How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID)

Abstract

ObjectivesTo investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic.MethodsBritish participants (18–59 years) completed a cross-sectional web survey 1 year (March–April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16–74 years) conducted in 2010–2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18–44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors.ResultsIn 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18–24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers.ConclusionsOur study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010–2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.

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

“…The Natsal-COVID study used a quasi-representative sample of the UK population and estimated that 36.8% (95% confidence interval (CI): 27.8%–46.8%) of GBMSM had had difficulty accessing condoms because of the pandemic, five times higher than our figure of 7.3% among GBMSM. 8 However, the Natsal-COVID sample included a smaller number of GBMSM ( n = 183), reflecting how it was a study of the general population, and defined GBMSM differently (any same-sex experience in the past 5 years). Indeed, it is worth noting that Natsal-COVID’s estimate was considerably lower at 4.9% (95% CI: 2.1%–11.1%) among the 117 participants who identified as gay, which is more in line with our study’s estimate.…”

“…It is interesting to note that this general population study found, as we did, that younger GBMSM (aged 18–29 years) were more likely to report difficulty accessing condoms because of the pandemic (50.4%). 8 This age effect suggests a continuation of inequalities that preceded the COVID-19 pandemic, 9 perhaps reflecting how knowledge of, and resources to access condoms, increases with age. However, we are unsure as to the cumulative effect of the pandemic on the magnitude of associations with age and difficulties accessing condoms.…”

“…The data also complement and contextualise the findings from other studies with smaller sample sizes, like Natsal-COVID. 8 …”

“…The data also complement and contextualise the findings from other studies with smaller sample sizes, like Natsal-COVID. 8 However, there are limitations. As a cross-sectional survey, associations between variables can be bidirectional and therefore we cannot infer causality.…”

Potential Impact on Sexual Behaviors, Access to HIV Care and Health for Men Who Have Sex with Men (MSM) during the COVID-19 Pandemic

“…But Dema et al found that the pandemic had resulted in a 50% unmet need for condoms among MSM aged 18 to 29 years. Because condoms provided by health services are further reduced, and finding condoms was more challenging [11].…”