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


At baseline (n = 78), 45% were 18–24 years old (n = 35) and the sample was 47% non-Hispanic white (n = 35), 27% non-Hispanic black (n = 20), and 16% Hispanic (n = 12, Table 1). The majority for participants identified as gay (n = 71, 91%), had at least a college education (n = 67, 88%), and a household income between $20,000 and 74,999/yr (n = 46, 63%). There were minor differences between the cohort at baseline and those who responded to the follow-up COVID-19 survey; notably, there was a smaller proportion who were non-Hispanic black (n = 10, 19%) and of ages 18–24 years (n = 22, 39%) who participated in the COVID-19 survey than at baseline.

Table 2 presents changes in STD/HIV testing, PrEP use, and sexual behaviors from the COVID-19 survey. Five participants (9%) reported discontinuing PrEP use. Several participants reported difficulties obtaining their PrEP medication (n = 8, 16%), and few participants noted switching to event-based dosing (n = 2, 4%). Many participants did not have an HIV test (n = 18, 32%) or STD test (n = 24, 43%) in the past 3 months. Furthermore, several cited difficulty obtaining an HIV test (n = 11, 20%) or STD test (n = 10, 18%) because of the pandemic.

Since the beginning of social distancing guidelines, 79% of participants reported having sex (n = 44), including with someone who lives with them (n = 3, 7%), someone who does not live with them that lives alone (n = 33, 75%), and someone who does not live with them that lives with other people (n = 25, 57%). The majority of participants reported decreases in all sexual behaviors examined, ranging from kissing (n = 34, 61%) to anal sex (n = 38, 68%) since the beginning of the COVID-19 pandemic. In addition, most reported decreases in sexual activity with casual partners (n = 46, 82%). By contrast, fewer participants reported decreases in sexual activity with a main partner (n = 21, 38%).

Examining longitudinal trends in sexual behaviors (Table 3), the percent reporting having ≥2 male sexual partner in the past 2 weeks was 31% in February (SE = 5), and this percent declined from February to April (percent = 8%, SE = 4), and then increased from April to June (percent = 25%, SE = 6). Examining earlier months before the pandemic (November–February), there did seem to be some random fluctuation in the percent reporting having ≥2 male sexual partner in the past 2 weeks. The 3 other sexual behavior indicators—percent having any anal sex, any oral sex, and any condomless sex—all measured in the past 2 weeks and with male partners also showed decreases from February to April, increases from April to June, and inconsistent, random fluctuations in months before the pandemic. By contrast, there did not seem to be substantial variation in the mean number of missed PrEP doses by calendar month among those who remained on PrEP.

On a scale of 0 (no risk) to 100 (highest risk), the median perceived level of COVID-19 acquisition risk was 100 [interquartile range (IQR): 14] for kissing; 74 for rimming (IQR: 66); 75 for oral sex (IQR: 67); and 66 for anal sex (IQR: 75; data not shown).