Changes in STI and HIV testing and testing need among men who have sex with men during the UK’s COVID-19 pandemic response

Abstract

ObjectivesWe examined the impact of COVID-19-related restrictions on sexual behaviours, STI and HIV testing and testing need among men who have sex with men (MSM) in the UK.MethodsWe used social media and dating applications to recruit to three cross-sectional surveys (S1–S3) during the UK’s pandemic response (S1: 23 June–14 July 2020; S2: 23 November–12 December 2020; S3: 23 March–14 April 2021). Surveys included lookback periods of around 3–4 months (P1–P3, respectively). Eligible participants were UK resident men (cisgender/transgender) and gender-diverse people assigned male at birth (low numbers of trans and gender-diverse participants meant restricting these analyses to cisgender men), aged ≥16 years who reported sex with men (cisgender/transgender) in the last year (S1: N=1950; S2: N=1463; S3: N=1487). Outcomes were: recent STI/HIV testing and unmet testing need (new male and/or multiple condomless anal sex partners without a recent STI/HIV test). Crude and adjusted associations with each outcome were assessed using logistic regression.ResultsParticipants’ sociodemographic characteristics were similar across surveys. The proportion reporting a recent STI and/or HIV test increased between P1 and P2 (25.0% to 37.2% (p<0.001) and 29.7% to 39.4% (p<0.001), respectively), then stabilised in P3 (40.5% reporting HIV testing). Unmet STI testing need increased across P1 and P2 (26.0% to 32.4%; p<0.001), but trends differed between groups, for example, unmet STI testing need was higher in bisexually-identifying (vs gay-identifying) MSM across periods (adjusted OR (aOR): P1=1.64; P2=1.42), but declined in HIV-positive (vs HIV-negative/unknown) MSM (aOR: P1=2.06; P2=0.68). Unmet HIV testing need increased across P1 and P2 (22.9% to 31.0%; p<0.001) and declined in P3 (25.1%; p=0.001). During P3, MSM reporting a low life-satisfaction level (vs medium–very high) had greater unmet need (aOR: 1.44), while from P2 onwards HIV pre-exposure prophylaxis users (vs non-users) had lower unmet need (aOR: P2=0.32; P3=0.50).ConclusionConsiderable unmet STI/HIV testing need occurred among MSM during COVID-19-related restrictions, especially in bisexually-identifying men and those reporting low life satisfaction. Improving access to STI/HIV testing in MSM is essential to prevent inequalities being exacerbated.

Sexual behaviour, STI and HIV testing and testing need among gay, bisexual and other men who have sex with men recruited for online surveys pre/post-COVID-19 restrictions in the UK

“…Testing levels recovered as restrictions were eased and plateaued as restrictions were reintroduced in October 2020. A repeat cross-sectional, community-based survey of GBMSM also observed this trend of recovery and then plateau between March 2020 and April 2021 as social restrictions changed 5…”

“…Initially, they were rapidly deployed (based on a previous 2017 survey)10 11 to capture the effects of the UK’s first national lockdown on GBMSM’s sexual behaviour and health service use. The subsequent surveys (2–4) captured these effects at different stages of the UK’s COVID-19 pandemic response 4 5. The latest iteration, survey 4, captured the time after most COVID-19-related social restrictions had been lifted in the UK.…”

“…Throughout 2020 and throughout 2021, varying degrees of social restrictions remained in place. Research suggests that behaviours with increased risk of STIs and HIV (hereon for brevity ‘sexual risk behaviour’), after an initial decrease during the first national lockdown, tended to fluctuate in line with social restrictions 4 5. National surveillance data on STI testing for the general population showed a 52%–59% decrease in testing in March/April 2020 (vs March/April 2019) 6.…”

Difficulty accessing condoms because of the COVID-19 pandemic reported by gay, bisexual and other men who have sex with men in the UK: findings from a large, cross-sectional, online survey

“…Online non-random recruitment through social media and dating applications will exclude GBMSM who do not use these platforms, are not seeking new sexual partners, and/or do not have Internet access, limiting the generalisability of our findings to all GBMSM. Finally, given the wording of the question, we cannot make inferences as to the extent to which SHS reconfiguration due to COVID-19, including reduced in-person access to SHS, 6 played a role in some GBMSM having difficulties accessing condoms during this time. It is also important to recognise the subjectivity surrounding the concepts of ‘needing to use condoms’ and also ‘because of the pandemic’ as per our question.…”

“…5 Levels of reported sexual behaviour also fluctuated in line with social restrictions, although a significant minority of GBMSM continued to report sexual risk behaviour during periods of tighter social restrictions eg, over one-quarter (27.6%) of GBMSM in a community-based survey reported multiple CAS partners during the UK’s third national lockdown. 6 Given the differing levels of access to in-person health services and social venues between March 2020 and July 2021, we explore how the pandemic impacted on GBMSM’s ability to access condoms when needed and examined associated factors.…”