HIV postexposure prophylaxis during COVID-19

56 Dean Street, a sexual health clinic in Soho (London, UK) provides free-of-charge HIV postexposure prophylaxis (PEPSE) by face-to-face assessment, in accordance with UK guidance.¹ In 2018, 56 Dean Street accounted for a quarter of the 12 000 PEPSE prescriptions given nationally.²

On March 23, 2020, the UK Government introduced lockdown measures to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), advocating for home isolation and physical distancing of 2 m when individuals have to leave their homes, such as for medical needs.³

During this period of lockdown, although 56 Dean Street has limited some face-to-face services, the assessment and provision of PEPSE as a walk-in service has been maintained.

Weekly prescriptions of PEPSE at 56 Dean Street decreased from a peak of 54 (from Feb 17–23, 2020) to four (from March 30–April 5, 2020) during lockdown (figure ). We did a case-note review of recipients of PEPSE in two 4 week periods (appendix). A 4 week period before lockdown (Jan 20, 2020, to Feb 16, 2020) was chosen as a comparison because this period was immediately before the SARS-CoV-2 outbreak began in the UK but was close enough to the date of the lockdown to minimise potential seasonal variability. Compared with this 4 week period before lockdown, there were more than 80% fewer PEPSE prescriptions in the first 4 weeks of the lockdown, from March 23, 2020, to April 19, 2020 (161 vs 28 prescriptions). In both periods, the majority of prescriptions were given to men and most PEPSE was given for unprotected, receptive anal intercourse. The median age of those receiving prescriptions was 32 years (IQR 27–39) in the pre-lockdown period and 32 years (26–45) for the period in lockdown. There was no difference in the amount of prescriptions given to individuals because of group sex between the two periods. However, HIV exposures were more likely to involve sex facilitated by recreational drug use with methamphetamine, mephedrone, ketamine, or gamma-hydroxybutyrate (known as chemsex) and sex facilitated by the injection of these substances (known as slamsex) in lockdown than before lockdown.

Figure.

Weekly prescriptions for HIV PEPSE at 56 Dean Street, London, UK, in 2020

PEPSE=postexposure prophylaxis following sexual exposure.

The most obvious explanation for this decline in prescriptions of PEPSE is that individuals are engaging in less condomless sex during lockdown. However, these values might reflect people's reluctance to travel during this period, which would mean that individuals are not accessing the PEPSE they require.

If our first explanation is correct, we expect that there would be fewer HIV transmissions during lockdown. If our second explanation is correct, there would be more HIV transmissions. In either case, we feel that promoting HIV testing in those at risk, and continuing to provide access to PEPSE for those who need it, is important.

As of the beginning of May, 2020, the UK is more than 1 month into lockdown. If people are having less sex and fewer individuals are in the 4-week window period of the standard fourth-generation HIV test, we now have an opportunity to find people with undiagnosed HIV by encouraging those at high risk of HIV to test now and before they resume their previous sexual frequency. To this end, 56 Dean Street has released a social media campaign to encourage testing.