• pre-exposure prophylaxis
• drug misuse
• antibiotic prophylaxis
• COVID-19
• sexual behaviour

The COVID-19 pandemic and social distancing restrictions have been associated with changes in use of HIV pre-exposure prophylaxis (HIV-PrEP), use of doxycycline as STI-PrEP and sexual behaviour including chemsex behaviour among men who have sex with men (MSM).1 2 As part of a local service needs assessment for the provision of services for MSM using PrEP and MSM engaging in chemsex, we asked MSM to complete a short anonymous online electronic survey after their PrEP monitoring appointment.

Of the 269 MSM who attended for HIV-PrEP monitoring between May and June 2021, 109 (41%) completed the survey: 105 cis-men and 4 transgender individuals. Thirty-four (31%) reported using recreational drugs in the previous 3 months, of whom 18 (17%) used drugs for sex (chemsex) and 12 (11%) as part of group sex; and 2 (2%) reported injecting drug use. All 18 were polydrug users: 9 used crystal methamphetamine, 9 gamma-hydroxybutyrate, 4 mephedrone, 3 ketamine and 4 Phosphodiesterase-5 inhibitorsPDE5 inhibitors. Of the 109 individuals, 5 (5%) reported buying doxycycline online for use as STI-PrEP. During the COVID-19 pandemic, 10 (9%) reported having the same or more non-household, non-steady sexual partners than before the pandemic, 57 (52%) less than before the pandemic, and 41 (38%) reported not meeting partners for sex at all during the pandemic. MSM engaging in chemsex were significantly more likely to use doxycycline PrEP (22% v 1%, p=0.003) and to have continued to see non-steady sexual partners (50% v 1%, p=0.0001) throughout the COVID-19 pandemic.

A small but significant proportion of MSM using HIV-PrEP during the COVID-19 pandemic continued to see the same or increased number of non-steady sexual partners. These MSM were more likely to have engaged in chemsex and use STI-PrEP. Provision needs to be made by services to facilitate adequate harm reduction interventions for this group.