Changes in Sexual Behavior, PrEP Adherence, and Access to Sexual Health Services Because of the COVID-19 Pandemic Among a Cohort of PrEP-Using MSM in the South

Sanjana Pampati, MPH; Kayla Emrick, MPH; Aaron J. Siegler, PhD; Jeb Jones, PhD


J Acquir Immune Defic Syndr. 2021;87(1):639-643. 

In This Article


Data Collection

Data come from a cohort study examining trajectories of PrEP use among MSM recruited online in the Southern United States from October 2019 to July 2020. Eligible participants were cisgender male, 18–34 years old, lived in the Southern United States, reported anal sex with a man in the past 6 months, were HIV-negative, and were current users of oral HIV PrEP. Participants were administered a baseline survey, 7 identical biweekly surveys assessing sexual behavior and PrEP use, and a final survey on sexual behavior and future plans for PrEP use. All survey materials, including the screener, were administered in English. As the end of the study's timeline coincided with the COVID-19 pandemic, an ad hoc survey assessing how the pandemic has influenced participants' sexual behavior, PrEP use, and access to sexual health services was administered in June–July 2020 to all current and previously enrolled participants and will hereafter be referred to as the COVID-19 survey. Of participants enrolled at baseline (n = 78), 56 participants responded to the COVID-19 survey (response rate = 72%). Participants were compensated for their participation. This study was approved by the Institutional Review Board at Emory University.


The COVID-19 survey included questions assessing how the pandemic and efforts to control it have influenced access to and utilization of sexual health services (eg, STD testing, HIV testing, and PrEP) and changes relating to a spectrum of sexual activities (eg, anal sex and sexual activity with causal partners). Participants were asked to indicate the perceived level of COVID-19 acquisition risk on a scale of 0 (no risk) to 100 (highest risk) associated with specific sexual behaviors. In addition, each of the 7 check-in surveys, the final survey, and the COVID-19 survey included identical items assessed over the past 2 weeks: number of missed PrEP doses, number of male sexual partners, anal sex acts, oral sex, and condomless anal sex.


This study includes both cross-sectional and longitudinal components. First, we conducted a cross-sectional analysis of the COVID-19 survey (n = 56), presenting percentages and number of respondents endorsing response options for questionnaire items. We computed the median and interquartile range for the 4 items assessing perceived risk of COVID-19 acquisition for specific sexual behaviors.

For longitudinal analyses, we used data from the larger cohort study and fit linear mixed-effect regression models to examine potential period effects for the number of missed PrEP doses, number of male sexual partners, any anal sex with male partners, any oral sex with male partners, and any condomless anal sex with male partners, all measured in the past 2 weeks. The calendar month the survey was submitted was the independent variable. Using these models, means/percents and SEs were computed of each repeated measure during 7 months (November, December, January, February, March, April, and June) representing distinct periods (ie, prepandemic, early pandemic, and later in the pandemic). All analyses were conducted in SAS 9.4 (SAS Institute, Cary, NC).