How the COVID-19 pandemic affected the sexual health of men who have sex with men

🧪 What was the study about?

This study used online surveys to look at how the COVID-19 pandemic and restrictions affected the sexual health of gay, bisexual and other men who have sex with men (GBMSM). The surveys included questions on sexual behaviours, testing for and being diagnosed with sexually transmitted infections (STIs)/HIV, and levels of unmet testing need (people at a higher risk of STIs/HIV who have not been recently tested) both before and during the COVID-19 pandemic.

❓ Why is this important?

Gay and bisexual men generally are at a higher risk for some STIs and HIV than other communities. Gay and bisexual men who are sexually active are advised to test once a year for these infections, and gay and bisexual men engaging in higher risk sexual behaviours are advised to test more often. The COVID-19 pandemic resulted in some sexual health services moving from in-person visits to online testing, affecting access to services for some people. It is important to see how the COVID-19 pandemic has affected the sexual health of gay and bisexual men, so services can find ways to reduce any negative impacts. The findings from this study can help inform the planning of sexual health services.

🔍 What did we do?

· We recruited men and gender diverse individuals living in the UK aged 16 and over who have sex with men, via social media and dating apps.  

· Links to online surveys were sent at three different time periods over the COVID-19 pandemic:  23 June–14 July 2020, 23 Nov–12 Dec 2020 and 23 March–14 April 2021 with the final one conducted in November-December 2021. Each survey asked participants about their experiences over the previous 3-4 months. Survey results were also compared with the results of a similar survey conducted before the pandemic in 2017.

· The surveys asked about sexual behaviour, access to and use of sexual health services and interventions such as condoms, and unmet need for STI testing.  

· We looked at the survey results to see how they changed over time, along with associated factors (for example which groups experienced the greatest unmet need for STI testing).

📊 Key findings

· Sexually active gay and bisexual men more likely to experience poor sexual health had greater difficulty accessing condoms during the pandemic.

·In 2021, unmet STI and HIV testing need varied among certain groups compared to others. There was more unmet testing need in older gay and bisexual men. There was less unmet testing need for people taking antiretroviral drugs for HIV before having sex (known as PrEP), HIV-negative participants and trans and non-binary participants. Between 2017 and 2021, some sexual risk behaviours increased. In 2021, more people reported recent testing for STIs but not for HIV. There were no notable changes in unmet STI and HIV testing need over time.

·Certain groups were more likely to have an unmet need for STI testing. This included those of Asian ethnicity, those living in Scotland or Northern Ireland, and those living with HIV. Compared to in 2017, in 2020 there was less evidence of sexual risk behaviours and less unmet need for STI testing.

·We showed how unmet testing need and the number of participants reporting a recent STI and/or HIV test changed throughout the COVID-19 pandemic. It showed that trends differed between groups, although there were unmet STI and HIV testing needs throughout the pandemic. Unmet STI testing need was higher in bisexual men but decreased in HIV-positive gay and bisexual men during the pandemic. The results from the third survey (23 March–14 April 2021) showed that gay and bisexual men reporting lower life satisfaction had greater unmet testing need while from both the second (23 Nov–12 Dec 2020) and the third survey onwards, HIV PrEP users had lower unmet testing need.

💡 What do these findings mean?

· We need to look at how to prevent differences in condom access amongst gay and bisexual men. This will help to make sure gay and bisexual men who need condoms can access them during future pandemics.  

· The surveys looked at sexual risk behaviours amongst gay and bisexual men, and how these behaviours were affected by the COVID-19 pandemic. The findings can help design programmes to support better sexual health for gay and bisexual men and guide public health planning to reduce sexual health risks during future pandemics.

· There was unmet STI/HIV testing need throughout the COVID-19 pandemic, which varied between different groups of gay and bisexual men. This means interventions can be developed to target these groups, for example improving access to sexual health services and STI/HIV testing in those groups who need it most. This will aim to reduce these differences and to lower unmet STI/HIV testing need.