Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men

Abstract

Background: In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV preexposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM). Methods: Participants in an ongoing online cohort study previously reported PrEP use from 2014 to 2019. In April 2020, 847 HIV-negative and untested participants completed questionnaires assessing changes in PrEP use as a result of COVID-19 public health measures. Binary logistic multiple regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to compare changes in PrEP use behaviors. Results: Among 847 men, mean age was 44.1 years (SD: 12.7). PrEP use rose from 4.9% in 2015 to 47.2% in 2020. Among those, 41.8% (n = 167) discontinued PrEP use during COVID-19 restrictions. Discontinuing PrEP during COVID-19 restrictions was independently associated with being less likely to have recently tested for HIV (aOR: 0.17; 95% CI: 0.09 to 0.34; P < 0.001) and less likely to report sex with casual partners (aOR: 0.28; 95% CI: 0.14 to 0.54; P < 0.001). Conclusions: By April 2020, following the introduction of COVID-19 restrictions, GBM dramatically reduced PrEP use, coinciding with a reduction in sexual activity. Longer-term impacts of COVID-19 restrictions on sexual behaviors among GBM need to be monitored because they may foreshadow fluctuations in prevention coverage and risk of HIV infection. Our findings indicate a potential need for clear, targeted information about resumption of PrEP and on-demand optimal dosing regimens in response to ongoing changes in restrictions.

Brief Report: Changes in PrEP Use, Sexual Practice, and Use of Face Mask During Sex Among MSM During the Second Wave of COVID-19 in Melbourne, Australia

“…Discontinuing PrEP during lockdown is most likely to be because of reduced sexual risk, but some may have also stopped PrEP because they feared catching SARS-CoV-2 when visiting the clinic for PrEP review and prescriptions. 6 , 9 We found that a substantial proportion of MSM either had no sexual contact or reduced their sexual risk, including group sex, chemsex and the number of casual partners during the second lockdown compared with the period when the first lockdown was eased. Furthermore, one in 10 MSM had ever worn a face mask during sex in the COVID-19 pandemic in May–August.…”

“…Although we cannot determine whether any behavioral changes from post-first lockdown to second lockdown are directly caused by the lockdowns themselves or related to other factors such as concerns about catching SARS-CoV-2, 9 other studies have also shown reductions in sexual risk during lockdown. 6 – 8…”

“… 3 – 5 There have been a few Australian and international studies examining pre-exposure prophylaxis (PrEP) use during the COVID-19 pandemic. 6 – 8 Our previous Melbourne-based study reported that one in 4 men who have sex with men (MSM) taking daily HIV PrEP in January–February 2020 (ie, before first lockdown) had stopped taking PrEP in early May. 9 Although Victoria had a second, more stringent lockdown and a more severe COVID-19 epidemic in July–October compared with the first lockdown in March–April, it is hypothesized that the proportion of MSM taking PrEP was similar in both lockdowns given there was no change in access to PrEP prescriptions and health care services.…”

Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study

“…The actual impact of COVID-19 on PrEP service provision for 2020 is unclear. Although disruptions in PrEP use 16 , 17 , 18 and PrEP service delivery 19 , 20 occurred in many places, there were more than 300 000 new PrEP initiations across PEPFAR-supported programmes in 2020, suggesting that PrEP user numbers continued to grow globally in 2020. Nevertheless, results of modelled COVID-19 disruption underscore the importance of adapting programmes to address barriers to access and continued engagement in PrEP services.…”

HIV and COVID-19 Pandemic Collision: Turning Challenges Into Opportunity

“…This type of confinement, if on the one hand has been demonstrated to be the most effective strategy, able to reduce the burden and diffusion of SARS-CoV-2, on the other hand, it creates more barriers for patients with chronic diseases such as those PLWHA [ 4 ]. Moreover, most of the outpatients’ facilities were temporary closed and consequently both HIV new diagnosis [ 5 ], postexposure prophylaxis [ 6 , 7 ] and pre-exposure prophylaxis dropped due to healthcare resources re-allocated to fight the COVID-19 pandemic [ 8 ].…”