Sexual Behavior Change Among Gay and Bisexual Men During the First COVID-19 Pandemic Wave in the United States

Abstract

Background: After decades of navigating HIV and other sexually transmitted infections, gay and bisexual men are responding to new and uncertain risks presented by the coronavirus (COVID-19) pandemic by adapting their sexual behavior.

Methods: This paper uses data from a national sample of 728 gay and bisexual men collected from April 10 to May 10, 2020, to examine changes to sexual behavior in response to the first wave of the pandemic in the USA. We also assess whether behavior modifications are associated with exposure to statewide public health measures, including Stay-at-Home orders.

Results: Sexual minority men report significant changes to their sexual behavior and partner selection during the first wave. Nine out of 10 men reported having either one sexual partner or no sexual partner in the last 30 days at the time of interview, a decrease compared to just before the pandemic for nearly half of men surveyed. Reporting no sexual partners in the last 30 days was significantly predicted by increased exposure to a Stay-at-Home order. Sexual minority men also reduced interactions with casual partners, increased no-contact sexual behaviors (e.g., masturbation and virtual sex), and engaged in new strategies to reduce their risks of infection from partners. HIV-positive men were particularly likely to adopt strategies including avoiding casual partners and avoiding public transportation to meet sexual partners.

Conclusion: Sexual minority men's behavior changes during the first wave may have reduced the impact of the coronavirus pandemic on their communities. Despite substantial changes in sexual behavior for most men in our sample during the initial first wave, we identify some concerns around the sustainability of certain behavioral changes over time and nondisclosure of COVID-19 symptoms to partners.

Keywords: Coronavirus; Gay and bisexual men; Men who have sex with men; Public health policy; Sex; Sexual behavior; Stay-at-Home order; United States.

Fig. 1

Sample distribution by state

Fig. 2

Distribution of responses to the question “Is [the number of partners you had in last 30 days] more or less than before the start of the coronavirus epidemic in the USA, around the end of February/beginning of March?” by number of sexual partners in last 30 days. Note: 57.8% (414) of sexual minority men reported no sexual partners, 32.8% (235) reported one sexual partner, and 9.4% (67) reported two or more sexual partners in the last 30 days from April 10, 2020, to May 10, 2020, in the United States

Fig. 3

Predicted probability of reporting no sex in the last 30 days among sexual minority men in the USA, by duration of statewide Stay-at-Home order at time of survey, April and May 2020. Note: The model controls for additional individual and state characteristics, including age, race, education, HIV status, state of residence, and number of positive COVID-19 cases in the state per 10,000 people

Fig. 4

Predicted probability of reporting two or more sexual partners in the last 30 days among sexual minority men in the USA, by duration of statewide Stay-at-Home order at time of survey, April and May 2020. Note: The model controls for additional individual and state characteristics, including age, race, education, HIV status, state of residence, and number of positive COVID-19 cases in the state per 10,000 people

Fig. 5

Predicted probability of reporting avoiding casual partners to avoid COVID-19 among sexual minority men in the USA, by duration of statewide stay-at-home order at time of survey and whether respondent had a coresident partner/spouse, April and May 2020. Note: The model controls for additional individual and state characteristics, including age, race, education, HIV status, state of residence, and number of positive COVID-19 cases in the state per 10,000 people

Fig. 6

Predicted probability of reporting only having sex with known partners to avoid COVID-19 among sexual minority men in the USA, by duration of statewide Stay-at-Home order at time of survey and whether respondent had a coresident partner/spouse, April and May 2020. Note: The model controls for additional individual and state characteristics, including age, race, education, HIV status, state of residence, and number of positive COVID-19 cases in the state per 10,000 people