Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Datasets from Two Global Online Surveys Via File Concatenation with Adjusted Weights (Preprint)

BACKGROUND Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may complicate efforts to prevention new HIV infections, reduce AIDS related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men’s ability to access services is not fully understood. OBJECTIVE To understand access to HIV services at the start of the COVID-19 pandemic. METHODS Our study used data collected from two independent global online surveys conducted with convenient samples of gay and bisexual men. The two datasets fused in the analysis were comprised of 6,188 consenting participants from the GMHR-4 and 13,562 from the COVID-19 Disparities surveys. We used file concatenation with adjusted weights and multiple imputations to explore social/structural enablers of and barriers to HIV service access among gay and bisexual men worldwide using data drawn from the two separate surveys. One survey was implemented prior to the start of the COVID-19 pandemic and the second at the height of its first wave. All predictors and outcomes were treated as continuous variables. Using the smpc command, we generated predicted values for our outcomes from the COVID-19 dataset and predictors from the GMHR-4 as a function of each other, using separate models for each pair of outcomes and predictors, controlling for the demographic characteristics that are jointly observed in both datasets, while defining an assumed partial correlation between the outcomes and predictors. We hypothesized that engagement with gay community and comfort with one’s healthcare provider would be positively associated with HIV service access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a healthcare provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. RESULTS With 19,643 observations after combining datasets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (Coef. = 0.81, 95% CI 0.75-0.86, p=0.00), while sexual stigma was negatively associated with access to HIV treatment (Coef. =-1.39, 95% CI -1.42 – -1.36, p=0.00). CONCLUSIONS The COVID-19 pandemic may be exacerbating existing barriers to HIV service access for gay and bisexual men. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real-time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual me worldwide.