Survey findings
Overall, 70 MSM responded to the online survey. The median age of participants was 33 years (IQR 18-66). The sample was largely white (n=66, 94%), educated with a university degree or higher (n = 45, 64%) and single (n = 43, 61%), full results detailed in Supplemental Material. Of these, 60% (n = 42) reported no sexual activity during lockdown with the main reason being that they were trying to limit social contact (n = 28, 67%). Other reasons included no privacy where they lived (n = 5, 18%) and not wanting sex (n = 4, 14%). Of those sexually active during lockdown (outside the household), 83% (n = 23) engaged in sex with someone outside of their household during lockdown. Most participants reported that they had fewer sexual partners during the lockdown than prior to lockdown (n = 52, 74%). Half of participants were concerned about contracting COVID-19 (n = 33, 51%), and 89% (n = 62) agreed with the lockdown measures.
Figure 1 presents how the lockdown measures reduced sexual behaviour of participants with almost half (n = 32, 46%) reporting that in an average week (pre-COVID) they would engage in sexual activity with two or more new partners. In comparison, during the 12 weeks of lockdown (23rd March 2020 to 15th June) over 80% (n = 56) reported no new sexual partners each week. However, the survey data also indicated that the number of participants engaging in sex with new partners subsequently increased as each week passed from 23rd March.
Findings also indicated that many sexual behaviours were reduced or stopped: (see Fig. 2) 70% (n = 49) stopped or reduced engaging in ‘hook-ups’ via apps (using apps to meet people for sex), 73% (n = 51) stopped or reduced oral sex, anal sex (with and without a condom) and group sex were stopped or reduced (n = 53 76%, n = 48 69% and n = 40 57%) respectively. Perhaps in response to this reduction in sexual behaviour with others, masturbation was reported to increase among many participants (n = 39, 56%). Virtual sex showed a mixture of responses across all options.
Interview findings
Twenty participants were interviewed, ages ranging from 19 to 53 years. Most participants reported being white British, gay (both 85%) and single (70%).
Overall impact on sex
Interview data indicated that the Covid-19 pandemic and lockdown measures enforced had resulted in major changes to participants’ own and others’ sexual behaviour. It was commonly reported that they themselves and others adhered stringently to the lockdown rules and avoided engaging in sexual contact with anyone outside of their household. Although, as with most rules, it was acknowledged that there were some who would not follow the rules and continue with their behaviour regardless of the pandemic.
“There has been definitely a shift in people’s opinions on going out and getting sex in a number of people that I speak to and that I know personally. However, I also know that throughout the lockdown, some people were still engaging in like sex parties or very, very risky, unhealthy behaviours.” P01.
However, as lockdowns started to ease it was believed that people took this as a green light to start to engage in sexual activity with others. Despite social distancing measures and rules against entering one another’s homes being in place.
“Well, I think last year it [first restrictions] definitely did [reduce sexual activity], but I don’t think it’s going to be long lasting. I think it’s going to… my perspective of it is the sooner lockdown’s… well, the moment lockdowns start to ease, people are going to be, in some ways, a bit worse than they were before, because they’re going to have missed that social contact. After the main lockdown of March and May last year, my friends were definitely a lot more wanting to do stuff because they thought, oh well, we can now. I don’t think we’re going to find people have less sex or do less things. But I think they’re just more restrained while we have lockdowns in place. The moment they get lifted, most of my friends are straight back onto Grindr.” P19.
One participant who had not engaged in sexual activity throughout the pandemic indicated that when restrictions are removed it would lead to the need for an enhanced conversation relating to sexual activity with future partners. His statement suggested that the pandemic may have enhanced his awareness and concerns relating to the transmission of infectious diseases, beyond solely STIs.
“I, during COVID, have physically touched no one and I intend to continue that way. But that’s a personal choice. But I think, you know, anything would have to… emerging from COVID, whenever that happens, involve probably an even deeper conversation than would have been the case previously.” P04
Lockdown fatigue
Interview data indicated that some participants viewed there to be different levels of adherence to the lockdown rules depending on the lockdown being discussed. The initial lockdown from March was seen to be most widely accepted with the majority following the rules and not meeting people outside their household for sex. As mentioned previously, the first easing of lockdown in July 2020 was viewed by some as an approval to return to normal in terms of sexual behaviour. The circuit break and winter lockdown were perceived to have had less impact on people’s behaviours as people were more likely to continue meeting people for sex.
“At the start of lockdown, the first one in March, I feel like it was just like the general consensus that most people weren’t meeting. But we’re in a full lockdown now [winter lockdown] and I don’t think people have the same attitude.” P16.
Although, the seriousness of the situation that led to the winter lockdown and increasing restrictions throughout latter months of 2020 did lead some to alter their behaviours and adhere to social distancing rules despite breaching them throughout the summer and autumn months.
“I went through a period between the initial lockdown and July where I did not have sex at all. The sod it button came out and I thought, oh f*** it, I’ll just go and… so that’s when I started being able to take PrEP. And was a little more active between about July and November. It tended to be people I already knew, people I’d maybe met with a dozen times or so before, regular partners but on a casual basis. I’ve not done anything since December, as things [Covid-19 cases] have got worse, progressively.” P13.
Shame
Among those who reported engaging in sexual activity during the lockdown, some described a sense of shame around the activity. They also described how sexual intercourse and intimacy was something they needed at that time to cope with the difficulties arising from the pandemic and restrictions. Suggesting sex is an activity to ease mental distress and ‘escape’ reality.
“I would be telling a lie if I said that I hadn’t hooked up with somebody during this… during this pandemic. Does that make me proud? Does that make me happy? No. But is it what I’ve needed in that moment to… you know, to not feel completely shut off from everything? And also, just to kind of… also sex is escapism, to forget this massive, horrible situation that is happening right now, right? And again, I’m not here to moralise anybody.” P05.
This sense of shame around having sex during the pandemic was mentioned by many participants with conversations suggesting that people have become “fearful about saying that they’ve had sex with somebody, because they’re going to be judged because of the whole Covid thing” (P02). This is believed to have led to sex being more hidden with people not engaging with sexual health services due to them not wanting to admit that they are having sex during the lockdowns.
“They aren’t going to a sexual health clinic because they’re not supposed to be out and about. When the whole Covid… when the whole lockdown, there was people from the group that were still going out, having unprotected sex and having sex with people. And it was only afterwards when we got to the end that we found out that some… that some people were [having sex]. So, it’s kind of… I think what it’s done is kind of driven it a bit more underground.” P02.
Impact of restrictions
Despite the pandemic and associated restrictions having a negative impact on people’s sex lives, some participants were able to identify some positive aspects. For example, some believed that the restrictions on social activities had resulted in a reduction of sexually transmitted infections. As one participant asserted: “This is really a firebreak, an STI firebreak.” (P08).
“I think culturally COVID-19 has forced people to limit the amount of people they see and limit the amount of like random encounters that people have. So, in terms of spreading STIs and STDs, it’s limited in that sense, because people are meeting less people.” P10.
However, concern was raised that despite there being a reduction in spread, there may also be a reduction in testing. Although in Wales postal testing for STIs was introduced while GUM clinics were closed, there was a concern that many people were not aware of the postal testing service. This could lead to an increase in spread if people are continuing to meet for sex but not getting tested/treated.
“But general sleeping around has got to have reduced over that time. If there was proper, you know, testing like these postal tests, like I did, around that time, I would imagine it’s had a positive effect in reducing the amount of STIs spreading around. But on the other hand, if people don’t know about those tests… the postal tests, like you said, they might have, you know, not… they might have missed two or three opportunities to go to a clinic when they had something.” P03.
Alternatively, while the lockdown and restrictions are seen to have a positive impact on the transmission of STIs, many of those interviewed believe that once all restrictions are lifted there will likely be a large rise in STI rates due to a surge in sexual activity among MSM.
“I say a bit of a spike, a huge orgy of activity once lockdown is finally lifted. And… yeah. I think everyone’s going to go wild, quite frankly. So that’ll be interesting to see how that happens.” P13.