By Dr Dean Murphy, Research Fellow, Kirby Institute, UNSW, Sydney and Alfred Health, Melbourne.

The initial period of the COVID-19 pandemic was characterised by decreases in the number of sexual partners/encounters among gay, bisexual, and queer-identifying (GBQ) men (1-6). In Australia, from late March, community-based LGBTQ and HIV organisations also started explicitly advising people in LGBTQ communities to refrain from having casual sex (7). However, to date, very few studies have explored risk-reduction strategies (4), which is somewhat surprising, given questions about the feasibility of sustaining such sudden and dramatic changes (2, 6), although some studies have at least reported how changes have been tempered by partner type (3).

A recent review of comments to open-ended questions about COVID-19 in an ongoing cohort study[i] of gay and bisexual men revealed that these men were adopting a range of strategies to avoid the risk of infection. In particular, men tended to restrict sex to partners who were ‘known’ to them – although there was quite a lot of variation in what was considered a ‘known’ partner. For some participants it referred specifically to people with whom they were already very familiar (including friends), whereas for others it was a much looser concept. This strategy was pursued because they had at least some awareness of these men’s lives – including their other sexual partners – and was also considered useful with regards to notifying recent contacts in case of infection. This strategy was often supplemented by other measures, such as spacing out sexual contacts temporally in order to account for the average incubation period of the disease – and therefore to reduce the likelihood of transmission within sexual networks.

Many men also reported that they screened potential sex partners, and this screening was based on a range of factors including: symptoms; residential location; recent travel; work role; and number of other sexual contacts. Less common were in situ practices to reduce risk, such as avoiding kissing or the exchange of semen. Several participants also speculated about the risk of transmission of SARS-CoV-2 through sexual contact, focusing for example on semen. Alongside their reporting of strategies to avoid transmission, participants also often indicated that they did not think these strategies were necessarily likely to be very effective between sexual partners. Notably, men rarely referred to testing as part of their strategies to reduce risk (and usually only speculatively), and the federal government’s COVIDSafe app was not referred to at all.

These findings provide insights into cultural responses to the pandemic, some of which have particular resonances with responses to HIV.

References

1. de Sousa AFL, Oliveira LB, Schneider G, Queiroz AAFL, de Carvalho HEF, de Araujo TME, et al. Casual sex among MSM during the period of social isolation in the COVID-19 pandemic: Nationwide study in Brazil and Portugal. medRxiv. 2020.
2. Sanchez TH, Zlotorzynska M, Rai M, Baral SD. Characterizing the Impact of COVID-19 on Men Who Have Sex with Men Across the United States in April, 2020. AIDS and behavior. 2020;24(7):2024-32.
3. Hammoud MA, Maher L, Holt M, Degenhardt L, Jin J, Murphy D, et al. Physical distancing due to COVID-19 disrupts sexual behaviours among gay and bisexual men in Australia: Implications for trends in HIV and other sexually transmissible infections. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2020;Epub Ahead of Print.
4. Shilo G, Mor Z. COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey. The journal of sexual medicine. 2020.
5. Brawley S, Dinger J, Nguyen C, Anderson JS. Impact of COVID-19 related shelter-in-place orders on PrEP access, usage and HIV risk behaviors in the United States. AIDS 2020: 23rd International AIDS Conference; July 6-10, 2020; Virtual (Abstract OADLB0101)2020.
6. Pebody R. A quarter of gay men report casual sex during UK lockdown: NAM; 2020 [updated 11 June 2020. Available from: https://www.aidsmap.com/news/jun-2020/quarter-gay-men-report-casual-sex-during-uk-lockdown.
7. ACON. COVID-19 Update: Casual Sex and Social Distancing Sydney2020 [updated 20 March; cited 2020 20 March]. Available from: https://www.acon.org.au/about-acon/latest-news/media-releases/page/2/#acon-covid-19-update-casual-sex-and-social-distancing.

[i] The Flux Study COVID-19 Diary

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