Brown Jack Rg, Reid David, Howarth Alison R, Mohammed Hamish, Saunders John, Pulford Caisey V, Hughes Gwenda, Mercer Catherine H
UCL Institute for Global Health, University College London, London, UK
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.
Sex Transm Infect. 2022 Jul 21;99(4):226-38. doi: 10.1136/sextrans-2022-055429.
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.
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.
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).
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.
我们研究了与新冠疫情相关的限制措施对英国男男性行为者（MSM）的性行为、性传播感染（STI）和艾滋病毒检测以及检测需求的影响。
我们利用社交媒体和约会应用程序，在英国应对疫情期间开展了三项横断面调查（S1 - S3）（S1：2020年6月23日至7月14日；S2：2020年11月23日至12月12日；S3：2021年3月23日至4月14日）。调查的回顾期约为3 - 4个月（分别为P1 - P3）。符合条件的参与者为英国居民男性（顺性别/跨性别）以及出生时被认定为男性的性别多样化人群（跨性别和性别多样化参与者数量较少，因此将这些分析限制在顺性别男性），年龄≥16岁，且在过去一年中有与男性（顺性别/跨性别）发生性行为的经历（S1：N = 1950；S2：N = 1463；S3：N = 1487）。研究结果包括：近期的性传播感染/艾滋病毒检测以及未满足的检测需求（新的男性和/或多个无保护肛交性伴侣且近期未进行性传播感染/艾滋病毒检测）。使用逻辑回归评估与每个结果的粗略和调整后的关联。
各调查中参与者的社会人口学特征相似。报告近期进行性传播感染和/或艾滋病毒检测 的比例在P1和P2之间有所增加（分别从25.0%增至37.2%（p < 0.001）和从29.7%增至39.4%（p < 0.001）），然后在P3稳定下来（40.5%报告进行了艾滋病毒检测）。未满足的性传播感染检测需求在P1和P2期间有所增加（从26.0%增至32.4%；p < 0.001），但不同组之间趋势有所不同，例如，在各阶段，双性恋身份的男男性行为者（与同性恋身份者相比）未满足的性传播感染检测需求更高（调整后的比值比（aOR）：P1 = 1.64；P2 = 1.42）），但艾滋病毒阳性的男男性行为者（与艾滋病毒阴性/未知者相比）未满足的性传播感染检测需求有所下降（aOR：P1 = 2.06；P2 = 0.68）。未满足的艾滋病毒检测需求在P1和P2期间有所增加（从22.9%增至31.0%；p < 0.001），并在P3下降（降至25.1%；p = 0.001）。在P3期间，报告生活满意度低（与中等 - 非常高相比）的男男性行为者有更大的未满足需求（aOR：1.44），而从P2开始，艾滋病毒暴露前预防使用者（与非使用者相比）未满足的需求较低（aOR：P2 = 0.32；P3 = 0.50）。
在与新冠疫情相关的限制措施期间，男男性行为者中存在大量未满足的性传播感染/艾滋病毒检测需求，尤其是在双性恋身份的男性和报告生活满意度低的人群中。改善男男性行为者获得性传播感染/艾滋病毒检测的机会对于防止不平等加剧至关重要。
