High risk sexual behavior, access to HIV prevention services and HIV incidence during the COVID-19 pandemic among men who have sex with men and transgender women in Brazil


BACKGROUND: Brazil has been severely affected by the COVID-19 pandemic. Changes in sexual practices and in health services use may impact HIV incidence rates. We investigated the association between COVID-19 control measures, sexual behavior, use of HIV prevention services, and the incidence of HIV infection among men who have sex with men (MSM) and transgender women in seven Brazilian cities.
METHODS: A web-based survey on COVID-19 nested in two PrEP cohorts - one for adolescents and the other for adults - was carried out between May-November/2020. Information about HIV tests was obtained from follow-up records from the cohorts, after completing the survey. Logistic regression was used to analyze predictors of unprotected anal intercourse (absence of both PrEP and condom use) with a casual partner (UAI). A decision tree analysis was performed to determine the PrEP service demand profile. P-value <.05 and 95% confidence interval were considered as the significance threshold.
RESULTS: Among 616 respondents (response rate 48,8%), most were MSM (89.4%), adolescents (15-19yo 47.5%), and black (55.1%). Prevalence of UAI was 15.9%. Resuming or starting sex work during the pandemic increased the chance of UAI in 3.09 times (1.05-9.13) and 1.61 times (1,03-2.51) for adults aged 30-62yo, when compared to 15-29yo. A total of 80.2% of people reporting UAI restricted sexual relations during the pandemic. Living with someone at increased risk for COVID-19 reduced the chance of UAI by 41% and greater adherence to quarantine measures reduced it by 12% (1-point increase on a scale of 1-10). One third did not access PrEP services, more frequently among those who abstained from sex (47.6%). Those reporting UAI had 1.99 times (1.14 ' 3.46) higher chance of making a same-day appointment. Three new HIV infections occurred (incidence rate of 0.49%; 0.1-1.42) in individuals aged <19yo who interrupted or did not adhere to PrEP during the pandemic.
CONCLUSIONS: Despite the reduction of sexual activity among participants and the availability of PrEP services during the COVID-19 pandemic, a significant occurrence of UAI and new HIV infections was observed, highlighting the importance of retention in HIV prevention services and PrEP adherence to control the HIV epidemic during sanitary crises.