This study is the first to report the change of sexual partner number, sexual behavior, and the related factors among MSM in China during the lockdown of COVID-19. This study extended the existing literature by Hongbo Jiang[12] and Hang Lyu[13]. We found that during the COVID-19 pandemic, more than 60% of MSM had fewer sex partners. Among participants who reduced the number of sexual partners compared to before COVID-19, casual sexual behavior during COVID-19 epidemic has decreased. MSM who had multiple sexual partners, recreational drug use, seeking sexual partners using apps, more frequent to seek sexual partners using apps compared to before COVID-19 measures, HIV test before COVID-19 and HIV test during COVID-19 were more likely to have casual sexual behavior during COVID-19.
Our study found that 60% of MSM decreased their number of sexual partners during COVID-19. We found the characteristics of MSM who reduce the sexual partners during the epidemic, including having multiple sexual partners, having causal sexual partners, using a condom with causal sexual partners, and seeking sexual partners using apps during the COVID-19 epidemic. This finding is similar to the studies conducted in high-income countries. A survey in UK found that 75% of MSM had fewer sexual partners than before the COVID-19 epidemic [6]. The decrease in sexual partner number may attribute to the blocking policy, making it impossible to find sexual partners easily. Clearly, the block policy during COVID-19 can suppress the number of sexual partners of MSM to a certain extent, which may impact the further transmission of HIV among this key population.
MSM who reduced the number of sexual partners were more prone to have casual sexual behavior during the COVID-19 epidemic. Casual sexual behavior, defined as anal sex with a new or unknown partner who was not previously in the same safe environment as the participants[14]. The casual sexual partnership is a significant public health concern among MSM. A previous study reported that 63% of MSM surveyed in New York City reported having casual sexual partners in three months [15]. A web-based survey conducted in the United States reported that 45% of MSM having casual sexual partners in the past six months[16]. As the government lockdown measures, it is difficult to keep sexual partners in Israel[11], UK[6], and USA[17], also in China, that is why this group of MSM prone to seek casual sex. Also, MSM may be more vulnerable to COVID-19 economic consequences and mental impacts compared to the general population, which may prompt them to seek casual sex[18].
Recreational drug use and seeking sexual partners using apps in the last three months were associated with casual and at-risk sexual behavior in our study. Compared with previous studies, they found cocaine and ketamine, as recreational drugs, correlated with multiple partners[19]. Also, cross-sectional online survey found people who using the geosocial networking apps (e.g., Tinder, Grindr) having three or more sex partners in the last year and condom-less sexual activity with new partners in the last 2 months[20]. The HIV testing is correlated with casual sexual behavior[21]. According to our data, people who had HIV test during or before COVID-19 were prone to have casual sexual behavior. Nadav, et al found MSM who had fewer than two casual partners in the past 6 months were related to lower odds of lifetime HIV and past year HIV testing[17]. High frequency of HIV testing can significantly inhibit the occurrence of Sexually transmitted infections (STIs) [22]. Those who usually get the HIV test means they are care about their health and confidence to their health state, so they usually have casual sexual behavior. A study from China found condom use can reduce HIV incidence among MSM [23]. The identification of MSM with at-risk sexual behavior helps control the spread of STI in the MSM group[24]. So, promote HIV test, such as HIV self-testing [25], may reduce the STI and improve risky behavior among MSM with at-risk sexual behavior[26].
This study also has several limitations. Firstly, this study is cross-sectional study, and it is impossible to infer a causal relationship. Secondly, this study was carried out after the COVID-19 epidemic, the data collected three months before the COVID-19 lockdown measures may have recall bias. But since the lockdown date was very close to the Spring Festival, this may help evoke the memories of participants. Third, the MSM included in this research can use the app. But those MSM without mobile phones or internet may not be included, which may lack generalizability.