Access to HIV prevention, treatment, and care services during COVID-19 by men who have sex with men in Zimbabwe, An interpretive phenomenological analysis study.

BACKGROUND: Key populations are disproportionately affected by the human immunodeficiency virus (HIV) but have less access to HIV prevention and treatment services. The Coronavirus disease-2019 (COVID-19) pandemic is reinforcing health inequities among vulnerable populations, including men who have sex with men (MSM). Therefore, this article presents the findings describing the experiences of MSM in accessing HIV services during COVID-19 in the second largest city of Zimbabwe. METHODS: An interpretative phenomenological analysis design was applied to gain some insights regarding the lived experiences of MSM in accessing HIV prevention, treatment, and care services during COVID-19 lockdowns era in Zimbabwe. Data were collected from 14 criterion purposively selected MSM using in-depth, one-on-one interviews. Data were analysed thematically guided by the interpretative phenomenological analysis framework for data analysis. RESULTS: The findings demonstrated that during the COVID -19 lockdowns in Zimbabwe, MSM faced several barriers as they tried to access HIV services. Some of the barriers included the need for travel authorisation letters and treatment interruption. The study also found that COVID-19 and related restrictive measures had psychosocial and economic effects that encompassed loss of income, intimate partner violence and psychological effects. CONCLUSIONS: Limited access to healthcare services by MSM due to COVID-19 lockdown may negatively affect the viral suppression and fuel the spread of HIV, which may reverse the gains toward the control of HIV epidemic. To sustain the gains toward HIV epidemic control and to ensure continuity of treatment, particularly for members of key populations, it is critical that the health-care delivery system adjusts by taking service to the community through adopting a differentiated service delivery approach.

Evaluating Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes: Quantitative Findings from the Ryan White HIV/AIDS Program Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

The Black Men who have Sex with Men (MSM) Initiative was implemented at eight sites to engage and retain Black MSM in HIV medical care and supportive services (SS) by addressing their behavioral health (BH) care needs. Using a pre-post design and generalized logistic mixed-effects models adjusting for patient-level random effects, site, baseline age, and baseline mental health status, we evaluated whether participants experienced increased postintervention attainment of (1) Awareness of HIV medical care, BH care, and SS; (2) Screening, referral, linkage, receipt, and engagement in HIV care, BH care, and SS; and (3) Retention, antiretroviral therapy prescription, and suppressed viral load. Among 758 evaluated participants, the proportion of participants who were aware of, screened for, screened positive for, and referred to BH and SS, retention in care (72% to 79%), and viral load suppression (68% to 75%) increased between baseline and postintervention. Among participants who screened positive and received BH services were statistically more likely to be linked to [OR, 1.34 (95% CI: 1.08-1.66)] and retained in [OR, 1.36 (95% CI: 1.00-1.83)] care. Among those who screened positive and received SS were statistically more likely to be retained in care [OR, 1.54 (95% CI: 1.07-2.22)]. Measures of linkage to care declined significantly during the study period, perhaps because of COVID-19 that delayed in-person care. This study suggests that interventions designed to increase utilization of BH services and SS can be effective at improving retention in care and viral load suppression among Black MSM, at least among those currently using HIV services.

Psychological Status of Men Who Have Sex with Men during COVID-19: An Online Cross-Sectional Study in Western China.

Background: The psychological status of men who have sex with men (MSM) as a vulnerable population during COVID-19 is worthy of attention. However, studies of Chinese MSM are limited. The aim of this study was to investigate the psychological status and influencing factors of MSM population and to provide a scientific basis for this group to actively respond to public health emergencies. Methods: From June to September 2020, we conducted an online survey. MSMs were recruited through collaboration with non-governmental organizations (NGOs) and peer recommendations. The variables we collected included four aspects: demographic and HIV-related characteristics; COVID-19-related knowledge, attitudes, and behaviors; COVID-19-related risk perception; epidemic exposure. The psychological status was assessed by the Psychological Questionnaire for Emergent Events of Public Health (PQEEPH), which defined the psychological status as five primary disorders: depression, neurasthenia, fear, anxiety, and hypochondria. Multivariate logistic regression was used to explore the influences of COVID-19-related factors on the psychological status. Results: We surveyed 412 MSM online during COVID-19. The five psychological status of high-risk states accounted for 16.99% (depression), 14.08% (neurasthenia), 16.75% (fear), 16.50% (anxiety), and 18.20% (hypochondria), respectively. Not being well-informed about the causes of COVID-19 (p = 0.020) and having experienced epidemic exposure (p = 0.006) were able to promote the occurrence of depression. Lack of knowledge of the curative effect of COVID-19 has a higher risk of occurrence neurasthenia (p < 0.001). Being afraid of the novel coronavirus (p < 0.001) promoted fear. The perceived prevalence of the epidemic (p = 0.003), being more susceptible to COVID-19 (p < 0.001), and not being well-informed about the causes of COVID-19 (p = 0.005) had a positive effect on anxiety. Considering that the epidemic was not effectively controlled (p = 0.017), being more susceptible to COVID-19 (p < 0.001) was a contributing factor to the hypochondria. Conclusions: The incidence of psychological disorders in Chinese MSM was higher than that in other groups during COVID-19. Factors associated with COVID-19 may cause a range of mental health problems in this population. Greater attention should be paid to the mental health status of special populations during the epidemic, and effective preventive education and intervention measures should be taken.

Advances and challenges in sexually transmitted infections prevention among men who have sex with men in Asia.

PURPOSE OF REVIEW: This review summarizes recently published research on sexually transmitted infections (STIs) and sexually transmitted diseases (STDs) among men who have sex with men (MSM) in Asia, covering four main areas: prevalence and consequences of STIs/STDs, factors associated with STI risk, strategies and measures of STI prevention, challenges in the prevention of SITs. RECENT FINDINGS: Studies show that STIs among Asian MSM are still prevalent, with the prevalence of STIs varying slightly from country to country. In addition to the number of sexual partners, frequency of condom use, high-risk sexual behaviors, the influence of Confucianism, law, and COVID-19 are also related to STI risk. Social stigma, weak health systems, lack of funding and policy support are the current challenges for STIs prevention. SUMMARY: In the future, new media technologies are encouraged to be used to enhance education and reduce stigma and discrimination against MSM and STIs. Expanding STI screening, strengthening STI knowledge propaganda and education among MSM population, and providing necessary counseling and medical services are main strategies in STI prevention. It is also important to strengthen STI awareness and policy support at the national level.

The impact of COVID-19 pandemic on mental health in gay, bisexual, and other men who have sex with men in China: Difference by HIV status.

Population-based measures and public health response to stem the spread of the coronavirus may have caused unintended isolation and increased the risk of psychiatric illnesses. The objective of this study is to assess psychological distress among gay, bisexual, and other men who have sex with men (MSM) in China during the COVID-19 pandemic and examine whether these mental health outcomes differ by HIV status. Data were derived from a cross-sectional survey on the impact of COVID-19 on users of Blued, the largest gay social networking app in July 2020. All active users on Blued were invited to complete a survey regarding sexual behaviors, HIV prevention and treatment service utilization, and various health and mental health outcomes. Among all participants (n = 1205), over half (53.2%) of the participants screened mild to severe psychological distress: 34.9% screened mild, 11.6% screened moderate, and 6.6% screened severe psychological distress. Of all participants, 20.9% met the criteria for anxiety and 19.6% for depression. Psychological distress was associated with younger age having a degree below college, being unemployed, and having lower income. MSM with HIV were more likely to report depression or anxiety compared to HIV negative/unknown status MSM after adjusting for study covariates (AOR = 1.80, 95%CI 1.01-3.26; AOR = 2.04, 95%CI 1.11-3.67, respectively). MSM in China experience a high burden of psychological distress during the COVID-19 pandemic. Integrated HIV treatment and mental health services are needed to provide adequate and timely mental health support to MSM living with HIV.

Higher Levels of Postnatal Depressive Symptomatology, Post-Traumatic Growth, and Life Satisfaction among Gay Fathers through Surrogacy in Comparison to Heterosexual Fathers: A Study in Israel in Times of COVID-19.

This study aimed to explore the psychological welfare, as indicated by postnatal depressive symptomatology, life satisfaction, and posttraumatic growth (growth after contending with stressful birth events), of Israeli gay fathers through surrogacy in comparison to heterosexual fathers. For that purpose, a sample of 167 Israeli fathers (M = 35.6, SD = 4.4) was recruited (68 identified as gay fathers through surrogacy and 99 as heterosexual fathers). Participants completed questionnaires assessing their postnatal depressive symptomatology, life satisfaction, and sense of posttraumatic growth after becoming fathers. Results indicated that gay fathers through surrogacy reported higher levels of life satisfaction and posttraumatic growth than heterosexual fathers. Yet, gay fathers also reported higher levels of postnatal depressive symptomatology than heterosexual fathers when life satisfaction or posttraumatic growth values were low or medium. The findings were interpreted in light of the hardships associated with cross-border surrogacy and the psychological outcomes associated with succeeding to become fathers after contending with them. The study contributes to the limited literature on postnatal depressive symptomatology and posttraumatic growth among gay fathers through surrogacy and provides clinicians and policymakers with relevant information on the psychological strengths and potential difficulties associated with cross-border surrogacy among gay fathers.

Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California.

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.

Exploring the Shift From HIV Pre-exposure Prophylaxis Awareness to Uptake Among Young Gay and Bisexual Men.

Introduction: HIV pre-exposure prophylaxis (PrEP) in the form of a daily oral medication is highly effective at preventing HIV. In the United States, awareness about PrEP has steadily increased over time among individuals vulnerable to HIV, however awareness has not translated into widescale uptake. Estimates are that fewer than 20% of 1.2 million Americans for whom PrEP is indicated are utilizing it. We sought to understand how individuals moved from PrEP awareness to PrEP utilization. Methods: We conducted a series (n = 31) of in-depth interviews with young people, predominantly gay and bisexual men, ages 18-29 years old between February 2015 and January 2016, as part of the evaluation of a multi-year demonstration project funded to test innovative approaches to improve sexual health outcomes and curb the HIV epidemic in California. Interviews were audio-recorded and transcribed verbatim. We conducted a thematic analysis. Results: We present a continuum of PrEP awareness that spans three phases-basic, moderate and advanced. Participants rarely reported becoming well-informed about PrEP over the course of an initial exposure to PrEP information. Learning occurred after multiple exposures to PrEP information through numerous intersecting forms, messengers and formal and informal communication channels. Positively framed messages delivered by formal messengers emphasizing PrEP as a sensible HIV prevention strategy and explicitly communicating a regard for sexual wellness were overwhelmingly persuasive and facilitated movement to the advanced awareness phase. Once participants reached the advanced phase of PrEP awareness, uptake was possible. Conclusions: Our analysis provides insights into how PrEP awareness led to PrEP uptake among young gay and bi-sexual men. Building demand among those in the basic awareness phase took longer than those in the moderate phase. Individuals involved in formal and informal PrEP education can set reasonable expectations about whether, when and how eventual uptake may occur when keeping the continuum of PrEP awareness framework in mind. Many young, gay and bi-sexual male prospective PrEP users will benefit from positively framed messages that emphasize personal well-being, including social, sexual and emotional benefits of PrEP use.

Sustaining an HIV Prevention and Wellness Program for Sexual Gender Minorities during the COVID-19 Pandemic.

Improving mental health, body image, and financial stability is paramount to achieving viral suppression and maintaining HIV-negative status for minoritized communities. The purpose of this paper is to describe the lessons learned from maintenance of an HIV prevention and wellness program during the COVID-19 pandemic. A three-session program was implemented in a hybrid format to account for county-wide restrictions and reopening processes. Lessons learned include the utility of a hybrid format, importance of CBPR partnership, innovation in virtual platform, value of social media presence and upkeep, and use of multiple methods to ascertain evaluative data. Sustaining an HIV prevention and wellness program requires strong research collaborations and ongoing engagement with priority populations and the flexibility to pivot as needed.

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men, Transgender Women, and Transgender Men Who Have Sex with Men: April-May 2020.

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n = 3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (ß = 0.90, 95% CI 0.40-1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR = 1.21), being Black (AOR = 1.79) or Latinx (AOR = 1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR = 1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.

Father-child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic.

RESEARCH QUESTION: What are the psychological implications of the COVID-19 pandemic for father-child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or Canada? DESIGN: Between 20 March and 29 July 2020, this cross-sectional case-control study collected data on father-child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. These fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic. RESULTS: Although father-child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father-child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate -1.47, SE 0.49, P=0.005), anxious (estimate -1.96, SE 0.55, P<0.001) and somatic symptoms (estimate -2.48, SE 0.52, P<0.001). CONCLUSIONS: The findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.

Positive and Negative Impacts of the COVID-19 Pandemic on Relationship Satisfaction in Male Couples.

Little is known about the impact of the coronavirus pandemic and control measures on gay, bisexual, and other men who have sex with men (GBMSM) couples. The goal of this study was to investigate individual-level relationship satisfaction during the COVID-19 pandemic in a sample of 209 coupled GBMSM in the United States. We analyzed reported happiness and feelings about a relationship's future and assessed the odds of changing relationship happiness and investment associated with pandemic-related life changes (pandemic-related employment change; COVID-19 illness; high-risk of severe illness), using logistic and multinomial logit models. Fifty-five percent of participants (N = 114) reported that their relationship happiness had not changed during the pandemic, but 30% (N = 62) reported increased relationship happiness. 25% (N = 53) reported they had become more invested in their relationship's future during the pandemic, and only one participant reported decreased investment. The odds of increased relationship investment was significantly associated with pandemic-related employment change (adjusted odds ratio (aOR), 95% confidence interval (CI): 2.19 [1.04, 4.61]) and increased sex during the pandemic (aOR: 4.38 [1.55, 12.41]). Those with a pandemic-related employment change also had significantly higher odds of increased relationship happiness than those without a change (aOR: 2.10 [1.01, 4.35]). COVID-19 cases that reported being at higher risk of serious COVID-19 disease had higher odds of decreased relationship happiness than high-risk non-cases (aOR: 6.58 [1.10, 39.39]). Additional research in this area is warranted to minimize the long-term impacts of the pandemic on coupled GBMSM.

Decrease in prevalence but increase in frequency of non-marijuana drug use following the onset of the COVID-19 pandemic in a large cohort of young men who have sex with men and young transgender women.

BACKGROUND: Substantial concern exists regarding the impact of the COVID-19 pandemic on substance use behaviors. This is especially true for subpopulations like young men who have sex with men and young transgender women (YMSM-YTW) who report higher rates of substance use. This study examines changes in prevalence and frequency of marijuana and non-marijuana drug use among YMSM-YTW following the onset of the pandemic. METHOD: Data for this analysis (n = 458 participants, 1356 observations) come from an ongoing longitudinal cohort study of YMSM-YTW. A series of Bayesian multilevel models were used to examine change in prevalence and frequency of use for marijuana and non-marijuana drugs. RESULTS: Results indicated no systematic change in prevalence or frequency of marijuana use. However, a decrease in non-marijuana drug use was observed (OR = 0.60, 95 % CrI: [0.37, 0.94]) following the onset of the pandemic. Furthermore, a small increase in the frequency of non-marijuana drug use was observed (OR = 1.79, 95 % CrI: [1.02, 3.21]) among individuals who used these substances. CONCLUSIONS: These findings concur with a small number of studies identifying a decrease in drug use prevalence but increase in frequency among those who continue to use drugs. Despite the protective effect of lower drug use prevalence, higher frequency of use may lead to additional negative health outcomes of drug use, particularly among groups facing multiple health challenges such as YMSM-YTW. However, the pandemic likely has a unique impact on substance use behaviors across subpopulations.

Associations Between Physical Distancing and Mental Health, Sexual Health and Technology Use Among Gay, Bisexual and Other Men Who Have Sex With Men During the COVID-19 Pandemic.

Physical distancing measures, designed to limit the spread of COVID-19, have been implemented globally. We sought to understand how physical distancing impacts gay, bisexual and other men who have sex with men (GBMSM), a group disproportionately affected by poor health outcomes. A cross-sectional online survey on Hornet, a networking application (N = 10,079), measured sociodemographics, physical distancing, mental health outcomes, and sexual behavior. Nearly two-thirds of participants (63%) reported only leaving their home for essentials. Those who practiced physical distancing were more likely to feel anxious (aOR = 1.37), feel lonely (aOR = 1.36), to report their sex life being impacted (aOR = 2.95), and less likely to be satisfied with their current sex life (aOR = 0.76). Those who practiced physical distancing were more likely to use social technologies to stay in touch with others. Risk reduction and telehealth opportunities may alleviate health challenges for GBMSM in the COVID-19 era.

COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK.

OBJECTIVES: The COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision. METHODS: We conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March-30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use. RESULTS: 814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in 'chemsex' and use of SHS than non-PrEP users. CONCLUSIONS: COVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

Physical Distancing Due to COVID-19 Disrupts Sexual Behaviors Among Gay and Bisexual Men in Australia: Implications for Trends in HIV and Other Sexually Transmissible Infections.

INTRODUCTION: In March 2020, Australian state and federal governments introduced physical distancing measures alongside widespread testing to combat COVID-19. These measures may decrease people's sexual contacts and thus reduce the transmission of HIV and other sexually transmissible infections (STIs). We investigated the impact of physical distancing measures due to COVID-19 on the sexual behavior of gay and bisexual men in Australia. METHODS: Between April 4, 2020, and April 29, 2020, 940 participants in an ongoing cohort study responded to questions to measure changes in sexual behaviors during the COVID-19 pandemic. Men reported the date they become concerned about COVID-19 and whether they engaged in sexual behavior with regular or casual partners or "fuckbuddies" in the 6 months before becoming concerned about COVID-19 (hereafter referred to as "before COVID-19"), and following the date, they become concerned about COVID-19 (hereafter referred to as "since COVID-19"). Before and since COVID-19 was based on individual participants' own perceived date of becoming concerned about COVID-19. RESULTS: The mean age of was 39.9 years (SD: 13.4). Most participants (88.3%) reported sex with other men during the 6 months before COVID-19. Of the 587 men (62.4%) who reported sex with casual partners before COVID-19, 93 (15.8%) continued to do so in the period since COVID-19, representing a relative reduction of 84.2%. CONCLUSION: Gay and bisexual men in Australia have dramatically reduced their sexual contacts with other men since COVID-19. These behavioral changes will likely result in short-term reductions in new HIV and STI diagnoses. If sexual health screenings are undertaken before resuming sexual activity, this could present a novel opportunity to interrupt chains of HIV and STI transmission.

Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and Other Men Who Have Sex with Men's Experience of Sex and HIV Prevention During the US COVID-19 Epidemic.

This paper presents data from a recent cross-sectional survey of gay, bisexual and other men who have sex with men (GBMSM) in the US, to understand changes in sexual behavior and access to HIV prevention options (i.e. condoms and pre-exposure prophylaxis (PrEP)) during the COVID-19 lockdown period. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May, 2020. GBMSM were recruited through advertisements featured on social networking platforms, recruiting a sample size of 518 GBMSM. Analysis considers changes three in self-reported measures of sexual behavior: number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms. Approximately two-thirds of the sample reported that they believed it was possible to contract COVID-19 through sex, with anal sex reported as the least risky sex act. Men did not generally feel it was important to reduce their number of sex partners during COVID-19, but reported a moderate willingness to have sex during COVID-19. For the period between February and April-May 20,202, participants reported a mean increase of 2.3 sex partners during COVID-19, a mean increase of 2.1 anal sex partners (range - 40 to 70), but a very small increase in the number of unprotected anal sex partners. Increases in sexual behavior during COVID-19 were associated with increases in substance use during the same period. High levels of sexual activity continue to be reported during the COVID-19 lockdown period and these high levels of sexual activity are often paralleled by increases in substance use and binge drinking. There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services.

A Rapid Qualitative Assessment of the Impact of the COVID-19 Pandemic on a Racially/Ethnically Diverse Sample of Gay, Bisexual, and Other Men who Have Sex with Men Living with HIV in the US South.

Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.

RESUMEN: Las personas que viven con VIH (PLWH por sus siglas en inglés) pueden tener mayor riesgo de contraer serias enfermedades relacionadas con el COVID-19. Nuestra investigación participativa basada en la comunidad recopiló y analizó datos de entrevistas semiestructuradas para entender el impacto inicial de la pandemia COVID-19 en una muestra de hombres gay, bisexuales y otros hombres que tienen sexo con hombres de diversos grupos étnicos y raciales que viven con VIH. Participaron quince hombres cisgénero con un promedio de edad de 28 años. Seis participantes fueron negros/afroamericanos, cinco latinx hispanohablantes y cuatro blancos. Emergieron diecisiete temas que fueron categorizados en seis ámbitos: conocimiento y percepciones de COVID-19; fuentes de información sobre COVID-19 y percepciones de confiabilidad; impacto de COVID-19 en comportamientos, salud y determinantes sociales de la salud e inquietudes generales relacionadas con COVID-19. Se necesitan intervenciones para garantizar que las personas que viven con VIH tengan información actualizada y cumplan con adherirse a su régimen de tratamiento y reducir el impacto de COVID-19 en lo que respecta a aislamiento social, estabilidad económica, acceso a los servicios de atención médica y otros determinantes sociales de la salud en estas poblaciones vulnerables.

Reducing sexually associated transmission of COVID-19 in men who have sex with men.

ABSTRACT: Believed to be zoonotic in origin, COVID-19 is a novel coronavirus subtype, which spreads from person to person through droplet transmission. As of late April, 2020, 895,766 cases of COVID-19 infections were recorded in the United States. This infection was responsible for 50,439 deaths. Because of close, person-to-person proximity, coupled with possible contact with body fluids, transmission of COVID-19 during sexual activity is possible. However, some activities carry higher risks of transmission than others. This article explores the risks of COVID-19 transmission associated with kissing, oral sex (fellatio and annilingus), and anal receptive and anal insertive intercourse among men who have sex with men (MSM). Recommendations for counseling MSM on safer sexual decision-making, many of which are applicable in the general prevention of sexually transmitted infections, are also provided. Nurse practitioners can serve as advocates in preventing sexually associated COVID-19 communication in MSM and contribute to the advancement of this continuously evolving area of public health science.

COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey.

BACKGROUND: Social distancing in the wake of the coronavirus disease 2019 (COVID-19) pandemic may affect the sexual behavior of men who have sex with men (MSM). In early March 2020, Israel imposed travel restrictions and limited social contacts to household members only. The effects of these restrictions on the sexual behavior and mental health of MSM are unknown. AIM: To assess sexual behaviors and mental health of Israeli MSM during social distancing and to compare sexual behaviors before and during social distancing, due to the COVID-19 pandemic. METHODS: Data were collected through anonymous web-based questionnaires in a popular geospatial application used by MSM between March and April 2020 during the social-distancing period. OUTCOMES: The dependent variable was casual sex, in violation of social-distancing regulations. Independent variables were demographic characteristics, sexual behaviors before and during social-distancing restrictions, and mental health. RESULTS: Of the 2,562 participants, 1,012 (39.5%) continued to meet new casual sex partners during this period. Being of a younger age, single, and with higher levels of mental distress predicted engagement in casual sex during the social-distancing period. MSM reduced their sexual risk and limited sexual repertoire-in particular, kissing with their sexual partners. Participants also spent more time in dating applications than in the pre-social-distancing period and increased their use of sex phone, webcams, and porn consumption. They perceived the threat of severe acute respiratory syndrome coronavirus to be greater than that of HIV: only 3.2% could imagine themselves having sex with a partner who is infected with SARS-CoV-2 compared with 30.1% in case of HIV, P < .01. CLINICAL IMPLICATIONS: MSM reduced their risk behaviors during social distancing because of the threat of COVID-19. Casual sex during social distancing was associated with negative feelings of mental distress. Future public health response in the future waves of COVID-19 morbidity should strike a balance between containment measures and the need for social distancing with its possible mental and social burdens. STRENGTHS AND LIMITATIONS: This is the first study in Israel and one of the few in the world to examine sexual behaviors among MSM during the COVID-19 social distancing period. It involved a relatively large sample, through convenience sampling, which limits causality. Findings should be interpreted cautiously, specifically because COVID-19-related behaviors and circumstances may change rapidly. CONCLUSION: The negative feelings of distress due to social distancing should be considered as a potential barrier to adherence among vulnerable populations, such as MSM. Future public health response should strike a balance between containment measures and its possible mental, social, and financial burdens. Shilo G, Mor Z. COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey. J Sex Med 2020;17:1827-1834.