaluate the knowledge of senior dental students and newly graduated dentists about the prevention, diagnosis and treatment of oral manifestations of syphilis. MATERIALS AND METHODS A 32-question questionnaire was designed with three domains: (I) demographic, academic and professional data of the participants, (II) attitudes, practices and self-perception regarding training about syphilis and (III) knowledge about syphilis. All knowledge responses were classified as correct or incorrect. Scores ranging from 1 to 14 were calculated, and grades were assigned to each participant according to their level of knowledge. RESULTS The sample comprised 408 dental students and 339 newly graduated dentists. The mean score was 7.70 ± 3.35 for undergraduates and 9.09 ± 3265 for dentists. The highest frequency of correct answers (>70%) was attributed to questions about the aetiology, transmission and treatment of syphilis. The questions with the lowest frequency of correct answers (<50%) were about the identification of oral manifestations and stages of syphilis. CONCLUSIONS The knowledge of dental practitioners and academics about the oral manifestations of syphilis was unsatisfactory. The lack of understanding of these aspects can delay the diagnosis and treatment of patients with this disease, which is concerning given the steady increase in cases in recent years.
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Rodriguez-Diaz CE, Seager L, Navalta C, Lapointe L, Laino A, Wilhite D, Melin K, Varga L, Zea MC. Experiences of Latinx sexual and gender minorities with access to healthcare during COVID-19 stay-at-home orders. Am J Health Syst Pharm 2024; 81:297-305. [PMID: 38146952 PMCID: PMC10988101 DOI: 10.1093/ajhp/zxad330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic affected all social systems, but healthcare services were particularly disrupted. The pandemic also had a disproportionate impact on populations made socially vulnerable. In this study, we documented the experiences of Latinx sexual and gender minority (SGM) individuals with access to care during COVID-19 stay-at-home orders. METHODS Semistructured qualitative interviews assessing experiences during the stay-at-home orders in response to the COVID-19 pandemic and patients' experiences accessing healthcare during this period were conducted with 21 Latinx SGM individuals from the Washington, DC, area. Data were analyzed using rapid qualitative analysis (RQA), and salient themes were identified. RESULTS The RQA revealed 3 themes reflecting participants' experiences with pharmaceutical care during COVID-19 stay-at-home orders: (1) challenges in accessing HIV services; (2) community engagement; and (3) providers supporting access to care. Participants experienced problems with adherence to medication, transportation, and technology, as well as delays in care and miscommunication with providers. Latinx SGM individuals demonstrated engagement in response to this emergency as a community and valued their providers and their efforts to facilitate access to care. CONCLUSION The COVID-19 pandemic strained healthcare services. Findings from this study show that the impact of the pandemic on the provision of care increased the vulnerability of Latinx SGM people. Future research should explore the impact of public health emergencies on the health of populations historically made socially vulnerable, and innovative solutions should be identified to eliminate these barriers to health equity.
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Affiliation(s)
| | - Loxley Seager
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassandra Navalta
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lauren Lapointe
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Alanna Laino
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Daniel Wilhite
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Kyle Melin
- School of Pharmacy, University of Puerto Rico, San Juan, PR, USA
| | - Leah Varga
- DC Department of Health, Washington, DC, USA
| | - Maria Cecilia Zea
- Department of Psychology and Brain Sciences, George Washington University, Washington, DC, USA
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Harfouch O, Comstock E, Kaplan R, Benator D, Rivasplata H, Wilson E. Impact of the COVID-19 Pandemic on the PrEP Cascade at Two Veterans Affairs Healthcare Systems. AIDS Behav 2024; 28:1227-1234. [PMID: 37542627 DOI: 10.1007/s10461-023-04146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/07/2023]
Abstract
Overall, fewer Veterans were eligible for PrEP in 2020, compared to 2019, and 2018 (Maryland Veterans Affairs Health Care System- MVAHCS-: n = 890 (2020), n = 1533 (2019); Washington DC Veterans Affairs Medical Center -DC VAMC- n = 1119 (2020), n = 1716 (2019)). While the proportion of Veterans engaged in PrEP out of those eligible for PrEP increased in 2020 compared to 2019 at both sites (MVAHCS: 5.73% (2020) vs. 3.39% (2019) p-value = 0.006; F = 7.58, and DC VAMC: 15.91% (2020) vs. 9.38% (2019) p-value < 0.001; F = 27.64), the absolute number of Veterans engaged in PrEP remained unchanged (MVAHCS n = 51 (2020) and n = 52 (2019); DC VAMC n = 178 (2020) and n = 161 (2019)). Engagement in PrEP was significantly lower among Black Veterans compared to White Veterans at the DC VAMC across all FY with a widening gap in 2020. Cisgender women were less likely to be engaged in PrEP compared to cisgender men at both sites and throughout all FY with a wider gender gap in 2020. There were no significant differences in retention in PrEP between FY.Anticipated improvements in linkage, engagement, and retention in PrEP in 2020 at the MVAHCS and DC VAMC may not have been seen due to the COVID-19 pandemic. Furthermore, engagement rates in PrEP remained low overall, particularly among Black Veterans and cisgender women. Novel PrEP delivery models are needed to engage these populations in PrEP following the COVID-19 pandemic. Interactive dashboards and tele-PrEP may have played a big role in sustained retention in PrEP at the VHA.
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Affiliation(s)
- Omar Harfouch
- School of Medicine, University of Maryland, Institute of Human Virology, Baltimore, MD, USA.
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Roman Kaplan
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Debra Benator
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | | | - Eleanor Wilson
- School of Medicine, University of Maryland, Institute of Human Virology, Baltimore, MD, USA
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
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Loosier PS, Ogale YP, Smith RC, Kachur R, Nicolae L, Heumann C. Sexual Behavior and Sexual Decision-Making Among Gay, Bisexual, and Other Men Who Have Sex with Men During the COVID-19 Pandemic: Observations from a Rapid Ethnographic Assessment in Marion County, Indiana, October-November 2021. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:871-877. [PMID: 38253741 DOI: 10.1007/s10508-023-02795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
From 2020 to 2021, Marion County, Indiana, USA, saw an increase in early syphilis diagnoses, primarily among gay, bisexual, and other men who have sex with men (GBMSM). This rapid ethnographic assessment combines survey data from GBMSM with data from key informant interviews with multiple groups of stakeholders, including GBMSM, to describe how COVID-19 impacted sexual behaviors, sexual decision-making, and access to sexually transmitted disease (STD) services among GBMSM in Marion County, Indiana. A total of 62 virtual, semi-structured qualitative interviews with 72 key respondents including health department staff, medical providers, community-based organization staff, and GBMSM were conducted from October 14 to November 22, 2021. Modifications to partner-seeking and sexual behaviors attributable to the pandemic were associated with the way in which individuals reacted to the pandemic in general. Some GBMSM adopted mitigation strategies to avoid COVID-19 when meeting sex partners, such as creating a "sex pod." Effects on mental health included increased loneliness, heightened anxiety, and a sense of hopelessness regarding the perceived inevitability of acquiring COVID-19. For some, the latter prompted decreased engagement in preventive measures when engaging in sexual activity. The pandemic decreased access to STD services and significantly curtailed public health outreach efforts, which may have limited access to needed STD treatment and care. Efforts focusing on ongoing public health concerns during extreme health events like COVID-19 may want to consider the many ways these events affect ancillary behaviors, such sexual decision-making and sexual behaviors. The role of mental health is key; messaging and guidance may benefit from a trauma-informed approach.
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Affiliation(s)
- Penny S Loosier
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA.
| | - Yasmin P Ogale
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Clark Smith
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Rachel Kachur
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Lavinia Nicolae
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS US12-2, Atlanta, GA, 30329-4027, USA
| | - Christine Heumann
- Marion County Public Health Department, Bell Flower Clinic and STD Control Program, Indianapolis, IN, USA
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Renfro KJ, Haderxhanaj LT, Loosier PS, Hogben M, Aral SO. Online Discussions of Sexually Transmitted Infections During COVID-19: Insights From the Social Media Platform Reddit. Sex Transm Dis 2024; 51:227-232. [PMID: 38039079 DOI: 10.1097/olq.0000000000001906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
BACKGROUND With the onset of the COVID-19 pandemic, reported rates of chlamydia and gonorrhea dropped and remained low for several months of 2020 as compared with 2019. Additional data are needed to reveal causes of reported rate changes. Here, we analyze sexually transmitted infection (STI)-related conversations from the online-discussion platform Reddit to gain insight into the role of the pandemic on public experience of STIs in 2020. METHODS We collected data from Pushshift's and Reddit's application programming interfaces via programs coded in Python. We focused data collection on the "r/STD" subreddit. Collected submissions contained the term(s) "covid" and/or "coronavirus" and were submitted between January 1, 2020, and December 31, 2020. We collected the title and text of each submission. We used a Latent Dirichlet Allocation algorithm to create a topic model of post content and complemented this approach with key term analysis and qualitative hand-coding. RESULTS Of the 288 posts collected, 148 were complete and included in analyses. Latent Dirichlet Allocation revealed 4 main topics in the collected posts: narration of sexual experiences, STI testing, crowdsourcing of visual STI diagnoses, and descriptions of STI-related pains and treatments. Hand-coding of COVID-19 mentions revealed pandemic-related anxieties about STI care seeking and experienced delays in and changes to quality of STI care received. CONCLUSIONS References to COVID-19 and associated mitigation efforts were woven into Reddit posts pertaining to several domains of STI care. These data support the notion that Reddit discussions may represent a valuable source of STI information, standing to corroborate and further contextualize STI survey and surveillance work.
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Affiliation(s)
- Kaytlin J Renfro
- From the Division of STD Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Pinto RM, Hall E, Im V, Lee CA, Ethan Park S. Disruptions to HIV services due to the COVID pandemic in the USA: a state-level stakeholder perspective. BMC Health Serv Res 2024; 24:196. [PMID: 38350945 PMCID: PMC10865595 DOI: 10.1186/s12913-024-10609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The United States envisions a 90% reduction in HIV infections by 2030. However, the COVID-19 pandemic disrupted the HIV continuum and disproportionately affected access to social and health services for people at the highest vulnerability. This study shows how stakeholders in the State of Michigan handled disruptions and their key recommendations. As a case study, this study adds to the literature about preparedness for future pandemics. METHODS We interviewed 33 statewide Michigan HIV/AIDS Council members-practitioners, researchers, and community representatives, guiding service planning, improvement, and resource allocations, measuring group cohesiveness using a tested scale. We measured group cohesiveness as a proxy for how individual opinions reflected those of the Council as a group. We used qualitative questions to assess: (1) how the COVID-19 pandemic disrupted HIV prevention; (2) how disruptions were handled; and (3) recommendation to help address disruptions now and in the future. Using thematic analysis, we coded the interviews. RESULTS We found a high degree of cohesiveness. Participants agreed that the pandemic disrupted HIV prevention services (e.g., HIV testing, PrEP education, referrals to primary care, etcetera) offered by community organizations, hospital clinics, and health departments across the state. In response, they developed online and curbside services to maintain HIV services, abate social isolation, and address structural issues like lack of food and public transportation. We organized results in four categories: (1) HIV service disruptions (e.g., "Housing for women and children who are fleeing a legal situation"); (2) Responses to disruptions (e.g., "Some of them, we would say, hey, weather permitting, we'll come out to your car"); (3) Minoritized groups disproportionately affected (e.g., "Especially in my community, to get people if there's ever a vaccine, Black people are going to be the last people to take it"); and (4) Recommendations (below). CONCLUSIONS The pandemic unsettled and further exacerbated every aspect of HIV service provision. The main recommendation was to overhaul communication systems between government and organizations offering HIV services to mitigate disruptions and improve the chances of achieving a 90% reduction.
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Affiliation(s)
- Rogério M Pinto
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, USA.
| | - Evan Hall
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, USA
| | - Vitalis Im
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, USA
| | - Carol A Lee
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sunggeun Ethan Park
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, USA
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10
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O'Cleirigh C, Foley JD, Stanton AM, McKetchnie SM, Gulbicki LR, Muten J, Chai P, Fitch C, Onofrey S, Klevens RM, Psaros C. Sexual Networking and HIV/STI Prevention Among Men who have Sex with Men and Identify as Persons of Color in the Era of COVID-19 in Boston, MA: Qualitative Findings from the National HIV Behavioral Surveillance Project. AIDS Behav 2024; 28:473-487. [PMID: 38165597 DOI: 10.1007/s10461-023-04238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/04/2024]
Abstract
Men who have sex with men and identify as persons of color (MSM of color) are significantly impacted by HIV in the United States. The COVID-19 pandemic may have disproportionately exacerbated HIV-related disparities among MSM of color by affecting sexual networking behaviors and disrupting access to sexual health care. The current study explored the impact of COVID-19 on sexual networking and HIV/sexually transmitted infection (STI) prevention behaviors among MSM of color in Boston, MA. Eighteen semi-structured interviews were conducted via the 2020-2021 Boston sample of the National HIV Behavioral Surveillance (NHBS) project. Eligible participants were at least 18 years old, identified as a man or non-binary person assigned male at birth and as a person of color, and endorsed ever having sex with men. Interviews were coded using inductive and deductive approaches, and themes were extracted using thematic analysis. When participants were asked about the impact of COVID-19 on sexual networking and HIV/STI prevention, the following themes emerged: (1) differing interpretations of COVID-19 public health guidance, (2) behavior change to meet social and sexual needs, (3) limited or changed access to HIV/STI prevention services; and (4) avoidance of healthcare appointments. Overall, the pandemic affected sexual networking and HIV/STI prevention behaviors among MSM of color. Though changes in sexual networking varied, most participants decreased in-person networking, increased dating app use, and prioritized longer-term relationships. Despite loosening of restrictions, these impacts may persist and should inform the adaptation of sexual networking guidance and interventions to mitigate HIV-related disparities in communities of color.
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Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jacklyn D Foley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Lauren R Gulbicki
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Muten
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Peter Chai
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA
| | - Calvin Fitch
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shauna Onofrey
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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11
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Liu M, Zhou J, Lan Y, Zhang H, Wu M, Zhang X, Leng L, Mi X, Li J. A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis. Clin Cosmet Investig Dermatol 2023; 16:2485-2496. [PMID: 37719933 PMCID: PMC10505047 DOI: 10.2147/ccid.s417522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/19/2023]
Abstract
The COVID-19 pandemic has profoundly changed our lives. While healthcare resources were redistributed and mobilized to focus on dealing with the COVID-19 crisis, there have been unmet medical needs of patients with other diseases such as syphilis, weaving an integral but neglected component of the pandemic story. In different countries, the epidemiology of newly reported syphilis underwent diverse changes during the COVID-19 pandemic. Asymptomatic cases experienced the largest decline in number. From the perspective of transmission, on one hand, the implementation of lockdown measures led to a higher degree of abstinence and sex distancing in many countries, thereby reducing the transmission of syphilis. On the other hand, vertical transmission was reported to have increased significantly during COVID-19. Meanwhile, the volume of STI clinic capacity declined, and STI staff were redeployed to facilitate the contact tracing of COVID-19. As a result, many STI centers converted traditional in-person clinical services to telemedicine and self-testing. However, syphilis testing and clinical treatment cannot fully adapt to this conversion. In syphilis diagnosis, COVID-19 infection and vaccination were reported to cause false positivity in syphilis serological tests. Diverse cutaneous manifestations of COVID-19 could resemble the skin lesions in syphilis patients, requiring differential diagnosis from clinicians. As for the post-pandemic years, consequent to service interruptions and diagnosis delays, a surge in the number of confirmed cases of syphilis is expected. The COVID-19 pandemic has also been a meaningful lesson for the control and prevention of infectious diseases. The experience in combating COVID-19 has underscored the importance of maintaining a robust and well-supported medical system for the provision of sexual health services and better healthcare equality even during eras of crisis, not least for syphilis patients.
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Affiliation(s)
- Mingjuan Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- 4+4 M.D. Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Jia Zhou
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Yining Lan
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Hanlin Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Mengyin Wu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinyi Zhang
- Departments of Internal Medicine and Cellular & Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Ling Leng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Xia Mi
- Department of Dermatology, Strategic Support Force Medical Center, Beijing, People’s Republic of China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
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12
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Daroya E, Grey C, Lessard D, Klassen B, Skakoon-Sparling S, Gaspar M, Perez-Brumer A, Adam B, Lachowsky NJ, Moore D, Sang JM, Lambert G, Hart TA, Cox J, Jollimore J, Tan DHS, Grace D. 'I did not have sex outside of our bubble': changes in sexual practices and risk reduction strategies among sexual minority men in Canada during the COVID-19 pandemic. CULTURE, HEALTH & SEXUALITY 2023; 25:1147-1163. [PMID: 36336339 DOI: 10.1080/13691058.2022.2139414] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
In efforts to prevent the spread of COVID-19, jurisdictions across the globe, including Canada, enacted containment measures that affected intimacy and sexual relations. This article examines how public health measures during COVID-19 impacted the sexual practices of sexual minority men- gay, bisexual, queer and other men who have sex with men-and how they adopted and modified guidelines to prevent the transmission of COVID-19, HIV and other sexually transmitted infections (STIs). We conducted 93 semi-structured interviews with men (n = 93) in Montreal, Toronto and Vancouver, Canada, between November 2020 to February 2021 (n = 42) and June to October 2021 (n = 51). Across jurisdictions, participants reported changes to sexual practices in response to public health measures and shifting pandemic contexts. Many men indicated that they applied their HIV/STI risk mitigation experiences and adapted COVID-19 prevention strategies to continue engaging in casual sexual behaviours and ensure sexual safety. 'Social bubbles' were changed to 'sex bubbles'. Masks were turned into 'safer' sex tools. 'Outdoor gathering' and 'physical distancing' were transformed into 'outdoor sex' and 'voyeuristic masturbation'. These strategies are examined in connection to the notion of 'reflexive mediation' to illustrate how sexual minority men are simultaneously self-responsibilising and resistant, self-monitoring and creative.
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Affiliation(s)
- Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Cornel Grey
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Gender, Sexuality, and Women's Studies, Western University, London, ON, Canada
| | - David Lessard
- Centre for Health Outcome Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ben Klassen
- Community-Based Research Centre, Vancouver, BC, Canada
| | | | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, ON, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - David Moore
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Jordan M Sang
- BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada
| | - Gilles Lambert
- Service Prévention et contrôle des maladies infectieuses, Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Joseph Cox
- Service Prévention et contrôle des maladies infectieuses, Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | - Darrell H S Tan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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13
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Sharpe JD, Siegler AJ, Sanchez TH, Guest JL, Sullivan PS. Effects of mode of transportation on PrEP persistence among urban men who have sex with men. AIDS Care 2023; 35:1411-1419. [PMID: 37232114 PMCID: PMC11167718 DOI: 10.1080/09540121.2023.2217375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Little is known about the effect of travel-related factors, such as mode of transportation, on retention in PrEP care, or PrEP persistence. We used data from the 2020 American Men's Internet Survey and conducted multilevel logistic regression to estimate the association between mode of transportation used for healthcare access and PrEP persistence among urban gay, bisexual, and other men who have sex with men (MSM) in the U.S. MSM using public transportation were less likely to report PrEP persistence (aOR: 0.51; 95% CI: 0.28-0.95) than MSM using private transportation. There were no significant associations between PrEP persistence and using active transportation (aOR: 0.67; 95% CI: 0.35-1.29) or multimodal transportation (aOR: 0.85; 95% CI: 0.51-1.43) compared to using private transportation. Transportation-related interventions and policies are needed to address structural barriers to accessing PrEP services and to improve PrEP persistence in urban areas.
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Affiliation(s)
| | | | | | - Jodie L. Guest
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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14
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Assoumou B, Pharr J, Coughenour C. Food insecurity and risky sexual behaviors among college students during the COVID-19 pandemic. BMC Public Health 2023; 23:1552. [PMID: 37582703 PMCID: PMC10428526 DOI: 10.1186/s12889-023-16330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. METHODS This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. RESULTS Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6 months (P < 0.01) compared to food secure students. There was no significant association between food insecurity and other RSBs evaluated in this study. CONCLUSIONS The current study provides valuable information on food insecurity and RSB among college students during the early stages of the COVID-19 pandemic. Larger and longitudinal studies are needed to assess the trajectory of the association between food insecurity and fellatio with no condom use and other RSB among college students.
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Affiliation(s)
- Bertille Assoumou
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA.
| | - Jennifer Pharr
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA
| | - Courtney Coughenour
- School of Public Health, University of Nevada, 4700 S. Maryland Parkway Suite # 335, Las Vegas, NV, 89119, USA
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15
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Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional Stigma as a Fundamental Cause of Health Disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. STIGMA AND HEALTH 2023; 8:325-343. [PMID: 37744082 PMCID: PMC10516303 DOI: 10.1037/sah0000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, NY
- Center for Drug Use and HIV/HCV Research, New York, NY
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Bruce Link
- Department of Sociology, University of California Riverside, Riverside, CA
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16
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Watson RJ, Morgan E, Sherman J, Caba AE, Wheldon CW, Chan PA, Eaton LA. Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample. Behav Med 2023; 49:283-291. [PMID: 35465800 PMCID: PMC9592674 DOI: 10.1080/08964289.2022.2048249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/02/2022]
Abstract
Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.
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Affiliation(s)
- Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA
- Infectious Disease Institute, The Ohio State University, Columbus, OH, USA
| | - Jessica Sherman
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Christopher W Wheldon
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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17
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Camp CE, Chan CT, Saberi P. Young Adult Perspectives on Sex, Dating, and PrEP Use During the Pandemic and Improving the Future of PrEP Care. AIDS Behav 2023; 27:2430-2438. [PMID: 36629971 PMCID: PMC9832408 DOI: 10.1007/s10461-022-03970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
Few studies have researched young adults' experiences taking HIV pre-exposure prophylaxis (PrEP) after the start of California's COVID-19 shelter-in-place (SIP) orders. The purpose of this study was to examine the experiences of young adults with sex, dating, and PrEP use during SIP and their perceptions on how to improve PrEP care in this age group. In this mixed-methods study, PrEP users ages 18-29 living in California between April 2020 and June 2021 completed a quantitative survey (N = 37) and one-on-one qualitative interviews (N = 18). Over half of survey participants reported trouble accessing PrEP care during SIP, citing difficulty obtaining medication refills, clinic appointments, and access to completing lab work. In qualitative interviews, participants expressed their preferences for more accessible PrEP service delivery across the PrEP care continuum. Despite pandemic SIP orders and trouble accessing PrEP services, young adults continued to engage in sexual behaviors.
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Affiliation(s)
- Christina E Camp
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, N405K, San Francisco, CA, 94143, USA.
| | - Carrie T Chan
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
- Stanford Children's Health, Palo Alto, CA, USA
| | - Parya Saberi
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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18
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Poteat TC, Wirtz AL, Adams D, Linton SL, Gutierrez C, Brown C, Miller M, Rich AJ, Williams J, Nguyen TQ, Reisner SL. Brief Report: Interruptions in HIV Prevention and Treatment During the COVID-19 Pandemic: A Cross-Sectional Study of Transgender and Gender Nonbinary Adults in the United States. J Acquir Immune Defic Syndr 2023; 93:181-186. [PMID: 36881811 PMCID: PMC10272025 DOI: 10.1097/qai.0000000000003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Transgender and gender nonbinary (TNB) people have been disproportionately affected by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identified factors associated with these interruptions. SETTING Data were drawn from LITE Connect, a US-based, nationwide, online, self-administered survey designed to examine the experiences of TNB adults during the COVID-19 pandemic. A convenience sample of 2134 participants were recruited between June 14, 2021, and May 1, 2022. METHODS The analytic sample was restricted to participants taking antiretroviral medications to prevent or treat HIV before the onset of the pandemic (n = 153). We calculated descriptive statistics as well as Pearson χ 2 bivariate tests and multivariable models to identify factors associated with HPT interruptions during the pandemic. RESULTS Thirty-nine percent of participants experienced an HPT interruption. We found a lower odds of HPT interruptions among participants living with HIV [adjusted odds ratios (aOR) 0.45; 95% Confidence Intervals (CI): 0.22, 0.92; P = 0.02] and essential workers [aOR 0.49; 95% CI: 0.23, 1.0; P = 0.06] and higher odds among people with chronic mental health conditions [aOR 2.6; 95% CI: 1.1, 6.2; P = 0.03]. When sex and education were included, we found a lower odds of interruptions among people with higher education. CI widened, but the magnitude and direction of effects did not change for the other variables. CONCLUSIONS Focused strategies to address longstanding psychosocial and structural inequities are needed to mitigate HPT treatment interruptions in TNB people and prevent similar challenges during future pandemics.
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Affiliation(s)
- Tonia C Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Sabriya L Linton
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Carmen Gutierrez
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carter Brown
- Black Transgender Advocacy Coalition, Dallas, TX
| | - Marissa Miller
- Trans Solutions Research and Resource Center, Indianapolis, IN
| | - Ashleigh J Rich
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jennifer Williams
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trang Q Nguyen
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA; and
- Department of Medicine, Harvard Medical School, Boston, MA
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19
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Kwon RH, Kim SH, Jung M. Behavioral predictors associated with HIV screening needs in gay Korean men during the COVID-19 pandemic. PLoS One 2023; 18:e0287061. [PMID: 37307274 DOI: 10.1371/journal.pone.0287061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
During the pandemic, the capacity of medical resources focused on testing, diagnosing and treating COVID-19 has severely limited public access to health care. In particular, HIV screening, for which homosexual males in Korea received free and anonymous testing at public health centers, was completely halted. This study investigated behavioral predictors related to the HIV screening needs of Korean male homosexuals during the pandemic. Data were collected by conducting a web survey targeting members of the largest homosexual portal site in Korea with support from the National Research Foundation of Korea (n = 1,005). The key independent variables are COVID-19-related characteristics and sexual risk behavior. The moderating variable is health information search behavior, and the dependent variable is the need for HIV screening. For a statistical analysis, a hierarchical multiple logistic regression analysis was conducted while controlling for potential confounding variables. According to the results of this study, the need for HIV screening was 0.928 times lower for older people (p<0.05, 95% CI = 0.966-0.998). However, if the respondent had a primary partner, the need for HIV screening was 1.459 times higher (p<0.01, 95% CI = 1.071-1.989). In addition, the need for screening was 1.773 times higher for those who preferred anal intercourse (p<0.01, 95% CI = 1.261-2.494) and 2.034 times higher (p<0.01, 95% CI = 1.337-3.095) if there was a history of being diagnosed with an STD. Finally, health information-seeking behavior was marginally significant. This study revealed that male Korean homosexuals who were young, preferred anal sex with a primary partner, and who had a history of a sexually transmitted disease had a high need for HIV screening at public health centers. They are more likely to be susceptible to HIV infection because they are usually consistent with gay men, characterized by risky behavior. Therefore, an intervention strategy that provides health information using a communication campaign is needed.
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Affiliation(s)
- Rang Hee Kwon
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
| | - So-Hyun Kim
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University, Seoul, South Korea
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
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20
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Ballester-Arnal R, Nebot-Garcia JE, Ruiz-Palomino E, García-Barba M, Fernández-García O, Gil-Llario MD. Sexual life of Spanish women during the lockdown by COVID-19: Differences according to sexual orientation? WOMENS STUDIES INTERNATIONAL FORUM 2023; 98:102719. [PMID: 37065932 PMCID: PMC10085747 DOI: 10.1016/j.wsif.2023.102719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
The COVID-19 pandemic may have exacerbated the sexual health differences that already existed among women based on their sexual orientation. Therefore, a total of 971 Spanish women aged 18-60 years (84 % heterosexual and 16 % with a minority sexual orientation) answered an ad hoc online questionnaire about sexual behavior during April 2020. Compared to heterosexual women, sexual minority women showed a greater increase in sexual frequency, masturbated more, had more sex with a housemate, and engaged in more online sexual activities during lockdown. The emotional impact of the pandemic, having privacy, and age showed a relationship with the quality of sexual life, but not sexual orientation. Based on these results, women's sexual lives are not as closely related to their sexual orientation as they are to other variables. Therefore, it seems more necessary to address issues affecting women in general during lockdown than to focus on their specific sexual orientation.
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Affiliation(s)
- Rafael Ballester-Arnal
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juan Enrique Nebot-Garcia
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - Estefanía Ruiz-Palomino
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Marta García-Barba
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Olga Fernández-García
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
| | - María Dolores Gil-Llario
- Department of Developmental and Educational Psychology, Universitat de València, Valencia, Spain
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21
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LeMasters K, Krajewski T, Nowotny K, Oser C, Mollan K, Brinkley-Rubinstein L. Context specific HIV risk: evidence from screening into the southern pre-exposure prophylaxis study (SPECS). AIDS Care 2023; 35:474-479. [PMID: 35377251 PMCID: PMC9530063 DOI: 10.1080/09540121.2022.2059054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
While Pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV, little is known about PrEP use among those on community supervision. The Southern Pre-Exposure Prophylaxis Study (SPECS) investigates barriers and facilitators for PrEP initiation and use among adults on community supervision (e.g., probation, parole). Challenges to PrEP use in this setting are abundant. SPECS uses a mixed-methods sequential design, including a multi-site, prospective cohort study in three southern states - North Carolina, Florida, and Kentucky. This analysis describes individual demographic, criminal legal, and HIV risk factor characteristics, by site and enrollment status. Pooled association analyses accounted for site via stratified statistical tests. Between June 2019-March 2020, SPECS screened 702 individuals and enrolled 276 participants (39%). Of those who were eligible, 98% agreed to enroll. Age, gender, and sexual orientation varied by enrollment and by site, while race/ethnicity varied by site but not enrollment status. Criminal legal histories varied by enrollment and HIV risk factors varied by site. SPECS provides a granular and detailed assessment of HIV risk in three diverse southern settings. It highlights how the level and type of HIV risk varies by location and by nature of criminal legal involvement and calls for the need for context-specific interventions for HIV prevention.
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Affiliation(s)
- Katherine LeMasters
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Taylor Krajewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Kathryn Nowotny
- Department of Sociology, University of Miami, Miami, Florida, United States
| | - Carrie Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, United States
| | - Katie Mollan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Lauren Brinkley-Rubinstein
- School of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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22
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Mann LM, Sanchez T, Stephenson R, Sullivan PS, Jenness SM. The Impact of the COVID-19 Pandemic on Sexual Behavior and HIV Prevention and Treatment Services Among U.S. Men Who Have Sex With Men in the Post-Lockdown Era. Am J Mens Health 2023; 17:15579883231168602. [PMID: 37081746 PMCID: PMC10119652 DOI: 10.1177/15579883231168602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Early in the COVID-19 pandemic, disruptions to sexual health services and changes to sexual behavior due to the first COVID-19 lockdowns were common among U.S. gay, bisexual, and other men who have sex with men (GBMSM). Less is known about the persistence of these changes after this initial lockdown period. These changes have long-term implications for HIV prevention for current and future pandemic periods. This study collected information on COVID-related impacts on sexual behavior and HIV-related health service disruptions from a cohort of U.S. GBMSM at three time points during the COVID-19 pandemic. We observed that COVID-related disruptions to sexual behavior continued from early lockdown periods through December 2020. Although early interruptions to pre-exposure prophylaxis (PrEP) access resolved in later 2020 and interruptions to antiretroviral therapy (ART) adherence were minimal, extended disruptions were observed in HIV testing, sexually transmitted infection (STI) testing, HIV care clinical visits, and HIV viral load testing. Although sexual behavior did not return to prepandemic levels in late 2020, the reduced access to HIV prevention, testing, and treatment services during this period could result in an overall increased HIV transmission rate, with long-term impacts to the trajectory of the U.S. HIV epidemic. Additional resources and programs are needed to address challenges created by the COVID-19 pandemic, as well as prepare for future potential pandemics and other disruptive events.
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Affiliation(s)
- Laura M Mann
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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23
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Gilchrist G, Potts LC, Connolly DJ, Winstock A, Barratt MJ, Ferris J, Gilchrist E, Davies E. Experience and perpetration of intimate partner violence and abuse by gender of respondent and their current partner before and during COVID-19 restrictions in 2020: a cross-sectional study in 13 countries. BMC Public Health 2023; 23:316. [PMID: 36782157 PMCID: PMC9924203 DOI: 10.1186/s12889-022-14635-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/15/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Intimate partner violence and abuse (IPVA) includes controlling behaviours, psychological, physical, sexual and financial abuse. Globally, surveys and emergency services have recorded an increase in IPVA since restrictions were imposed to limit COVID-19 transmission. Most studies have only included heterosexual women. METHODS Data from the Global Drug Survey (an annual, anonymous, online survey collecting data on drug use) Special Edition were analysed to explore the impact of COVID-19 on people's lives, including their intimate relationships. Five relationship groupings were created using respondents' lived gender identity: women partnered with men (46.9%), women partnered with women (2.1%), men partnered with men (2.9%), men partnered with women (47.2%), and partnerships where one or both partners were non-binary (1%). Self-reported experience and perpetration of IPVA in the past 30 days before (February) and during COVID-19 restrictions (May or June) in 2020 (N = 35,854) was described and compared for different relationship groupings using Fishers Exact Tests. Changes in IPVA during restrictions were assessed using multivariable logistic regression. RESULTS During restrictions, 17.8 and 16.6% of respondents had experienced or perpetrated IPVA respectively; 38.2% of survivors and 37.6% of perpetrators reported this had increased during restrictions. Greater proportions of non-binary respondents or respondents with a non-binary partner reported experiencing or perpetrating IPVA (p < .001) than other relationship groupings. 22.0% of respondents who were non-binary or had a non-binary partner, 19.5% of men partnered with men, 18.9% of men partnered with women, 17.1% of women partnered with women and 16.6% of women partnered with men reported experiencing IPVA. Respondents with higher psychological distress, poor coping with pandemic-related changes, relationship tension and changes (increases or increases and decreases) in alcohol consumption reported increased experience of IPVA during restrictions. CONCLUSIONS This study confirmed that IPVA can occur in all intimate relationships, regardless of gender of the perpetrator or survivor. Non-binary respondents or respondents with non-binary partners reported the highest use and experience of IPVA. Most IPVA victim support services have been designed for heterosexual, cisgender women. IPVA support services and perpetrator programmes must be tailored to support all perpetrators and survivors during the pandemic and beyond, regardless of their sexual or gender identity.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Laura C. Potts
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dean J. Connolly
- grid.13097.3c0000 0001 2322 6764National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.439471.c0000 0000 9151 4584Barts Health NHS Trust, Whipps Cross University Hospital, London, UK
| | - Adam Winstock
- grid.83440.3b0000000121901201Institute of Epidemiology and Health Care, University College London, London, UK ,Global Drug Survey, London, UK
| | - Monica J. Barratt
- grid.1017.70000 0001 2163 3550Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, Australia ,grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, UNSW Sydney, Randwick, Australia
| | - Jason Ferris
- grid.1003.20000 0000 9320 7537Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elizabeth Gilchrist
- grid.4305.20000 0004 1936 7988School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Emma Davies
- grid.7628.b0000 0001 0726 8331Centre for Psychological Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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24
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Pre-exposure Prophylaxis Persistence at a Diverse Sexual Health Clinic: Comparison of the pre-COVID-19 era to the COVID-19 era. AIDS Behav 2023:10.1007/s10461-023-03996-3. [PMID: 36738345 PMCID: PMC9898849 DOI: 10.1007/s10461-023-03996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic interrupted health care delivery and exacerbated disparities. Many sexual health clinics transitioned to telemedicine, including for pre-exposure prophylaxis (PrEP). We conducted a retrospective cohort study of patients at an urban sexual health clinic to assess the likelihood and predictors of PrEP persistence in the year following PrEP initiation. We compared patients starting PrEP in the four months preceding the first COVID surge to those starting PrEP one year prior. We found lower PrEP persistence in the COVID cohort compared to the pre-COVID cohort (50.8% vs. 68.9%, respectively). In both cohorts, most care was provided through in-person visits and telemedicine was rare. In the pre-COVID cohort, older patients and those identifying as non-Hispanic White were more likely to persist on PrEP. In the COVID cohort, these disparities in PrEP persistence were not observed. Flexible models of care may facilitate equitable care engagement and re-engagement.
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25
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Li L, Taeihagh A, Tan SY. A scoping review of the impacts of COVID-19 physical distancing measures on vulnerable population groups. Nat Commun 2023; 14:599. [PMID: 36737447 PMCID: PMC9897623 DOI: 10.1038/s41467-023-36267-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Most governments have enacted physical or social distancing measures to control COVID-19 transmission. Yet little is known about the socio-economic trade-offs of these measures, especially for vulnerable populations, who are exposed to increased risks and are susceptible to adverse health outcomes. To examine the impacts of physical distancing measures on the most vulnerable in society, this scoping review screened 39,816 records and synthesised results from 265 studies worldwide documenting the negative impacts of physical distancing on older people, children/students, low-income populations, migrant workers, people in prison, people with disabilities, sex workers, victims of domestic violence, refugees, ethnic minorities, and people from sexual and gender minorities. We show that prolonged loneliness, mental distress, unemployment, income loss, food insecurity, widened inequality and disruption of access to social support and health services were unintended consequences of physical distancing that impacted these vulnerable groups and highlight that physical distancing measures exacerbated the vulnerabilities of different vulnerable populations.
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Affiliation(s)
- Lili Li
- Policy Systems Group, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | - Araz Taeihagh
- Policy Systems Group, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore.
| | - Si Ying Tan
- Alexandra Research Centre for Healthcare in The Virtual Environment (ARCHIVE), Department of Healthcare Redesign, Alexandra Hospital, National University Health System, Singapore, Singapore
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26
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Hensel DJ, Rosenberg M, Luetke M, Fu TC, Herbenick D. The Impact of Household Context on Self-Perceived Changes in Solo and Partnered Sexual Behaviors During the COVID-19 Pandemic: Findings from a U.S. Probability Survey. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:655-667. [PMID: 36376743 PMCID: PMC9662764 DOI: 10.1007/s10508-022-02459-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 05/16/2023]
Abstract
To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables-including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural).All solo and partnered sexual behaviors showed some amount of significant change-increased activity for some and decreased for others-for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more "normal" (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.
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Affiliation(s)
- Devon J Hensel
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, 410 West 10th Street Room 1001, Indianapolis, IN, 46202, USA.
- Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, IN, USA.
- Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
| | - Molly Rosenberg
- Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Institute for Social Research and Data Innovation/Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Maya Luetke
- Institute for Social Research and Data Innovation/Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Tsung-Chieh Fu
- Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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27
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Houang ST, Kafka JM, Choi SK, Meanley SP, Muessig KE, Bauermeister JA, Hightow-Weidman LB. Co-occurring Epidemic Conditions Among Southern U.S. Black Men Who Have Sex with Men in an Online eHealth Intervention. AIDS Behav 2023; 27:641-650. [PMID: 35986818 PMCID: PMC9391640 DOI: 10.1007/s10461-022-03799-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/09/2022]
Abstract
Black men who have sex with men (BMSM) face disproportionately higher risks for adverse sexual health outcomes compared to their non-Hispanic White counterparts. This disparity can be attributable to overlapping and intersecting risk factors at the individual and structural levels and can be understood through syndemic theory. Using longitudinal data from the HealthMPowerment trial (n = 363), six conditions related to stigma syndemics were indexed as a cumulative risk score: high alcohol use, polydrug use, depression and anxiety symptomology, and experiences of racism and sexual minority stigma. Using Poisson regression, we found a positive association between baseline risk scores and sexual risk behavior (b: 0.32, SE: 0.03, p < 0.001). Using a Generalized Estimating Equation, we also found a 0.23 decrease in the within-participant risk scores at 3-month follow-up (SE: 0.10, p < 0.020). Future work examining how care and prevention trials improve health outcomes in this population is needed.
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Affiliation(s)
- Steven T Houang
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA.
| | - Julie M Kafka
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
| | - Seul Ki Choi
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Steven P Meanley
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Kathryn E Muessig
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
| | - Jose A Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, USA
| | - Lisa B Hightow-Weidman
- Department of Health Behavior, University of North Carolina Chapel Hill, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, 27599, USA
- Institute for Global Health and Infectious Diseases, University North Carolina Chapel Hill, Chapel Hill, USA
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28
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Nadarzynski T, Nutland W, Samba P, Bayley J, Witzel TC. The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:617-627. [PMID: 36344786 PMCID: PMC9640839 DOI: 10.1007/s10508-022-02458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.
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Affiliation(s)
- Tom Nadarzynski
- School of Social Sciences, University of Westminster, Room 6.101, 115 New Cavendish Street, London, W1W 6UW, UK.
| | - Will Nutland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Phil Samba
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
- The Love Tank CIC, London, UK
| | - Jake Bayley
- Sexual Health and HIV Department, Barts NHS Trust, London, UK
| | - T Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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29
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Ferraz D, Rossi TA, Zucchi EM, de Deus LFA, Mabire X, Ferguson L, Magno L, Grangeiro A, Préau M, Botelho FC, Rodrigues A, Steele S, Dourado I. "I Can't Take This Shitty Quarantine Anymore": Sexual Behavior and PrEP Use Among Young Men Who Have Sex with Men and Transgender Women in Brazil During the COVID-19 Pandemic. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:689-702. [PMID: 35881251 PMCID: PMC9321283 DOI: 10.1007/s10508-022-02364-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
This study analyzes how the COVID-19 pandemic affected sexual behavior and use of HIV prevention methods among young transgender women (YTGW) and young gay, bisexual and other men who have sex with men (YGBMSM) participating in an HIV pre-exposure prophylaxis (PrEP) demonstration study in Brazil. Online interviews with 39 participants aged 15-22 years old were conducted between September and November 2020 and analyzed based on social constructionism and human rights-based approaches to health. The pandemic disrupted interviewees' routines, negatively affecting their life conditions. Among those who did not have a steady partner, social distance measures led to temporary interruption of sexual encounters and increased sexting and solo sex. Conversely, for those who had a steady relationship such measures contributed to increasing sexual practices and intimacy. Participants who had sexual encounters during the pandemic reported having continued to use PrEP. However, home confinement with family, lack of privacy, loss of daily routines and changes in housing impaired PrEP adherence and attendance at follow-up consultations. These results highlight the importance of maintaining HIV-service delivery for these groups during a public health crisis, as well as to address the structural drivers of the epidemic with comprehensive HIV prevention policies and by ensuring access of YGBMSM and YTGW to social protection policies.
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Affiliation(s)
- Dulce Ferraz
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France.
- Institut de Psychologie, Université de Lausanne, Lausanne, Switzerland.
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz (FIOCRUZ), Brasília, Brazil.
| | - Thais Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos (UniSantos), Santos, Brazil
| | - Luiz Fabio Alves de Deus
- Programa de Pós-Graduação em Psicologia Social e Institucional, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Xavier Mabire
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France
- Institut de Psychologie, Université de Lausanne, Lausanne, Switzerland
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marie Préau
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, France
| | - Fernanda Cangussu Botelho
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ayra Rodrigues
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos (UniSantos), Santos, Brazil
| | - Sabrina Steele
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia (UFBA), Salvador, Brazil
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30
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Goodreau SM, Delaney KP, Zhu W, Smith DK, Mann LM, Sanchez TH, Hamilton DT, Hoover KW. Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta. PLoS One 2023; 18:e0282503. [PMID: 36943832 PMCID: PMC10030006 DOI: 10.1371/journal.pone.0282503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023] Open
Abstract
The COVID-19 pandemic has disrupted HIV prevention, care, and transmission opportunities. This likely varies by geography, given differences in COVID-19 burden and mandates over time, and by age, given different likelihoods of severe COVID-19 consequences. We consider changes in sexual behavior, HIV testing, pre-exposure prophylaxis (PrEP) use and antiretroviral therapy (ART) use among men who have sex with men (MSM) over the first year of the COVID-19 epidemic, comparing the Atlanta metropolitan area and New York City (NYC). We use two continuous time-series datasets and one panel dataset, assessing changes over time within city and comparing across cities, and disaggregate major findings by age. For clinical results, ART use showed by far the smallest reductions, and testing the largest. Disruptions occurred concurrently between cities, despite the major wave of COVID-19, and government mandates, occurring later in Atlanta. Test positivity increased in NYC only. In both cities, younger MSM saw the greatest reductions in testing and PrEP use, but the smallest in sexual behavior. Reduced clinical service usage would be unconcerning if stemming solely from reductions in exposure; however, the patterns for young MSM suggest that the COVID-19 epidemic likely generated new conditions for increased HIV transmission, especially in this cohort.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States of America
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weiming Zhu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dawn K Smith
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura M Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Karen W Hoover
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Holt M, Chan C, Broady TR, Mao L, MacGibbon J, Rule J, Wilcock B, Prestage G, Bavinton BR. Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men's HIV-Related Behaviour in Australia. AIDS Behav 2023; 27:518-534. [PMID: 35895148 PMCID: PMC9326145 DOI: 10.1007/s10461-022-03788-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants' HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017-June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020-June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australian Federation of AIDS Organisations, Sydney, Australia
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Suen YT, Wong EMY, Chan RCH. Experiences of COVID-19 among Chinese-speaking lesbian, gay and bisexual people in Hong Kong: an inductive thematic analysis of survey response data. Sex Reprod Health Matters 2022; 30:2102537. [PMID: 36017871 PMCID: PMC9423823 DOI: 10.1080/26410397.2022.2102537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
As social inequalities during the COVID-19 pandemic have been recognised, emerging research showed that lesbian, gay and bisexual (LGB) people may be additionally affected during the pandemic. This paper adds to the understanding of the experiences of LGB people during the pandemic with a focus on Hong Kong, where issues of space significantly influence LGB people’s lives in this city with high population density. As part of a larger community study of LGB lives in Hong Kong, COVID-19-related impact on 434 Chinese-speaking LGB people was explored. Data collection was conducted from 20 May to 30 June 2020. Inductive thematic analysis of the open-text response survey data found that the LGB participants described both negative and positive impacts brought by COVID-19. Such impacts could be dimensionalised into those related to personal space and privacy, romantic and sexual space, and community space. It was also found that the experiences of COVID-19 among LGB people in Hong Kong were intersectional, along the lines of living arrangement and relationship status. Such findings make unique contributions to the emerging literature. First, there needs to be a more nuanced understanding of sexual minority individuals’ experiences during COVID-19 across cultural contexts. Second, COVID-19 was described as having brought positive impact in addition to its widely known negative impact.
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Affiliation(s)
- Yiu Tung Suen
- Associate Professor, Gender Studies Programme, Chinese University of Hong Kong, Room 250, 2/F, Sino Building, Shatin, Hong Kong. Correspondence:
| | - Eliz Miu Yin Wong
- PhD Candidate, Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Randolph C. H. Chan
- Associate Professor, Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
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Characterizing the Impact of the COVID-19 Pandemic on HIV PrEP care: A Review and Synthesis of the Literature. AIDS Behav 2022; 27:2089-2102. [DOI: 10.1007/s10461-022-03941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AbstractThe global COVID-19 pandemic and associated lockdown measures have caused disruptions to sexual health services and created additional barriers to the continuity of HIV pre-exposure prophylaxis (PrEP) among key populations. This review provides an examination of the influences of the pandemic on engagement in the PrEP care continuum. Using the PRISMA guideline, 46 studies were included in this review and the synthesis. Most of the studies were conducted in high-income settings through quantitative analysis. A majority of studies examining the changes in PrEP use suggested a decline or discontinuation in PrEP uptake during the pandemic. The most common reasons for stopping using PrEP were perceived barriers to PrEP-related care, having reduced sexual behaviors and fewer sexual partners, and reduced perceived risk of HIV infection. Limited studies documenting an increase in PrEP uptake were all in specific PrEP optimizing programs. During the pandemic, there is also an emerging trend of switching to on-demand PrEP from daily oral PrEP. Future studies should understand the mechanism of strategies that facilitated the improvements during the pandemic. PrEP implementation programs should consider alternative PrEP modalities and provide consistent and comprehensive knowledge about correct information.
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Bundy C, Xavier Hall CD, Foran JE, Jozsa K, Newcomb ME, Mustanski B. Reassessing the Importance of PrEP Use Given Reduced Sex During the COVID-19 Pandemic: Perspectives From a Sample of Young Sexual Minority Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:441-452. [PMID: 36454133 PMCID: PMC9979445 DOI: 10.1521/aeap.2022.34.6.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research has begun to examine sexual behavior during the COVID-19 pandemic using quantitative methods, but less is known about the context surrounding these changes using qualitative methods, including corresponding changes in risk reduction methods. This qualitative study, guided by the Integrated Behavioral Model, examines the pandemic's impact on PrEP adherence among young men who have sex with men in Chicago. PrEP-using participants from a cohort study were recruited into a 90-day diary study measuring sexual behaviors and PrEP use. Between April and September 2020, a subset of participants was recruited for qualitative interviews (n = 28) exploring prevention strategies, including the impact of the pandemic. Although most were highly adherent pre-pandemic, many took fewer pills or discontinued during the pandemic due to decreased sex. Findings suggest the importance of counseling for PrEP reinitiation as "seasons of HIV risk" increase, as well as use of telehealth as a facilitator of PrEP use throughout the pandemic.
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Affiliation(s)
- Camille Bundy
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Casey D. Xavier Hall
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James E. Foran
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Kyle Jozsa
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Michael E. Newcomb
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian Mustanski
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hubach RD, Owens C. Findings on the Monkeypox Exposure Mitigation Strategies Employed by Men Who Have Sex with Men and Transgender Women in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3653-3658. [PMID: 36103027 PMCID: PMC9472716 DOI: 10.1007/s10508-022-02423-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 05/14/2023]
Affiliation(s)
- Randolph D Hubach
- Department of Public Health, Purdue University, Matthews Hall, 220, 812 W. State St, West Lafayette, IN, 47907, USA.
| | - Christopher Owens
- Department of Health Behavior, Texas A&M University, College Station, TX, USA
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36
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Intersecting epidemics: the impact of coronavirus disease 2019 on the HIV prevention and care continua in the United States. AIDS 2022; 36:1749-1759. [PMID: 35730392 DOI: 10.1097/qad.0000000000003305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To summarize the broad impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV prevention and care in the United States with a focus on the status-neutral HIV care continuum. DESIGN We conducted an editorial review of peer-reviewed literature on the topics of HIV-risk behaviors, sexually transmitted illness (STI) and HIV prevalence, HIV prevention and treatment trends, and evolving practices during the COVID-19 pandemic. METHODS For relevant literature, we reviewed, summarized, and categorized into themes that span the HIV prevention and care continua, including sexual risk behaviors, mental health, and substance use. RESULTS We identified important changes within each component of the HIV care continuum across the United States during the COVID-19 pandemic. Shifts in prevention practices, engagement with care, care provision, medication adherence, testing, and prevalence rates were observed during the pandemic. CONCLUSION Although heightened disparities for people at risk for, and living with, HIV were seen during the COVID-19 pandemic, many health systems and clinics have achieved and maintained engagement in HIV prevention and care. This review highlights barriers and innovative solutions that can support durable and accessible health systems through future public health crises.
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de la Court F, Boyd A, Coyer L, van den Elshout M, de Vries HJC, Matser A, Hoornenborg E, Prins M. The impact of COVID-19-related restrictions in 2020 on sexual healthcare use, pre-exposure prophylaxis use, and sexually transmitted infection incidence among men who have sex with men in Amsterdam, the Netherlands. HIV Med 2022; 24:212-223. [PMID: 36226479 PMCID: PMC9875115 DOI: 10.1111/hiv.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We studied the effects of restrictions related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) pandemic on the use of sexual healthcare and pre-exposure prophylaxis (PrEP) and on the incidence of sexually transmitted infections (STIs) among men who have sex with men (MSM) in a prospective, open-label PrEP demonstration study (AMPrEP) in Amsterdam, the Netherlands. METHODS We retrieved data from 2019 to 2020 for participants with one or more study visit in 2019 (n = 305) and from two COVID-19 questionnaires (2020: n = 203; 2021: n = 160). Analyses were stratified for three periods of pandemic-related restrictions (first: 15 March 2020-15 June 2020; second: 16 June 2020-15 September 2020; third: 16 September 2020-31 December 2020 or 1 April 2021 for the COVID-19 questionnaire). Endpoints included returning for care during the pandemic, PrEP use (increased/unchanged vs. deceased/stopped, relative to 2019), and any STI/HIV. We modelled determinants of care and PrEP use via multivariable logistic regression and STI incidence using piecewise Poisson regression, comparing the 2020 and 2019 periods. RESULTS Of the 305 MSM included in the analysis, 72.8% returned for care during the pandemic, and this was significantly more likely among daily (vs. event-driven) PrEP users (p < 0.001). Increased/unchanged PrEP use ranged from 55.2% to 58.1% across the three pandemic periods and was more likely among those reporting chemsex in the first (p = 0.001) and third (p = 0.020) periods and among those reporting an increased/unchanged number of sex partners during the second period (p = 0.010). STI incidence was significantly lower in 2020 than in 2019 during the first period (incidence rate ratio [IRR] 0.43; 95% confidence interval [CI] 0.28-0.68) and not significantly different during the second (IRR 1.38; 95% CI 0.95-2.00) and third (IRR 1.42; 95% CI 0.86-2.33) periods. No HIV was diagnosed. CONCLUSION COVID-19-related restrictions coincided with reduced care and PrEP use. Changes in STI incidence suggest delayed diagnoses. Ways to ensure continued access to sexual healthcare during restrictions are needed.
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Affiliation(s)
- Feline de la Court
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Anders Boyd
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,stichting hiv monitoringAmsterdamthe Netherlands
| | - Liza Coyer
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Mark van den Elshout
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Henry J. C. de Vries
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Amsterdam UMC location University of AmsterdamDepartment of DermatologyAmsterdamthe Netherlands
| | - Amy Matser
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamthe Netherlands,Amsterdam UMC location University of AmsterdamDepartment of Infectious Diseases, Amsterdam institute for Infection & Immunity (AII)Amsterdamthe Netherlands
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Toldam NE, Graugaard C, Meyer R, Thomsen L, Dreier S, Jannini EA, Giraldi A. Sexual Health During COVID-19: A Scoping Review. Sex Med Rev 2022; 10:714-753. [PMID: 37051956 PMCID: PMC9242892 DOI: 10.1016/j.sxmr.2022.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The COVID-19 pandemic impacted profoundly on the wellbeing and social interactions of the world population, and all dimensions of sexual health were potentially affected by globally implemented preventive measures. OBJECTIVES The scoping review aimed to compile existing research investigating possible effects of COVID-19 lockdowns on adult sexual health, that is, sexual behavior, functioning, and satisfaction. Further, studies on the interplay between mental health and sexual well-being during the pandemic were reviewed. METHODS The review was conducted in accordance with guidelines established by the Joanna Briggs Institute and the Extension for Scoping Reviews (PRISMA-ScR) Checklist. On October 11-12, 2021, PubMed, Embase, PsycInfo, Cinahl, Cochrane, Sociological Abstracts and Scopus were systematically searched for relevant peer-reviewed papers employing quantitative methodology. Additionally, unpublished ("grey") research studies on the subject were retrieved. The screening, data extraction, and analysis of evidence were conducted by 4 independent reviewers using an iterative approach. RESULTS Based on 107 studies included, the scoping review showed that the pandemic had had a wide impact on all dimensions of sexual health. Except for solo sex activities, mainly negative COVID-19 implications were identified, although findings were, in sum, characterized by complexity and unpredictability. Thus, sexual behavior, functioning, and satisfaction during the pandemic appeared to be mitigated by a broad range of sociodemographic and contextual factors. Finally, sexual health seemed deeply entwined with overall mental health. CONCLUSION The scoping review revealed a broad range of COVID-19-related effects on sexual health, including an overall decline in partnered sex and a concurrent increase in solo sex activities. It also emphasized a need for future research to shed light on possible long-term consequences of the pandemic in various population groups and on all aspects of sexual health. Toldam NE, Graugaard C, Meyer R, et al. Sexual Health During COVID-19: A Scoping Review. Sex Med Rev 2022;10:714-753.
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Affiliation(s)
- Nana Ernst Toldam
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Denmark,Sexological Clinic, Mental Health Center, Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Denmark
| | - Rikke Meyer
- Clinical Pharmacology Unit, Zealand University Hospital, Roskilde, Denmark
| | | | | | | | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center, Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Corresponding Author: Annamaria Giraldi, MD, PhD, FECSM, IF, Sexological Clinic, Mental Health Center, Copenhagen, Copenhagen University Hospital – Mental Health Services CPH, Ole Maaloesvej 14, 2200 Copenhagen, Denmark. Tel: + 45 38 64 71 69
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39
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Hamill MM, Yu T, Armington GS, Hsieh YH, Manabe YC, Melendez JH. Factors Associated With New Sexual Partnerships During the COVID-19 Pandemic: A Survey of Online Sexually Transmitted Infection Testing Platform Users. Sex Transm Dis 2022; 49:695-699. [PMID: 35830655 PMCID: PMC9477713 DOI: 10.1097/olq.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic has coincided with an explosion of online platforms for sexually transmitted infections (STIs) testing using self-collected, mail-in specimens. Reports on the effect of COVID-19-associated restrictions on sexual behaviors have been mixed, but STI transmissions have continued during the pandemic. We sought to understand the pandemic impact on sexual habits associated with STIs among IWantTheKit users. METHODS Users of IWantTheKit, a free, online STI testing platform, were invited to complete an anonymous questionnaire. Descriptive statistics were used to describe survey responses. Associations with reports of new sex partnerships were explored as a marker of STI risk. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze individual characteristics and reported behaviors associated with self-reported new sexual partnerships during the first 2 COVID-19 pandemic waves. RESULTS Of the 3462 users of the online STI testing platform between June 2020 and February 2021, 1088 (31.4%) completed the online survey; 705 (66.2%) of 1065 reported a new sex partner. One-quarter met their sex partners using apps. Overall, 10% were symptomatic and almost 18% were concerned that their partner had an STI. White race in men (odds ratio, 1.81; 95% confidence interval, 1.04-3.16), women younger than 25 years (odds ratio, 1.85; 95% confidence interval, 1.09-3.14), and increased condom use in both men and women were significantly associated with reports of new sexual partnerships in adjusted analysis. CONCLUSIONS Despite pandemic restrictions on social gatherings, new sexual partnerships were common in this population, associated with common risk factors, and may help to explain ongoing STI transmission.
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Affiliation(s)
- Matthew M. Hamill
- From the Division of Infectious Diseases, John Hopkins School of Medicine
- Sexual Health and Wellness Clinics, Baltimore City Health Department
| | - Tong Yu
- From the Division of Infectious Diseases, John Hopkins School of Medicine
| | | | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, John Hopkins School of Medicine, Baltimore MD
| | - Yukari C. Manabe
- From the Division of Infectious Diseases, John Hopkins School of Medicine
| | - Johan H. Melendez
- From the Division of Infectious Diseases, John Hopkins School of Medicine
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40
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Morgan E, Caba AE, Eaton LA, Watson RJ. PrEP Access Affected by COVID-19 Is Associated With Increased Odds of HIV Seroconversion. J Acquir Immune Defic Syndr 2022; 91:138-143. [PMID: 36094479 PMCID: PMC10284373 DOI: 10.1097/qai.0000000000003036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals report lower uptake and adherence to pre-exposure prophylaxis (PrEP) compared with White SMMGD. For some, the COVID-19 pandemic has resulted in reduced access to PrEP prescriptions and related changes to PrEP use, yet little is known how pandemic-related changes to PrEP access and sexual activity might influence sexually transmitted infection (STI) status and HIV seroconversion among SMMGD of color. We used data from 4 waves of a national study of Black and Hispanic/Latino SMMGD's HIV, PrEP, and health experiences to assess whether self-reported changes to sexual activity were associated with STI status, and whether self-reported changes to PrEP access were associated with HIV seroconversion. Those who reported greater impact to their sexual activity during the pandemic [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI): 1.10 to 1.40] and a greater number of sexual partners (aOR = 1.29; 95% CI: 1.21 to 1.38) were more likely to report a positive STI test. In addition, we found that compared with those who did not report pandemic-related changes to PrEP access, those who did report changes to PrEP access had significantly higher odds of HIV seroconversion during the study period (aOR = 2.80; 95% CI: 1.02 to 7.68). These findings have implications for HIV and STI prevention and highlight the importance of novel interventions to improve PrEP access among Black and Hispanic/Latino SMMGD. Importantly, these findings also demonstrate the need to stay focused on key populations at risk of HIV infection during emerging public health crises to avoid an increase in rates of new diagnoses.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH
- Infectious Disease Institute, The Ohio State University, Columbus, OH
| | - Antonia E. Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, US
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41
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Sharpe JD, Sanchez TH, Siegler AJ, Guest JL, Sullivan PS. Association between the geographic accessibility of PrEP and PrEP use among MSM in nonurban areas. J Rural Health 2022; 38:948-959. [PMID: 34997634 PMCID: PMC9259757 DOI: 10.1111/jrh.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The US HIV epidemic has become a public health issue that increasingly affects men who have sex with men (MSM), including those residing in nonurban areas. Increasing access to pre-exposure prophylaxis (PrEP) in nonurban areas will prevent HIV acquisition and could address the growing HIV epidemic. No studies have quantified the associations between PrEP access and PrEP use among nonurban MSM. METHODS Using 2020 PrEP Locator data and American Men's Internet Survey data, we conducted multilevel log-binomial regression to examine the association between area-level geographic accessibility of PrEP-providing clinics and individual-level PrEP use among MSM residing in nonurban areas in the United States. FINDINGS Of 4,792 PrEP-eligible nonurban MSM, 20.1% resided in a PrEP desert (defined as more than a 30-minute drive to access PrEP), and 15.2% used PrEP in the past 12 months. In adjusted models, suburban MSM residing in PrEP deserts were less likely to use PrEP in the past year (adjusted prevalence ratio [aPR] = 0.35; 95% confidence interval [CI] = 0.15, 0.80) than suburban MSM not residing in PrEP deserts, and other nonurban MSM residing in PrEP deserts were less likely to use PrEP in the past year (aPR = 0.75; 95% CI = 0.60, 0.95) than other nonurban MSM not residing in PrEP deserts. CONCLUSIONS Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the United States are needed to address the growing HIV epidemic in these communities.
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Affiliation(s)
- J. Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Travis H. Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Uhrmacher M, Skaletz-Rorowski A, Nambiar S, Schmidt AJ, Ahaus P, Serova K, Mordhorst I, Kayser A, Wach J, Tiemann C, Münstermann D, Brockmeyer NH, Potthoff A. HIV pre-exposure prophylaxis during the SARS-CoV-2 pandemic: Results from a prospective observational study in Germany. Front Public Health 2022; 10:930208. [PMID: 36091531 PMCID: PMC9449641 DOI: 10.3389/fpubh.2022.930208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023] Open
Abstract
Aims Since 2017, HIV pre-exposure prophylaxis (PrEP) care has been provided through an intersectoral collaboration at WIR (Walk-in-Ruhr, Center for Sexual Health and Medicine, Bochum, Germany). The aim of this study was to establish possible impact of COVID-restrictions on the sexual behavior of PrEP users in North Rhine-Westphalia. Methods The current PrEP study collected data of individuals using PrEP, their sexual behavior and sexually transmitted infections (STIs) before (each quarter of year 2018) and during the COVID-19 pandemic (each quarter of year 2020). Results During the first lockdown in Germany from mid-March until May 2020, PrEP-care appointments at WIR were postponed or canceled. Almost a third of PrEP users had discontinued their PrEP intake in the 2nd quarter of 2020 due to alteration of their sexual behavior. The number of sexual partners decreased from a median of 14 partners in the previous 6 months in 1st quarter of 2020, to 7 partners in 4th quarter of 2020. Despite such a significant reduction in partner number during the pandemic in comparison to the pre-pandemic period, a steady rate of STIs was observed among PrEP users in 2020. Conclusion The SARS-CoV-2-pandemic has impacted PrEP-using MSM in North Rhine-Westphalia with respect to their PrEP intake regimen and sexual behavior in 2020. Our study revealed a steady rate of STI among PrEP users even during the pandemic, thus highlighting the importance of ensuring appropriate HIV/STI prevention services in times of crisis.
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Affiliation(s)
- M. Uhrmacher
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Skaletz-Rorowski
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - S. Nambiar
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. J. Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom,Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - P. Ahaus
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - K. Serova
- Institute of Educational Research, Ruhr Universität Bochum, Bochum, Germany
| | - I. Mordhorst
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Kayser
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Aidshilfe Bochum e.V. (Aids-Service Organization Bochum), Bochum, Germany
| | - J. Wach
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Local Health Department Bochum, Bochum, Germany
| | - C. Tiemann
- Laboratory Krone, Bad Salzuflen, Germany
| | | | - N. H. Brockmeyer
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany
| | - A. Potthoff
- WIR – Walk in Ruhr, Center for Sexual Health and Medicine, Bochum, Germany,Interdisciplinary Immunological Outpatient Clinic, Center for Sexual Health and Medicine, Department of Dermatology, Venereology and Allergology, Ruhr Universität Bochum, Bochum, Germany,*Correspondence: A. Potthoff
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Schumacher CM, Thornton N, Wagner J, Tilchin C, Ghanem KG, Hamill MM, Latkin C, Rompalo A, Ruhs S, Greenbaum A, Jennings JM. Sexually Transmitted Infection Transmission Dynamics During the Coronavirus Disease 2019 (COVID-19) Pandemic Among Urban Gay, Bisexual, and Other Men Who Have Sex With Men. Clin Infect Dis 2022; 75:e1137-e1144. [PMID: 35169833 PMCID: PMC8903324 DOI: 10.1093/cid/ciab1053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) mitigation measures on sexually transmitted infection (STI) transmission and racial disparities remains unknown. Our objectives were to compare sex and drug risk behaviors, access to sexual health services, and STI positivity overall and by race during the COVID-19 pandemic compared with pre-pandemic among urban sexual minority men (MSM). METHODS Sexually active MSM aged 18-45 years were administered a behavioral survey and STI testing every 3-months. Participants who completed at least 1 during-pandemic (April 2020-December 2020) and 1 pre-pandemic study visit (before 13 March 2020) that occurred less than 6 months apart were included. Regression models were used to compare during- and pre-pandemic visit outcomes. RESULTS Overall, among 231 MSM, reports of more than 3 sex partners declined(pandemic-1: adjusted prevalence ratio 0.68; 95% confidence interval: .54-.86; pandemic-2: 0.65, .51-.84; pandemic-3: 0.57, .43-.75), substance use decreased (pandemic-1: 0.75, .61-.75; pandemic-2: 0.62, .50-.78; pandemic-3: 0.61, .47-.80), and human immunodeficiency virus/preexposure prophylaxis care engagement (pandemic-1: 1.20, 1.07-1.34; pandemic-2: 1.24, 1.11-1.39; pandemic-3: 1.30, 1.16-1.47) increased. STI testing decreased (pandemic-1: 0.68, .57-.81; pandemic-2: 0.78, .67-.92), then rebounded (pandemic-3: 1.01, .87-1.18). Nei-ther Chlamydia (pandemic-2: 1.62, .75-3.46; pandemic-3: 1.13, .24-1.27) nor gonorrhea (pandemic-2: 0.87, .46 1.62; pandemic-3: 0.56, .24-1.27) positivity significantly changed during vs pre-pandemic. Trends were mostly similar among Black vs. non-Black MSM. CONCLUSIONS We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared with pre-pandemic. Our findings underscore the need for novel STI prevention strategies that can be delivered without in-person interactions.
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Affiliation(s)
- Christina M Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nicole Thornton
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Wagner
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carla Tilchin
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Matthew M Hamill
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- STI/HIV Program, Baltimore City Health Department, Baltimore, Maryland, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne Rompalo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Adena Greenbaum
- STI/HIV Program, Baltimore City Health Department, Baltimore, Maryland, USA
| | - Jacky M Jennings
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Chase Brexton Health Services, Baltimore, Maryland, USA
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Cascalheira CJ, Morrison C, D’Angelo AB, Villanueva OG, Grov C. The Impact of the COVID-19 Pandemic on HIV-Positive Men Who Have Sex With Men: (Dis)connection to Social, Sexual, and Health Networks. PSYCHOLOGY & SEXUALITY 2022; 14:306-320. [PMID: 36743519 PMCID: PMC9897219 DOI: 10.1080/19419899.2022.2112745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has disproportionately affected HIV-positive cisgender men who have sex with men (MSM). Between May and June in 2020, we conducted one-on-one semi-structured qualitative interviews with 20 HIV-positive MSM aiming to describe their (dis)connection to social, sexual, and health networks during the COVID-19 pandemic. All participants relied on social support networks to manage pandemic-based distress, using computer-mediated communication as well as physical proximity. To connect to sexual networks, this sample described adaptations to their partner selection strategies, such as enumerating harm reduction approaches. To connect to health networks, participants depended on reassuring providers, resourceful case managers, telehealth, and streamlined access to their antiretroviral therapy (ART) medications. Nonetheless, stay-at-home recommendations reduced community connection, sexual activity, and healthcare access for many participants, and perceptions of these losses were shaped by psychosocial burdens (e.g., loneliness), structural burdens (e.g., environmental barriers, financial difficulties), and health-protective factors (e.g., hopeful outlook, adherence to a regular routine). The COVID-19 pandemic appears to have exacerbated health-related issues for HIV-positive MSM. Given the ongoing COVID-19 mutations, community-based organizations, clinicians, and researchers might use these findings to modify HIV prevention and intervention efforts.
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Affiliation(s)
| | - Corey Morrison
- City University of New York (CUNY) Institute for Implementation Science in Population Health
| | - Alexa B. D’Angelo
- City University of New York (CUNY) Institute for Implementation Science in Population Health
- CUNY Graduate School of Public Health and Health Policy
| | | | - Christian Grov
- City University of New York (CUNY) Institute for Implementation Science in Population Health
- CUNY Graduate School of Public Health and Health Policy
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45
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Walsh AR, Sullivan S, Stephenson R. Intimate Partner Violence Experiences During COVID-19 Among Male Couples. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP14166-NP14188. [PMID: 33866839 DOI: 10.1177/08862605211005135] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In addition to the growing morbidity and mortality related to the 2019 novel coronavirus (SAR-CoV-2) pandemic, social distancing measures during the pandemic may result in increased intimate partner violence (IPV). However, it is yet unknown if gay, bisexual, and other men who have sex with men (GBMSM)'s IPV risk has increased during this time. This article describes and analyzes IPV experiences during the COVID-19 pandemic in a sample of coupled-GBMSM in the United States. We hypothesized that pandemic-driven stressors would be associated with increased IPV prevalence and severity. A sample of 214 coupled men living in the US who had previously participated in HIV-related couple studies was surveyed in July-September 2020. Respondents reported demographic, sexual and substance use behaviors, and relationship characteristics. Surveys also collected data on pandemic-related life-changes (employment, substance use, COVID-19 illness). IPV victimization and perpetration were measured with the Gay and Bisexual Men Intimate Partner Violence scale and measured individually experienced or perpetrated violence, sexual, emotional, monitoring, or controlling behaviors, and if a given behavior was new and/or had changed in frequency during the pandemic. Reported prevalence and pandemic-related changes in victimization and perpetration were described. New or more frequent IPV victimization was modeled against employment, substance use changes, COVID-19 illness, and outside sexual partners (modified by a couple's sexual agreement). IPV perpetration prevalence was 15.17%, 34.44% of which was new or more frequent. Victimization prevalence was 14.95%, of which 46.88% was new or more frequent. After adjustment, outside sexual partners were associated with IPV among those with nonmonogamous sexual agreements; each outside sexual partner increased the odds of new or more frequent victimization by 70% (OR = 1.70; 95% CI [1.16, 2.51]). Given this study's documented rise in IPV among a sample of coupled men, additional research into IPV predictors, interventions, and support strategies in GBMSM populations are warranted.
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46
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Juan Carlos MP, Julio VC, Héctor Alexis LB, Ignacio LV, Shelley L. C. Differences in Sexual Health of Mexican Gay and Bisexual Youth and Adults During the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:614-626. [PMID: 38596397 PMCID: PMC10903613 DOI: 10.1080/19317611.2022.2097357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 04/11/2024]
Abstract
Objective: compare and analyze the implications of COVID-19 on the sexual health of Mexican gay and bisexual young and adult men (GBM). Method: an online survey with 1001 GBM participants. Information was collected on sexual desire, use of mobile applications, sexual practices during the pandemic, and prevention of sexually transmitted infections (STIs) from August to October 2020. Young participants were compared with adults. Results: Young GBM reported more challenges to their sexual health in the pandemic. There was an increase in sexual desire, mobile applications, and a decrease in access to STIs prevention supplies. Discussion: Implications for sexual health policies for these groups during health contingencies are discussed.
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Affiliation(s)
- Mendoza-Pérez Juan Carlos
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Vega-Cauich Julio
- Facultad de Educación, Universidad Autónoma de Yucatán, Merida, Mexico
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Labs J, Nunn AS, Chan PA, Bessey S, Park CJ, Marshall BDL, Patel RR, Mena LA, Goedel WC. Projected Effects of Disruptions to Human Immunodeficiency Virus (HIV) Prevention Services During the Coronavirus Disease 2019 Pandemic Among Black/African American Men Who Have Sex With Men in an Ending the HIV Epidemic Priority Jurisdiction. Open Forum Infect Dis 2022; 9:ofac274. [PMID: 35855962 PMCID: PMC9214131 DOI: 10.1093/ofid/ofac274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Disruptions in access to in-person human immunodeficiency virus (HIV) preventive care during the coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on our progress towards the Ending the HIV Epidemic goals in the United States. Methods We used an agent-based model to simulate HIV transmission among Black/African American men who have sex with men in Mississippi over 5 years to estimate how different reductions in access affected the number of undiagnosed HIV cases, new pre-exposure prophylaxis (PrEP) starts, and HIV incidence. Results We found that each additional 25% decrease in HIV testing and PrEP initiation was associated with decrease of 20% in the number of cases diagnosed and 23% in the number of new PrEP starts, leading to a 15% increase in HIV incidence from 2020 to 2022. Conclusions Unmet need for HIV testing and PrEP prescriptions during the COVID-19 pandemic may temporarily increase HIV incidence in the years immediately after the disruption period.
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Affiliation(s)
- Jennifer Labs
- Department of Applied Mathematics, Brown University, Providence, Rhode Island, USA
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - S Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Carolyn J Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rupa R Patel
- John T. Milliken Department of Internal Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Leandro A Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Stephenson R, Sullivan SP, Pitter RA, Hunter AS, Chavanduka TMD. Are We Still Having Sex? Results of Round Two of the Love and Sex in the Time of COVID Survey with Gay, Bisexual and Other Men Who Have Sex with Men. AIDS Behav 2022; 26:2338-2348. [PMID: 35044555 PMCID: PMC8767038 DOI: 10.1007/s10461-022-03580-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
This paper presents data from the Love and Sex in the Time of COVID survey, an online survey with US gay, bisexual and other men who have sex with men. The first round of the Love and Sex in the Time of COVID-19 survey was conducted online from April to May, 2020: the second round was collected November 2020 to January 2021. GBMSM were recruited through advertisements featured on social networking platforms. Analysis examines changes in self-reported measures of sexual behavior (number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms) between those with complete data for round one and round two of the surveys (n = 280). While in round one, men reported a moderate willingness to have sex during COVID-19 (3.5 on a scale from 1 to 5), this had reduced significantly to 2.1 by round two. Men reported declines in the number of unprotected anal sex partners since pre-COVID. Perceptions of a longer time until the end of the COVID-19 pandemic were associated with increases in the number of sex partners and UAI partners. The results illustrate some significant declines in sexual behavior among GBMSM as the COVID-19 pandemic progressed. As vaccine programs continue to roll out across the U.S, as lockdowns ease and as we return to some normalcy, it will be important to continue to think critically about ways to re-engage men in HIV prevention.
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Affiliation(s)
- Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, USA.
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA.
| | - Stephen P Sullivan
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Renée A Pitter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
| | - Alexis S Hunter
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Mental Well-Being and Sexual Intimacy among Men and Gender Diverse People Who Have Sex with Men during the First UK COVID-19 Lockdown: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126985. [PMID: 35742234 PMCID: PMC9222884 DOI: 10.3390/ijerph19126985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/04/2022]
Abstract
This mixed-methods study aimed to explore mental well-being, circumstances and strategies around managing sexual intimacy and risk during the first UK COVID-19 lockdown (Spring 2020) among men and gender diverse people who have sex with men (MGDPSM), commencing while lockdown was in progress. n = 1429 MGDPSM completed the survey and 14 undertook an in-depth interview. Low mental well-being was reported by 49.6% of the survey participants. Low mental well-being was not predicted by relationship and living circumstance, sexual networking app use, or by casual sexual partners. Low mental well-being was associated with more frequent COVID-19 anxiety (OR = 5.08 CI: 3.74, 6.88 p < 0.001) and with younger age (18−24 years OR = 2.23 CI:1.41−3.53 p = 0.001, 25−34 years OR = 1.45 CI:1.04−2.02 p = 0.029, 35−44 years OR = 1.41 CI:1.00−1.99 p = 0.052). The interview participants understood their lockdown experiences as being relative to normalcy, and those experiencing more dramatic changes faced greater challenges. Living with partners was felt to protect well-being. Many participants reported intimacy interruption challenges. The findings indicate that mental well-being is predicted by age and COVID-19 impact, highlighting opportunities for targeting MGDPSM who are most vulnerable to poor mental health. Services that support MGDPSM during COVID-19 recovery efforts must provide non-judgemental and affirming support.
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Storer D, Prestage G, McManus H, Maher L, Bavinton BR, Ellard J, Jin F, Philpot S, Holt M, Saxton P, Haire B, Murphy D, Hammoud MA. Relationship Between Sexual Behaviors with Non-committed Relationship Partners and COVID-19 Restrictions and Notification Rates: Results from a Longitudinal Study of Gay and Bisexual Men in Australia. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:825-836. [PMID: 35669626 PMCID: PMC9142826 DOI: 10.1007/s13178-022-00733-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 05/28/2023]
Abstract
Introduction COVID-19 related lockdowns have impacted the sexual activity of gay and bisexual men (GBM). We investigated trends in sexual behaviors and the COVID-19 context in which they occurred (COVID-notification rates and jurisdictional restrictions) to understand changes in the duration and severity of periods of lockdown on the sexual behavior of Australian GBM. Methods In an online, prospective observational study of 831 GBM from May 2020 to May 2021, we investigated associations between changes in sexual behavior among Australian GBM, lockdowns, and COVID-19 notification rates through weekly surveys from May 2020 to May 2021. Results The mean age was 45.71 years (SD: 13.93). Most identified as gay (89.0%) and 10.2% were living with HIV. There was an overall increase in the mean weekly number of non-committed relationship partners (0.53-0.90, p < 0.001). The state of Victoria experienced a significant extended COVID-19 outbreak, accompanied by severe lockdown restrictions. In response, Victorian men's partner numbers shifted three times, while elsewhere there was an overall gradually increasing trend. Conclusions Less severe outbreaks with shorter lockdown periods, involving fewer and geographically contained, COVID-19 notifications were accompanied by non-significant changes in sex with non-relationship partners than more severe outbreaks over extended periods and larger geographical areas. Supplementary Information The online version contains supplementary material available at 10.1007/s13178-022-00733-8.
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Affiliation(s)
- Daniel Storer
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Hamish McManus
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Lisa Maher
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Steven Philpot
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Peter Saxton
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Bridget Haire
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Dean Murphy
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
| | - Mohamed A. Hammoud
- The Kirby Institute, UNSW, Wallace Wurth Building, Sydney, NSW 2052 Australia
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