How COVID-19 Altered HIV Care, PrEP Use, and Sexual Behaviors of MSM in the Southern US

debunking the patient zero theory of AIDS
This ad hoc survey focused on changes in sexual behaviors and utilization of and access to sexual health services by MSM during the COVID-19 pandemic.

A large proportion of men who have sex with men (MSM) discontinued or altered their pre-exposure prophylaxis (PrEP) regimens, reported interruptions in HIV services, and decreased risky sexual behaviors due to the COVID-19 pandemic, according to a survey published in the Journal of Acquired Immune Deficiency Syndromes. This study adds to a research trend showing COVID-19’s significant impact on HIV/AIDS prevention and treatment. 

Investigators performed cross-sectional and longitudinal analyses on data collected from a cohort study that examined PrEP use among MSM surveyed online between October 2019 and July 2020. Participants were cisgender men aged 18 to 34 years, who lived in the southern US, reported engaging in anal sex with a man in the past 6 months, were HIV negative, and were currently on PrEP.

There were 78 participants enrolled at baseline in October 2019. Then from June to July 2020, 56 (72%) responded to an additional survey, referred to as “the COVID-19 survey,” which asked specifically about the COVID-19 pandemic’s effect on participants’ sexual behavior, PrEP use, and access to sexual health services such as sexually transmitted disease (STD) testing, HIV testing, and PrEP access.

At baseline, 45% (n=35) were 18 to 24 years of age, 27% (n=20) were non-Hispanic Black, and 91% (n=71) identified as gay. In the COVID-19 survey, 39% (n=22) were 18 to 24 years old and 19% (n=10) were non-Hispanic Black.

In the cross-sectional analysis of the COVID-19 survey, 9% (n=5) of participants discontinued PrEP use, 16% (n=8) reported difficulty obtaining PrEP, and 4% (n=2) reported switching to event-based dosing. Additionally, 32% (n=18) did not have an HIV test, and 43% (n=24) did not have an STD test in the past 3 months, with 20% (n=11) reporting difficulty obtaining an HIV test and 18% (n=10) reporting difficulty obtaining an STD test because of the COVID-19 pandemic.

Most participants reported a decrease in all sexual behaviors examined since the beginning of the COVID-19 pandemic except for sexual activity with a main partner. In the longitudinal analysis of baseline participants, all sexual behavior indicators – having multiple sexual partners, anal sex, oral sex, and condomless sex – in the past 2 weeks declined from February to April, then increased from April to June, compared with inconsistent, random fluctuations in the months before the pandemic.

The study had some limitations. Investigators could not longitudinally examine how testing behaviors were affected by the COVID-19 pandemic. All the data were self-reported and susceptible to social desirability biases, and selection bias may have occurred because the COVID-19 survey was optional and not completed by all the baseline participants. The surveys were available only in English, excluding non-English-speaking populations from this analysis.

These findings emphasize the need to make adaptations to the delivery of HIV services during a pandemic, such as “laboratory-only visits for indicated HIV/STD tests, at-home HIV/STD testing, self-testing for HIV through an oral swab-based test, extending the prescription of PrEP to a 90-day supply…using telemedicine when possible, and finally referring patients elsewhere if needed services cannot be provided,” the study authors wrote.


Pampati S, Emrick K, Siegler AJ, Jones J. Changes in sexual behavior, PrEP adherence, and access to sexual health services due to the COVID-19 pandemic among a cohort of PrEP-using MSM in the South. J Acquir Immune Defic Syndr. 2021;87:639-643. doi:10.1097/QAI.0000000000002640