BACKGROUND: In late-March 2020, Australian state and federal governments introduced physical distancing measures to combat COVID-19.
We investigated the impact of physical distancing measures on HIV pre-exposure prophylaxis (PrEP) use and sexual behaviour among gay and bisexual men (GBM) in Australia.
METHODS: In April 2020, 940 participants in an ongoing cohort study responded to questions about COVID-19 and changes in PrEP use and sexual behaviours before and following enactment of physical distancing measures.
RESULTS: Mean age was 43.9 years (SD: 13.4). Among the 664 men who reported sex with either fuckbuddies or casual partners, 82.8% had ceased sex with those partners entirely following COVID-19 and the average number of partners per day decreased from 0.089 (SD: 0.144) to 0.031 (SD: 0.097; p<0.001), representing a reduction of 65.2%.
Among non-HIV positive GBM, 48.2% reported PrEP use prior to COVID-19 physical distancing measures. Among those, 58.4% continued to use PrEP and 41.6% ceased use since physical distancing restrictions were imposed. Men who ceased PrEP use were more likely to cease having sex with casual partners (90.8% vs 74.8%; p<0.001) and with fuckbuddies (88.2% vs 64.4%; p<0.001).
Most (86.0%) indicated that the reason for their cessation of PrEP use was 'I'm not having sex' but 17.0% also indicated that they had found it more difficult to access PrEP during social distancing restrictions.
CONCLUSIONS: The dramatic decreases in PrEP use and sexual activity observed in these data will likely result in short-term reductions in new HIV and sexually transmissible infections diagnoses in the short term, but they may be transient as COVID-19 physical distancing restrictions are eased, and reinstated, over time. These dramatic reductions in sexual activity may be difficult to sustain throughout physical distancing restrictions.
On-demand PrEP messaging could be usefully deployed to GBM who have ceased their PrEP use during physical distancing measures. The possibility of continued non-use of PrEP, or lack of preparedness for recommencement of PrEP when physical distancing measures eventually ease may lead to short term increases in HIV infections. Policy responses and harm reduction interventions will need to be appropriately targeted as GBM engage with a 'new normal'.