Projected HIV and Bacterial Sexually Transmitted Infection Incidence Following COVID-19–Related Sexual Distancing and Clinical Service Interruption

Abstract

Background The global COVID-19 pandemic has the potential to indirectly impact the transmission dynamics and prevention of HIV and other sexually transmitted infections (STI). It is unknown what combined impact reductions in sexual activity and interruptions in HIV/STI services will have on HIV/STI epidemic trajectories. Methods We adapted a model of HIV, gonorrhea, and chlamydia for a population of approximately 103,000 men who have sex with men (MSM) in the Atlanta area. Model scenarios varied the timing, overlap, and relative extent of COVID-related sexual distancing and service interruption within four service categories (HIV screening, PrEP, ART, and STI treatment). Results A 50% relative decrease in sexual partnerships and interruption of all clinical services, both lasting 18 months, would generally offset each other for HIV (total 5-year population impact for Atlanta MSM: -227 cases), but have net protective effect for STIs (-23,800 cases). If distancing lasted only 3 months but service interruption lasted 18 months, the total 5-year population impact would be an additional 890 HIV cases and 57,500 STI cases. Conclusions Immediate action to limit the impact of service interruptions is needed to address the indirect effects of the global COVID pandemic on the HIV/STI epidemic.

‘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

“…Modelling research has indicated that a decrease in sexual partnerships and interruption of clinical services over 18 months would reduce STI transmission. 22 Our analysis also suggested a reduction in unmet need for STI testing during lockdown compared with 2017. The shift from face-to-face testing to selfsampling is in line with findings of a rapid uptake in HIV hometesting among US MSM during social distancing.…”

“…[17][18][19][20][21] However, our finding of a reduction in sexual activity with continued risk for HIV/STI transmission has been found elsewhere. 7 8 17-19 Other aspects of what may be described as COVID-19 'sexual distancing' 22 include increased use of phone sex, web cams and pornography, 8 18 20 and in our study, about one-sixth of participants had engaged in virtual sex since lockdown began.…”

Decreases in Reported Sexually Transmitted Infections During the Time of COVID-19 in King County, WA: Decreased Transmission or Screening?

“…Indeed, one study projected that long clinical service interruptions combined with a return to normal levels of sexual activity could result in thousands of excess STI cases over the next several years among MSM in Atlanta. 24 …”

The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management

“…Social distancing and lockdown measures have led to decreased rates of diagnosis of syphilis in Rome and Madrid and syphilis and HIV in Taiwan compared to same time periods in previous years [76][77][78][79][80][81][82][83][84][85][86][87][88]. This phenomenon has also been noted in public health reports comparing 2020 data for HIV and syphilis in regions in Canada and in the USA [79,80]. It is unclear if the reduction is due to less frequent sexual encounters and a true decline in syphilis and HIV rates or if patients are postponing diagnosis and care leading to under-reporting as seen in other specialties.…”