Potential interruptions in HIV prevention and treatment services for gay, bisexual, and other men who have sex with men associated with COVID-19 (preprint)

BackgroundGlobally, the coronavirus pandemic has necessitated a range of population-based measures in order to stem the spread of infection and reduce COVID-19-related morbidity and mortality. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 mitigation strategies and interruptions to HIV prevention and treatment services for MSM. MethodsData for this study were collected as part of a COVID-19 Disparities Survey implemented by the gay social networking app Hornet, with data collected between April 16th, 2020 and May 24th, 2020. Data were assessed for countries where at least 50 participants completed the survey, to best evaluate country-level heterogeneity. We used a modified Poisson regression model, with clustering at the country-level, to assess the association between stringency of pandemic control measures and access to HIV services. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index; each country received a score (0-100) based on the number and strictness of nine indicators related to school and workplace closures and travel bans. ResultsA total of 10,654 MSM across 20 countries were included in these analyses. The mean age was 34.2 (standard deviation: 10.8), and 12% (1264/10540) of participants reported living with HIV. The median stringency score was 82.31 (Range:[19.44, Belarus]-[92.59, Ukraine]). For every ten-point increase in stringency, there was a 3% reduction in the prevalence of access to in-person testing (aPR: 0.97, 95% Cl:[0.96, 0.98]), a 6% reduction in the prevalence of access to self-testing (aPR: 0.94, 95% Cl:[0.93, 0.95]), and a 5% reduction in access to PrEP (aPR: 0.95, 95% Cl:[0.95, 0.97]). Among those living with HIV, close to one in five (n = 218/1105) participants reported being unable to access their provider either in-person or via telemedicine during the COVID-19 pandemic, with a greater proportion of interruptions to treatment services reported in Belarus and Mexico. Almost half (n = 820/1254) reported being unable to refill their HIV medicine prescription remotely. ConclusionsMore stringent government responses were associated with decreased access to HIV diagnostic, prevention, and treatment services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to facilitate minimize service interruptions to MSM communities during this and potential future waves of COVID-19.

Economic, Mental Health, HIV Prevention and HIV Treatment Impacts of COVID-19 and the COVID-19 response on a Global Sample of Cisgender Gay Men and Other Men who have sex with Men (preprint)

There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n= 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many men not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. Consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. Findings underscore the crucial need to mitigate the multifaceted impacts of COVID-19 among gay men and other MSM, especially for those with intersecting vulnerabilities.