ABSTRACT
Introduction Use of condoms to prevent STIs/HIV and unplanned pregnancy remains important during the COVID-19 pandemic. However, it is unknown whether the pandemic affected condom access and which population groups were most impacted. Methods 6658 participants (18-59y) completed a cross-sectional web survey one-year after the initial British lockdown from 23 March 2020. Quota-based sampling and weighting resulted in a sample that was quasi-representative of the British population. We report the prevalence of unmet need for condoms because of the pandemic among sexually-experienced participants aged 18-44 years (n=2869). Adjusted odds ratios (AOR) quantify associations with demographic and behavioural factors. Results Overall, 6.9% of women and 16.2% of men reported unmet need for condoms in the past year because of the pandemic. This was more likely to be reported by participants who: were aged 18-24 years vs. 35-44 (AOR: men 2.25 [95% CI:1.26-4.01], women 2.95[1.42-6.16]);were Black or Black British vs. White (men 2.86 [1.45-5.66], women 1.93 [1.03- 8.30]);reported same-sex sex vs. not (past five years;men 2.85 [1.68-4.86], women 5.00 [2.48-10.08]);or ≥1 new relationships vs. not (past year, men 5.85 [3.55-9.66], women 6.38 [3.24-12.59]). Men, but not women, reporting STIrelated service use (past year) were more likely to report unmet need for condoms compared to men that did not report service use (3.83 [2.18-6.71]). Discussion Unmet need for condoms because of the pandemic was more likely to be reported by populations at higher risk of adverse sexual health outcomes, including STI/HIV transmission. Improved access to free/low-cost condoms is crucial for all.
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Introduction The COVID-19 pandemic presented challenges to delivery of reproductive health services. To explore effects, we examined patterns of contraceptive use, service access and pregnancy planning in the year following the first UK lockdown. Methods The Natsal-COVID Wave 2 survey was conducted in March-April 2021, one year after the first lockdown began in Britain. We analysed a subset of sexually-active participants aged 18-44 years and described as female at birth. We estimated differences in outcomes by age and markers of vulnerability. We examined changing contraception use, access to and unmet need for contraceptive services, and London Measure of Unplanned Pregnancy scores (LMUP;range 0-12). Results Of 1,488 eligible participants, 78.0% were considered at risk of unplanned pregnancies. Of 441 at-risk participants who tried to access contraceptive services, 16.4% faced barriers. Young participants (18-24 years) were most likely to report trying to access contraceptive services (38.4%;(32.2, 45.0);vs 28.4% overall) and to face barriers doing so (OR: 2.87 (1.36, 6.06)). Encountering barriers was more likely among participants reporting no educational qualifications and those reporting symptoms of anxiety or depression. 199 participants reported a pregnancy in the last year. Pregnancies to young participants were less likely to be 'planned' (difference in mean LMUP score: -2.95;(-3.91, -1.99)). Less 'planned' pregnancies were associated with lower social grades and becoming unemployed. Discussion Young and vulnerable participants were more likely to report difficulties accessing reproductive services and less planned pregnancies during the pandemic. In navigating pandemic recovery, sexual health services should consider the needs of these at-risk groups.
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Introduction Prior to the COVID-19 pandemic, STIs disproportionately affected some Black communities. We examined ethnic inequalities in sexual health during the pandemic. Methods Analyses were restricted to England residents aged 18-59. We included 5,240 sexually-experienced participants from Natsal-COVID survey Wave 2 (quasi-representative web panel survey) reporting one-year outcomes from March 2020- April 2021. We estimated weighted proportions and adjusted odds ratios (AORs) between ethnicity and sexual risk behaviour (condomless sex with new partner on first occasion), sexual health service (SHS) use, and unmet need (trying but failing to access SHS). Using GUMCAD national surveillance data from before (March 2019-March 2020) and during (March 2020-March 2021) the pandemic, we compared proportional differences in rates of STI tests and diagnoses by ethnicity. Results Compared to Natsal-COVID participants of White ethnicity, sexual risk behaviour (8%) was higher among participants of Mixed/Other (22%, AOR:2.26 [95% CI 1.08-4.73]) and Asian (15%, 1.58 [1.07-2.35]);SHS use (5%) was higher in Black (20%, 3.04 [1.75-5.28]) and Mixed/Other (20%, 2.64 [1.35-5.14]);and unmet need (2%) was higher in Black (11%, 5.01 [2.26-11.09]) and Asian (5%, 2.33 [1.11-4.90]) ethnicity. In GUMCAD, among people attending SHS, we observed similar reductions of around 50% in testing and diagnoses during the pandemic across different ethnic groups, although the greatest reduction was in people of Asian ethnicity (56% and 52% respectively). Discussion Two independent national data sources showed sexual health inequalities persisted during the first year of the pandemic with evidence of more unmet need among minority ethnicities, but further work is needed to assess whether these worsened.
ABSTRACT
Global infection and mortality rates from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are disproportionately high in certain populations, including the elderly. Care home residents are frequently exposed to infection due to contact with staff and other residents, and are highly susceptible to infection due to their age and co-morbidity. In England, official statistics suggest that at least 25% of all deaths in care home residents since the start of pandemic are linked to coronavirus disease 2019 (COVID-19), but limited testing for SARS-CoV-2 early in the pandemic means estimates of the true burden of disease are lacking. Additionally, little is known about patterns of transmission between care homes, the community and hospitals, or the relationship between infection and immunity in care home staff and residents. The VIVALDI study plans to address these questions. VIVALDI is a prospective cohort study aiming to recruit 6,500 staff and 5000 residents from 105 care homes across England. Successive rounds of testing for infection will be performed over a period of 12 months. Nasopharyngeal swabs will detect evidence of viral RNA and therefore active infection (accompanied by collection of data on symptoms), whereas blood tests will detect antibodies and evidence of cellular immunity to SARS-CoV-2. Whole genome sequencing of viral isolates to investigate pathways of transmission of infection is planned in collaboration with the COVID-19 Genomics UK Consortium. Qualitative interviews with care home staff will investigate the impact of the pandemic on ways of working and how test results influence infection control practices and behaviours. Data from residents and staff will be linked to national datasets on hospital admissions, antibody and PCR test results, mortality and care home characteristics. Data generated will support national public health efforts to prevent transmission of COVID-19 and protect care home staff and residents from infection © 2020. Krutikov M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
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Background SARS-CoV-2 infection represents a major challenge for long-term care facilities (LTCFs) and many residents and staff are seropositive following persistent outbreaks. We aimed to investigate the association between the SARS-CoV-2 antibody status at baseline and subsequent infection in this population. Methods We did a prospective cohort study of SARS-CoV-2 infection in staff (aged <65 years) and residents (aged >65 years) at 100 LTCFs in England between Oct 1, 2020, and Feb 1, 2021. Blood samples were collected between June and November, 2020, at baseline, and 2 and 4 months thereafter and tested for IgG antibodies to SARS-CoV-2 nucleocapsid and spike proteins. PCR testing for SARS-CoV-2 was done weekly in staff and monthly in residents. Cox regression was used to estimate hazard ratios (HRs) of a PCR-positive test by baseline antibody status, adjusted for age and sex, and stratified by LTCF. Findings 682 residents from 86 LCTFs and 1429 staff members from 97 LTCFs met study inclusion criteria. At baseline, IgG antibodies to nucleocapsid were detected in 226 (33%) of 682 residents and 408 (29%) of 1429 staff members. 93 (20%) of 456 residents who were antibody-negative at baseline had a PCR-positive test (infection rate 0.054 per month at risk) compared with four (2%) of 226 residents who were antibody-positive at baseline (0.007 per month at risk). 111 (11%) of 1021 staff members who were antibody-negative at baseline had PCR-positive tests (0.042 per month at risk) compared with ten (2%) of 408 staff members who were antibody-positive staff at baseline (0.009 per month at risk). The risk of PCR-positive infection was higher for residents who were antibody-negative at baseline than residents who were antibody-positive at baseline (adjusted HR [aHR] 0.15, 95% CI 0.05-0.44, p=0.0006), and the risk of a PCR-positive infection was also higher for staff who were antibody-negative at baseline compared with staff who were antibody-positive at baseline (aHR 0.39, 0.19-0.82;p=0.012). 12 of 14 reinfected participants had available data on symptoms, and 11 of these participants were symptomatic. Antibody titres to spike and nucleocapsid proteins were comparable in PCR-positive and PCR-negative cases. Interpretation The presence of IgG antibodies to nucleocapsid protein was associated with substantially reduced risk of reinfection in staff and residents for up to 10 months after primary infection. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
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BackgroundCOVID-19 has impacted all aspects of life, including people’s sex lives, via experience of the disease and measures to prevent transmission. We examined sexual behaviour in Britain during the initial national ‘lockdown’ (≥23/3/2020) and compared this to the 3 months pre-lockdown.MethodsWe analysed weighted web-panel survey data from a quota-based sample of 6,654 people in Britain. The questionnaire, fielded 29/7–10/8/2020, included questions about sexual activities pre- and during lockdown, and perceived changes in frequency between these timeframes. We used descriptive statistics and multivariable regression to examine independent associations with relationship status, age, gender, and health.ResultsAltogether, 91.2% of sexually-experienced participants reported any sexual activity during lockdown;85.7% reporting ‘in-person’/physical partnered activities. Around half reported no change in frequency of partnered-sex versus pre-lockdown, however, those not cohabiting were more likely than those cohabiting to report changes (75.6% versus 35.1%) – typically declines. Masturbation (62.0%) and virtual/digital activities (54.3%) were less commonly reported during lockdown, although they were more commonly reported in those not cohabiting versus cohabiting (69.2% versus 57.9%, 67.4% versus 46.7%, respectively). Changes in reported frequency of virtual/digital activities were more common (66.4%) than in-person activities, with increases as likely as declines, except for porn use, where twice as many perceived an increase than a decrease. After adjustment, those reporting a decline in sex were more likely to be: non-cohabiting (AOR:1.68,95%CI:1.45–1.95), aged <25 years (AOR:1.99,1.57–2.51), male (AOR:1.17,1.02–1.35), to report depressive/anxiety symptoms (AOR:1.63,1.41–1.89) or COVID symptoms/diagnosis (AOR:1.24,1.01–1.52).ConclusionsMost people reported some form of sex during lockdown and around half had not experienced changes in partnered-sex compared to pre-lockdown. However, considerable differences existed for certain populations (e.g. young people) that may exacerbate, or be exacerbated by, COVID-19’s wider detrimental effects on physical and mental health. This potential intersectionality needs consideration when designing individual and public health interventions.
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BackgroundBy regulating behaviour at household level, COVID-19 restrictions drastically altered relationships. Given strong links between intimate relationships and health, we investigated how the pandemic impacted relational and sexual aspects of steady relationships in Britain in the 4-months following first national lockdown (23/3/2020).Methods6,657 participants aged 18–59 years completed a web-panel survey questionnaire between 29/7–10/8/20. A quasi-representative population sample was achieved via quotas and weighting. We analysed sexual activity by age, gender and cohabitation status, and used descriptive statistics and logistic regression to explore self-perceived changes in sex and relationship quality among those in steady relationships (n=4,271).ResultsOf the full sample, 64.2% were in a steady relationship, mostly cohabiting (88.8%). Following lockdown, 48.9% of those in cohabitating relationships and 36.4% in non-cohabiting relationships reported sex (anal/vaginal/oral) at least weekly. Frequency of sexual activity varied by age, gender and cohabitation status. The majority reported no change in their sex life and relational quality compared with the months pre-lockdown. Among those perceiving change, quality of sex life was more commonly reported to deteriorate, whereas quality of relationship was more commonly reported to improve. Change – both positive and negative – was more commonly reported by younger people. Overall, 7% reported deterioration to a ‘lower quality’ relationship, with deterioration more commonly reported by those: in mid-life (35–44 vs. 45–59) (men, AOR:2.31;95%CI:1.45–3.66;women, AOR=1.63;95%CI:1.03–2.56);living in an urban area (among men) (AOR:2.61;95%CI:1.15–5.90);and not living with a partner (among women) (AOR:2.01;95%CI:1.28–3.16). Deterioration was associated with poor health and with decline in sexual aspects of the relationship.ConclusionCOVID-19 led to an early net gain in relationship quality but net loss in quality of sex lives in steady relationships in UK. A sizeable minority of steady relationships were adversely affected with implications for sexual – and wider – wellbeing.
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BackgroundSexual and reproductive health (SRH) services in Britain shifted rapidly in response to COVID-19 and the first national lockdown. We investigated SRH service access and unmet need in Britain in the 4-months following lockdown (23/03/2020) to inform service delivery during and after the pandemic.Methods6,657 participants aged 18–59 years completed a web-panel survey (29/07/2020–10/08/2020). Quota-based sampling and weighting enabled a quasi-representative population sample. We estimated the prevalence of reported SRH service access and failed access, and calculated age-adjusted odds ratios (aOR) for sexually-experienced (≥1 sexual partner/lifetime;n=3,065) and sexually-active (≥1 sexual partner/past year;n=2,752) participants aged 18–44 years.Results20.8% (95%CI:19.3%-22.3%) of sexually-experienced participants reported accessing ≥1 SRH service in the 4-months from lockdown. 9.7% (8.6%-10.8%) reported being unable to access a service they needed, though many of these participants (76.4%) also reported successful access. 14.8% (13.1%-16.6%) of sexually-experienced women reported accessing contraception services since lockdown, and this was more likely for younger women (OR, 18–24 vs. 35–44 years: 2.96 (1.95 – 4.49)). Among sexually-active participants, 4.8% (4.0%-5.7%) reported accessing STI-related services (STI/HIV testing and follow-up care) and this was higher in those aged 18–24 years (10.1%). Participants reporting any new condomless partner(s) since lockdown were more likely to report accessing STI-related services (aOR, men: 23.77 (11.55–48.92), women: 10.53 (3.94–28.15)) and, amongst men, to report a failed attempt (aOR 13.32 (5.39–32.93)). Among those reporting STI testing (n=106), 33.4% (24.1%-44.2%) did so online, 31.5% (22.0%-42.9%) by phone, 43.9% (33.4%-55.0%) in-person, and 14.8% (8.3%-25.2%) via video consultation.ConclusionOur findings are consistent with SRH services in Britain adapting rapidly in response to COVID-19 and prioritising access for those in need. However, a significant proportion of participants reported difficulty accessing care, suggesting that services may need to adapt further to address and prevent a backlog of need among some high-risk groups.
ABSTRACT
Global infection and mortality rates from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are disproportionately high in certain populations, including the elderly. Care home residents are frequently exposed to infection due to contact with staff and other residents, and are highly susceptible to infection due to their age and co-morbidity. In England, official statistics suggest that at least 25% of all deaths in care home residents since the start of pandemic are linked to coronavirus disease 2019 (COVID-19), but limited testing for SARS-CoV-2 early in the pandemic means estimates of the true burden of disease are lacking. Additionally, little is known about patterns of transmission between care homes, the community and hospitals, or the relationship between infection and immunity in care home staff and residents. The VIVALDI study plans to address these questions. VIVALDI is a prospective cohort study aiming to recruit 6,500 staff and 5000 residents from 105 care homes across England. Successive rounds of testing for infection will be performed over a period of 12 months. Nasopharyngeal swabs will detect evidence of viral RNA and therefore active infection (accompanied by collection of data on symptoms), whereas blood tests will detect antibodies and evidence of cellular immunity to SARS-CoV-2. Whole genome sequencing of viral isolates to investigate pathways of transmission of infection is planned in collaboration with the COVID-19 Genomics UK Consortium. Qualitative interviews with care home staff will investigate the impact of the pandemic on ways of working and how test results influence infection control practices and behaviours. Data from residents and staff will be linked to national datasets on hospital admissions, antibody and PCR test results, mortality and care home characteristics. Data generated will support national public health efforts to prevent transmission of COVID-19 and protect care home staff and residents from infection. Protocol registration: ISRCTN14447421 05/06/2020.