Examining the impacts of the COVID-19 pandemic on syndemic conditions and PrEP use among HIV among gay, bisexual and other men who have sex with men in Vancouver, Canada


BACKGROUND: The secondary impacts of the COVID-19 pandemic may disproportionately affect the health and wellbeing of gay, bisexual and other men who have sex with men (GBM), particularly related to HIV. We assessed trends of syndemic production and trends and correlates of pre-exposure prophylaxis (PrEP) interruptions among HIV-negative/unknown GBM in Vancouver.
METHODS: Sexually-active GBM, aged '¥16 years, were recruited through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview every 6 months and data were linked to BC HIV Drug Treatment Program to assess PrEP uptake and continuation. We used univariable generalized-linear mixed models to examine 1) trends in syndemic conditions (i.e. anxiety, depression, interpersonal violence, polysubstance use, alcohol use) and 2) trends in PrEP interruptions (6-month periods) among HIV-negative/unknown GBM. We also applied 3-level mixed-effects logistic regression with RDS clustering to examine the individual additive and interaction effects of syndemics among GBM reporting PrEP use before study visit and factors associated with PrEP use interruptions. Follow-up analyses includes data from before and during the COVID-19 pandemic (March 2018-April 2021).
RESULTS: Our study included 760 participants/data on 2339 visits, from March 2018-April 2021. Depressive symptoms increased over the study period (OR=1.33, 95%CI=1.14-1.54) with an increase after the onset of COVID-19 pandemic in Canada. We also found an increasing trend of GBM reporting PrEP interruptions over time (aOR=2.59, 95%CI=1.96, 3.42). The time-period after the onset of COVID-19 (Sept 2020-April 2021) had greater odds of PrEP interruptions (aOR=16.33, 95%CI=4.73, 56.44) compared to the March 2018-March 2020 time-period. The only associated syndemic condition was depression (aOR=7.22, 95%CI=1.12,46.47). We did not find interactions with other syndemic conditions. Assessing HIV risk, GBM who met clinical eligibility for PrEP were less likely to report PrEP interruptions than GBM who were not PrEP eligible (aOR=0.15, 95%CI=0.04-0.53).
CONCLUSIONS: We found increased depressive scores and PrEP interruptions among HIV-negative/unknown GBM since the onset of the COVID-19 pandemic. However, those most at risk for HIV were less likely to have PrEP interruptions. Additional mental health services and targeted follow-up for assessment for PrEP continuation may be needed to mitigate the impacts of the pandemic on GBM.

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