COVID-19 HISTORY REPORTED BY MEN WHO HAVE SEX WITH MEN (MSM) IN THE UK IN A LARGE, COMMUNITY SURVEY ('RIISH-COVID')

Introduction As COVID-19 has deepened health inequalities, we examine the COVID-19 experience of MSM as a population disproportionately affected by poor-health. Methods An online cross-sectional survey of MSM recruited via social media and dating applications for 3 weeks in November/December 2021. Questions included those on COVID-19 experience addressing: COVID-19 test history;when (if ever) tested positive;self-perception of ever having had COVID-19 and long-COVID. Logistic regression was used to assess sociodemographic and behavioural characteristics associated with these outcomes. Results Among 1,038 participants (median age: 41;88.1% white ethnicity): most reported ever testing for COVID-19 (95.0%;n=987), while 19.6% (193/987) reported a positive result [8.1% (80/987) testing positive since August 2021]. In those without a prior positive test (n=793) or testing history (n=52), an additional 148 participants reported self-perceived COVID, resulting in 32.8% (341/1038) with a COVID-19 history. In these, one-quarter (25.2%;86/341) reported long- COVID (8.3%;86/1038 of all) and 4.1% (14/341) hospitalisation history for COVID-related symptoms (1.8%;19/1038 of all). COVID-19 history was associated with residence in England (aOR:1.52,95%CI:1.02-2.28), degree-level education (aOR:1.33;95%CI:1.01-1.75), and vaccination status (aOR:2.98,95%CI:1.61-5.53, none/one dose vs. boosted). Long-COVID was associated with hospitalisation history (aOR:3.21;95%CI:1.09-9.45) and degree-level education (aOR:0.56;95%CI:0.36-0.99). Conclusion In this large community sample, one in five MSM reported testing positive for COVID-19, and one-third had a COVID-19 history. There was no evidence of age or ethnicityrelated inequalities, although long-COVID appears to exceed general population estimates. Continued monitoring of long- COVID in MSM is warranted as COVID-19 infections in the UK continue to increase.

DIFFICULTY ACCESSING CONDOMS BECAUSE OF THE COVID-19 PANDEMIC REPORTED BY MEN WHO HAVE SEX WITH MEN (MSM) IN THE UK IN A LARGE, COMMUNITY-BASED CROSS-SECTIONAL SURVEY ('RIISHCOVID')

Introduction COVID-19 restrictions severely impacted in-person sexual health services, an important access point for condoms. We examine whether MSM in the UK had difficulty accessing condoms because of COVID-19 restrictions and associated factors. Methods Data on difficulty accessing condoms since the start of the pandemic (23rd March 2020) were collected as part of a short, online cross-sectional survey of MSM in November/ December 2021, recruited via social media and Grindr. Eligible participants were UK-resident MSM (cis/trans/non-binary person assigned male at birth - AMAB), aged ≥16 years who were sexually active (reported sex with men in the last year). Multivariable logistic regression to adjust for age and numbers of new sex partners was used to examine if and how reporting this outcome varied by key sociodemographic factors. Results Of all participants (N=1039), over 1 in 7 (13.3%;n=138) reported ever having difficulty accessing condoms, of whom, over half (55.8%;n=77) reported difficulty due to the pandemic (7.4% of all participants). Reporting difficulty accessing condoms was significantly higher among: Younger MSM (aged 16-29 years vs. ≥45;12.8% vs. 4.9%;aOR=2.78);trans/non-binary AMAB participants (vs. cisgender males;24.4% vs. 6.6%;aOR=4.86);bisexually-identifying MSM (vs. gay-identifying;11.1% vs. 6.5%;aOR=1.78);and MSM without degree level education (vs. having a degree;9.8% vs. 5.6%;aOR=2.01). Discussion A minority of sexually active MSM reported difficulty accessing condoms because of the pandemic, however, this was more common among those who already experience a disproportionate burden of poor sexual health. Interventions are needed to address these inequalities in accessing this important primary STI/HIV prevention measure. (Table Presented).

COVID-19 VACCINATION UPTAKE AND COVERAGE REPORTED BY MEN WHO HAVE SEX WITH MEN (MSM) IN THE UK IN A LARGE, COMMUNITY SURVEY ('RIISHCOVID')

Introduction MSM are disproportionately affected by health inequalities which may be exacerbated by COVID-19 and pandemic- related restrictions. We examine uptake of the COVID- 19 vaccine in MSM and assess factors associated with vaccination status. Methods An online cross-sectional survey of MSM recruited via social media and dating applications for 3 weeks in November/December 2021. Questions included those on vaccine offer and uptake (1 dose/2 doses/2 doses+booster). Logistic regression assessed factors associated with reporting full vaccination status (≥2 doses) by sociodemographic characteristics, HIV status, self-reported COVID history, and mental health indicators. Results Of 1,039 participants, 98.2% (n=1,020) reported everhaving been offered a COVID vaccine, of which 98.0% (1,000/1,020) reported ≥1 dose and 96.5% (985/1020) full vaccination status. In multivariate models, full vaccination status was associated with: age (aOR:1.04, 95%CI:1.01-1.06 per increasing year), gender (aOR: 0.26, 95%CI:0.09-0.72, gender minority vs cis male), degree-level education (aOR: 2.11,95% CI:1.12-3.98), employment since lockdown (aOR: 2.07,95% CI:1.08-3.94), single relationship status (aOR: 0.50,95% CI:0.25-1.00), self-reported COVID-19 history (aOR: 0.47, 95%CI:0.25-0.88), HPV vaccination history (aOR: 3.32, 95% CI:1.43-7.75), and self-reported low life-worth (aOR: 0.29, 95%CI:0.15-0.54). Conclusion This large community survey suggests COVID-19 vaccine uptake and coverage is high in MSM and exceeds general population vaccination estimates. However, inequalities appear to exist in some groups, including younger age-groups, gender minorities, and those with poorer mental health less likely to report full vaccination. Efforts are needed to limit COVID-related exacerbation of health inequalities in these groups who already experience a greater burden of poor health relative to other MSM.

SEXUAL BEHAVIOUR, STI AND HIV TESTING AND TESTING NEED AMONG MEN WHO HAVE SEX WITH MEN (MSM) PRE- AND POST-COVID-19 RESTRICTIONS IN THE UK

Introduction We examine changes in sexual behaviour, STI & HIV testing and testing need among MSM in the UK preand post-COVID-19 restrictions. Methods An online survey of 1,309 MSM recruited via social media and Grindr over three weeks in November/December 2021. Questions on sexual behaviour and service use had an approximate three-month lookback period corresponding to a period of no/limited COVID-19 restrictions. Unmet testing need was defined as reporting any new and/or multiple condomless anal sex (CAS) partners without a recent STI/HIV test. MSM recruited through Grindr who were UK-resident, cisgender, aged ≥16 years who reported sex with men in the last year (N=430) were compared to those from a related 2017 survey (N=1914) using multivariable regression to adjust for demographic differences between the samples. Results Compared to the 2017 survey, sexual risk behaviour was higher in the 2021 survey: ≥1 recent new sex partner (71.5% vs. 81.5%, respectively, aOR=1.80);≥2 recent CAS partners (30.1% vs. 48.8%, aOR=2.23). Reporting recent testing for STIs/HIV was also higher in late 2021 (37.3% vs. 42.6%, aOR=1.34;and 48.7% vs. 45.1%, aOR=1.27, respectively). However, there was no significant change in the proportion with unmet need for STIs (41.4% vs. 44.2%) and HIV (34.8% vs. 39.3%). Discussion These large, community surveys of MSM in the UK suggest greater sexual risk behaviour post-restrictions in 2021 compared to 2017. However, while we found no evidence of reduced service accessibility following the removal of most restrictions, there remains considerable unmet STI/HIV testing need among UK MSM. (Table Presented).