Differences in Sexual Health of Mexican Gay and Bisexual Youth and Adults During the COVID-19 Pandemic

Abstract

Objective: compare and analyze the implications of COVID-19 on the sexual health of Mexican gay and bisexual young and adult men (GBM). Method: an online survey with 1001 GBM participants. Information was collected on sexual desire, use of mobile applications, sexual practices during the pandemic, and prevention of sexually transmitted infections (STIs) from August to October 2020. Young participants were compared with adults. Results: Young GBM reported more challenges to their sexual health in the pandemic. There was an increase in sexual desire, mobile applications, and a decrease in access to STIs prevention supplies. Discussion: Implications for sexual health policies for these groups during health contingencies are discussed.

Introduction

COVID-19 is an infection caused by the SARS-CoV-2 virus, which can lead to multi-organ damage and is transmitted from person to person through contact of respiratory secretions of people with the virus. The first case was reported on December 8, 2019 in Wuhan, China, and by March 2020, the World Health Organization declared COVID-19 as a new global pandemic (Maguiña Vargas et al., 2020). The first case in Mexico was detected on February 27, 2020 (Suárez et al., 2020), and due to the rapid increase of cases, the federal government implemented a social distancing policy on March 23, 2020. In addition, other preventive measures were recommended, such as frequent hand washing, use of antibacterial gel, covering the nose and mouth with masks in public places, greeting from a distance, and confining people with symptoms to their homes (Suárez et al., 2020).

The temporary suspension of non-essential activities and voluntary social isolation was proposed to mitigate the spread of COVID-19. Such restrictions were more strongly recommended for those at higher risk of acquiring COVID-19 or presenting severe symptoms. For example, those aged 60 years or older, people with cancer, diabetes, HIV, AIDS, pregnant people, or people with cardiorespiratory disease were consistently asked to socially isolate themselves (Suárez et al., 2020). Despite these strategies, by July 25, 2021, almost three million cases were confirmed, and 238,424 deaths had been reported in Mexico (Ministry of Health, 2021).

The primary strategy to prevent SARS-CoV-2 transmission in Mexico consisted of the “Epidemiological Traffic Light,” which included monitoring and regulating public space and social mobility system. In its most critical state (red light), the system demanded a complete cessation of non-essential economic activities and social and educational activities. This meant that nightclubs, bars, malls, libraries, restaurants, and non-essential businesses were closed, and participating in social gatherings was strongly discouraged. This system also included the migration of digital and television-based schooling, the suspension of health services not related to COVID-19, and the mandatory use of facemasks in every public space. In sum, the government’s actions to mitigate the spread of the virus were captured by the phrase “stay home,” which was circulated widely across mass media (Mexico City Government, 2022; Ministry of Health, 2022).

The impact of these public health directives on the sexual health of individuals, especially those with social vulnerabilities or stigmatized identities, such as gay or bisexual men (GBM), is so far unknown. However, their experiences are relevant to public health because of their direct risks of acquiring COVID-19, the likelihood of complications due to their preexisting social vulnerabilities, and the impact of pandemic policies on their wellbeing (Banerjee & Nair, 2020).

According to the Kaiser Family Foundation (2021), COVID- 19 acutely affects LGBT groups due to the high incidence of comorbidity, less access to health services, and stigma that leads to discrimination and violence. LGBT people, including GBM, are also more exposed to violence because they spend more time at home with people who victimize them (United Nations, 2020). However, although the pandemic has had a profound impact on all LGBT populations, the role of age and sexuality in ther experiences remains unclear.

From a biomedical perspective, age can be a factor in the presence or absence of comorbidities (Martínez Hernández, 2007). However, from a sociocultural perspective, age becomes a fundamental factor in the human experience, as it is in GMB's sexual health.

One’s age group determines socially defined roles and tasks, rights and responsibilities, their relationship with their peers and with other generations, and limits possible behavior alternatives (Kropff, 2010; Martínez et al., 2010). Therefore, the behaviors, attitudes, roles, rights, and responsibilities regarding the experience of sexuality differ among young GBM and adult GBM. These identities are in constant movement and conflict with one another and are part of specific space-time contexts (Giménez, 2007). For this reason, it is even more essential to understand the differences between young and adult GBM during COVID-19 as there may be asymmetries and inequities in health that existed prior to the pandemic but are also specific to this health context.

Context of GBM prior to COVID-19 confinement

In addition to the implications of the COVID-19 pandemic, the current situation of GBM is complicated by the conditions of social inequality due to sexual orientation. It has been reported that GBM experience unequal treatment in terms of employment opportunities, scholarships, loans, and even when requesting public services such as health care (Ministry of State et al., 2018). The spaces where GBM usually experience discrimination are in the family and school. In addition, some GBM with HIV also experience discrimination because of their serological status (The International Lesbian, Gay, Bisexual, Trans, and Intersex Association for Latin America and the Caribean, 2020; Ministry of State & National Council for the Prevent of Discrimination, 2017).

In terms of sexual health and the use of dating apps and/or social media, a study showed that the frequency of young men that have sex with men (MSM) using these apps was over 50% before the pandemic, which did not differ from the amount of adult MSM that used those apps. However, young MSM reported that they used those apps mostly to find hookups and sexual partners, even though many participants reported using them with other means. Furthermore, the study found that young MSM engaged in risky sexual practices, another fact that was not different from that reported by adult MSM. Both age groups reported a high degree of risk of acquiring HIV and engaging in unprotected anal sex (Macapagal et al., 2018).

Other research reports that sexual practices among GBM could be associated with the risk of acquiring HIV or other sexually transmitted infections (STIs), such as nonuse of condoms, multiple sexual partners, casual sex partners, and drug and alcohol use before or during sex (Gomes et al., 2020; Jiménez-Vázquez et al., 2018; Ortiz Hernández & Garcia Torres, 2005). The use of dating apps has been described as an easy, fast and safe way to meet partners without exposing too much of the users’ personal information (Choi et al., 2020). However, their use has also been linked to risky sexual practices due to an increase in the possibility of having multiple sexual partners, casual sexual encounters where condom nonuse is persistent as well as the practice of chemsex (sexual activity accompanied by substance use) (Choi et al., 2020; Gomes et al., 2020). Finally, it has been documented that GBM have difficulties accessing health services due to fear of being discriminated against because of their sexual identity or practices (Blackwell, 2021) as many have experienced discrimination in these spaces (Alencar Albuquerque et al., 2016).

Prior to the pandemic, Mexican studies of GBM groups had reported inconsistent condom use (Maguiña Vargas et al., 2020; Suárez et al., 2020), higher HIV prevalence than in the general population (Maguiña Vargas et al., 2020), drug use during or prior to sex (Sánchez Medina et al., 2016) as well as experiences of discrimination based on their sexual orientation in different spaces such as family, school, public and private spaces, as well as in health services (Mendoza-Perez & Ortiz-Hernandez, 2021).

Sexual health status of GBM during the pandemic

In the context of COVID-19, a study conducted in Brazil and Portugal revealed that the pandemic has not completely limited the sexual activity of MSM. More than 50% of respondents mentioned having had sex during pandemic home restrictions despite the risks involved, as the duration of confinement and the feelings derived from it may be partly related to risky sexual behaviors (de Sousa et al., 2021). In addition, other studies have revealed that, even though GBM have reduced their number of sexual partners, their sexual activity has not stopped (Döring, 2020).

Furthermore, most of the available health services were focused on addressing complications associated with COVID-19, which limited GBM’s ability to address their sexual health in terms of prevention or medical care. For example, people with HIV reported decreased access to medications (Newman & Guta, 2020). HIV testing also decreased and was stigmatized due to the fear of disclosing sexual encounters during confinement (Newman & Guta, 2020; Rao et al., 2021; Santos et al., 2021).

Additionally, the impact of confinement has also been found to disproportionately affect young GBM, where youth have reported the most significant problems in accessing condoms, increased recreational drug use, use of dating apps, and a decrease in STIs testing (Sanchez et al., 2020). It is possible that this is because sexual behavior in GBM varies due to the generational effect of age (Hunt et al., 2019), so it is important to consider differentiated analyses according to age groups.

Available data allows us to infer that confinement had positive effects in reducing COVID-19 transmission; however, other aspects of health including sexual health were affected (de Sousa et al., 2021). The actions of the Mexican government during the months in which COVID-19 had the most significant epidemiological impact neglected preventive actions and sexual health care, which could negatively impact the sexual health of GBM. Considering this, the objective of the present study was to analyze the implications of the COVID-19 context on the sexual health of GBM in Mexico, including by comparing youth with adults to understand the necessary elements of providing adequate public health responses to address these distinct groups in future pandemics.

Method

A cross-sectional online study was conducted from August to October 2020 with a non-probabilistic sample utilizing Alchemer (survey software). The parent survey was designed to learn about the experiences of lesbian, gay, bisexual, trans, and other non-heterosexual sexual orientations and cis-gender identities (LGBT+) during the COVID-19 pandemic. Recruitment was carried out through social media, LGBTQ + online media, and collaborations with non-government organizations that provide health services to LGBTQ + groups. The rate of response was approximately 63%. Participation was voluntary, and no type of incentive was offered.

Sexual orientation was assessed through self-identification with the social group that each participant identified with. Participants could select “gay/homosexual¹” or “bisexual man,” among other options such as “trans man,” “trans woman,” or “bisexual woman.” In contrast to Anglo-Saxon countries, people are socially grouped amongst the different LGBT populations in Mexico. The possible combinations and specificities between sexual orientation and gender identity (i.e., gay trans man) are not generally socialized amongst the general population, and it is widespread that these combinations only be used in academic or activist language. Because of this, participation in the present study was open to anyone who identified as a gay or bisexual man. This is under the premise that health processes and their characteristics depend on the social group the participant ascribes to. In this case, gay and bisexual men who are not trans have a different specific social determination than those who are (Eslava Castañeda, 2017). Study inclusion criteria included residents of Mexico at the time of the survey and LGBT + persons 16 years of age or older.

Participants

A total of 1525 LGBT + people participated in the parent study. Of that sample, 1001 were identified as GBM, which is the subsample for this analysis. These sample demographics are detailed in Table 1. The mean age of the GBM was 31.5 years (SD = 9.50), with 90.9% identifying as gay men and 9.1% as bisexual men. For the analysis, the sample was divided into two age groups, youths from 16 to 29 years old (46.7%) and adults from 30 to 69 years old (53.3%). Participants primarily resided in urban areas (95.3%), most notably Mexico City (41.2%), followed by the central region of the country (24.6%). The predominant educational level of the respondents were those who completed undergraduate and graduate-level studies. When asked about occupation, most participants reported only working or only studying. The majority of the young GMB reported living with a family member (73.7%), while most adults lived alone (65.7%). Almost one-quarter of the participants reported living with HIV, with a higher percentage of adults reporting this status.

Table 1.

Sociodemographic Characteristics.

Variable	Youth (N = 467)	Adults (N = 534)	General (N = 1001)	OR	(95% CI)
Sexual orientation
Gay/homosexual	86.7	94.6	90.9	0.375***	[0.237–0.594]
Bisexual man	13.3	5.4	9.1	Ref.
Geographical area
North	14.1	11.1	12.5	1.780**	[1.18–2.66]
Midwest	13.5	12.2	12.8	1.542*	[1.03–2.29]
Center	27.6	21.9	24.6	1.754***	[1.27–2.41]
South-Southeast	10.7	7.5	9.0	1.989**	[1.25–3.15]
Mexico City	34.1	47.4	41.2	Ref.
City of residence
Urban	92.9	97.4	95.3	0.354***	[0.18–0.67]
Rural	7.1	2.6	4.7	Ref.
Schooling
High school or less	27.8	10.5	18.6	Ref.
Bachelor’s degree	64.9	53.6	58.8	0.456***	[0.32–0.64]
Postgraduate	7.3	36.0	22.6	0.076***	[0.04–0.12]
Occupation
Study	37.0	4.3	19.6	11.66***	[6.63–20.50]
Work	37.3	71.7	55.6	0.705	[0.47–1.05]
Work and study	15.2	9.7	12.3	2.118**	[1.27–3.51]
Unemployed and not studying	10.5	14.2	12.5	Ref.
Living with a relative
Yes	73.7	34.3	52.6	Ref.
No	26.3	65.7	47.4	0.186***	[0.14–0.24]
Having HIV
Yes	15.0	33.0	24.6	0.359***	[0.26-0.49]
No	85.0	67.0	75.4	Ref.

*p < 0.05; **p < 0.01; ***p <0 .001.

Variables

Sociodemographic data. Key demographic variables included: sexual orientation (gay, bisexual), geographic area (north, center-west, center, south-southeast, and Mexico City, the latter being an area with the highest concentration of population in the country), locality of residence: urban or rural, and the highest level of education. Participants were asked if they resided with a family member and about their HIV status at the time of the survey. Questions related to sexual health were based on the study conducted by Sanchez et al. (2020) (Table 2).

Table 2.

Variables Regarding Sexual Health During Confinement due to COVID-19.

Item	Response options
In comparison to before the COVID-19 confinement, tell us if the confinement has impacted the following aspects of your sexuality: Your sexual desire Your use of dating and hookup apps or social media to virtually meet other people (FB, Twitter, Instagram, Grindr, Hornet, Manhunt, Tinder, Blued, etc.)	Has decreased/is less because of COVID-19. There has been no change, or it has changed due to other reasons besides COVID-19. It has increased/it is because of COVID-19 It does not apply/I do not use apps
In comparison to before the COVID-19 confinement, tell us if the confinement has impacted the following aspects of your sexuality: Number of different sexual partners Opportunities to have sex Use of female or male condoms or latex gloves Your use of hookup apps or social media to meet other people for sex (FB, Twitter, Instagram, Grindr, Hornet, Manhunt, Tinder, Blued, etc.) Access to STIs testing, except for HIV (i.e., syphilis, gonorrhea, HPV, or chlamydia).	Has decreased/ is less because of COVID-19 There has been no change, or it has changed due to other reasons besides COVID-19 It has increased/is higher because of COVID-19 Does not apply/I do not use them
Have you experienced any problems getting an appointment for PrEP treatment/follow-up due to the COVID-19 confinement?	Yes No I have not tried to get an appointment during the COVID-19 confinement
Have you experienced any problems getting tested for HIV due to COVID-19 sanitary restrictions?	Yes No I have not tried to get tested for HIV during the confinement
In comparison to before the COVID-19 confinement, tell us if the following has changed during the COVID-19 confinement Supply of HIV testing Access to HIV testing Access to PEP (Post Exposition Prophylaxis Post for VIH)	Has decreased /Is less because of COVID-19 There has been no change, or it has changed due to other reasons besides COVID-19. It has increased/is higher because of COVID-19 It does not apply/ I do not use these services
During the COVID-19 confinement, did you have a sexually transmitted infection that was not HIV?	I had no infections Yes
Have you had problems getting tested for a sexually transmitted infection that was not HIV (i.e., HPV, chlamydia, syphilis) due to sanitary restrictions because of COVID-19?	Yes No

Note. Based mainly on Sanchez et al. (2020).

Sexual desire and use of apps. We asked whether there were changes during the pandemic in sexual desire and the use of applications to meet people and have sexual encounters. The response categories for these variables were ordinal, with the following scale: decreased, no change, and increased.

Sexual practices during the context of the COVID-19 pandemic. This section was only answered by participants who reported being sexually active prior to the pandemic confinement. In the context of the COVID-19 pandemic, participants were asked whether there had been changes in the number of different sexual partners and the opportunities to have sexual relations; the response categories for these two variables were: decreased, no change, and increased. Participants were asked whether they had engaged in sexual intercourse during this period. People who reported using drugs during the health contingency were asked if they had used drugs during sexual activity. They were also asked if they had ever had a sexually transmitted infection (STIs) and, finally, if they had used a condom during their last sexual intercourse in the last month.

Prevention of sexually transmitted infections. This section was only applied to people who had ever had sexual intercourse in their lifetime. Participants were asked whether, in the context of the COVID-19 pandemic, they had noticed changes in access to condoms, availability of HIV tests, frequency of HIV testing, access to tests for STIs other than HIV, availability of pre-exposure prophylaxis (PrEP), and access to post-exposure prophylaxis (PEP); the response categories for these six variables were (1) decreased, (2) no change, and (3) increased. They were also asked whether they had had problems getting tested for HIV during the contingency or problems getting tested for STIs other than HIV.

Statistical analysis

Descriptive analyses were performed considering the total sample and age groups, dividing the population into youths aged 16 to 29 and adults aged 30 years or more. Subsequently, given that some items had low response rates and the prevalence was relatively infrequent in some variables, odds ratios (Cummings, 2009) were calculated between adults and young people, both bivariate and adjusted for sociodemographic variables like geographic area, locality, schooling, occupation, and residence status. Odds ratios were calculated through logistic regression models to obtain the adjusted odds ratios. In all cases, a confidence level of 95% was considered.

Ethical considerations

The research project was registered with the Ethics Committee of the Faculty of Medicine of the National Autonomous University of Mexico (UNAM). At the beginning of the survey, informed consent was given, describing the study’s objectives and the voluntary nature and confidentiality of participation.

Results

Sexual desire and use of apps

Results show significant differences between the two age groups regarding the increase of sexual desire during COVID-19 confinement (Table 3): the youth group was 2.5 times more likely to report increases in sexual desire [95% CI 1.70–3.74] compared to adults. The same pattern was found in the category of an increased level of use of apps to meet people (OR = 1.67; 95% CI = 1.08–2.56), as well as to have sexual encounters (OR = 2.01; 95% CI = 1.24–3.22), with youth reporting a greater increase compared to adults. After adjusting for sociodemographic and control variables, significant differences were present only in increased sexual desire, where an increase of up to 1.9 times [95% CI = 1.14–3.15] was still observed in the youth group versus adults.

Table 3.

Sexual Desire and Use of Dating Apps During the Sanitary Confinement due to COVID-19.

Variable	Youth		Adults		General		OR (95%CI)	AOR (95% CI)
	N	%	N	%	N	%
Sexual desire
Decreased	(106)	32.8	(175)	43.9	(281)	38.9	0.897 [0.637–1.26]	1.22 [0.79–1.89]
No change	(108)	33.4	(160)	40.1	(268)	37.1	Ref.	Ref.
Increased	(109)	33.8	(64)	16.0	(173)	24.0	2.523*** [1.70–3.74]	1.90* [1.14–3.15]
Use of apps to meet people	(246)	74.1	(304)	74.5	(550)	74.3	0.979 [0.70–1.36]	1.18 [0.77–1.81]
Level of use of apps to meet people
Decreased	(84)	34.2	(112)	36.8	(196)	35.6	1.205 [0.77–1.86]	1.27 [0.738–2.19]
No change	(56)	22.8	(90)	29.6	(146)	26.6	Ref.	Ref.
Increased	(106)	43.1	(102)	33.6	(208)	37.8	1.67* [1.08–2.56]	1.32 [0.769–2.29]
Use of dating or social networks/hooking up to meet other people for sexual encounters.	(210)	70.2	(296)	72.7	(506)	71.7	0.885 [0.64–1.23]	1.171 [0.77–1.78]
Level of use of apps for sex
Decreased	(88)	41.9	(128)	43.2	(216)	42.7	1.36 [0.87–2.11]	1.36 [0.78–2.37]
No change	(48)	22.9	(95)	32.1	(143)	28.3	Ref.	Ref.
Increased	(74)	35.2	(73)	24.7	(147)	29.1	2.01** [1.24–3.22]	1.61 [0.88–2.93]

Note. OR: unadjusted odds ratio, AOR: odds ratio adjusted for geographic area, locality, education level, occupation, and residence status.

*p < 0.05; **p < 0.01; ***p < 0.001.

Sexual intercourse during confinement by COVID-19

Regarding sexual intercourse during the confinement period, youth reported significantly lower odds of ever engaging in sexual intercourse than the adult group (OR = 0.023; 95% CI = 0.003–0.169) (Table 4). This same pattern was observed for having sex in the last month during confinement (OR = 0.557; 95% CI = 0.409–0.759), and for drug use during confinement (OR = 0.453; 95% CI = 0.244–0.841). Similarly, opportunities for sexual intercourse had varied changes in the youth group, with young people being more likely to report a decrease (OR = 1.47; 95% CI = 1.01–2.15) or an increase (OR = 1.875; 95% CI = 1.06–3.29) compared to the adult group. Although the differences in condom use were not significant, it is important to mention the report of no condom use in almost half of the participants. In the adjusted model, compared to adults, the youth continued to have a lower chance (OR = 0.758; 95% CI = 0.009–0.619) of ever having had sex in their lifetime, and these differences were significant.

Table 4.

Sexual Relations During the Health Contingency for COVID-19.

Variable	Youth		Adults		General		OR (95%CI)	AOR (95% CI)
	N	%	N	%	N	%
Ever had sexual intercourse (lifetime)
No	(32)	9.6	(1)	0.3	(33)	4.5	Ref.	Ref.
Yes	(300)	90.4	(407)	99.8	(707)	95.5	0.023*** [0.003–0.169]	0.758** [0.009–0.619]
Number of different sexual partners
Decreased	(134)	57.8	(197)	58.6	(331)	58.3	0.964 [0.671–1.38]	1.01 [0.646–1.59]
No change	(79)	34.1	(112)	33.3	(191)	33.6	Ref.	Ref.
Increased	(19)	8.2	(27)	8.0	(46)	8.1	0.998 [0.519–1.91]	0.878 [0.383–2.01]
Opportunities to have sex
Decreased	(181)	66.5	(237)	62.4	(418)	64.1	1.472* [1.01–2.15]	1.31 [0.823–2.10]
No change	(55)	20.2	(106)	27.9	(161)	24.7	Ref.	Ref.
Increased	(36)	13.2	(37)	9.7	(73)	11.2	1.875* [1.06–3.29]	1.847 [0.940–3.62]
Had sexual intercourse in the past month during COVID-19 confinement
No	(135)	45.2	(128)	31.5	(263)	37.3	Ref.	Ref.
Yes	(164)	54.9	(279)	68.6	(443)	62.8	0.557*** [0.409–0.759]	0.873 [0.586–1.298]
Drug use during sexual intercourse in the last month
No drug use	(41)	62.12	(49)	42.61	(90)	49.72	Ref.	Ref.
Drug use	(25)	37.88	(66)	57.39	(91)	50.28	0.453* [0.244–0.841]	0.905 [0.585–1.402]
Having an STIs, other than HIV, during confinement
No infections	(267)	89.3	(370)	90.9	(637)	90.2	Ref.	Ref.
Infections	(32)	10.7	(37)	9.1	(51)	9.8	1.198 [0.727–1.973]	1.068 [0.580–1.966]
Condom use during the last sexual intercourse in the last month
No	(80)	48.8	(139)	49.8	(219)	49.4	Ref.	Ref.
Yes	(84)	51.2	(140)	50.2	(224)	50.6	1.042 [0.709–1.530]	0.861 [0.541–1.368]

OR: unadjusted odds ratio, AOR: odds ratio adjusted for geographic area, locality, education level, occupation, and residence status.

*p < 0.05; **p <0. 01; ***p < 0.001.

Prevention of HIV and other STIs

Regarding HIV and other STIs prevention strategies (Table 5), the youth group compared to the adult group was more likely to report a decrease in access to condoms by almost 50% (OR = 1.46; 95% CI = 1.02–2.08), in problems to get tested for HIV by almost twice as much (OR = 1.90; 95% CI = 1.07–3.36), as well as problems getting tested for other STIs (OR = 1.95; 95% CI = 1.22–3.12). Similarly, young people reported a decrease of more than 70% in being offered HIV testing (OR = 1.73; 95% CI = 1.13–2.64) and in actually getting tested for HIV (OR = 1.72; 95% CI = 1.13–2.62). Once adjusting for sociodemographic variables, a higher likelihood of decreased access to HIV testing (OR = 2.166; 95% CI = 1.21–3.87) and HIV testing (OR = 1.83; 95% CI = 1.03–3.25) was reported.

Table 5.

Prevention of HIV and Other STIs During the Sanitary Confinement due to COVID-19.

Variable	Youth		Adults		General		OR (95% CI)	AOR (95% CI)
	N	%	N	%	N	%
Access to condoms during confinement by COVID-19
Decreased	(93)	35.9	(91)	27.5	(184)	31.2	1.464* [1.02–2.08]	1.17 [0.741–1.85]
No change	(155)	59.9	(222)	67.1	(377)	63.9	Ref.	Ref.
Increased	(11)	4.3	(18)	5.4	(29)	4.9	0.875 [0.402–1.91]	0.576 [0.227–1.46]
Problems with HIV testing due to confinement
Yes	(48)	19.2	(32)	11.9	(80)	15.4	1.902* [1.07–3.36]	1.88 [0.986–3.87]
No	(56)	22.4	(71)	26.5	(127)	24.5	Ref.	Ref.
Has not attempted an HIV test during the period of confinement	(146)	58.4	(165)	61.6	(311)	60.0	1.122 [0.74–1.70]	1.109 [0.637–1.931]
HIV testing offer
Decreased	(94)	54.3	(83)	42.8	(177)	48.2	1.731* [1.13–2.64]	2.166** [1.21–3.87]
No change	(70)	40.5	(107)	55.2	(177)	48.2	Ref.	Ref.
Increased	(9)	5.2	(4)	2.1	(13)	3.5	3.439* [1.02–11.60]	1.810 [0.402–8.13]
Getting tested for HIV
Decreased	(97)	55.4	(82)	42.5	(179)	48.6	1.725* [1.13–2.62]	1.83* [1.03–3.25]
No change	(72)	41.1	(105)	54.4	(177)	48.1	Ref.	Ref.
Increased	(6)	3.4	(6)	3.1	(12)	3.3	1.45 [0.452–4.70]	0.961 [0.230–0.401]
Problems with non-HIV STIs testing during confinement
Yes	(61)	20.4	(59)	14.5	(120)	17.0	1.953** [1.22–3.12]	1.369 [0.764–2.45]
No	(63)	21.1	(119)	29.2	(182)	25.8	Ref.	Ref.
Access to non-HIV STIs testing
Decreased	(131)	53.7	(138)	46.2	(269)	49.5	1.341 [0.952–1.88]	1.200 [0.771–1.87]
No change	(109)	44.7	(154)	51.5	(263)	48.4	Ref.	Ref.
Increased	(4)	1.6	(7)	2.3	(11)	2.0	0.807 [0.231–2.82]	0.757 [0.188–3.03]
Offer of pre-exposure prophylaxis (PrEP)
Decreased	(58)	61.1	(58)	57.4	(116)	59.2	1.167 [0.656–2.07]	1.718 [0.735–4.01]
No change	(36)	37.9	(42)	41.6	(78)	39.8	Ref.	Ref.
Increased	(1)	1.1	(1)	1.0	(2)	1.0	1.167 [0.070–19.3]	0.247 [0.009–6.14]
Access to PEP (HIV post exposure prophylaxis)
Decreased	(57)	66.3	(46)	54.1	(103)	60.2	1.698 [0.904–3.19]	2.188 [0.829–5.77]
No change	(27)	31.4	(37)	43.5	(64)	37.4	Ref.	Ref.
Increased	(2)	2.3	(2)	2.4	(4)	2.3	1.370 [0.181–10.35]	1.881 [0.172–20.45]

Note. OR: unadjusted odds ratio, AOR: odds ratio adjusted for geographic area, locality, education level, occupation, and residence status.

*p < 0.05; **p <0 .01

Discussion

This study found that during the COVID-19 confinement, young GBM experienced increased sexual desire and a greater increase in the number of opportunities to have sex, particularly compared to GBM adults. However, adult GBM reported having more frequent sex in the past month and using drugs during sexual activity. Almost half of all GBM participants did not use a condom during their last sexual intercourse, and youth reported having less access to condoms and testing for HIV and other STIs.

The marked increase in sexual desire by young GBM in contrast to adults is consistent with another study finding that young GBM show an emotional and intimate need linked to sexual experiences and report being more satisfied with casual sex compared to adults, who do not idealize affectionate relationships and prefer to be direct about sexual needs (Nimbi et al., 2020). A possible reason why the youth group reported greater sexual desire might be their age and the challenges they face to engage in sexual practices during confinement when they are likely living with their parents, which lead to greater isolation and the need to contain sexual energy, as well as dealing with family stigma against same-sex sexual practices.

The youth group reported increased use of sex and dating apps compared to the adult group. Technological developments have allowed GBM to remain sexually active with an effective, convenient, and fast way to locate sexual partners compared to traditional face-to-face methods (Queiroz et al., 2019). However, due to the pandemic restrictions, young people likely did not have the same freedom as adults to have sex during this period, so they relied on dating apps to connect with other GBM and socialize or engage in cybersex.

Adults were more likely to report having had sex in the last month and having used drugs while having sex (chemsex). Even though several studies have shown that young people tend to consume cannabis when having sex (Palacios & Álvarez, 2018; Sanz-Ugena, 2019), the pandemic restrictions may have made it more challenging to acquire drugs as well as have sex due to the limitations on freedom of movement (World Trade Organization, 2020b).

Almost half of the participants reported not using a condom in their last sexual encounter. Studies conducted prior to COVID-19 have found that condom use is inconsistent with GBM due to factors among such as discomfort, trust in the partner, and drug use (da Fonte et al., 2017; Gutiérrez Reyes et al., 2012; Mendoza-Pérez & Ortiz-Hernández, 2009; Sánchez Medina et al., 2016). Inconsistent condom use persists and perhaps even worsens during times of health contingency, so it is essential to consider that HIV prevention strategies should continue, even when pandemic conditions exist. In addition, in the face of inconsistent or nonuse of condoms, other preventive technologies such as PrEP could be proactively offered to GBM who engage in unprotected sex.

Finally, a substantial proportion of GBM reported a decrease in the possibility of accessing and being tested for HIV and other STIs and access to PrEP. Other studies have concluded that HIV testing is currently stigmatized because it is related to having sexual encounters during confinement, which implies a violation of the public health mandates of social distancing (Newman & Guta, 2020). Added to this was the limited freedom of movement of young people, which may have resulted in decreased access to testing and treatment for HIV and other STIs.

This study is limited by the non-probabilistic cross-sectional design. The results cannot be generalized to all GBM in Mexico. However, they reflect the experiences of a range of GBM based on their sociodemographic characteristics. In Mexico, prior to the pandemic, internet access by the general population was limited (National Institute of Statistics and Geography, 2019), so we assume that during the pandemic, this problem worsened. The lack of access may have affected the participation of GBM; this is reflected mainly in the low participation of people from rural areas.

Conclusion

This study found that GBM youth and adults did not completely stop their sexual activity during the COVID-19 restrictions. While the sex lives of GBM were modified during this period (White, 2020), youth and adults continued to engage in sexual activity through face-to-face encounters or dating apps. Even though GBM continued with their sexual activity, the Mexican government did not consider the associated public health concerns when implementing strategies to prevent acquiring or transmitting SARS-CoV-2. The “stay at home” policy did not account for the sexual lives of GBM, which has resulted in limitations to health services for testing and control of STIs as well as access to barrier methods such as condoms, which may complicate the health of GBM in the future (Brennan et al., 2020; de Sousa et al., 2021).

It is important to highlight that young GBM have probably been one of the most impacted populations during COVID-19. Their sexual and mental health has been significantly impacted due to the lack of mobility and social support, challenges with coping mechanisms due to the stress of the pandemic, and stigmatizing families (Craig et al., 2021; World Trade Organization, 2020a). The needs of vulnerable GBM need to be identified and addressed through government actions.

A strength of this study is the analysis of the age of Mexican GBM. There is little information in the country that differentiates age and sexuality, so our results can be used to design taior early educational interventions their development needs and guarantee sexual health services that have a long-term impact on preventing sexual risk. During any pandemic context, it is necessary to have state actions that provide STIs (including HIV) detection services, the provision of supplies (such as external and internal condoms), access to PrEP and PEP, as well as sexual health education programs that contribute to safe sex during the context of the pandemic and beyond. Given the use of dating apps by GBM in Mexico, information and communication technologies can provide greater access to these interventions.

Regarding young Mexican GBM, it is essential to note the impact of dating and hookup apps, social media, and general online resources for sexual education and risk prevention. As some studies suggest, the use of online media reduced the risk of youth acquiring STIs and HIV because it allowed them to have other types of sexual experiences that did not require face-to-face interactions (Nelson et al., 2020). Even though the data from this study shows that this is partially true, there is still an important percentage of GBM that engaged in sexual practices during pandemic confinement, and over half reported not using a condom.

Consequently, it would be essential to analyze the impact of online media on sexual health and question the lack of access that young GBM have to prevention strategies because even though the risk lessens, it does not disappear. Furthermore, it is essential to research the impact of dating/hook up apps on erotic and affective practices and sexual education due to the positive effect of online media on self-acceptance, identity development, and safe sexual practices (Mustanski et al., 2011). It has also been found that the expression of sexual desire and the adverse effects of confinement on skills to socialize virtually during confinement could favor the dissemination of limited or false information about health and sexual identity.

Regarding GBM adults, it is important to note the effects of confinement on partner relationships, sexual satisfaction, and reduction of desire. This study shows that adults had more opportunities to have sex sometime during confinement, even though they reported decreased sexual desire.

This data aligns with findings in previous studies that demonstrate that pandemic confinement has important effects on reducing sexual desire and satisfaction with primary stable partners (Hammoud et al., 2020; Holloway et al., 2021). The present study shows that a significant percentage of participants lived with their primary partner during confinement, so a health strategy that can help adult GBM cope with the consequences of confinement and undertake a pleasant and healthy sex life is recommended.

Another relevant aspect to consider is that while study findings point to an increase in the use of dating and hookup apps, there is a large variability in their use, particularly among those 35 years old and older (Holloway et al., 2021). This may be explained by the fact that increase in app use is not consistent with reports of pleasant sexual experiences, possibly related to more frequent sexual encounters during confinement, as well as diverse use and the negative impact of online media on the sexual health of adult GBM.

Finally, some measures that should be disseminated to reduce sexual risks during COVID-19 may include reducing the number of sexual partners, washing hands before and after sexual intercourse, and avoiding kissing on the mouth or performing positions that involve face-to-face contact. In addition, it is essential to emphasize the responsibility of the State to facilitate access to HIV prevention and medical care for HIV and other STIs (Stephenson et al., 2021) and to generate mechanisms to ensure care for COVID-19 patients without neglecting other sexual and reproductive health services.

Funding Statement

This study was funded by the Social Sciences and Humanities Research Council of Canada through a Partnership Grant [SSHRC #895-2018-1000].

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.