The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

Author:

Toller Erausquin Jennifer1ORCID,Tan Rayner K J234,Uhlich Maximiliane5,Francis Joel M6,Kumar Navin7,Campbell Linda89,Zhang Wei Hong910,Hlatshwako Takhona G11,Kosana Priya11,Shah Sonam11,Brenner Erica M11,Remmerie Lore9,Mussa Aamirah12,Klapilova Katerina1314,Mark Kristen15,Perotta Gabriela16,Gabster Amanda1718,Wouters Edwin8,Burns Sharyn19,Hendriks Jacqueline19,Hensel Devon J2021,Shamu Simukai2223,Marie Strizzi Jenna24,Esho Tammary25,Morroni Chelsea1226,Eleuteri Stefano27,Sahril Norhafiza28,Yun Low Wah29,Plasilova Leona1314,Lazdane Gunta30,Marks Michael18ORCID,Olumide Adesola31,Abdelhamed Amr32,López Gómez Alejandra33,Michielsen Kristien9,Moreau Caroline3435,Tucker Joseph D31118,Adebayo Adedamola,Adebayo Emmanuel,Ani Ahmad Noor,Brunet Nicolás,Kagesten Anna,Kemigisha Elizabeth,Kpokiri Eneyi,Maatouk Ismael,Manguro Griffins,Nimbi Filippo M,Nobre Pedro,O’Hara Caitlin,Oyetunde Oloruntomiwa,Taufik Ramli Muhd Hafizuddin,Rezeberga Dace,Carlos Rivillas Juan,Tang Kun,Tavares Ines,

Affiliation:

1. Department of Public Health Education, University of North Carolina–Greensboro , Greensboro, North Carolina , USA

2. Dermatology Hospital of Southern Medical University , Guangzhou , China

3. University of North Carolina Project–China , Guangzhou , China

4. Saw Swee Hock School of Public Health, National University of Singapore , Singapore

5. Department of Psychology, Western University , London, Ontario , Canada

6. Department of Family Medicine, School of Clinical Medicine, University of Witwatersrand , Johannesburg , South Africa

7. Department of Sociology, Yale University , New Haven, Connecticut , USA

8. Center for Population, Family, and Health, University of Antwerp , Antwerp , Belgium

9. Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent , Ghent , Belgium

10. School of Public Health, Université Libre de Bruxelles , Brussels , Belgium

11. Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA

12. Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership , Gaborone , Botswana

13. Faculty of Humanities, Charles University, Prague , Czech Republic

14. National Institute of Mental Health , Klecany , Czech Republic

15. Department of Family Medicine and Community Health, University of Minnesota Medical School , Minneapolis, Minnesota , USA

16. Faculty of Psychology, University of Buenos Aires , Buenos Aires , Argentina

17. Gorgas Memorial Institute for Health Studies , Panama City , Panama

18. Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , London , United Kingdom

19. Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University , Perth , Australia

20. Department of Pediatrics, Indiana University School of Medicine , Indianapolis, Indiana , USA

21. Department of Sociology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana , USA

22. Health Systems Strengthening, Foundation for Professional Development , Pretoria , South Africa

23. School of Public Health, University of Witwatersrand , Johannesburg , South Africa

24. Department of Public Health, University of Copenhagen , Copenhagen , Denmark

25. End FGM/C Centre of Excellence, Amref Health Africa , Nairobi , Kenya

26. MRC Centre for Reproductive Health, University of Edinburgh , Edinburgh , United Kingdom

27. Department of Psychology, Sapienzo University , Rome , Italy

28. Ministry of Health Malaysia , Putrajaya , Malaysia

29. Asia–Europe Institute, Universiti Malaya , Kuala Lumpur , Malaysia

30. Institute of Public Health, Riga Stradins University , Riga , Latvia

31. College of Medicine, University of Ibadan , Ibadan , Nigeria

32. Department of Dermatology, Venereology & Andrology, Sohag University , Sohag , Egypt

33. Department of Psychology, University of the Republic , Montevideo , Uruguay

34. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA and

35. Primary Care and Prevention, Center for Research in Epidemiology and Public Health, National Institute of Health and Medical Research 1018 , Villejuif , France

Abstract

Abstract Background There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. Results Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [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. Conclusions Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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