Objectives To describe the early impact of COVID-19 and associated control measures on the sexual behaviour of pre-exposure prophylaxis (PrEP) users in Wales.
Methods Data were obtained from an ecological momentary assessment study of PrEP use and sexual behaviour. Participants were individuals accessing PrEP through the National Health Service (NHS) sexual health clinics across four health boards in Wales. Weekly data documenting condomless sex in the preceding week were analysed between 03/02/2020 and 10/05/2020. The introduction of social distancing measures and changes to sexual health clinics in Wales occurred on the week starting 16/03/2020. Two-level logistic regression models were fitted to condomless sex (yes/no) over time, included an indicator for the week starting 16/03/2020, and were extended to explore differential associations by relationship status and sexual health clinic.
Results Data were available from 56 participants and included 697 person-weeks (89% of the maximum number that could have been obtained). On average, 42% of participants reported condomless sex in the period prior to the introduction of social distancing measures and 20% reported condomless sex after (OR=0.16, 95% CI 0.07 to 0.37, p<0.001). There was some evidence to suggest that this association was moderated by relationship status (OR for single participants=0.09, 95% CI 0.06 to 0.23; OR for not single participants=0.46, 95% CI 0.16 to 1.25).
Conclusions The introduction of social distancing measures and changes to PrEP services across Wales was associated with a marked reduction in reported instances of condomless sexual intercourse among respondents, with a larger reduction in those who were single compared with those who were not. The long-term impact of COVID-19 and associated control measures on this population’s physical and mental health and well-being requires close examination.
- sexual behaviour
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Handling editor Tristan J Barber
Twitter @DaveGuk87 @prep_do, @HughesDyfrig, @Richard_GP @GP_SexualHealth, @adamthomasjones, @AdamDaleNewman1, @kerryhood
Contributors DG led the design, collected data, conducted statistical analysis and drafted the manuscript. CK contributed to the design and interpretation of the article and drafted the change to PrEP services in Wales. All other authors (DH, ZC, FW, MdB, RM, ATJ, AW and KH) contributed to the design and interpretation of the article and critically revised the manuscript.
Funding The DO-PrEP study was funded by the Welsh Government through Health and Care Research Wales (project ref HF-17-1411).
Disclaimer The funder had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication. The corresponding author confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests DG, KH and FW report receiving funding from Health and Care Research Wales during the conduct of this work. RM reports funding from National Institute for Health Research during the conduct of this study.
Patient consent for publication Not required.
Ethics approval Ethical approval to study sexual behaviour of PrEP users in Wales, how this changes over time and associated contextual effects was granted by the Wales Research Ethics Committee 3 (reference number 19/WA/0175).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.
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