Sex in the Time of COVID-19: Patterns of Sexual Behavior Among LGBTQ+ Individuals in the U.S

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

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.

Evidence for Sex Differences in Depression, Sexual Attitudes, and Impulsivity as Predictors of Breaking Shelter-in-Place Orders During the COVID-19 Pandemic

Although the call to understand how sexual behaviors have been impacted by the COVID-19 pandemic has been established as an important area of study, research examining the extent to which gender, sexual attitudes, impulsivity, and psychological distress predicted breaking shelter-in-place (SIP) orders to engage in sexual behaviors with partners residing outside the home is undefined. Obtaining a deeper examination of the variables which predict risky sexual behaviors during SIP has important implications for future research at the intersection of public health, sexuality, and mental health. This study addressed the gap in the literature by considering how partnered sexual behaviors may be used during the COVID-19 pandemic to alleviate stress, as measured by breaking SIP orders for the pursuit of sexual intercourse. Participants consisted of 186 females and 76 males (N = 262) who predominately identified Caucasian/White (n = 149, 57.75%) and heterosexual/straight (n = 190, 73.64%) cultural identities with a mean age of 21.45 years (SD = 5.98, range = 18-65). A simultaneous logistic regression was conducted to examine whether mental health symptoms, sexual attitudes, and impulsivity predicted participants' decision to break SIP orders to engage in sexual intercourse. Based on our results, breaking SIP orders to pursue sexual activities with partners residing outside the home during the COVID-19 pandemic may be understood as an intentional strategy among men with less favorable birth control attitudes to mitigate the effects of depression. Implications for mental health professionals, study limitations, and future areas of research are additionally provided.

Changes in Solo and Partnered Sexual Behaviors following the First COVID-19 Wave: Data from an International Study of 26 Countries

Objective

To determine individual- and country-level factors associated with self-reported changes in solo and partnered sexual behaviors in an international sample of adults during COVID-19.

Methods

Data were from the International Sexual Health And REproductive Health during COVID-19 study (I-SHARE)-a cross-sectional, multi-country study (N = 26 countries) assessing adult (N = 19,654) sexual/reproductive health before and during the first wave of COVID-19. We examined self-reported changes (three-point scale: decreased, no change, increased) in solo masturbation, hugging/holding hands/cuddling with a partner, sex with a primary partner, sex with a casual partner, sexting with a partner, viewing sexually explicit media and partnered cybersex. Ordinal regression assessed the impact of individual (age, gender- and sexual-identity, romantic partnership status, employment and income stability, household change and content, mental well-being, changes in alcohol use, and changes in marijuana use) and country-level (e.g., Oxford Stringency Index, Human Development Index, and the Palma Ratio) factors on behavior change.

Results

The most common behavior to increase was hugging, kissing, or cuddling with a partner (21.5%), and the most common behavior to decrease was sex with a main partner (36.7%). Household factors like job/income instability and having children over the age of 12 years were significantly associated with decreased affectionate and sexual partnered sexual behaviors; more frequent substance use was linked to significantly increased solo, partnered, and virtual sexual behaviors.

Conclusions

Understanding changes in sexual behaviors-as well as the factors that make changes more or less likely among adults around the world-are important to ensure adequate sexual health support development for future public health emergencies.

LGBTQ+ College Students' Relationship Satisfaction During the COVID-19 Pandemic

Research suggests that COVID-19-related restrictions affected individuals' ability to engage in relationship maintenance behaviors and have led to poorer romantic relationship quality. Poor relationship quality may be especially problematic for lesbian, gay, bisexual, transgender, queer or questioning, and otherwise non-heterosexual or-cisgender (LGBTQ+) college students, who often lack family support and are at greater risk for mental health issues. We used a social exchange theory lens to examine correlates of relationship satisfaction for LGBTQ+ college students during the early months of the pandemic. The analytic sample consists of 175 LGBTQ+ students (Mage = 20.5) who completed an online survey and reported being in a romantic relationship. Our findings demonstrate that LGBTQ+ students with more supportive partners were more satisfied with their relationships. These results can inform clinicians how to better support LGBTQ+ college couples when they experience relationship stress.

Sexual life of Spanish women during the lockdown by COVID-19: Differences according to sexual orientation?

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.

Mental and sexual health during the COVID-19 pandemic: Differences between lesbian and bisexual women and gay and bisexual men in Mexico

COVID-19 had implications for sexual minorities who faced challenges due to situations related to their sexual orientation. The objective of this article was to analyze the differences in sexual and mental health experiences between lesbian and bisexual women (LBW) and gay and bisexual men (GBM) in Mexico in the context of the pandemic. An online survey captured the mental and sexual health experiences of a total of 932 participants consisting of 720 GBM and 212 LBW with a mean age of 30.5 years. Regarding mental health, women reported higher levels of depression, anxiety, and a greater possibility of suicidal ideation. Regarding sexual health, men were more likely to use drugs during sexual intercourse, have problems getting tested for sexually transmitted infections (STI), and have had STI during the lockdown. These findings identify particularities that each group faced, which can inform recommendations for public policies addressing specific sexual and mental health problems during and after the current pandemic.

Impact of COVID-19 on the Belgian HIV epidemic: slowdown of HIV transmission and testing and adaptation of care

BACKGROUND

To gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years.

METHODS

Belgian national HIV surveillance data 2017-2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %).

RESULTS

In 2020, 725 HIV infections were diagnosed in Belgium (- 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April-May but also present in July-December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March-May and October-December (- 57.5% in April and -25.4% in November 2020 compared to monthly 2017-19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [- 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March-May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April-May 2020 (respectively - 45.7%, - 47.4%, - 77.9% in April compared to February 2020).

CONCLUSIONS

The significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April-May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.

Sexuality Transmitted Infection in the COVID-19 Pandemic and Non-Pandemic Time

On March 11, 2020, the World Health Organization recognized the SARS-CoV-2 infection as a pandemic. The pandemic itself in addition to its containment measures affects individuals' lifestyles and welfare including their sexual behaviors. Thus, we hypothesized that sexually transmitted infection (STI) incidence may be changed and so we evaluate urethritis incidence as the most common STI in men and some other related factors. Two cross-sectional surveys during the first 6 months of 2019 and 2020 were undertaken and data were collected from 11 urology offices located in different parts of the capital city. In total, 34,611 male participants were included in our study, and 191 (.55%) patients' clinical diagnoses were urethritis. The urethritis incidence significantly decreased from 149 of 17,950 (.83%) to 42 of 16,661 (.25%) individuals in the same period of the years 2019 and 2020, respectively (p-value < .001). There was a higher percentage of single (p-value = .049) and older (p-value < .001) urethritis patients in the first 6 months of the year 2020 compared with 2019. Our survey provided urethritis incidence, demographics, symptoms, and treatment characterization. As our results show, the proportion of urethritis patients in all populations admitted to urologist offices had dramatically decreased during the COVID-19 pandemic compared with prior. The indirect effects of the pandemic and its containment measures on people's sexual health should be noticed and an appropriate reaction and policy-making are recommended to manage issues properly in different aspects of sexual health.

Biological, Behavioral, and Demographic Drivers of Recent Syphilis Infection Among Emerging Adult Sexual Minority Men in New York City: The P18 Cohort Study

The rate of syphilis infections among sexual minority men (SMM) has continued to increase in recent decades. As such, this analysis sought to identify demographic, biological, and behavioral factors associated with recent syphilis infection in emerging adult SMM. Data were drawn from a 3-year cohort study of emerging adult SMM (n = 665), from July 2014 to March 2019. Biannual study assessments included rapid HIV testing and behavioral surveys. At baseline, and at the 18- and 36-month time points, participants underwent chlamydia, gonorrhea, and syphilis screening. Generalized estimating equations were used to generate four models of repeated syphilis screening. In this racially/ethnically and socioeconomically diverse sample of SMM, 5.0% of participants tested positive for syphilis at baseline and 9.0% had an infection at the subsequent time points. Across all models, racial/ethnic minority SMM had higher odds of syphilis. Higher odds of syphilis infection were also significantly associated with more frequent condomless anal sex, more frequent marijuana use, HIV seropositivity, not currently using pre-exposure prophylaxis (PrEP), and not receiving syphilis testing in the previous 6 months; lower odds were associated with more frequent oral sex and more frequent alcohol use. These findings support current screening guidelines based on SMM who may be at increased risk for sexually transmitted infection (STI) acquisition, such as people living with HIV or those who engage in condomless sex. Further, our findings of reduced syphilis incidence among those who are on PrEP and engaged in regular STI testing support existing efforts to increase the availability and accessibility of preventive sexual health care for SMM.