Identifying STI risk groups among heterosexuals in a cohort study based on behavioural and psychological characteristics during the COVID-19 pandemic

van Wees, D.; Godijk, N.; den Daas, C.; Kretzschmar, M.; Heijne, J.

Measures to reduce Coronavirus disease (COVID-19) transmission, including physical distancing, and downscaling of sexual health care impact behaviour and sexual health. We aimed to examine the impact of COVID-19 measures on sexual behaviour, and to characterize heterosexuals who were at high risk of acquiring sexually transmitted infection (STI) during the pandemic. A longitudinal cohort study (2016- 2020) was conducted among Dutch heterosexual males and females aged 21-28 years in 2020. We used data on behavioural and psychological characteristics from: pre-lockdown (June-August 2019), lockdown (March-May 2020), and postlockdown (June-August 2020). Behaviour change was compared between subgroups identified with latent class analysis. Four latent classes were identified (n=239). Individuals in class 1 (48% of study population) and 2 (36%) were at low risk of acquiring STI pre-lockdown, during, and post-lockdown, and reported mostly steady partnerships. Individuals in class 3 (9%) and 4 (7%) reported multiple casual partners pre-lockdown, and class 4 continued having multiple partners during lockdown (56% reported same/increased partner numbers compared to pre-lockdown versus 18% in class 3). Class 4 was characterized by less condom use, lower health goals, less positive STI/COVID-19 prevention attitudes, and higher impulsiveness compared to class 3. Post-lockdown, 36% in class 3 and 42% in class 4 reported same/increased partner numbers compared to pre-lockdown. Of individuals who wanted an STI test during or post-lockdown in class 3 (57%) and 4 (75%), 62% and 56% respectively did not get tested, mainly because they were not able to get an appointment. STI risk during the COVID-19 pandemic was low in most heterosexuals, but specific subgroups engaged in high-risk behaviour during lockdown and post-lockdown. During and after the COVID-19 pandemic, impulsive individuals with low health goals and less positive infection prevention attitudes should be prioritized for STI testing, and targeted with behavioural interventions tailored to these psychological characteristics..