Global sexual health suffered during COVID-19 first wave
Researchers said the COVID-19 pandemic that began in 2020 prevented many from accessing sexual health services like abortions, HIV tests and contraceptives. They also warned that sexual violence could increase as the world emerges from the pandemic, and that monitoring is key in regions where health systems are already stressed, like Africa.
Billions of people globally needed to quarantine to stay safe. Researchers suspected the quarantines in the first wave of the pandemic changed many people's social and sexual behaviour, and impacted their sexual and reproductive health (SRH). In this study they aimed to find out exactly how this changed.
Researchers specifically wanted to know if people changed their sexual behaviours, such as condom use or how often they had sex. They also wanted to know if people experienced more or less violence from their intimate partner.
Lastly, they wanted to know if people changed how they used or were able to access SRH services, such as abortion facilities and testing for sexually transmitted infections (STIs).
The researchers did an online survey to gather information about how the first COVID-19 wave affected people's sexual lives. Almost 23 000 people from 30 countries participated in the survey. Of these, 4 countries were in Africa, 11 countries were in Europe, 6 in the Americas, and 4 in Asia and Oceania.
The survey asked various questions about sexuality, gender identity, sexual behaviour, abortion, and violence from an intimate partner.
The survey showed that condom use stayed the same for about 74% of people and decreased for about 14% of people. It also showed that sexual violence slightly declined from 7% to 9%.
It was also clear that COVID-19 prevention made it difficult to access sexual health services. For example, 9% of people could not access condoms, 8% could not access contraceptives, and 31% could not be tested for STIs. Nearly 31% of people who needed abortion services were prevented or hindered.
This study confirmed that sexual health and behaviour changed during the first wave of the COVID-19 pandemic. This suggests that healthcare authorities need to plan for ways to serve people better in future emergencies.
The researchers suggested implementing telemedicine and self-testing services.
They also showed that online global collaborations like this study are a viable option for future research.
They further emphasised that, once the effects of the COVID-19 pandemic have significantly reduced, researchers must look again at violence from intimate partners. This is because previous studies suggested that this tends to increase more drastically after an emergency than during one.
Previous studies also focused on high-income countries. These researchers did study some low- and middle-income countries, but they say more work is needed to include these countries.
The researchers cautioned that their results might not apply to everyone. For example, the majority of the people who answered their survey questions were women and people from rich countries. Also, since the survey was online, people without proper internet access could not participate.
These researchers were from Botswana, Egypt, Kenya, Nigeria, South Africa, the USA, China, Singapore, Switzerland, Belgium, Czech Republic, Argentina, Panama, UK, Australia, Denmark, Italy, Malaysia, Latvia, Uruguay, and France. They said this research is essential for African countries because their health systems were already under stress before the pandemic.
Background The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium.
Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses.
Results Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy.
Conclusion Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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