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The implications of COVID-related sexual distancing and medical service interruption

A recent study in the Atlanta area shows that sexual distancing related to Coronavirus Disease 2019 (COVID-19), along with an interruption in clinical service for sexually transmitted diseases, may increase the future incidence of human immunodeficiency virus (HIV) and others sexually transmitted infections (STIs). The study is currently available on the medRxiv * preprint server.

Since its inception, the COVID-19 pandemic has severely impacted the health systems and economies of many countries around the world. In addition, control measures that were used to contain the pandemic, such as: B. social distancing, indirectly affects the spread of HIV and other sexually transmitted diseases by reducing sexual activity. Another critical impact of the pandemic is disruption of clinical care for HIV / STIs.

In the United States, sexual activity between male partners is the leading cause of transmission of HIV / STIs. However, due to the limitations associated with COVID-19, reductions in the number of partners as well as the frequency of sexual activity have been observed in men who have sex with men (MSM). At the same time, HIV / STI-related clinical benefits such as diagnostic screening, the use of pre-exposure prophylaxis, and the continuation of therapies for MSM have been reduced in US regions with high HIV / STI prevalence such as Atlanta.

In the current study, scientists from Emory University, the University of North Carolina, and Harvard Medical School sought the combined impact of the reduction in transmission caused by sexual distancing and the induction of transmission caused by the interruption of service on the overall incidence of HIV / to determine. STIs in the long run.

Relationship between duration of sexual distancing and service interruption in the cumulative (5-year) incidence of HIV and STIs per 1000 susceptible MSM. Individual fields show the distribution of 500 simulations on each scenario.

Current study design

The study used a network-based model for the simultaneous spread of HIV, gonorrhea and chlamydia for black, Spanish and white MSM patients (age group: 15 to 65 years) in Atlanta. Scientists examined the impact of COVID-19-related changes in the behavior of sexual partnerships (main, casual, and one-time relationships) on the overall incidence of HIV / STIs. In addition, they investigated how an interruption of the COVID-19 service (HIV screening, HIV pre-exposure prophylaxis, HIV treatment and STI treatment) could affect the HIV / STI trajectories over the next 5 years.

Important observations

The researchers observed that an 18% reduction in clinical service and the partnership network for 18 months could largely offset the mutual effects on HIV. However, it has been found that the same situation has a positive effect on STI incidence.

It was found that a decrease in clinical service over a longer period of time is associated with a higher incidence of HIV and STIs. A reduction in the incidence of HIV / STI has been observed with long-term sexual distancing. Various clinical services have found that an interruption in antiretroviral therapy services to HIV patients has the greatest impact on the estimated increase in HIV cases. Based on the study model’s situation of 3 months of sexual distancing along with 18 months of reduction in clinical service, the scientists estimated that there would be an additional 900 and 57,000 cases of HIV and STIs in the MSM population in Atlanta, respectively, over the next 5 years. This indicates that while practicing sexual distancing may have a balancing effect on the disruption of service, the timing of these changes is important in determining the incidence rate of HIV / STIs. A short-term change in sexual behavior, along with a long-term interruption in service, can actually increase the incidence rate.

Overall, the study projections suggest that reducing the number of sexual partners along with long-term sexual distancing has a strong impact on reducing the incidence of HIV and other sexually transmitted diseases. In contrast, long-term interruption of clinical services without sexual distancing can significantly increase the incidence of these infections.

However, these results are limited to the MSM population, which has a higher baseline incidence of HIV and other STIs and lower baseline access to clinical services related to HIV / STI. Therefore, additional studies are needed to extrapolate the data for other populations.

Study significance

The study results show the indirect effects of the COVID-19 pandemic on the prevention and management of other infectious diseases. This requires improved government policies to ensure uninterrupted clinical service. A step should also be taken to raise awareness of protective sexual behavior during the COVID-19 pandemic.

* Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.

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