An online survey found that COVID-19 restrictions impacted access to sexual health services, sexual behaviour and mental health of HIV-negative gay men in London. Survey respondents reported many risk reduction strategies, such as increased sexting, having fewer sex partners, and discussing COVID-19 risk and transmission with partners. However, self-reported sexual activity remained high, with around three-quarters of survey respondents having sex during restrictions, 28% reporting an STI, and 19% engaging in chemsex. In addition, many respondents reported that isolation and loneliness led them to have sex, which often led to feelings of guilt, shame, or anxiety about the sex or COVID-19.
During the UK’s first lockdown of March to June 2020, sexual health services saw an 80% decline in activity and there were limitations on face-to-fact patient visits. These COVID-19 restrictions also prohibited meeting people from outside their household, yet little was known about how well people followed the guidelines. The survey explored how COVID-19 restrictions impacted access to sexual health services, sexual behaviour, and mental health of HIV-negative gay men. Lack of access to sexual health services could lead to an increased risk for both STI and HIV transmission, and the survey results can inform the delivery of sexual health services during COVID-19 restrictions.
London’s busiest sexual health clinic, 56 Dean Street, administered the anonymous online questionnaire to HIV-negative gay men who were at increased risk for HIV and had previously signed up to receive HIV prevention services through a web-based platform. The survey asked about perceived changes in sexual behaviour, emotions about sexual activity and accessing sexual health services between 23 March and 30 June 2020 (lockdown). A total of 814 gay men completed the survey. The median age was 40 years old, 83% were White and 75% reported PrEP use during COVID-19 restrictions.
Overall, 76% of respondents reported sexual activity during COVID-19 restrictions. Three-quarters of sexually active respondents reported fewer partners during restrictions than in the months preceding the lockdown, with a median of three partners reported. Nineteen per cent of respondents reported engaging in chemsex during the study period. Of those reporting sexual activity, 76% reported sex partners outside their household, citing isolation and loneliness (48%), boredom (29%), and stress/anxiety (27%) as motivations for having sex. Notable changes in sexual behaviour before and after restrictions were reported. These included an increase in exchanging explicit messages or photos, also known as sexting (39%), limiting sex partners to those who were geographically close (28%), and choosing only one sex partner during restrictions (21%).
A large majority of those having sex partners outside their household (73%) reported discussing COVID-19 transmission risk with sex partners. They also used COVID-19 risk reduction strategies during sex, such as handwashing before sex (48%), using sex positions that reduce face-to-face contact (14%), avoiding kissing (14%), and switching to cruising sites or outdoor venues (12%). Around one in four survey respondents expressed concerns about COVID-19 exposure or transmission during sex, 19% experienced guilt, and 14% reported regret after sex.
"It is critical that patients receive non-judgemental care and are not dissuaded from seeking services, even if their sexual activity is contrary to current public health restrictions."
Thirty-six per cent of survey respondents accessed sexual health services at least once during lockdown. Of those receiving sexual health services during the study period, 30% reported difficulties accessing testing or treatment and 9% said they were unable to access sexual health services when needed.
Twenty eight per cent had an STI diagnosis during lockdown, diagnosed through a clinic or home testing. There were no differences in STI diagnoses by PrEP use, but PrEP users did report more sex partners, were more likely to have sex partners outside of the household during restrictions, were more likely to report chemsex, and were more likely to access sexual health services compared to those not on PrEP.
This survey had some limitations because it relied on people’s memories of their sexual activity before and during restrictions. Further, the men who took the survey were considered to be at increased risk for HIV and had already opted in to an online HIV-prevention platform prior to the study. So, it is unclear to what extent the finding of the survey reflect wider trends of sexual behaviour among gay men in London.
These findings highlight the importance of ensuring sexual health services, particularly provision of PrEP, remain available during COVID-19 lockdowns or restrictions. It is critical that patients receive non-judgemental care and are not dissuaded from seeking services, even if their sexual activity is contrary to current public health restrictions. The results also highlight the importance of alternative methods of testing and treatment, such as home testing and medication home-delivery, to ensure services remain accessible.
Hyndman I et al. COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK. Sexually Transmitted Infections, published online ahead of print, 18 January 2021 (open access).