The lasting impact of the COVID 19 pandemic on sexual health care in a metropolitan region

Trolard, A.; Weingarten, L.; Cherabie, J.; Reno, H.

Background In the US, health policies accompanying the COVID-19 pandemic led to restricted healthcare access and decreased clinical services. Low public health funding was a barrier to accessing sexual healthcare before the pandemic and intensified during restrictions. Surveillance of the sexual healthcare landscape can inform program development to improve sexual health. Methods We collected information from clinics offering STI testing in the St. Louis region, Missouri, USA twice during 2020: in the spring during the first pandemic lockdown and in the fall as restrictions eased. Clinics were interviewed about sexual health services and categorized into three categories: open fully with no changes;modified if hours open and/or the ability to accept walk-ins were reduced;or fully closed. We also collected chlamydia rates by zip code and categorized zip codes as low (0-174 cases per 100,000);medium (175- 653);or high (654-1291) prevalence. Results Of the 112 clinics, 47 are federally qualified health centers (serve the un-and underinsured);16 were local public health authorities;and the remaining 49 include community, school, and private settings. In the fall, 29% of clinics were open, 55% modified, 5% closed compared with spring when 7% of clinics were open, 63% were modified, 17% were closed. There was a 450% and 200% increase in the number of clinics that were open in high and medium prevalence zip codes respectively in the fall compared to the spring. Fortynine clinics remain modified or closed in medium and high prevalence zip codes. Discussion The COVID pandemic has a significant effect on sexual health care in a metropolitan region of the US;that effect is lasting, especially in areas of medium and high chlamydia rates. Health systems must consider how the pandemic has impacted care provided for all major public health problems, including STIs/HIV or risk worsening sexual health..