Background: The coronavirus pandemic has necessitated a range of population-based measures in order to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM.
Setting: Data for this study were collected between 16-Apr-2020 and 24-May-2020 as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of nine indicators related to restrictions, closures, and travel bans.
Methods: We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services.
Results: A total of 10,654 MSM across 20 countries were included. 38% (3992/10396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to PrEP, and 10% (990/9542) interruptions to condom access. For every ten-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95%CI: [0·96, 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95%CI: [0·93, 0·95]), and a 5% reduction in access to PrEP (aPR: 0·95, 95% CI: [0·95, 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely.
Conclusion: More stringent responses were associated with decreased perceived access to services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to minimize service interruptions to the community of gay men and other MSM during this and future waves of COVID-19.