Changes in STI and HIV testing and testing need among men who have sex with men during the UK's COVID-19 pandemic response

Jack Rg Brown; David Reid; Alison R Howarth; Hamish Mohammed; John Saunders; Caisey V Pulford; Gwenda Hughes; Catherine H Mercer

doi:10.1136/sextrans-2022-055429

Changes in STI and HIV testing and testing need among men who have sex with men during the UK's COVID-19 pandemic response

Sex Transm Infect. 2022 Jul 21;99(4):226-238. doi: 10.1136/sextrans-2022-055429. Online ahead of print.

Authors

Jack Rg Brown^{1

2}, David Reid^{3

2}, Alison R Howarth^{3

2}, Hamish Mohammed^{3

2

4}, John Saunders^{3

2

4}, Caisey V Pulford^{2

4}, Gwenda Hughes^{2

5}, Catherine H Mercer^{3

2}

Affiliations

¹ UCL Institute for Global Health, University College London, London, UK jack.brown@ucl.ac.uk.
² The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with the UK Health Security Agency, London, UK.
³ UCL Institute for Global Health, University College London, London, UK.
⁴ Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK.
⁵ UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine Department of Infectious Disease Epidemiology, London, UK.

Abstract

Objectives: We examined the impact of COVID-19-related restrictions on sexual behaviours, STI and HIV testing and testing need among men who have sex with men (MSM) in the UK.

Methods: We used social media and dating applications to recruit to three cross-sectional surveys (S1-S3) during the UK's pandemic response (S1: 23 June-14 July 2020; S2: 23 November-12 December 2020; S3: 23 March-14 April 2021). Surveys included lookback periods of around 3-4 months (P1-P3, respectively). Eligible participants were UK resident men (cisgender/transgender) and gender-diverse people assigned male at birth (low numbers of trans and gender-diverse participants meant restricting these analyses to cisgender men), aged ≥16 years who reported sex with men (cisgender/transgender) in the last year (S1: N=1950; S2: N=1463; S3: N=1487). Outcomes were: recent STI/HIV testing and unmet testing need (new male and/or multiple condomless anal sex partners without a recent STI/HIV test). Crude and adjusted associations with each outcome were assessed using logistic regression.

Results: Participants' sociodemographic characteristics were similar across surveys. The proportion reporting a recent STI and/or HIV test increased between P1 and P2 (25.0% to 37.2% (p<0.001) and 29.7% to 39.4% (p<0.001), respectively), then stabilised in P3 (40.5% reporting HIV testing). Unmet STI testing need increased across P1 and P2 (26.0% to 32.4%; p<0.001), but trends differed between groups, for example, unmet STI testing need was higher in bisexually-identifying (vs gay-identifying) MSM across periods (adjusted OR (aOR): P1=1.64; P2=1.42), but declined in HIV-positive (vs HIV-negative/unknown) MSM (aOR: P1=2.06; P2=0.68). Unmet HIV testing need increased across P1 and P2 (22.9% to 31.0%; p<0.001) and declined in P3 (25.1%; p=0.001). During P3, MSM reporting a low life-satisfaction level (vs medium-very high) had greater unmet need (aOR: 1.44), while from P2 onwards HIV pre-exposure prophylaxis users (vs non-users) had lower unmet need (aOR: P2=0.32; P3=0.50).

Conclusion: Considerable unmet STI/HIV testing need occurred among MSM during COVID-19-related restrictions, especially in bisexually-identifying men and those reporting low life satisfaction. Improving access to STI/HIV testing in MSM is essential to prevent inequalities being exacerbated.

Keywords: COVID-19; HIV; sexual behaviour; sexual health.