The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Cross-Sectional Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave

Erausquin, J. T.; Tan, R. K. J.; Uhlich, M.; Francis, J. M.; Kumar, N.; Campbell, L.; Zhang, W.-H.; Hlatshwako, T. G.; Kosana, P.; Shah, S.; Brenner, E. M.; Remmerie, L.; Mussa, A.; Klapilova, K.; Mark, K.; Perotta, G.; Gabster, A.; Wouters, E.; Burns, S.; Hendriks, J.; Hensel, D. J.; Shamu, S.; Strizzi, J. M.; Esho, T.; Morroni, C.; Eleuteri, S.; Sahril, N.; Low, W. Y.; Plasilova, L.; Lazdane, G.; Olumide, A.; Michielsen, K.; Moreau, C.; Tucker, J. D.; consortium, I-SHARE research

Background: To better understand sexual and reproductive health (SRH) during the initial COVID-19 wave, we organized a multi-country cross-sectional survey. Methods: Consortium research teams conducted online surveys in 30 countries. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Findings: Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed steady for 3374 (74.4%); 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) than before (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Interpretation: The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.