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COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK
  1. Iain Hyndman,
  2. Diarmuid Nugent,
  3. Gary George Whitlock,
  4. Alan McOwan,
  5. Nicolò Girometti
  1. 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Nicolò Girometti, 56 Dean Street, Chelsea and Westminster Hospital NHS Foundation Trust, London 40126, UK; nicogir{at}


Objectives The COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision.

Methods We conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March–30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use.

Results 814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in ‘chemsex’ and use of SHS than non-PrEP users.

Conclusions COVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

  • sexual behaviour
  • sexual health
  • homosexuality
  • pre-exposure prophylaxis
  • health services research

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  • Handling editor Adam Huw Bourne

  • Contributors IH and NG made substantial contributions to the conception and the design of the work. GGW contributed to the acquisition, analysis and interpretation of data for the work. AMcO and DN provided substantial contribution in the drafting and revision of the paper. All authors approved the submitted manuscript and made substantial contributions that warrant authorship. The paper has not been published previously nor is not under consideration for publication elsewhere.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.