Access to HIV and sexual healthcare during COVID-19: gay and bisexual men's experiences during concurrent epidemics


BACKGROUND: The implementation of COVID-19 public health measures resulted in disruptions to sexual health services for many Canadians. We examined how disruptions affected access to sexual and mental health services and impacts on the health of gay, bisexual, and other men who have sex with men (GBM) living with HIV.
METHODS: Engage-COVID-19 is a mixed-methods study examining the impact of COVID-19 on GBM living in Vancouver, Toronto, and Montreal. Using purposive sampling, we conducted two rounds of in-depth qualitative interviews (11/2020-02/2021 and 06/2021-10/2021) with 93 GBM; 20 were living with HIV. GBM discussed the impact of COVID-19 on their lives. Interviews were coded in NVivo software using thematic analysis.
RESULTS: HIV-negative GBM described challenges in accessing HIV/STI testing during various waves of the COVID-19 pandemic. Some participants indicated less/no need for sexual health services since they were having less sex during the pandemic. Most GBM living with HIV accessed health services for HIV without disruption (e.g., prescription refills, bloodwork). There were some changes to in-person healthcare visits during COVID-19 such as masking and social distancing requirements, and extended prescriptions for HIV medications. Although online healthcare appointments posed a challenge for some participants, most GBM living with HIV generally reported high levels of satisfaction with the care received. In contrast, some GBM living with HIV reported interruptions in access to care for mental health and substance use. These participants, most of whom lived alone, also described feelings of loneliness and depression while public health restrictions were in place, as they were unable to see family and friends.
CONCLUSIONS: For GBM living with HIV and already linked to care, there appears to be stability and adaptability of the HIV care system in these Canadian cities. Nonetheless, GBM living with HIV experienced interruptions to mental health and substance use services, posing challenges to their overall health. Our findings signal the need to expand our understanding of essential HIV care to include mental health and substance use supports.

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