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
Jennifer Toller Erausquin, Rayner Kay Jin Tan, Maximiliane Uhlich, Joel M Francis, Navin Kumar, Linda Campbell, Wei‐Hong Zhang, Takhona Grace Hlatshwako, Priya Kosana, Sonam Shah, Erica M. Brenner, Lore Remmerie, Aamirah Mussa, Kateřina Klapilová, Kristen P. Mark, Gabriela Perotta, Amanda Gabster, Edwin Wouters, Sharyn Burns, Jacqueline Hendriks, Devon J. Hensel, Simukai Shamu, Jenna Marie Strizzi, Tammary Esho, Chelsea Morroni, Stefano Eleuteri, Norhafiza Sahril, Wah Yun Low, Leona Plášilová, Gunta Lazdāne, Michael Marks, Adesola Olumide, Amr Abdelhamed, Alejandra López Gómez, Kristien Michielsen, Caroline Moreau, Joseph D. Tucker, Adedamola Adebayo, Emmanuel Adebayo, Noor Ani Ahmad, Nicolas D. Brunet, Anna Kågesten, Elizabeth Kemigisha, Eneyi E. Kpokiri, Ismaël Maatouk, Griffins Manguro, Filippo Maria Nimbi, Pedro Nobre, Caitlin Alsandria O’Hara, Oloruntomiwa Oyetunde, Muhd Hafizuddin Taufik Ramli, Dace Rezeberga, Juan Carlos Rivillas, Kun Tang, Ines Tavares
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.