'Just like you would with an STI or HIV': sexual risk mitigation during COVID-19 among gay, bisexual, and other men who have sex with men (GBM) in Canada

BACKGROUND: The COVID-19 pandemic has impacted the sexual behaviours of gay, bisexual, and other men who have sex with men (GBM). Some GBM decreased their sexual behaviours, while others kept engaging in sex with people outside of their households or increased their number of sex partners. However, few studies have focused on how GBM who continued to engage in sexual behaviours assessed and managed risks. We examined the strategies GBM have implemented to negotiate and mitigate sexual risks associated with COVID-19, HIV, and other sexually transmitted infections (STIs) during COVID-19 lockdowns.
METHODS: We conducted semi-structured interviews with 93 GBM as part of Engage-COVID-19, a mixed-methods study examining the impacts of COVID-19 on GBM living in Vancouver, Toronto, and Montreal. Participants were recruited along four key dimensions: ethno-racial backgrounds, age, gender identity, and HIV status. Two rounds of online interviews took place between November 2020-January 2021 and June-October 2021. Interviews were transcribed verbatim and thematically coded using NVivo.
RESULTS: Participants ranged in age from 24-76 years old. 73 participants self-identified as HIV-negative and 20 as living with HIV. We identified four key preventive practices: (1) Asking about health status: participants who reported engaging in sexual behaviours mitigated sexual risks by inquiring about potential partners' HIV, STI, and COVID-19 status; (2) Reducing physical contact during sex: a few men implemented mask-wearing, avoided kissing, and engaged in voyeuristic masturbation to minimize physical contact; (3) Sex with regular partners: some engaged in sexual behaviours only with people they already knew and trusted; and (4) Vaccine status sorting: most participants reported increased sexual activities after receiving COVID-19 vaccinations and used vaccine status sorting by only having sex with partners who have received COVID-19 vaccines.
CONCLUSIONS: Our results show that GBM who continued engaging in sexual behaviours during the COVID-19 pandemic implemented mitigation strategies to reduce risks associated with HIV, other STIs, and COVID-19. Our findings shed light on how GBM are using knowledge gained from HIV prevention to inform their protective behaviours during the COVID-19 pandemic. Significant efforts are needed to provide resources acknowledging the multiple pandemics GBM are attempting to navigate at this time.