Changes in sexual behavior among men who have sex with men during the spread of COVID-19 in China: results of an online survey

Background: Sexual behavior drives the transmission of sexually transmitted infections, especially among men who have sex with men (MSM). This study aims to evaluate the sexual behavior changed among MSM during the outbreak of COVID-19. Material: and Methods: An online survey was conducted to collect sociodemographic, sexual behavioral, and HIV testing information before and during the COVID-19 epidemic. Chi-square was used to determine the behavior differences before and during the COVID-19 pandemic. We identified the factors associated with casual sexual behavior among MSM using bivariate and multivariable logistic regression. Results: : A total of 506 MSM participated in the online survey. The 506 MSM were individuals born biologically as a male, self-identified as a male, aged 18 or over, and ever engaged in sex with a man (in the past three month). Compared with participants who didn't reduce the number of sexual partners (n = 193, 38.1%), participants who reduced sexual partners (n = 313, 61.9%) had higher values of multiple sexual partners, causal sexual partners, used a condom with causal sexual partners, and sought sexual partners using apps (all p< 0.05). Participants who reduced the number of sexual partners than before COVID-19, reported having a higher proportion of causal sexual behavior (66.77% vs 46.11%, c 2 = 21.047, p< 0.001), which means engaged in casual sex in the last three months. But at-risk sexual behavior, which means unprotected anal sex with a casual partner without using condom protection, did not change significantly between the two groups during COVID-19 (p>0.05). Multiple factors are related to casual sexual behavior and at-risk sexual behavior. Conclusions: : During the COVID-19 pandemic, the lockdown measures significantly impacted the sexual behavior of Chinese MSM. Sustain behavior interventions are still needed during the COVID-19 pandemic.