Background: The COVID-19 pandemic has had unforeseen consequences on the delivery of HIV and STD prevention services. However, little is known about how the pandemic has impacted PrEP-using men who have sex with men (MSM).

Methods: Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered ten surveys in total, including one ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n=56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effects regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months.

Results: A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally-number of male sexual partners, anal sex acts, condomless anal sex, oral sex (all measured in the past 2 weeks)-there was a decrease from February to April followed by an increase from April to June.

Discussion: Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.