Institute for Global Health, University College London, London, UK
Institute for Global Health, University College London, London, UK.
Sex Transm Infect. 2023 Jun;99(4):261-267. doi: 10.1136/sextrans-2022-055516. Epub 2022 Aug 18.
To investigate how differential access to key interventions to reduce STIs, HIV and their sequelae changed during the COVID-19 pandemic.
British participants (18-59 years) completed a cross-sectional web survey 1 year (March-April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16-74 years) conducted in 2010-2012. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually experienced participants (18-44 years) (n=3869, Natsal-COVID; n=8551, Natsal-3). ORs adjusted for age and other potential confounders describe associations with demographic and behavioural factors.
In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18-24 years, of black or black British ethnicity, and reporting same-sex sex (past 5 years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners and with cervical screening among smokers.
Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, there was not strong evidence that differential access has changed during the pandemic when compared with 2010-2012. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.
探究在 COVID-19 大流行期间，减少性传播感染（STI）、艾滋病毒及其后遗症的关键干预措施的获取机会差异是如何变化的。
18-59 岁的英国参与者在英国首次封锁后一年（2021 年 3 月至 4 月）完成了一项横断面网络调查。基于配额的抽样和加权产生了一个准代表性的人口样本。我们将 Natsal-COVID 数据与 Natsal-3 进行了比较，后者是 2010-2012 年进行的一项基于家庭的概率抽样横断面调查（16-74 岁）。对有过性经验的参与者（18-44 岁）（Natsal-COVID：n=3869；Natsal-3：n=8551）报告的因大流行而未满足的 condom 需求以及接受衣原体检测/艾滋病毒检测/宫颈癌筛查的情况进行了分析。调整年龄和其他潜在混杂因素后的 OR 描述了与人口统计学和行为因素的关联。
2021 年，6.9%的女性和 16.2%的男性报告因大流行而未满足 condom 需求。在以下参与者中，这种情况更有可能发生：年龄在 18-24 岁之间，属于黑人或黑人英国种族，报告过去 5 年内有同性性行为或有一个或多个新伴侣。较年轻的参与者更常报告接受衣原体和艾滋病毒检测，报告与新性伴侣发生无 condom 性行为的参与者和报告有同性伴侣的男性更常报告这些检测；与 10 年前（Natsal-3）的分布非常相似。然而，在大流行期间存在差异，包括与报告有同性伴侣的男性的衣原体检测、与报告有新性伴侣的女性的 HIV 检测以及与吸烟者的宫颈癌筛查之间的关联更强。
我们的研究表明，在 COVID-19 大流行的第一年，减少 STI/HIV 的主要和次要预防干预措施的获取机会存在差异。然而，与 2010-2012 年相比，没有强有力的证据表明在大流行期间这种获取机会发生了变化。虽然大流行可能没有加剧获得初级和次级预防的不平等，但很明显，这种不平等仍然存在，通常存在于面临最大 STI/HIV 风险的人群中。
