Findings from a convenience sample survey of over 1,000 gay, bisexual, and other men who have sex with men (MSM) found many men reporting the COVID-19 pandemic was having an adverse impact on their mental health, economic security, and access to sexual health services. The impacts were particularly high among young men ages 15 to 24.
The study, published in AIDS and Behavior, sampled a subset of the 10,000 men from the annual American Men’s Internet Survey (AMIS), to “understand how COVID-19 is impacting their general wellbeing, sexual health, substance use, and access to HIV prevention and treatment services.”
The survey was conducted from April 2 to 13, 2020. In order to participate in this survey, participants had to be at least 15 years old, assigned male at birth, a U.S. resident, and have reported oral and/or anal sex with a man at least once in their lives. A total of 1,051 men completed the survey; 70% of the respondents were white, 14% Latinx, 8.5% Black, and 6% marked multiracial or “other.” The median age was 35 years old. Twelve percent of the respondents reported that they were living with HIV, and only one person said they were diagnosed with COVID-19.
So while there is no direct correlation yet identified between being gay, bisexual, or queer and COVID-19, the changes in social and sexual connections and access to HIV prevention or treatment in this time may in fact become issues over the long haul.
“COVID-19 has produced widespread changes to U.S. economic resources, social networks, and health care services,” wrote the authors of the study. “Our study provides the first evidence of the scope of these disruptions among U.S. MSM, including direct impacts on sexual partnering and access to HIV prevention and treatment.”
Mental and Emotional Health
Nearly 70% of all respondents said that their overall quality of life has decreased, 73% reported having increased levels of anxiety, and 56% had decreased connection to friends. For many gay, bisexual, or queer-identified men, being connected to friends or “chosen family” networks has been shown in other studies to provide emotional and mental health support, among people who too often deal with homophobia, biphobia, and other forms of stigma in their biological families. Younger men may be sheltering in place in home environments that may create even more anxiety, or may be hostile or violent.
The researchers also asked about substance use and using hookup apps, which for some MSM can be ways to cope with anxiety, depression, or other mental health challenges. Just over half of all respondents said that they had fewer sexual partners, but 48% said they had no change in their sexual partners. And while most men said their use of hookup apps to connect with men (but not to meet in person) had decreased or not changed, younger men were more likely to use the apps to talk to other users. When asked if they used the apps to meet men in person, 49% of all respondents had decreased meeting potential partners in person, while 45% reported no change in their behavior.
When it came to substance use, 10% of all participants said that their use of recreational drugs had increased during the COVID-19 pandemic, but 18% of men up to the age of 24 reported increased drug use. About 31% of those 15 to 24 years old and nearly 25% of men over 25 reported drinking more alcohol.
Accessing HIV/STI Services
With the numbers of MSM who reported no changes in their sexual activity, it is no surprise that despite social distancing measures put in place in many jurisdictions, one-third of respondents attempted to seek STI/HIV testing. High proportions of those men reported some challenges to getting an appointment, due to COVID-19. Most men on pre-exposure prophylaxis (PrEP) reported no problems with getting prescription refills.
Among MSM in the study who are living with HIV, few reported problems accessing or maintaining their antiretroviral therapy. However, far more reported problems with keeping appointments with care providers due to COVID-19 restrictions on what are considered essential care visits. Almost one-third of respondents with HIV said they were getting fewer care visits, 20% said they were having problems making or keeping appointments, and 24% said they were having more issues getting viral load testing or other labs.
While it is clear the impacts of the COVID-19 pandemic are likely to last for many more years, the researchers conclude that HIV prevention and care services must be prepared to actively meet this new paradigm to serve the prevention and care needs of MSM.
“To avoid exacerbating health disparities, we must also make rapid progress on deploying large-scale seroprevalence studies to better understand potential co-morbidity of HIV and SARS-CoV-2 among MSM from across the U.S.,” they write. “Ultimately, systematically characterizing the outcomes and mitigation strategies of both the U.S. COVID-19 epidemic and associated impacts on HIV prevention and care represents a rapidly emerging priority for gay men and other MSM in 2020.”