PrEP RATHER THAN COVID-19 INFLUENCED SEXUAL ACTIVITY among MSM in TOKYO

ABSTRACT

Background: COVID-19 drastically changed life style in Japan. However, the influence of COVID-19 on sexual activity among men who have sex with men (MSM) have not been fully understood. Although, the number of new HIV infection in Japan in 2020 decreased by 11.4%, the number of public HIV and sexually transmitted infection (STI) tests at health centers decreased by half due to overwhelmed burden by COVID-19, which made it difficult to access concise situations. Thus, we retrospectively evaluated incidence of HIV/STIs among MSM in Japan before and after COVID-19 endemic in a non HIV-infected MSM cohort in Tokyo, Japan. Methods: MSM over 16 years old have been recruited in the cohort at Sexual Health Clinic in Tokyo, Japan since 2017. The participants were examined for HIV infection, syphilis (quantitative RPR/TPHA), and rectal/pharyngeal Chlamydia trachomatis and Neisseria gonorrhea infections every 3 months in the cohort. In the participants of the cohort, incidence of HIV and STI were evaluated before and after COVID-19 pandemic. The period between July 2018 and December 2019 was defined as before COVID-19 (BC) and the period between January 2020 and June 2021 was defined as after COVID-19 (AC). As other factors to influence on sexual activity, use of pre-exposure prophylaxis (PrEP) was also evaluated before and after COVID-19 pandemic. Results: 1614 MSM were recruited in the cohort as of June 2021 (348 prior to June 2019, 661 in BC and 605 in AC). 21 (3.2%) and 14 (2.3%) MSM were excluded from the cohort due to HIV infection at the enrollment in BC and AC. The number and average age of MSM with at least 2 HIV/STI tests were 935 (34.4 years) in BC and 1324 (34.9 years) in AC, respectively. The table demonstrated that while the incidence of STIs showed no substantial changes from BC to AC in all MSM, the incidence of STIs decreased in the non-PrEP users and increased in the PrEP users consistently from BC to AC. The differences in the incidence of STIs between the non-PrEP and the PrEP users were more remarkable in AC than BC. In AC, the incidence of STIs almost tripled in the PrEP users compared to the non-PrEP users. These findings might be explained that increasing recognition of PrEP rather than the impact of COVID-19 leads to initiation of PrEP by MSM with higher risk in addition to risk compensation in the cohort. Conclusion: PrEP should be implemented with intensive STI tests in Japan for further decrease in STIs in the long run.