Condom use during COVID-19: Findings from an Australian sample of heterosexual young adults

Self-reported condom use among Washington State residents prior to and during the COVID-19 pandemic: a cross-sectional analysis of BRFSS data

OBJECTIVES

COVID-19 significantly impacted healthcare access and sexual behaviour, but little is known about how COVID-19 affected condom use. This study aimed to investigate whether self-reported condom use and sex in Washington State changed during pandemic restrictions compared with prepandemic.

DESIGN

Cross-sectional survey data from the Behavioral Risk Factor Surveillance System.

SETTING

Washington State.

PARTICIPANTS

11 684 participants aged 18-65.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was changes in the prevalence of condom use by time of interview pre-COVID-19, before the Washington State lockdown (1 January 2019 to 23 March 2020, n=7708) and during COVID-19, after the first state lockdown (24 March 2020 to 31 December 2020, n=3976). The secondary outcome was changes in the prevalence of reported sex during the same periods. We assessed whether associations differed by rurality and HIV risk behaviour.

RESULTS

Condom use was similar during COVID-19 (37.3%) compared with pre-COVID-19 (37.8%) (adjusted prevalence ratio (PR): 0.98, 95% CI 0.89, 1.01). Associations did not differ by rurality or HIV risk behaviour. Compared with pre-COVID-19 (83.0%), a smaller proportion of respondents reported having sex in the last 12 months during COVID-19 (80.5%), a relative decrease of 3% (PR: 0.97, 95% CI 0.96, 0.99; p<0.001).

CONCLUSIONS

The prevalence of reported sex declined during COVID-19, but condom use remained steady in Washington. As our reproductive health system faces increased challenges, these results may inform future sexual health services.

(Un)forgotten Sex Lives During the COVID-19 Pandemic: Coping Strategies That Work and the Role of Experience

Available literature points to a worsening trend in sexual functioning, desire, and satisfaction during the pandemic. Nevertheless, virtually no empirical research was conducted on the mechanisms of coping with the pandemic's impacts on sex life. Thus, the purpose of this exploratory study was to examine a variety of coping mechanisms and their perceived usefulness by people who have and have not tried these coping strategies to maintain and enhance their sex lives during the first year of the pandemic. The cross-sectional data were collected using an online survey methodology (N = 420; 66.9% women) and analyzed utilizing exploratory factor analysis, analysis of variance, and multiple regression. The results revealed nine factors/coping mechanisms (based on 59 items/strategies), including goal-setting strategies, risk and experimentation strategies, relational strategies, caution and logistical strategies, creativity and innovation strategies, substances and context-related strategies, online and technology strategies, diversion strategies, and educational strategies. Consistently, across all the specific coping strategies and overall coping mechanisms, people who tried them found them significantly more useful than those who had not tried these coping strategies. Moreover, a higher diversity of tried strategies per coping mechanism consistently and significantly predicted the perceived usefulness of that coping mechanism. These results emphasize the crucial role of experience with coping mechanisms and show that amidst COVID-related adversity and challenges, many people found ways to adapt their sex lives and enjoy silver-lining opportunities. This exploratory study offers promising evidence for potential sexual coping strategies during times of stress that could be informative for clinical practice and education.

Changes in sexually transmitted infections-related sexual risk-taking among young Croatian adults: a 2005-2021 three-wave population-based study

AIM

To assess the prevalence and dynamics of risky sexual behaviors among Croatian emerging adults in the 2005-2021 period.

METHODS

Three surveys were conducted on large-scale national samples of young adults aged 18-24 in 2005 (N=1092) and 18-25 in 2010 and 2021 (N=1005 and N=1210, respectively). The 2005 and 2010 studies were conducted with face-to-face interviews on stratified probabilistic samples. The 2021 study was conducted by computer-assisted web-interviewing on a quota-based random sample from the largest national online panel.

RESULTS

Compared with 2005 and 2010, the age at coital debut increased for both genders in 2021 (by a median of one year, to 18 years, and by a mean of half a year, to 17.5 years, in men and to 17.9 in women). In the 2005-2021 period, condom use increased by about 15% both at first intercourse (to 80%) and in consistent use (to 40% in women and 50% in men). When we controlled for basic socio-demographics, Cox and logistic regressions indicated that, for both genders, in 2005 and 2010 compared with 2021, the risks/odds were significantly higher for reporting an earlier sexual debut (adjusted hazard ratio 1.25-1.37), multiple sexual partners (adjusted odds ratio [AOR] 1.62-3.31), and concurrent relationships (AOR 3.36-4.64), while the odds were lower for condom use at first sexual intercourse (AOR 0.24-0.46) and consistently (AOR 0.51-0.64).

CONCLUSION

Risky sexual behaviors decreased in the 2021 survey compared with the previous two waves, in both genders. Nonetheless, sexual risk-taking is still frequent among young Croatian adults. The introduction of sexuality education and other national-level public health interventions to reduce sexual risk-taking thus remains a public health imperative.

Sexual Coping Mechanisms During the COVID-19 Pandemic and Their Determinants of Use, Usefulness, and Effects on Sex Life

Introduction

The COVID-19 pandemic has taken a toll on many people's sex lives. The ways people cope with these adverse impacts are an urgent area that needs to be recognized by sexual health researchers, practitioners, and policymakers. Thus, this study investigated sexual coping mechanisms during the pandemic while clarifying their determinants of use and usefulness and examining their impacts on the quantity and quality of sex life.

Methods

The cross-sectional data (N = 675) were collected using an online survey methodology in February-May 2021. The data were analyzed with one-sample and independent-samples t-tests, one-way between-subjects ANOVA, and multivariate multiple regression.

Results

This study identified eight sexual coping mechanisms during the pandemic, including creativity and pleasure, diversion, goal-setting, relational, educational, caution and logistical, online and technological, and innovation and experimentation strategies. All the coping mechanisms were used and rated significantly useful, albeit to different degrees. Gender, availability of a sex partner, the existence of children, and age served as determinants of different coping mechanisms' scope of use and degree of usefulness. The coping mechanisms predicted the frequency of sexual activity, sexual desire, and satisfaction with sex life during the pandemic.

Conclusions

This study's results can help scholars and practitioners prevent or mitigate the deterioration of sex life during the pandemics and other crises and stressors. It is essential to train people concerning sexual coping resources and strategies to protect their sexual wellbeing and quality of life.

Policy Implications

Health researchers, practitioners, and policymakers must consider maintaining sexual health as an essential service. Recognizing sexual health, rights, education, and counseling is a prerequisite for appropriate prevention measures during the pandemic. It is vital to ensure the availability of proper resources supporting people's sexual coping processes during and after the pandemic.

Impact of the COVID-19 pandemic on access to HIV testing and condom use among two-spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba

This cross-sectional online survey (n = 347) examined the impact of the COVID-19 pandemic on access to HIV testing and condom use among Two-Spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba. Logistic regression assessed the relationship between socio-demographics and the impact of COVID-19 on access to HIV testing and condom use. Among those who answered a question on testing (n = 282), 27.7% reported reduced access to HIV testing. Among those who answered questions on condom use (n = 327), 54.4% reported decreased use of condoms. Compared to living in Winnipeg, living in a medium-sized city (Brandon) and in rural and remote areas were both associated with higher odds of reporting reduced access to HIV testing due to COVID-19. Participants who were dating (vs. married or partnered) were significantly more likely to report reduced access to HIV testing, but less likely to report decreased use of condoms, while younger age was associated with decreased use of condoms. Service providers must be prepared to respond to the impact of COVID-19 on HIV testing and condom use among younger, sexually active 2SGBQ + men, as well as those who live in small, rural, and remote areas in Manitoba.

The Impact of First UK-Wide Lockdown (March-June 2020) on Sexual Behaviors in Men and Gender Diverse People Who Have Sex with Men During the COVID-19 Pandemic: A Cross-Sectional Survey

The global COVID-19 pandemic resulted in strict social distancing measures restricting close physical contact. Men (cis and trans) and other gender diverse people who have sex with men (MGDSM) are at higher risk of sexually transmitted infections (STIs) and may have experienced changes in sexual behavior during government restrictions on social and sexual contact. We aimed to examine self-reported sexual behavior of MGDSM during the first UK-wide lockdown to identify the characteristics of the individuals who might most require sexual health promotion and clinical support. In April-May 2020, we conducted an online survey of MGDSM, promoted on social media and Grindr. Our exploratory approach used descriptive analysis to identify self-reported changes in sexual behavior and performed regression analyses to identify correlates of casual sex during the lockdown. A total of 1429 respondents completed the survey: mean age 36 years, 84% White, 97% male or trans male, 98% assigned male sex at birth, 2% female or non-binary, 65% degree educated or higher. During the lockdown, 76% reported not having any casual sex partners. While the majority reported reduced casual sex, 3% reported an increase in casual sex with one person and 2% with three or more people (group sex). About 12% of the sample engaged in casual sex with only one person and 5% with four or more sexual partners during the lockdown. Reporting casual sex during lockdown was associated with: lower level of education OR = 2.37 [95% CI 1.40-4.01]; identifying as a member of an ethnic minority OR = 2.27[1.40-3.53]; daily usage of sexual networking apps OR = 2.24[1.54-3.25]; being less anxious about contracting SARS-CoV-2 through sex OR = 1.66[1.12-2.44]; using PrEP before lockdown OR = 1.75[1.20-2.56]; continuing to use PrEP OR = 2.79[1.76-4.57]; and testing for STIs during lockdown OR = 2.65[1.76-3.99]. A quarter of respondents remained sexually active with casual partners, indicating a need to provide STI screening services and health promotion targeted to groups most likely to have need over this period. Future research is required to better understand how to support sexual and gender minorities to manage sexual risk in the context of pandemic public health initiatives.

The Mediation Effect of Attitudes for the Association between Thoughts and the Use of Condoms in a Mobile-App Environment: From Thought to Intention

The ubiquity of mobile devices and access to the internet has changed our daily life and, in some cases, promoted and facilitated social and sexual interrelationships. There are many applications of technology and campaigns promoting healthy behaviors and prevention of sexually transmitted infections. Can we develop a strategy for the same purpose using mobile devices, based on the theory of attitude change? We developed an app and tested it with 105 undergraduate students, where they had to actively think in favor of condom use with a high amount of elaboration, leading to attitudes and behavioral intention (BI) in concordance with contemporary theories about attitudes and behavioral change. PROCESS macro models were used to analyze potential mediations. Results show a significant correlation between thoughts and attitudes, and attitudes partially mediated the association between thoughts and condom use. Individuals with positive thoughts tended to positively correlate their thoughts with their attitudes, and, consequently, these attitudes with their BI. In this study, we showed that (1) it was possible to develop and test an app based on the elaboration likelihood model (ELM); (2) consistent with previous studies, attitudes partially mediated the association between thoughts and condom use (BI) in a mobile environment; and (3) applications of this strategy can be used to build new approaches for prevention in health care.

PrEP Access Affected by COVID-19 Is Associated With Increased Odds of HIV Seroconversion

ABSTRACT

Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals report lower uptake and adherence to pre-exposure prophylaxis (PrEP) compared with White SMMGD. For some, the COVID-19 pandemic has resulted in reduced access to PrEP prescriptions and related changes to PrEP use, yet little is known how pandemic-related changes to PrEP access and sexual activity might influence sexually transmitted infection (STI) status and HIV seroconversion among SMMGD of color. We used data from 4 waves of a national study of Black and Hispanic/Latino SMMGD's HIV, PrEP, and health experiences to assess whether self-reported changes to sexual activity were associated with STI status, and whether self-reported changes to PrEP access were associated with HIV seroconversion. Those who reported greater impact to their sexual activity during the pandemic [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI): 1.10 to 1.40] and a greater number of sexual partners (aOR = 1.29; 95% CI: 1.21 to 1.38) were more likely to report a positive STI test. In addition, we found that compared with those who did not report pandemic-related changes to PrEP access, those who did report changes to PrEP access had significantly higher odds of HIV seroconversion during the study period (aOR = 2.80; 95% CI: 1.02 to 7.68). These findings have implications for HIV and STI prevention and highlight the importance of novel interventions to improve PrEP access among Black and Hispanic/Latino SMMGD. Importantly, these findings also demonstrate the need to stay focused on key populations at risk of HIV infection during emerging public health crises to avoid an increase in rates of new diagnoses.

Sexual health literacy and preventive behaviors among middle-school students in a rural area during the COVID-19 situation: A mixed methods study

Background: This study explored the association between sexual health literacy (SHL) and preventive behaviors of pregnancies and sexually transmitted diseases (STDs) among middle-school students during the COVID-19 outbreak to aid in the development of an informative program.

Methods: Mixed-method study with stratified two-stage cluster sampling was used to obtain 730 students from 20 middle schools in a rural province of Thailand. Online self-administered questionnaire was used to collect data from February 2020 to February 2021. Two brainstorming sessions were conducted with a purposeful sample of 25 stakeholders. Multiple linear regressions were used to assess the relationships.

Results: The associated significant factors with the preventive behaviors were sex (b=2.06, 95% CI: 1.07, 3.05), nightlife (b=-2.33, 95% CI: -3.99, -0.67), drinking alcoholic beverages (b=2.24, 95% CI: -3.24, -1.23), sexual intercourse experience (b=-2.64, 95% CI: -4.56, -0.72), and SHL (b=0.12, 95% CI: 0.08, 0.16). The stakeholders recommended an edutainment online program via Facebook.

Conclusion: This study investigated factors associated with SHL and preventive behaviors among middle school students. The most effective variable in this model was SHL. Therefore, a trial of an online program emphasizing SHL improvement should be examined for effectiveness among these students and seems appropriate, considering their rural area context and middle-school status.

“Compared to COVID, HIV Is Nothing”: Exploring How Onshore East Asian and Sub-Saharan African International Students in Sydney Navigate COVID-19 versus BBVs/STIs Risk Spectrum

Background: While a large body of evidence indicates changes in alcohol and other drug use among young people as a result of the COVID-19 pandemic, there is a lack of evidence around changes in sexual practices and how the pandemic may be impacting the potential spread of blood-borne viruses and sexually transmissible infections (BBVs/STIs). Most of what we know about sex during COVID-19 lockdowns is largely based on solitary sexual practices, which may not answer the critical question around how the pandemic may be shaping sexual practices among young people. Against this backdrop, this study explored how the COVID-19 pandemic may be shaping BBVs/STIs risk and protective practices among a sample of onshore African and Asian international students in Sydney, Australia. Methods: This phenomenological qualitative study involved semi-structured telephone and face-to-face interviews with 16 international university students in Sydney, between September 2020–March 2021. Generated data were coded using NVivo and analysis was guided by reflexive thematic analysis. Results: Participants reported elevated mental health distress because of the COVID-19 pandemic. Some participants reported engaging in casual sexual hook-ups as a strategy to mitigate the mental health distress they were experiencing. Some of these sexual hook-ups were condomless partly because COVID-related disruptions impacted condom accessibility. Additionally, the preventive practices of some participants who were sexually active during the lockdowns were focused on preventing COVID-19, while the risk of BBVs/STIs were downplayed. Conclusions: This study indicates a need for a comprehensive public health response to the evolving and near-endemic COVID-19 situation. Such a comprehensive approach should focus on empowering young people to prevent both SARS-CoV-2 and BBVs/STIs.

COVID-19 and Sexual Desire: Perceived Fear Is Associated with Enhanced Relationship Functioning

Lifestyle changes caused by the COVID-19 pandemic had mostly negative consequences for individual, relationship, and sexual functioning. However, some individuals have reported increases in sexual desire and made new additions to their sex lives. Given that stress-provoking situations can sometimes make mortality more salient and heighten sexual desire, it is possible that lifestyle changes and fear of COVID-19 infection may have benefited some relationships. We conducted a cross-sectional study with 303 romantically involved adults (58.1% men) and found that lifestyle changes were associated with negative changes in one's sex life, unrelated to wanting to spend time with one's partner, and positively associated with relationship quality. Lifestyle changes were also positively associated with sexual desire, but only for participants with high (vs. low) fear of COVID-19 infection. For these participants, sexual desire was associated with positive changes in one's sex life and wanting to spend time with one's partner, but not with overall relationship quality. Results were consistent after controlling for pandemic-related anxiety and demographic variables. This study advances literature focused on the importance of romantic relationships in stress-provoking situations such as the COVID-19 pandemic by shedding light on the association between sexual desire and personal and relational well-being.

Partnership status, living arrangements, and changes in sexual behaviour and satisfaction during the COVID-19 lockdown: insights from an observational, cross-sectional online survey in Singapore

Background The SARS-CoV-2 (coronavirus disease 2019; COVID-19) pandemic and its concomitant movement control measures have had a profound impact on the world. In spite of its potential impact on sexual health, there is a lack of research on how the pandemic and its movement control measures have impacted sexual wellbeing among Singaporeans. Methods This observational, cross-sectional study was conducted from August to September 2020. Participants were recruited through an online survey instrument promoted through social media. Respondents self-reported their sexual behaviours and levels of sexual satisfaction prior to and during the COVID-19 pandemic movement control measures. Results We recruited a total of 562 participants, of whom 338 (60.1%) ever had a sexual experience. Singles (n=106, 31.4%) and those not living with their partners (n=115, 34.0%) reported a greater decrease in partnered sexual activities but a greater increase in individual sexual activities such as masturbation, sending and receiving nudes and watching pornography, relative to those who were living with their partners (n=117, 34.6%). Multivariable analyses indicated that relative to singles, those who were not living with their partners were more likely to experience a decrease in sexual satisfaction (adjusted prevalence ratio [aPR]=1.42, 95% CI [1.07, 1.90]), whereas those who were living with their partners were less likely to experience a decrease in sexual satisfaction (aPR=0.45, 95% CI [0.25, 0.81]). Conclusions Interventions may focus on enhancing sexual wellness by educating on and supporting individual or partnered sexual activities that may vary along the lines of partnership status and living arrangements during the implementation of movement control measures.