The Impact Of Social Restriction In Early Stage Of COVID-19 Pandemic On HIV High-Risk Behaviour And HIV Testing Among Men Who Have Sex With Men (MSM) In China

Objective(1)Exploring the impact of social restriction measures on HIV high-risk behaviors among men who have sex with men(MSM),including unprotected sex,multiple sex partners,and substance abuse;(2)Exploring the impact of social restriction measures in the early stage of COVID-19 on HIV testing among the MSM;(3)To understand the awareness and utilization of pre-exposure and post-exposure prophylaxis in among MSM during the COVID-19 pandemic.Methods This study is a hybrid research conducted in the form of semi-structured interview,in which face-to-face interviews with closed and open-ended questions were conducted using the Timeline Follow-back(TLFB)method for collecting retrospective data including frequencies of HIV high-risk behaviors,HIV testing,and data related to awareness and utilization of pre-exposure and post-exposure prophylaxis.A recording pen was used to record the interview.Face-to-face interviews were conducted in Changsha City Center for Disease Control and Prevention and three gay-friendly community-based organizations in Changsha from November 2020 to January 2021.Snowball sampling was used to recruit MSM who have sexual behaviors with homosexual partners during the COVID-19 lockdown period(January to May,2020)and post-lockdown period(June to October,2020).All statistical analyses were conducted with SPSS 22.0.The statistical methods included descriptive analysis,Mc Nemar’s Chi-square test,Wilcoxon signed-rank test,Binary Logistic regression analysis,and multiple linear regression analysis.Content analysis was performed with the assistance of the NVivo 12.0 software to analyze the qualitative data which were transcribed verbatim.Results(1)Basic characteristics: the average age of 159 MSM was27(M±SD:26.79±8.04)years old,30.8%(49/159)of MSM were students,81.7%(130/159)of MSM had a high school diploma or above,and 45.3%(72/159)of MSM had a regular sexual partner.16.4%(26/159)of MSM were confirmed HIV infection,7.5%(12/159)of MSM were waiting to be diagnosed during the interview period of this study.(2)Sexual behavior characteristics: During the lockdown period(from January to May,2020),43.4%(69/159)MSM had HIV high-risk behaviors,in which,23.9%(38/159)MSM had unprotected sexual behavior,23.3%(37/159)MSM had multiple partners,16.4%(26/159)of MSM had the experience of substance use.However,during the post-lockdown period(from June to October),65.4%(104/159)MSM had high-risk behaviors,in which 35.2%(56/159)had unprotected sexual behavior,35.2%(56/159)had multiple partners and 27%(43/159)once used the substance.In conclusion,the number of unprotected sexual behaviors increased by 30.2%(48/159),multiple partner behaviors increased by 49.1%(78/159),and substance use increased by 23.9%(38/159).All the above changes were statistically significant(P < 0.01).The main reasons for the rebounding of MSM high-risk sexual behaviors included: 1)feeling empty and boring during the social restriction period;2)Increased use of social software during the social restriction period.(3)HIV testing: 73.7%(112/152)of MSM(excluded seven MSM who had diagnosed HIV infection statues before January,2020)had at least one HIV testing experience within the ten months of TLFB interviews,among which the HIV testing rate during the lockdown period was 36.8%(56/152),and 65.8%(100/152)during the post-lockdown period.The difference was being statistically significant(P < 0.01).During the lockdown period,20.3%(31/152)of MSM were tested through the self-testing kit,and 21.1%(32/152)of MSM were still tested for HIV through the self-testing kit.Reasons for the rebounding of HIV testing included: 1)Gay-friendly community-based organizations resumed routine HIV testing services after the COVID-19 social restriction;2)Due to the increase in high-risk sexual behaviors,the frequency of HIV testing was also increased after the social restriction.(4)Awareness and utilization of Pr EP and PEP: 57.9%(92/159)of 159 MSM had once heard about the Pre-exposure prophylaxis(Pr EP),while only two MSM had once used Pr EP;84.9%(135/159)of MSM had once heard about Post-exposure prophylaxis(PEP)and only one person(0.6%,1/159)had used PEP after HIV high-risk behaviors from January to October,2020.Excluding the 26 MSM witch confirmed HIV infection,52.6%(70/133)of MSM said they would not consider using the Pr EP,while 29.3%(39/133)MSM said they would not consider using the PEP.Reasons mainly included the high price,lack of knowledge,and worry about side effects.Conclusions The social restriction measures during the early stage of the COVID-19 pandemic reduced the frequency of sexual behaviors,HIV high-risk behaviors,and HIV testing among MSM.However,after the restriction measures had been removed,the frequency of sexual behaviors,HIV high-risk behaviors,and HIV testing was increased.Figures 15,tables 8,references 125.