Sexual behaviour, STI and HIV testing and testing need among gay, bisexual and other men who have sex with men recruited for online-surveys pre- and post-COVID-19 restrictions in the UK

Objectives: We examined sexual behaviour, STI and HIV testing and testing need, and identified associated factors, among gay, bisexual and other men who have sex with men (GBMSM) in the UK after COVID-19 restrictions ended and compared these to ‘pre-pandemic’ estimates.

Methods: We analysed survey data from GBMSM (N=1,039) recruited via social media and Grindr November–December 2021. We then compared Grindr-recruited 2021 participants (N=437) to those from an equivalent survey fielded March–May 2017 (N=1,902). Questions on sexual behaviour and service use had 3–4 month lookback periods in both surveys. Unmet testing need was defined as reporting any new male and/or multiple condomless anal sex (CAS) partners without recent STI/HIV testing. Participants were UK-resident, GBMSM, aged ≥16 years who reported sex with men in the last year. Multivariable logistic regression identified associated sociodemographic and health-related factors with unmet STI/HIV testing need in 2021, and then for 2017/2021 comparative analyses, adjusting for demographics differences.

Results: In 2021, unmet STI and HIV testing need were greater among older GBMSM (aged ≥45 years vs. 16-29; aOR:1.45,aOR:1.77, respectively), and lower for PrEP users (vs. non-PrEP users; aOR:0.32,aOR:0.23, respectively). Less unmet STI testing need was observed among HIV-positive participants (vs. HIV-negative/unknown;aOR:0.63), and trans and non-binary participants (vs. cisgender male;aOR:0.34). Between 2017 (ref) and 2021, reported sexual risk behaviours increased: ≥1 recent new male sex partner (72.1%-81.1%,aOR:1.71); ≥2 recent CAS partners (30.2%-48.5%,aOR:2.22). Reporting recent STI testing was greater in 2021 (42.6%-37.5%,aOR:1.34) but not recent HIV testing, and there was no significant change over time in unmet STI (39.2% vs. 43.7%) and HIV (32.9% vs. 39.0%) testing need.

Discussion: Comparable community surveys suggest that UK GBMSM may have engaged in more sexual risk behaviour in late 2021 than pre-pandemic. While there was no evidence of reduced STI/HIV service access during this time, there remained considerable unmet STI/HIV testing need.