Let’s talk about sex: A look at sex and sexual health services in the time of COVID-19, according to BCCDC
By Province of British Columbia
A survey led by the BC Centre for Disease Control’s Clinical Prevention Services highlights challenges in accessing sexual health services during the pandemic and the potential for virtual care.
The COVID-19 pandemic continues to impact us both personally and professionally, altering the way we work, live and play. Everything from family gatherings, to commuting, to sexual activity and safety, has changed. Many health services, including sexual health services, initially closed or reduced availability during the first phase of the pandemic.
The BC Centre for Disease Control (BCCDC) surveyed nearly 1,200 clients of the Sexually Transmitted Infections (STI) Clinic and GetCheckedOnline between July 21 and August 4, 2020 to find out more about how people’s sexual health and needs for sexual health services evolved during the early days of the pandemic, before the second wave in B.C.
Troy Grennan, physician lead, HIV/STI Program, Mark Gilbert, medical director and Hsiu-Ju Chang, research manager, all from the Clinical Prevention Services team at BCCDC, shared some of the findings of the survey and what these results mean for British Columbians.
Less sex, but also not seeking needed care
The survey was developed and conducted when BCCDC’s STI clinic saw declines in STI testing rates and diagnoses in the initial months of the pandemic. The survey suggested that during this time, people had fewer partners and therefore less need for testing.
More concerning, however, the survey also showed that just over half of people did not seek the care they needed. This may have led to people not getting timely STI testing or treatment, or other services such as accessing birth control medications.
The most common reasons people gave for avoiding or delaying seeking sexual health services were:
- Public messages early in the pandemic to avoid seeking any healthcare that was not essential
- Concern about getting COVID-19 while travelling to or at a clinic or lab
- Closure of sexual health services due to the pandemic.
“We felt it was important to look at how this pandemic impacted British Columbians and their lives so that our clinics can better meet their needs,” said Grennan.
“We found that many individuals needing sexual health services did not have their needs met during the pandemic for a variety of reasons, including, but not limited to, concerns about COVID-19 transmission.”
“The silver lining was the fact that users of GetCheckedOnline, BC’s online testing service for STIs, were less likely to report unmet sexual health needs during the pandemic, suggesting that internet-based testing services and other virtual health care services play an important role in mitigating service access issues,” added Gilbert.
New service options to fit client needs
In addition to GetCheckedOnline, BCCDC also provides virtual visits for HIV pre-exposure prophylaxis, telephone triage, and online chat services. During the pandemic, there was an increasing focus on these services. The survey uncovered other potential options that appear popular to clients surveyed, such as test kits or antibiotics at home in plain packaging, self-collection kits for testing, and express testing. Express testing is where clients can get tested at a clinic for sexually transmissible and blood-borne infections (STBBI) without seeing a nurse or physician if they do not have symptoms and do not have a concerning event.
“Overall, the survey shows that our clients are interested in services that reduce in-person visits,“ said Grennan. “BCCDC is up to the challenge of increasing access to our sexual health services by continuing developing and implementing new service options that fit our clients’ needs.”
What’s next?
These findings affirm the direction the BCCDC STI clinic work to develop alternative methods for sexual health care, many of which can extend the reach of the clinic beyond the Vancouver area, as well as providing support for new approaches such as express testing.
BCCDC has also shared the results of the survey with knowledge users including STI nurses and physicians, and HIV and sexual health service leads to help with future planning, and development of new service options to address the identified barriers.
The findings have also informed provincial discussions about the unintended consequences of the response to the COVID-19 pandemic, and will be included in an upcoming provincial report.
Other notable results
The survey also found that the COVID-19 pandemic had other impacts including worsening of mental health, stress due to financial pressure, and increases in substance use, notably alcohol. These findings support the role for providers of sexual health services in supporting client needs in these areas.
Many participants reported feeling judged by others for having sex during the pandemic, and many of them used COVID-19 risk reduction strategies, highlighting the importance of using sex-positive, harm reduction approaches to sexual health promotion.
- 64% of participants looked for or received information about being exposed to COVID-19 infection during sexual encounters
- 35% of participants felt they would feel judged by others for having sex during the pandemic
- Overall, 26% of participants agreed that they were, or would soon be, having sex with more people than earlier in the pandemic.
- In the first phase of the BC pandemic (March to mid-May 2020), 65% of participants reported worry about getting COVID-19 during sexual encounters. By the time of the survey, 26% reported feeling less worried.
For the full survey results, please visit this link.
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