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With COVID Here, 90% of Australian
MSM Have Less Sex, 40% Stop PrEP
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AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
With the arrival of COVID-19 in Australia, almost 90% of a gay/bisexual study group had much less sex and 40% using PrEP stopped, according to analysis of 940 men who have sex with men (MSM) [1]. About 1 in 6 men found it harder to access PrEP after COVID-19 took hold.
Australia began taking measures to control the COVID-19 epidemic in January 2020 by banning travelers from China. In February everyone coming into Australia had to self-isolate for 14 days, and the country banned all foreign nationals from entering in March. Restrictions on public gatherings went also went into place in March. In the same month, five of eight Australian states closed borders to other states. Later in March, the country limited public gatherings to 2 people, except for people who already lived together.
Researchers at the University of New South Wales asked how these physical-distancing measures, and the epidemic itself, affected sexual behavior and PrEP use among MSM by surveying men in the FLUX Study, a prospective observational cohort of gay and bisexual men. In April 2020, 940 men answered questions about sexual behaviors and PrEP use in the 6 months before they personally became concerned about COVID-19 and in the time after they became concerned.
The 940 study participants averaged 43.9 years in age; 91% called themselves gay, and 69% had a university education. Almost all men, 96%, had been tested for HIV, 7.4% had HIV infection, and 53% were in a relationship. About half of participants became personally concerned about COVID-19 in February 2020. By the end of April almost 100% reported personal concern about the epidemic.
Among men who had sex with fuckbuddies [2], 76% stopped having sex after becoming personally concerned about COVID-19 while 24% continued having sex. This change reflected a 65.2% drop in average number of fuckbuddies per day. Among men who had sex with casual partners, 84% stopped having sex when COVID-19 arrived and only 16% continued, a change reflecting a 58.1% fall in average number of casual partners per day. Altogether, almost 90% of men said they had much less sex since COVID-19 began spreading in Australia.
Among 864 men who answered questions about PrEP, 394 (45.6%) used PrEP before COVID-19 restrictions took hold and 470 (54.4%) did not. Of the 394 using PrEP, only 230 (58.4%) continued the preventive strategy when COVID-19 spread through Australia, while 164 (41.6%) quit PrEP. (Between 2014 and 2018, only 1% of FLUX men who started PrEP stopped.) In a US study also presented at AIDS 2020, one third of 394 PrEP users quit after COVID-19 arrived [3]. A large majority of FLUX Study men who stopped PrEP, 86%, linked their quitting to COVID-19. But only 17% who stopped PrEP said they had difficulty accessing PrEP.
Among FLUX Study men who continued having sex with fuckbuddies after COVID-19 reached the island continent, 82% kept using PrEP. Among men who continued sex with casual partners, 80% continued PrEP.
The researchers suggested men who stopped PrEP when COVID-19 arrived could find that restarting the preventive pill may not be automatic when COVID-19 recedes. And that could lead to short-term jumps in HIV transmission. The investigators proposed that a post-COVID return to PrEP use could offer the opportunity for other PrEP dosing options, such as only before and after sex ("on-demand PrEP").
References
1. Grulich A, Maher L, Holt M, et al. Impact of social distancing due to COVID-19 on sexual behaviour among gay and bisexual men in Australia: Implications for trends in HIV and other sexually transmissible infections. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OACLB0103.
2. A fuckbuddy is "a type of regular sexual partner with whom men have ongoing sexual contact, generally in the absence of romantic attachment." Cornelisse VJ, Fairley CK, Phillips T, Walker S, Chow EPF. Fuckbuddy partnerships among men who have sex with men--a marker of sexually transmitted infection risk. Int J STD AIDS. 2018;29:44-50. https://doi.org/10.1177/0956462417717647.
3. Brawley S, Dinger J, Nguyen C, Anderson J. Impact of COVID-19 related shelter-in-place orders on PrEP access, usage and HIV risk behaviors in the United States. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract OADLB0101.
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