COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey

Sexual and mental health of Singaporean gay, bisexual and other men who have sex with men in times of COVID-19: a qualitative study

OBJECTIVES

COVID-19 had significant influences on everyone's lives. This study aimed to explore impacts of COVID-19 on mental and sexual health and access to health services among gay, bisexual and other men who have sex with men (GBMSM) in Singapore.

METHODS

This qualitative study recruited 16 self-identified GBMSM via purposive sampling and semi-structured individual interviews were conducted. Three themes and seven sub-themes were derived from analysis done using the framework method.

RESULTS

Participants shared how COVID-19 led to negative emotions and experiences at an intrapersonal level and interpersonal level (with families or partners), which were also worsened by prevailing stigma that GBMSM already face in Singapore and within their social networks. Sexual behaviours associated with HIV and other sexually transmitted infections risk and substance use were seen to be maladaptive coping methods of social isolation due to COVID-19. These dynamics were all exacerbated by the closure of "non-essential" services, which included many important services for mental and sexual health that were relevant to the GBMSM community.

CONCLUSIONS

Changes in policies and community efforts should be explored to improve these areas, enhancing the psychosocial and sexual well-being of GBMSM.

HIV Pre-Exposure Prophylaxis (PrEP) Users' Experiences of PrEP Access, Sexual Behaviour, and Well-Being During the COVID-19 Pandemic: A Welsh Qualitative Study

BACKGROUND

HIV Pre-Exposure Prophylaxis (PrEP) has been available in Wales since 2017. The coronavirus disease (COVID-19) pandemic impacted UK sexual health services, leading to a reduction in service provision. There is a lack of research on the experiences of PrEP users during this time.

OBJECTIVE

We aimed to explore the experiences of PrEP users in Wales following the introduction of COVID-19 pandemic measures.

METHODS

We conducted a secondary data analysis of two prior interview studies (DO-PrEP and UPrEP). Data collection was undertaken between May 2020 and February 2021 using remote interviewing. Semi-structured interviews were conducted. Participants were ≥18 years of age, residents of Wales, current or previous PrEP users, and men who have sex with men (MSM). Reflexive thematic analysis was conducted.

RESULTS

A total of 32 interviews were included in the analysis. Themes include the following: (1) PrEP use during COVID-19, (2) sexual behaviour and relationship changes following COVID-19 restrictions, (3) NHS service provision during the COVID-19 pandemic, and (4) wider contextual effects of the pandemic. Participants reported a change in PrEP use (pausing or switching to event-based PrEP). Participants reported reduced access to clinics and appointments. Support for changing to event-based PrEP was varied. Social isolation resulted in varied responses to lockdown rules, especially in later lockdowns.

CONCLUSION

This study provides patient perspectives on the challenges the COVID-19 pandemic posed to PrEP use and access. It offers insights into the broader support needs around PrEP use when an individual's circumstances change. Flexible models of PrEP provision, which can be adapted to the patient's needs, will be essential as PrEP delivery extends into the wider community.

PATIENT AND PUBLIC CONTRIBUTION

Both the DO-PrEP and UPrEP studies received input from various stakeholders in the design of the topic guides for the study; these included public lay members, PrEP users, PrEP providers, and individuals involved with HIV advocacy and policy.

The Resurgence of Treponema pallidum Infections and Reinfections during the COVID-19 Pandemic in Greece

The beginning of the COVID-19 pandemic was marked by a sharp decline in syphilis infections in many countries worldwide, including Greece. However, a resurgence of positive cases started to appear in the second half of 2020. The aim of this study was to explore the impact of the pandemic on the incidence of new syphilis infections and reinfections and analyze the sociodemographic characteristics associated with recurrent episodes. We analyzed medical records from a 14-month period after the beginning of the pandemic and compared them with the respective period before the start of the pandemic. Our participants consisted mainly of men, with a median age of 43 years, homosexual orientation, and higher education. During COVID-19, more HIV patients presented for syphilis testing (38.0% vs. 34.6%, p = 0.025). Overall, we observed almost a two-fold increase in positive syphilis cases during COVID-19 (21.1% vs. 12.4%, p < 0.001), with new infections rising from 8.4% to 13.2% and reinfections from 4.0% to 7.9%. Multivariable logistic regression analysis revealed that the COVID-19 pandemic, among different parameters (such as age, gender, sexual orientation, HIV status, and educational level), was the only factor associated with higher positive syphilis rates (OR 1.47, 95% CI: 1.07-2.01, p = 0.003). Our results highlight the need to ensure enhanced prevention and undisrupted healthcare services, with a focus on future pandemics.

Changes in Partner-Seeking and Sexual Behavior Among US Adults During the First 2 Years of the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic may have influenced partner-seeking and sexual behaviors of adults.

METHODS

We examined cross-sectional survey data collected at the end of the first year (n = 1161) and second year (n = 1233) of the COVID-19 pandemic by the National Opinion Research Center's nationally representative, probability-based AmeriSpeak panel. Data were analyzed to (1) quantify behavioral changes across pandemic years, (2) examine changes of in-person dating prevalence during year 2, and (3) assess risk perception for acquiring COVID-19 or HIV/STIs through new partnerships during year 2. Weighted percentages were calculated for responses; univariate relationships between demographic characteristics and outcomes were assessed.

RESULTS

Prevalence of new partners for dating remained stable across pandemic years (year 1: n = 1157 [10%]; year 2: n = 1225 [12%]). The prevalence of in-person sex with new partners was also stable (year 1: n = 1157 [7%], year 2: n = 1225 [6%]), marking a decline from a prepandemic estimate (2015-2016: 16%). Partner-seeking experiences varied by age and sexual identity in both years, and by race/ethnicity during year 2. Reports of in-person dating fluctuated throughout year 2, without clear relationship to viral variants. Respondents who met new partners in person during year 2 generally reported greater concern and preparedness for reducing risks associated with HIV/STIs than COVID-19.

CONCLUSIONS

The prevalence of US adults seeking new partners for dating or sex remained stable across pandemic years. During future public health emergencies, public health officials are encouraged to offer guidance for reducing disease risks in partnerships, while emphasizing sexual health and providing tailored messaging for persons more susceptible to infection.

The Influence of the COVID-19 Pandemic on the Sexual Lives of Polish Young Adults

Background: The COVID-19 pandemic brought significant changes to daily life in Poland, with restrictions affecting various sectors, including entertainment, education, and travel. The pandemic's impact extended to intimate aspects of life. This study aimed to compare the sexual functioning of young adults in Poland before and during the pandemic, using the Changes in Sexual Functioning Questionnaire (CSFQ-14). Methods: The research involved an online survey with demographic questions, the CSFQ-14 for pre-pandemic sexual functioning, and modified CSFQ-14 questions for the pandemic period. Sexual dysfunction was determined using predefined cutoff scores. Results: Overall, the study found no significant difference in the sexual functioning of young Poles during the COVID-19 pandemic compared to before. However, there were gender-specific trends. Women reported enhanced pleasure, satisfaction, and orgasm during lockdown, while men faced challenges with erection and ejaculation. A higher proportion of women experienced overall sexual dysfunction compared to men, both before and during the pandemic. This research provides insights into the impact of the COVID-19 pandemic on the sexual lives of young Poles. While overall sexual functioning remained relatively stable, specific aspects varied by gender. Conclusions: The study emphasizes the need to consider demographic factors, such as age and gender, when assessing the effects of external stressors like a pandemic on sexual health. Further research is essential to fully grasp these complexities and their potential long-term consequences.

Trends in Sexual Health of Gay, Bisexual, and Other Men Who Have Sex with Men, and Transgender Individuals: Apps Driven Testing Program for HIV and Other STIs in Barcelona, Spain (2016-2023)

Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18-2.64), active syphilis was 3.37% (CI 2.46-4.50) and acute HCV was 0.40% (CI 0.11-1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58-48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02-9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14-5.29), inconsistent condom use (aOR = 3.38; CI 1.37-8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24-6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies.

The Pre-Exposure Prophylaxis Stigma Scale: Measurement Properties of an Adaptation in German and French

Objectives

This study aimed to adapt and validate the HIV PrEP Stigma Scale (HPSS) in French and German languages (HPSS-FR/DE) and assess its applicability across diverse linguistic and cultural contexts.

Methods

The original scale was adapted to French and German and administered through an online survey in multiple European nations. A four-factor structure was extracted from the data, including negative social consequences, social pressure, self-support, and external support. The scale's construct validity, reliability, and cross-linguistic consistency were evaluated.

Results

The adapted HPSS-FR/DE demonstrated robust psychometric properties, good construct validity, acceptable reliability, and consistent measurement across different languages. This adaptation enhances its utility in multicultural settings, offering a comprehensive tool to assess PrEP-related stigma.

Conclusion

This study provides a suitable tool to address PrEP stigma in multicultural environments to enhance PrEP uptake and adherence among men who have sex with men. Moreover, it lays the groundwork for further investigations into PrEP stigma across diverse populations and cultural settings, enabling the development of targeted public health interventions and policies to combat this issue effectively.

Patterns of sex behaviors and factors associated with condomless anal intercourse during the COVID-19 pandemic among men who have sex with men in Hong Kong: A cross-sectional study

OBJECTIVES

The present study examined the patterns of sex behaviors before and during COVID-19, and identified the factors associated with condomless anal intercourse during COVID-19 from individual, interpersonal, and contextual level among men who have sex with men (MSM) in Hong Kong.

METHODS

A cross-sectional study was conducted among MSM in Hong Kong. A total of 463 MSM completed a cross-sectional telephone survey between March 2021 and January 2022.

RESULTS

Among all participants, the mean number of regular sex partners, non-regular sex partners, and casual sex partners during the COVID-19 period were 1.24, 2.09, and 0.08 respectively. Among those who had sex with regular, non-regular, and casual sex partner during the COVID-19 period, respectively 52.4%, 31.8% and 46.7% reported condomless anal intercourse. Compared to the pre-COVID-19 period, participants reported significantly fewer number of regular and non-regular sex partners during the COVID-19 period. However, a higher level of condomless anal intercourse with all types of sex partners during the COVID-19 period was also observed. Adjusted for significant socio-demographic variables, results from logistic regression analyses revealed that perceived severity of COVID-19 (aOR = 0.72, 95% CI = 0.58, 0.88), COVID-19 risk reduction behaviors in general (aOR = 0.68, 95% CI = 0.48, 0.96), COVID-19 risk reduction behaviors during sex encounters (aOR = 0.45, 95% CI = 0.30, 0.66), condom negotiation (aOR = 0.61, 95% CI = 0.44, 0.86), and collective efficacy (aOR = 0.79, 95% CI = 0.64, 0.98) were protective factors of condomless anal intercourse with any type of sex partners during the COVID-19 period.

CONCLUSION

The COVID-19 control measures have caused a dramatic impact on the sexual behavior of MSM in Hong Kong. Interventions that promote condom use during the COVID-19 pandemic are still needed and such interventions could emphasize prevention of both COVID-19 and HIV.

Online Discussions of Sexually Transmitted Infections During COVID-19: Insights From the Social Media Platform Reddit

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.

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

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.

Sexual Distancing During 5 Periods Around and During the COVID-19 Pandemic, Amsterdam, the Netherlands

BACKGROUND

Social and sexual distancing (ie, abstaining from sex with persons outside one's household) was important in the control of the COVID-19 pandemic. Compliance to distancing measures can change over time. We assessed changes in compliance to the sexual distancing measures during five periods of the COVID-19 pandemic in the Netherlands.

METHODS

Between November 2021 and March 2022, we used a structured questionnaire containing questions about sexual behavior and factors that could have influenced compliance with sexual distancing. Variables related to sexual behavior were measured for 5 periods, before and during the pandemic, delineated by imposement and relaxation of lockdown measures.

RESULTS

Eight hundred seventy participants (predominantly MSM) completed the questionnaire. We found that compliance to the sexual distancing measures decreased over time. The number of casual partners was highest after the lockdown measures were relaxed for the second time (April 2021 to March 2022), and even higher than before the first lockdown. Factors positively associated with sexual distancing compliance were: having confidence in the information provided by the government and experiencing less or similar need for physical contact compared with before the pandemic. Factors that lowered compliance over time were: previously having had COVID-19, perceiving the lockdown measures as overstated, having sex with casual partners and similar drug use during the pandemic as before.

CONCLUSIONS

Our findings suggest that sexual distancing measures are difficult to maintain for a long period. Other measures, such as confinement to a small network of known partners, might be more effective for longer pandemics in minimizing the spread of infectious diseases.

Seroconversion rate of SARS-CoV-2 IgG antibodies and dating behaviour in HIV-PrEP users in a German metropolis during the COVID-19 pandemic

BACKGROUND

At the beginning of the COVID-19 pandemic, when mortality was high, social distance was the only option to prevent transmission of SARS-CoV-2 and prohibit uncontrolled spreading. As the impact of social distancing on sexual behavior was unclear, we aimed to assess the influence of sexual risk behavior on SARS-CoV-2 seroconversion in HIV pre-exposition prophylaxis (PrEP) users after declaration of the pandemic.

METHODS

Prospective study on SARS-CoV-2 IgG-antibody seroconversion rate over time in men having sex with men (MSM) using PrEP at a single tertiary university hospital in Munich, Germany, during quarterly (Q) routine HIV-PrEP visits over 1 year per participant (May 2020 - September 2021). Seroconversion was defined as at least one positive anti-nucleocapsid (anti-N) SARS-CoV-2 IgG antibody test as surrogate for past infection. In addition, sexually transmitted infections (STIs), personal estimated risk behavior and sexual contacts were assessed.

RESULTS

Seroconversion rate during the full observation period was 7.3% (9/124 subjects) by September 2021. Percentage of subjects with symptomatic STIs (T. pallidum, N. gonorrhoeae, C. trachomatis and M. genitalium) was 18.7% in Q3-20, 8.1% in Q4-20, 11.1% in Q1-21, 11.6% in Q2-21 and 9.5% in Q3-21. Perception of subjective threat of SARS-CoV-2 infection and adequacy of preventive measures decreased during the observation period. However, self-reported sex behavior remained stable during the observation period.

CONCLUSIONS

Our cohort showed low proportion of PrEP-users with anti-N IgG by September 2021, comparable to the local incidence. Sexual behavior in this cohort did not change, despite local recommendations for social distancing.

Cannabis Use and Sharing Practices Among Sexual Minority and Heterosexual Individuals During the COVID-19 Pandemic

Purpose: Cannabis behaviors during the COVID-19 pandemic among sexual minority (SM) individuals in the United States remain understudied. This study assessed the prevalence and correlates of cannabis use and cannabis sharing, a potential risk for COVID-19 transmission, among SM and heterosexual-identified individuals in the United States during the COVID-19 pandemic. Methods: This cross-sectional study used data from an anonymous, US-based web survey on cannabis-related behaviors from August to September 2020. Included participants reported past-year nonmedical cannabis use. Associations between frequency of cannabis use and sharing behaviors by sexual orientation were evaluated using logistic regression analysis. Results: Overall, 1112 respondents reported past-year cannabis use; mean age 33 years (standard deviation = 9.4), 66% male identified (n = 723), and 31% SM identified adults (n = 340). Increased cannabis use during the pandemic was similar among SM (24.7%; n = 84) and heterosexual (24.9%; n = 187) respondents. Any sharing during the pandemic was 81% for SM adults (n = 237) and 73% for heterosexual adults (n = 486). In the fully adjusted models, the odds of daily/weekly cannabis use and the odds of any cannabis sharing among SM respondents were 0.56 (95% confidence interval [CI] = 0.42-0.74) and 1.60 (95% CI = 1.13-2.26), respectively, compared with heterosexual respondents. Conclusions: SM respondents were less likely to use cannabis with high frequency during the pandemic but more likely to share cannabis compared with heterosexual respondents. Sharing cannabis was high overall, which may increase COVID-19 risk. Public health messaging around sharing may be important during COVID-19 surges and respiratory pandemics especially as cannabis becomes more widely available in the United States.

Coronavirus (COVID-19) and sexualised drug use among men who have sex with men: a systematic review

Drug-related harms, including harms from sexualised drug use (SDU), are disproportionately experienced by sexual and gender minority people, relative to their majority counterparts. Chemsex, a type of SDU practiced mainly by MSM, is associated with methamphetamine use and increased HIV seropositivity or risk of acquisition. Therefore, participants are at increased risk of immunocompromise. Existing evidence suggests that drug use increases following natural disasters. The impact of coronavirus disease 2019 (COVID-19) on chemsex is unknown. A PRISMA-adherent systematic review was conducted to synthesise reports of changes in the prevalence, frequency, or characteristics of drug use (and factors associated with these changes) following the onset of the COVID-19 pandemic. This report presents findings related to SDU/chemsex among MSM. A comprehensive search across nine databases, supplemented with backward-forward citation searching and contact with key opinion leaders, was conducted. Two reviewers carried out title-abstract screening, full-text screening, and data extraction. Following a final, single database search, nine studies were included in the narrative synthesis. More than half the sample were studies investigating HIV pre-exposure prophylaxis use. Twenty percent of participants in most studies reported chemsex participation. In four, participants reported a net increase or maintenance of chemsex participation during the pandemic and five reported a net decrease. Increased chemsex participation was associated with loneliness, cravings, and working during the pandemic. Decreased chemsex practice was associated with COVID-19-related fear. This synthesis suggests that chemsex practice continued, and for some MSM increased, throughout COVID-19 pandemic 'lockdowns'. This may have increased COVID-19 transmission and severity among potentially vulnerable MSM.

A Neglected Narrative in the COVID-19 Pandemic: Epidemiological and Clinical Impacts of the COVID-19 Outbreak on Syphilis

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.

'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

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.

Compulsive Sexual Behavior and Changes in Solitary Sexual Behaviors During the COVID-19 Pandemic

The aim of with this brief report is to examine how the COVID-19 pandemic differentially impacted solitary sexual behaviors in those with and without clinically significant compulsive sexual behavior (CSB). A total of 944 individuals in the United States completed an online cross-sectional survey in October 2020. Participants were asked to retrospectively report their frequency of masturbation and pornography use during the pandemic and prior to the pandemic. Participants also completed assessments of CSB, depression symptoms, and experiences of financial stress caused by the pandemic. Individuals who screened positive for clinically significant CSB reported statistically significant increases in masturbation and pornography use during the pandemic. Those who screened negative for CSB reported no significant increase in masturbation and a very small, statistically significant increase in pornography use. Those screening positive for CSB also reported significantly higher levels of depression symptoms but did not report increased likelihood of experiencing financial distress due to the pandemic. This suggests that increases in masturbation and pornography use reported by some, but not all, recent studies on sexual behaviors during the COVID-19 pandemic may be driven by individuals with CSB. Future research on sexual behaviors during the pandemic should assess CSB to further clarify its relationship with sexual behavior changes.

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.

Balancing risk, intimacy and (non)compliance: a qualitative study of sex across household during COVID-19 social restrictions

Government controls over intimate relationships, imposed to limit the spread of Sars-CoV-2, were unprecedented in modern times. This study draws on data from qualitative interviews with 18 participants in Natsal-COVID, a quasi-representative web-panel survey of the British population (n = 6,654 people), reporting that they had sex with someone from outside their household in the preceding four weeks; a period in which contact between households was restricted in the UK. Whilst only 10% of people reported sexual contact outside their household, among single people and those in non-cohabiting relationships, rates were much higher (Natsal-COVID). Our findings show that individuals did not take decisions to meet up with sexual partners lightly. Participants were motivated by needs-for connection, security, intimacy and a sense of normality. People balanced risks-of catching COVID-19, social judgement and punishment for rule-breaking-against other perceived risks, including to their mental health or relationships. We used situated rationality and social action theories of risk to demonstrate that people weighed up risk in socially situated ways and exhibited complex decision-making when deciding not to comply with restrictions. Understanding motivations for non-compliance is crucial to informing future public health messaging which accounts for the needs and circumstances of all population members.

Is There a Reduction in Chemsex Practice in Men Who Have Sex With Men During COVID-19 Lockdown? Results of the CheRRLock Study

BACKGROUND AND AIMS

Chemsex is a growing concern among men who have sex with men (MSM). COVID-19 lockdowns have had consequences on social and sexual interactions. We aimed to assess changes in chemsex practices during COVID-19 lockdown in France among MSM and factors associated with maintaining or increasing chemsex practice.

METHODS

Repeated face-to-face questionnaires were conducted at "Le 190" Sexual Health Center, Paris, France, exploring lifestyle, sexual, and chemsex practices, COVID-19 concerns and mental health before and during second lockdown in France (30/10/2020-15/12/2020). Inclusion criteria were chemsex practices at least 3 times throughout lifetime and at least once in the 3 months before second lockdown. The primary end point was the proportion of participants who declared having stopped, decreased, maintained, or increased their chemsex practice during lockdown. Univariable and multivariable logistic regressions were used to analyze factors associated with evolutions of chemsex practice.

RESULTS

Ninety-three MSM were included: 66% HIV-positive and 30% taking PrEP. Drugs most used were cathinones (91%) and GHB/GBL (52%). Participants reported stopping, decreasing, maintaining, and increasing chemsex drugs use in 14%, 22%, 22%, and 42% of cases, respectively. Despite this overall increase in chemsex practice, MSM decreased their number of sexual partners. Factors significantly associated with maintaining or increasing chemsex drugs use were feeling lonely (OR = 3.24), craving (OR = 4.51), and working during lockdown (OR = 3.27), contrasting with fear of COVID-19 (OR = 0.31).

CONCLUSION

Restriction measures lead to changes in sexual behavior and seem to increase chemsex practice. Maintaining care for most isolated patients should be a priority in COVID-19 context.

Changes in sexual activities, function, and satisfaction during the COVID-19 pandemic era: a systematic review and meta-analysis

Introduction

Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction.

Aim

The aim of the present study was to systematically review people's sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic.

Methods

Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities.

Results

Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex.

Conclusion

The COVID-19 pandemic led to increased challenges and changes for individuals' sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.

How to have sex in a pandemic: the development of strategies to prevent COVID-19 transmission in sexual encounters among gay and bisexual men in Australia

Although many studies reported on decreases in sexual partner numbers among gay and bisexual-identifying men in the early period of the COVID-19 pandemic, few studies have explored COVID-19 risk-reduction strategies. Drawing on free-text responses in an online survey (from April to July 2020), we describe the ways in which men sought to minimise the risk of COVID-19 in sexual encounters. Partner selection was an important strategy, in particular, restricting sex to men they already knew. Accounts also indicate how participants assessed risk from potential sex partners based on symptoms, residential location, recent travel, work role, and number of other sexual contacts. Less common were in situ practices, such as avoiding kissing. Participants' responses provide insight into creative community-based responses in the early months of the pandemic, some of which have resonances with early responses to HIV. Findings are discussed in relation to the concepts of 'lay epidemiology' and 'counterpublic health'. In particular, we examine how risks and health are experienced and valued in relation to local knowledges, meanings, and practices; and how practices emerge in response to dominant public health discourses that produce an idealised public based on (hetero)normative assumptions.

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

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.

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

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.

"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

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.

Disruptions of sexually transmitted and blood borne infections testing services during the COVID-19 pandemic: accounts of service providers in Ontario, Canada

BACKGROUND

Since the onset of the COVID-19 pandemic in March 2020 in Canada, the availability of sexual health services including sexually transmitted and blood-borne infection (STBBI) testing has been negatively impacted in the province of Ontario due to their designation as "non-essential" health services. As a result, many individuals wanting to access sexual healthcare continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of testing, such as virtual interventions and self-sampling/testing. Our objective was to investigate service providers' experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario, Canada, and their acceptability of alternative testing services.

METHODS

Between October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n = 18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by three Peer Researchers and a Community Advisory Board was consulted throughout the research process. Transcripts were transcribed verbatim and analysed with NVivo software following grounded theory.

RESULTS

Service providers identified the reallocation of public health resources and staff toward COVID-19 management, and closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in access to sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing risks of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less onerous compared to traditional clinic-based models, and that they helped fill the gaps in testing caused by the pandemic.

CONCLUSIONS

Acceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario. There is a need to approach sexual health services as an essential part of healthcare and to sustain sexual health services that meet the needs of diverse individuals.

Syphilis: recommendations for dermatologists on a resurgent epidemic

Despite reaching historical lows in the early 2000s, cases of both primary and secondary syphilis and congenital syphilis have increased dramatically in the U.S. over the last decade. In the U.S., the current syphilis epidemic is disproportionately impacting communities that have been historically underserved in medicine. These include men who have sex with men, especially those infected with HIV; people of color; and reproductive-age women with poor access to prenatal care. With syphilis now being more commonly diagnosed in non-STI than STI clinics in all genders, and since primary and secondary syphilis and congenital syphilis present with characteristic mucocutaneous manifestations, dermatologists are in a position to help reduce the advance of this preventable epidemic, by actively considering this diagnosis and incorporating syphilis screening into their practice. Herein, we delineate strategies by which dermatologists can contribute to this critical effort in their roles as clinicians, public health advocates, and researchers. In particular, we discuss the rapidly changing demographics of syphilis, nuances in serologic testing and treatment, strategies to increase public healthcare access and equity in these underserved populations, and research gaps in this field.

Changes in Sexual Behavior Over the COVID-19 Pandemic Among a Community-Based Cohort of Men Who Have Sex With Men in Columbus, Ohio

BACKGROUND

The purpose was to assess COVID-19 beliefs and attitudes and examine COVID-19-related changes in sexual behavior of men who have sex with men during 3 time periods: April-July 2020 (T1), August-December 2020 (T2), January-May 2021 (T3).

METHODS

Data were analyzed from 157 men who have sex with men in Ohio recruited to participate in a longitudinal multisite network study of syphilis epidemiology in 3 US cities: Columbus, Ohio; Baltimore, Maryland; and Chicago, Illinois. In April 2020, a COVID-19 module was appended to existing baseline and follow-up surveys to assess beliefs, attitudes, and changes in sexual behavior. Sample characteristics were summarized. Correlations between demographic variables (age, racial identity) and COVID-19 outcomes were examined.

RESULTS

In response to COVID-19 social distancing restrictions and self-reported anxiety, some men limited sexual activity at T1, but the majority (n = 105 [67%]) continued to engage in sex. The number of men engaging in sex increased over time (T2: n = 124 [79%]; T3: n = 121 [77%]). At T1, men not in a relationship more frequently reported having less sex compared with prepandemic (n = 39 [57%]). By T3, men in a relationship more frequently reported less sex (n = 32 [54%]). Increased anxiety about sex and condom use was positively correlated with identifying as a man of color (P < 0.001). Most of the sample reported either starting or increasing online sexual activity during each time period.

CONCLUSIONS

Future efforts to target sexual health during a pandemic or other health emergencies should prioritize men of color and address the unique perspective of both single and partnered men.

Impact of COVID 19 on erectile function

Purpose: COVID-19, a novel infection, presented with several complications, including socioeconomical and reproductive health challenges such as erectile dysfunction (ED). The present review summarizes the available shreds of evidence on the impact of COVID-19 on ED.Materials and methods: All published peer-reviewed articles from the onset of the COVID-19 outbreak to date, relating to ED, were reviewed. Results: Available pieces of evidence that ED is a consequence of COVID-19 are convincing. COVID-19 and ED share common risk factors such as disruption of vascular integrity, cardiovascular disease (CVD), cytokine storm, diabetes, obesity, and chronic kidney disease (CKD). COVID-19 also induces impaired pulmonary haemodynamics, increased ang II, testicular damage and low serum testosterone, and reduced arginine-dependent NO bioavailability that promotes reactive oxygen species (ROS) generation and endothelial dysfunction, resulting in ED. In addition, COVID-19 triggers psychological/mental stress and suppresses testosterone-dependent dopamine concentration, which contributes to incident ED.Conclusions: In conclusion, COVID-19 exerts a detrimental effect on male reproductive function, including erectile function. This involves a cascade of events from multiple pathways. As the pandemic dwindles, identifying the long-term effects of COVID-19-induced ED, and proffering adequate and effective measures in militating against COVID-19-induced ED remains pertinent.

The impact of COVID-19 lockdown on men having sex with men (MSM)

Social distancing including lockdowns are acceptable measures to cope with the COVID-19 pandemic. In this cross sectional study, we surveyed the impact of these measurements on sexual behavior and pre-exposure prophylaxis for HIV (PrEP) use among MSM. A digital questionnaire was distributed via social media and geographically based meeting applications after the first lockdown (March-April 2020). 1194 MSM responded, 91.8% were HIV negative, 19.4% of them used PrEP regularly, and 8.2% were people living with HIV (PLWH). Median age was 34.5 years. 54.4% reported that they kept strictly social distancing guidelines. Low education, hazardous sexual behavior, moderate/severe, and depression predicted low compliance with social distancing guidelines. 66.7% reported a significant decrease in the number of casual sex partners. 55% of those who took PrEP reduced their PrEP intake. Many of the PLWH and PrEP users reduced their medical follow-up. In light of the continuous outbreak and the risk of further outbreaks in the future consideration should be given to provide continuing access to HIV and sexual health clinics.

Sexual Health During COVID-19: A Scoping Review

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.

'Stay at home …': exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK

OBJECTIVES

The first UK national lockdown began on 23 March 2020, in response to the COVID-19 pandemic, and led to reduced STI/HIV service provision in the UK. We investigated sexual behaviour, use and need for sexual healthcare during the pandemic.

METHODS

Participants (N=2018), including men (cis/transgender), transwomen and gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth, completed an online cross-sectional survey (23 June 2020-14 July 2020), in response to adverts on social media and dating apps.Sexual behaviour, service use and unmet need for STI testing (any new male and/or multiple condomless anal sex (CAS) partners without STI testing) in the 3 months since lockdown began were examined and compared using multivariable analyses with an equivalent 3-month period in a 2017 survey (N=1918), conducted by the same research team.

RESULTS

Since lockdown began, 36.7% of participants reported one or more new partners, 17.3% reported CAS with multiple partners, 29.7% HIV testing (among 1815 of unknown/negative status), 24.9% STI testing and 15.4% using pre-exposure prophylaxis (PrEP).Since lockdown began, 25.3% of participants had unmet need for STI testing. This was more likely among Asian versus white participants (adjusted OR (aOR)=1.76, (1.14 to 2.72), p=0.01); for participants living in Scotland (aOR=2.02, (1.40 to 2.91), p<0.001) or Northern Ireland (aOR=1.93, (1.02-3.63), p=0.04) versus England; and for those living with HIV (aOR=1.83, (1.32 to 2.53), p<0.001).Compared to 2017, the equivalent 2020 subsample were less likely to report new male partners (46.8% vs 71.1%, p<0.001), multiple CAS partners (20.3% vs 30.8%, p<0.001) and have unmet need for STI testing (32.8% vs 42.5%, p<0.001) in the past 3 months.

CONCLUSIONS

We found potential for ongoing STI/HIV transmission among men who have sex with men during the initial UK lockdown, despite reduced sexual activity, and inequalities in service access. These findings will support public health planning to mitigate health risks during and after the COVID-19 response.

Intimate Relationships during COVID-19 across the Genders: An Examination of the Interactions of Digital Dating, Sexual Behavior, and Mental Health

The COVID-19 pandemic has resulted in economic hardship, psychological stress, anxiety, and depression in a significant proportion of the global population. However, the bidirectional effects of social isolation and pre-existing or developed psychological stress could inform sexual behaviors and affect digital dating outcomes. Additionally, it is unknown whether intimate behaviors and relationships have been equally affected across the genders during the COVID-19 pandemic. The purpose of this study is to contrast the course of intimate relationships pre-and post-COVID-19, with a focus on diverse genders, digital dating, mental health, and behavior. A review of the dating landscape during COVID-19 is developed in this study, encompassing themes including diverse genders, sexual orientation, demographic characteristics, sexual behavior, the state of psychological wellbeing, and interactions with digital dating apps. The authors reviewed the trends and challenges of digital romance. Dating before and during the pandemic is explored, discussing how COVID-19 experiences may inform future romantic partnerships. Mobile dating applications saw a surge in downloads and usage across popular platforms, including Tinder (3 billion swipes in March 2020) and Ok Cupid (700% increase in dates), with the top 20 dating apps gaining 1.5 million daily users. Cross-sectionally, being younger, single, and having higher levels of stress was a predictor of higher dating-app usage during the COVID-19 lockdowns. Risky sexual behavior and having multiple sexual partners were reduced during social distancing as there was an increased worry of contracting the virus. Heightened incidents of domestic/intimate partner abuse have caught the headlines in several countries. COVID-19 during lockdown has also posed barriers to accessing support and help from sexual and mental health services.

Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County

BACKGROUND

Pre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County.

SETTING

Men who have sex with men, residing in Los Angeles County.

METHODS

We developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021-2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality).

RESULTS

HIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021-2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14).

CONCLUSIONS

Microsimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.

A review study of the effects of the COVID-19 pandemic on individual sexual behavior, purchasing sex toys, and related consequences

Globally, COVID-19, both during and after the pandemic, has not only slowed countries’ economic development but has also affected social and daily life. Due to COVID-19, physical contact among couples has been reduced, and physical sexual activities have been affected and decreased. In order to satisfy their sexual needs and avoid mental health issues, individuals have shown an increasing inclination to purchase sex toys. Therefore, we conducted this review study to investigate the impacts of the COVID-19 pandemic on sexual activities, purchasing sex toys, and related consequences. Specifically, the present paper examines 45 studies and focuses on four themes: (1) COVID-19 and sex toys; (2) COVID-19 and sex (i.e. sexual life, sexuality, sexual health, sexual behavior); (3) factors affecting purchasing sex toys; and (4) COVID-19 consequences. The study findings reflect that, during to the pandemic, sex toy sales doubled in Australia, Colombia, Denmark, and the UK, and tripled in New Zealand. Sex toys have entailed positive (i.e. increased satisfaction, confidence, pleasure) and negative (addiction, allergic reaction, risk of sexually transmitted infection, embarrassment, and guilt) implications. In addition, participants all over the world engaged more in using sex toys and watching pornography to satisfy their sexual needs. Further, the use of online dating applications also increased, in order to have sex with close or casual partners. Regarding purchasing sex toys, we postulate that people buy these products due to lack of opportunity, relationship avoidance, loneliness, cost-effectiveness, time-saving, and emotionless behavior. Moreover, the pandemic has worsened family and sexual relationships. It has also increased anxiety, stress, and violence in society. In this context, we assert that there is still a need to explore the factors influencing individuals’ intentions toward purchasing sex toys, and studies need to be conducted to understand in more detail COVID-19's effects, both during and after the pandemic.

Changes in HIV Testing Utilization Among Chinese Men Who Have Sex With Men During the COVID-19 Pandemic in Shenzhen, China: An Observational Prospective Cohort Study

Background

The Coronavirus Diseases 2019 (COVID-19) directly affects HIV prevention and sexual health services utilization among men who have sex with men (MSM). This study investigated changes in human immunodeficiency virus (HIV) testing utilization among MSM before and after the COVID-19 pandemic received initial control in Shenzhen, China.

Methods

This study was a sub-analysis of a prospective observational cohort study conducted among MSM in Shenzhen, China between August 2020 and May 2021. Participants were recruited through outreaching in gay venues, online recruitment, and peer referral. Participants completed a baseline online survey between August and September 2020 and a follow-up online survey between April and May 2021. This study was based on 412 MSM who reported to be HIV-negative/unknown sero-status at baseline, 297 (72.1%) of them completed the follow-up online survey. Multilevel logistic regression models (level 1: sources of recruitment; level 2: individual participants) were fitted.

Results

When comparing follow-up data with baseline data, a significant increase was observed in the uptake of any type of HIV testing (77.9% at Month 6 vs. 59.2% at baseline, p < 0.001). After adjusting for age group, education level, current employment status and monthly personal income, two predisposing factors were associated with higher uptake of HIV testing during the follow-up period. They were: (1) condomless anal intercourse with male non-regular male sex partners at follow-up only (AOR: 5.29, 95%CI: 1.27, 22.01) and (2) sanitizing before and after sex at baseline (AOR: 1.26, 95%CI: 1.02, 1.47). Regarding enabling factors, utilization of HIV testing (AOR: 3.90, 95%CI: 2.27, 6.69) and STI testing (AOR: 2.43, 95%CI: 1.20, 4.93) 6 months prior to the baseline survey was associated with higher uptake of HIV testing during the follow-up period. Having the experience that HIV testing service providers reduced service hours during the follow-up period was also positively associated with the dependent variable (AOR: 3.45, 95%CI: 1.26, 9.41).

Conclusions

HIV testing utilization among MSM might rebound to the level before the COVID-19 outbreak after the pandemic received initial control in China. This study offered a comprehensive overview to identify potential reasons that can influence the uptake of HIV testing among Chinese MSM.

Effects of the COVID-19 Pandemic on LGBTQ+'s Sexual Behaviors in Turkey: "Everything about Sex Had Become A Black Box"

The COVID-19 pandemic has forced changes in the behavior patterns of many population groups due to restrictive measures all over the world. In this study, qualitative research method based on a phenomenological approach was used to determine the changes in the sexual behavior of a group of LGBTQ+ people living in Turkey. The COVID-19 pandemic has culminated in changes in the sexual life of LGBTQ+s. It has been determined that feelings such as the need of emotional support, loneliness, devaluation and helplessness were experienced, and quarantine and curfew restrictions were effective on sexuality and sexual behaviors. In addition, it has been determined that LGBTQ+s have changed in the standards of determining partners during the pandemic process. The use of sex toys has increased, the sensitivity toward self-care and hygiene rules has increased, the tendency to have sexual fantasies has changed, the sexual behavior of people in their social environment has changed, and the disruptions in health services have posed negative effects. It is recommended to carry out studies focusing on the sexual behavior of LGBTQ+s and to develop counseling services regarding the sexual behaviors of LGBTQ+s and the situations that occur in their sexual lives.

The sexual experience of Italian adults during the COVID-19 lockdown

From March 11 to April 26, 2020, the Italian government imposed a nationwide COVID-19 lockdown, a quarantine that resulted in significant restrictions on the movement and social contacts of the population, with a view to limiting the pandemic outbreak. The quarantine forced people to experience distorted social distance in two contrasting ways. For some people, it resulted in social distancing and isolation, for example by separating noncohabiting couples into different dwellings. For others, however, quarantine increased and imposed social closeness, forcing couples and families into constant, daily, and prolonged cohabitation. The aim of this study was to investigate the sexual health and behaviors of Italian adults during the lockdown period using a multimethod research. An open- and a closed-ended e-questionnaire were administered immediately after the end of the lockdown. A total of 465 Italian adults completed the digital questionnaire (female = 78.7%). Participants recognized their lived sexual experience with generally positive characteristics (related to openness, unproblematic relationship with the body, and awareness and self-reflection about one's sexuality), while negative thoughts such as worry and pain were quite scarce. Participants with a disability (5.6%) showed a marked inversion compared to the mean of respondents, recognizing themselves mainly in negative thoughts related to low self-esteem, inadequacy, and feelings of suffering, yet reporting a higher than mean level of arousal. In the qualitative analysis, the Frequency-Inverse Document Frequency (TF-IDF) index was computed to measure the salience of the word used by participants to respond to the open-ended five questions. It revealed a generally depressed emotional experience associated with the experience of lockdown, both in terms of desire, which seemed to be shifted more to the level of imagination and fantasies, and the actual possibility of experiencing sexual activity as usual. Nevertheless, the participants emphasized an opening to new possibilities in terms of expressing sexuality, accompanied by a rediscovery of the value of tenderness and affectivity as well as a clearer awareness of their sexual life, needs, and desires.

How has COVID ‐19 affected sex and fertility?

COVID‐19 pandemic has had an effect on our sex lives, but whether it has an impact on fertility or can be sexually transmitted are yet to be determined.

Changes in sexual behavior, PrEP use, and COVID-19 experience among men who have sex with men in Mexico

This study aimed to explore the impact of COVID-19 lockdown on sexual behavior and PrEP use among a sample of men who have sex with men (MSM) in Mexico. Between April 20th and 27th, 2020 - well into Mexico's lockdown - we conducted a virtual survey among 637 MSM exploring sexual behavior during the first month of the COVID-19 epidemic in Mexico and the impact of lockdown on PrEP use. We applied logistic regression models to assess predictors of PrEP use continuation. Over half the participants (52%) reported having a sexual encounter in the last two weeks. 75% of participants reported a decrease in the number of sexual partners because of COVID-19. The use of PrEP dropped from 90% to 64% during the first month of lockdown. Multivariate logistic regression models showed that younger participants were less likely to continue using PrEP than those 25 + years. Also, those who perceived themselves as not likely to acquire COVID-19 and those who reported using a condom in their last sexual encounter were more likely to continue using PrEP during the lockdown. This study provides evidence of the impact of COVID-19 on sexual behavior and PrEP use among MSM in Mexico during the lockdown. Sexual and reproductive health services will need to consider the risk of COVID-19 in providing HIV and PrEP programs to guarantee participants' and health care providers' safety.

Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.

Partner Seeking and Sexual Behavior in the United States During the COVID-19 Pandemic, March 2020 to March 2021

ABSTRACT

We examined partner seeking and sexual behaviors among a representative sample of US adults (n = 1161) during the first year of the COVID-19 pandemic. Approximately 10% of survey respondents sought a new partner, with age and sexual identity being associated with partner seeking behavior. Approximately 7% of respondents had sex with a new partner, which marks a decrease as compared with a prepandemic estimate from 2015 to 2016 in which 16% of US adults reported having sex with a new partner during the past year. Among respondents who had in-person sex with a new partner during the first year of the pandemic, public health guidelines for in-person sexual activity were infrequently followed.

Engagement with HIV and COVID-19 prevention: a national cross-sectional analysis of users on a geosocial networking app (Preprint)

Background

Objective

Methods

Results

Conclusions

Factors Predicting COVID-19 Vaccination Uptake Among Men Who Have Sex With Men in China: An Observational Prospective Cohort Study

Background

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected sexual minorities including men who have sex with men (MSM). This study investigated factors associated with the uptake of COVID-19 vaccination among MSM in China.

Methods

Inclusion criteria were: (1) born biologically male, (2) had oral or anal sex with men in the past year, (3) aged at least 18 years, and (4) lived in Shenzhen, China. Prospective participants were recruited through outreach in gay bars and saunas, online recruitment, and peer referrals. Participants completed a baseline online survey between August and September 2020 and a follow-up online survey between April and May 2021. Logistic regression models were fitted for data analysis.

Results

Among 420 participants who completed the baseline survey, 303 completed the follow-up survey. Among participants being followed up, 113 (37%) received at least one dose of COVID-19 vaccination during the study period. After adjusting for significant sociodemographic characteristics, five baseline predisposing factors predicted COVID-19 vaccination uptake during the follow-up period, including asking whether their partners had COVID-19 symptoms [adjusted odds ratio (AOR): 1.17, 95% confidence interval (CI): 1.00-1.38], washing hands before and after sex (AOR: 1.23, 95% CI: 1.03-1.46), sanitizing before and after sex (AOR: 1.17, 95% CI: 1.00-1.37), perceived higher risk of COVID-19 transmission through sexual behaviors (AOR: 1.28, 95% CI: 1.04-1.58), and panic about COVID-19 (AOR: 1.48, 95% CI: 1.16-1.89). Regarding enabling factors, receiving testing for sexually transmitted infections (STI) (AOR: 2.19, 95% CI: 1.25-3.85) and other prevention measures for human immunodeficiency virus (HIV)/STI (AOR: 2.61, 95% CI: 1.56-4.37) 6 months prior to the baseline survey were associated with higher uptake of COVID-19 vaccination.

Conclusion

MSM's uptake rate of COVID-19 vaccination was comparable to that of the general population in Shenzhen, China. This study offered an overview for us to identify tapping points that can encourage COVID-19 vaccination uptake among Chinese MSM.

Changing Characteristics of Patients Living with HIV/AIDS after COVID-19 Pandemics in Turkey

AIMS

COVID-19 pandemic has substantially changed the life and presented several barriers to health services. HIV care continuum needs a high rate of diagnosis, an effective treatment and a sustained suppression of viral replication. COVID-19 pandemic has affected these three steps of HIV care. In this study, we investigated the characteristics of newly diagnosed patients living with HIV/AIDS (PLWH) during the COVID pandemic and compared them with those before the pandemic.

METHODS

All newly diagnosed patients in three HIV healthcare center, in Istanbul, Turkey were included into the study. Pandemic period included April 1, 2020 to April 1, 2021 and pre-pandemic period included March 1, 2019 to March 1, 2020.

RESULTS

During pre-pandemic period, 756 patients were diagnosed HIV/AIDS. In pandemic period, this figure was 58% less: 315. Patients in pre-pandemic and pandemic period had comparable age and gender distributions. PLWH diagnosed in pandemic period had higher rates of low CD4 cells: low CD4 (<350 cells /mm3) was measured in 243 (36.4%) patients in pre-pandemic, while it was done in 126 (47.9%) in pandemic period (p<0.01). Also the distribution of CD4 cells was significantly different between periods: In pandemic period, CD4 cell distribution skewed to lower CD4 categories significantly. Symptomatic patient rate and AIDS-defining disorder rate among symptomatic patients were comparable. Viral loads were not significantly different in two periods.

CONCLUSION

Less number of newly diagnosed PLWH can be explained by less HIV testing, less admission to the health care or actual decrease of HIV prevalence during pandemic. Sexual behaviors may have changed during COVID-19 pandemic which could lead to HIV transmission restriction. Lower CD4 counts among the newly diagnosed PLWH suggest that admittance to health care is late and a significant portion of PLWH remain undiagnosed.

Stability of Risk Perception Across Pandemic and Non-pandemic Situations Among Young Adults: Evaluating the Impact of Individual Differences

Previous research suggests a higher perceived risk associated with a risky behavior predicts a lower likelihood of involvement in that behavior; however, this relationship can vary based on personality characteristics such as impulsivity and behavioral activation. During the COVID-19 pandemic, individuals began to re-evaluate the level of risk associated with everyday behaviors. But what about risks associated with "typical" risk-taking behaviors? In the present study, 248 undergraduate student participants completed measures of impulsivity, behavioral activation and inhibition, propensity to take risks, numeracy, and perceptions of and involvement in both risk-taking behavior and health promoting behavior (e.g., blood donation, registering as an organ donor, vaccination). Our study revealed that higher behavioral inhibition and greater propensity to take risks predicted greater likelihood of involvement in COVID-19-related risk behaviors, even after accounting for perceived risks and benefits of the behavior. Greater likelihood of involvement in social risk behaviors was predicted by greater numeracy and risk-taking propensity. Identifying as male, a greater propensity to take risks, and greater impulsivity predicted increased health/safety risk behaviors. Younger age, lower risk-taking propensity, and lower impulsivity were associated with a greater likelihood of donating blood. For the likelihood of registering to become an organ donor, increasing risk perception, both before and during the pandemic, was associated with greater likelihood of registering, but greater risk-taking propensity was associated with a decreased likelihood of organ donation registration. For flu vaccination, a greater propensity to take risks was associated with a greater likelihood of flu vaccination during the 2020-2021 flu season. Both cognitive and personality factors can predict involvement in risk-taking and health-promotion behaviors, warranting their continued examination.

The Global Impact of the COVID-19 Pandemic on Individuals' and Couples' Sexuality

The COVID-19 pandemic and its related restrictions significantly impacted individuals' health, wellbeing, and security. Isolation, limitation of movement, social distancing, and forced cohabiting have had a strong influence on all areas of people's lives as well as on their sexuality. Investigating how the COVID-19 outbreak and its consequences impacted people's sexuality was the primary aim of this review. Particularly, we focused on: (1) the variables associated with the improvement or the deterioration of individuals' and couples' lives during the pandemic; (2) the use of sex as a coping strategy; (3) the impact of COVID-19 outbreak on LGBT people. Results have shown that the worsening of sexual life seems to be related to couples' conflict, emotions and psychological difficulties, being female, being single or away from the partner, being a health care worker, and having children. Moreover, a detrimental effect on sexuality was associated with stress, forced cohabitation, routine, anxiety and worry about the job and the pandemic, feeling partner distance, being unhappy with their partner, and lack of privacy. On the other hand, improvements in sexuality were associated with living happily with a partner, being happy and satisfied with a partner, feeling less stressed and more bored, having more free time, having fewer recreation opportunities, and having minor workload. During the pandemic, there was an increase in using sex toys, pornography consumption, masturbating, and trying sexual experimentations. Among LGBT people, an increase was found in the number of casual sexual partners potentially due to the perceived lower likelihood of transmission through sex. Moreover, the increase in sexual activity may have represented a coping strategy to quarantine-related distress.

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men, Transgender Women, and Transgender Men Who Have Sex with Men: April-May 2020

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n = 3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β = 0.90, 95% CI 0.40-1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR = 1.21), being Black (AOR = 1.79) or Latinx (AOR = 1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR = 1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.