Men Sex Workers and Other Men Who Have Sex With Men: How Do Their HIV Risks Compare in New Zealand?

Sex workers have their perspective on HIV transmission, claiming that in general they are more similar than different from other people in HIV status and the practice of safe sex. Such an assertion of similarity goes against public and professional opinion that prostitution is a major vector in the spread of AIDS. Taking the sex workers' similarity claim seriously, this paper considers the conditions under which it would be valid. We focus on those factors that make a population more or less vulnerable to HIV and how they affect its spread into the sex work population. Data from New Zealand comparing men sex workers and other men who have sex with men is used to evaluate these ideas. Data partially support the hypothesis in that these two groups of men are similar with regard to their HIV status. We do find the sex workers to be different, however, in their being less likely to engage in safe sex practices. We provide an explanation for why this has not lead to their having a higher rate of seropositivity.     

Sex Work Among Men Who Have Sex with Men and Transgender Women in Bogotá

This qualitative study examined sex work among internally displaced male and transgender female sex workers in Bogotá, Colombia. Internal displacement has occurred in Colombia as a result of decades of conflict among armed groups and has created large-scale migration from rural to urban areas. Informed by the polymorphous model of sex work, which posits that contextual conditions shape the experience of sex work, we examined three main research questions. The first dealt with how internal displacement was related to the initiation of sex work; the second concerned the effect of agency on sex worker satisfaction; and the third examined how sex work in this context was related to HIV and other risks. Life history interviews were conducted with 26 displaced individuals who had done sex work: 14 were men who have sex with men and 12 were transgender women (natal males). Findings revealed that many participants began doing sex work in the period immediately after displacement, because of a lack of money, housing, and social support. HIV risk was greater during this time due to limited knowledge of HIV and inexperience negotiating safer sex with clients. Other findings indicated that sex workers who exerted more control and choice in the circumstances of their work reported greater satisfaction. In addition, we found that although many sex workers insisted on condom use with clients, several noted that they would sometimes have unprotected sex for additional money. Specific characteristics affecting the experience of sex work among the transgender women were also discussed.     

Should Men who have sex with Men be allowed to donate blood in Israel?

Background

The present permanent deferral policy in Israel for MSM was established in 1977 and was based on the previous (now outdated) USA Food and Drug Administration standards. This study analyses epidemiological data regarding blood donations among MSM, in order to estimate the risk for HIV transfusion transmitted infection (TTI) if the policy is changed to allow at-risk MSM to donate blood.

Methods

An Excel based spreadsheet model integrated demographic, epidemiological data from the HIV National Register, laboratory, blood donation and testing data in order to calculate TTI due to false-negatives in known HIV+ donors, windows period donations, asymptomatic carriers and laboratory misclassification errors. A sensitivity analysis of our estimated TTIs for deferral periods for MSM was performed based on a literature review regarding this overall policy issue worldwide.

Results

MSM in Israel have a considerably higher relative risk (RR) of both prevalence (115) and incidence (143) of being HIV+ than persons without a risk factor. Allowing MSM to donate blood, without any deferral period, will add an additional five HIV TTI cases over the next decade. Imposition of a 1 or 5 years deferral of abstinence will increase the number of HIV TTI cases only by 0.10 and 0.05 cases, respectively.

Conclusion

A 1 year deferral period for blood donations from MSM in Israel is recommended.

     

“Cum Play” among Gay Men

The exchange of semen, often referred to as “cum play,” has featured in gay literature and may be a unique aspect of many gay men’s sexual behavior. We investigated the prevalence of “cum play” and its context among 1153 HIV-negative and 147 HIV-positive Australian gay men in an online survey. Receptive cum play (partner ejaculating or rubbing his semen over participant’s anus, or participant using partner’s semen as lubricant) was reported by one in six HIV-negative and one quarter of HIV-positive men on the same occasion of protected anal intercourse with a casual partner (PAIC). HIV-negative men who engaged in receptive cum play during PAIC often believed that their partner was HIV seroconcordant and tended to trust that partner. They were also generally more optimistic about the likelihood of HIV transmission, and they often only used condoms at their partners’ instigation. Cum play was not uncommon and highlights the narrowness (or danger) of focusing on condom use without considering the implications of broader sexual practices and their meaning for sexual health promotion. “Safe sex” for some gay and bisexual men does not necessarily mean consistent commitment to condom use or to avoiding semen exchange. Many feel confident in their knowledge of their partner’s HIV serostatus and only use condoms with these partners at their partner’s request. Their commitment to safe sex may not necessarily be compromised by their practice of cum play, but the extent to which this could represent a risk for HIV transmission depends on the reliability of their assessment of their partners’ HIV serostatus.     

Where are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Sex with Men in Los Angeles County

Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N?=?100, M _age?=?25.0?years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0?% of all participants had previously attended an HIV prevention program, and that 21.3?% of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6?months compared to those who had not (p?<?.05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0?%), not perceiving themselves to be at risk for HIV infection (14.0?%), and believing that they already knew everything they needed to know about HIV transmission (23.0?%). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.     

A Qualitative Analysis of Father–Son Relationships among HIV-Positive Young Black Men Who Have Sex with Men

Young black men who have sex with men (YBMSM) are experiencing high and rising rates of HIV infection, more than any other age-risk group category in the USA. Contributors to HIV risk in this group remain incompletely elucidated. We conducted exploratory qualitative interviews with 20 HIV-positive YBMSM aged 17–24 and found that father–son relationships were perceived to be important sociocontextual influences in participants’ lives. Participants discussed the degree of their fathers’ involvement in their lives, emotional qualities of the father–son relationship, communication about sex, and masculine socialization. Participants also described pathways linking father–son relationships to HIV risk, which were mediated by psychological and situational risk scenarios. Our thematic analysis suggests that father–son relationships are important to the psychosocial development of YBMSM, with the potential to either exacerbate or attenuate sexual risk for HIV. Interventions designed to strengthen father–son relationships may provide a promising direction for future health promotion efforts in this population.     

What Makes a Respondent-Driven Sampling “Seed” Productive? Example of Finding At-Risk Massachusetts Men Who Have Sex with Men

Several recent studies have sought to elaborate upon the applicability and validity of respondent-driven sampling (RDS) to find hard-to-reach samples in general and men who have sex with men (MSM) in particular. Few published studies have elucidated the characteristics associated with initial RDS participants (“seeds”) who successfully recruited others into a study. A total of 74 original seeds were analyzed from four Massachusetts studies conducted between 2006 and 2008 that used RDS to reach high-risk MSM. Seeds were considered “generative” if they recruited two or more subsequent participants and “non-generative” if they recruited zero or one participant. Overall, 34% of seeds were generative. In separate multivariable logistic regression models controlling for age, race, health insurance, HIV status, and the study for which the seed was enrolled, unprotected anal sex in the past 12 months [adjusted odds ratio (AOR) = 6.68; 95% confidence interval (95% CI) = 1.27–35.12; p = 0.03], cocaine use during sex at least monthly during the past 12 months (AOR = 8.81; 95% CI = 1.68–46.27; p = 0.01), and meeting sex partners at social gatherings (AOR = 7.42; 95% CI = 1.58–34.76; p = 0.01) and public cruising areas (AOR = 4.92; 95% CI = 1.27–19.01; p = 0.02) were each significantly associated with increased odds of being a generative seed. These findings have methodological and practical implications for the recruitment of MSM via RDS. Finding ways to identify RDS seeds that are consistently generative may facilitate collecting a sample that is closer to reflecting the MSM who live in all of the communities in a given location or study sample.     

Latino Men’s Sexual Behavior with Transgender Persons

Male-to-female transgender persons are thought to be “vectors” for HIV/STI transmission, yet little quantitative information exists about the risk behavior of their male sexual partners who may serve as a “bridge” for HIV transmission into the general population. As part of an online survey examining the sexual risk behavior of Latino men who have sex with men (N = 1,026), we identified 44 (4%) participants who reported having had sex with a transgender partner. Compared with a randomly selected sub-sample of 200 men who did not report sex with a transgender person, sexual partners of transgender persons were almost three times more likely to have had unprotected sexual intercourse in the last three months. In addition, men who had sex with transgender persons were more likely to be HIV-positive; married, separated, or divorced; identify as bisexual or straight; have sex with women; and live in rural or small town communities. Regression analysis revealed that community size, sexual compulsivity, and having had a transgender partner were independent predictors of unprotected sex. Among Latino men who have sex with men, men with a history of sex with a transgender person appear more likely to be sexually compulsive and at greater risk for HIV and other sexually transmitted infections. These men may, therefore, also serve as a “bridge” for HIV transmission to (as opposed to from) the transgender population.     

The Psychology of Gay Men’s Cuckolding Fantasies

Cuckolding (also known as troilism) is a sexual interest in which one obtains sexual arousal from the experience of a romantic partner engaging in sexual activity with someone else. The present study investigated fantasies about and experiences with cuckolding in a large and diverse sample of predominately gay-identified men (N = 580). Compared to previous research focusing on heterosexual men’s cuckolding fantasies, our results indicate that gay men’s cuckolding fantasies share many common elements; however, they differ in some important ways. Most notably, interracial and BDSM themes do not appear to be as common in gay men’s cuckolding fantasies as they are among heterosexual men. Our findings also indicate that frequent fantasies about cuckolding are linked to several overlapping sexual interests (e.g., voyeurism, group sex) and, further, the content of these fantasies is associated with a number of individual differences (e.g., agreeableness, sensation seeking, sociosexuality). Finally, this study also suggests that gay men who act on their cuckolding fantasies tend to report positive experiences; however, the likelihood of reporting positive outcomes appears to depend upon one’s personality and attachment style.     

Viewing Pornography Depicting Unprotected Anal Intercourse: Are There Implications for HIV Prevention Among Men Who Have Sex with Men?

We used an Internet-based questionnaire to investigate whether viewing pornography depicting unprotected anal intercourse (UAI) was associated with engaging in UAI in a sample of 821 non-monogamous men who have sex with men (MSM). In the 3 months prior to interview, 77.2% viewed pornography depicting UAI, 42.6% engaged in insertive UAI, and 38.9% engaged in receptive UAI. Polytomous logistic regression of the 751 subjects who provided data on pornography viewing showed significantly elevated odds ratios for having engaged in receptive UAI, insertive UAI, and both receptive and insertive UAI associated with increasing percentage of pornography viewed that depicted UAI. We also found independently significant associations of engaging in UAI with age, use of inhalant nitrites, and HIV status. Although the data cannot establish causality, our findings indicate that viewing pornography depicting UAI and engaging in UAI are correlated. Further research is needed to determine if this observation may have utility for HIV prevention.     

Understanding Men’s Self-Reported Sexual Interest in Children

A few studies have found that even in the general population, a minority of adults—men as well as women—report some sexual interest in a young age group. The purpose of the present study was to identify factors associated with self-reported sexual interest in children among a community-based sample of men. Using an online survey methodology, we examined the extent to which different types of childhood adversities (witnessing parental violence, sexual, physical, and emotional abuse), atypical childhood sexual experiences, and participants’ self-reported likelihood of engaging in a variety of sexual behaviors (heightened sexual interest) were related to sexual interest in children (SIC) reported by a non-forensic/non-clinical sample of 173 men. Data were analyzed using hierarchical multiple regression. After controlling for physical and emotional abuse and witnessing parental violence, self-reported experiences of childhood sexual abuse (CSA) significantly increased the amount of variance explained in SIC scores. However, only early masturbation and current heightened sexual interests contributed significantly to the final model. Total variance explained by the model as a whole was 24% (adjusted R² = 20%). Early masturbation and heightened sexual interests significantly mediated the relationship between CSA and SIC scores. Findings add to the small but growing body of literature examining the etiology of pedophilic sexual interests in non-clinical samples.     

Systematic Review of Racial Disparities in Human Papillomavirus–Associated Anal Dysplasia and Anal Cancer Among Men Who Have Sex With Men

We systematically reviewed the literature on anal human papillomavirus (HPV) infection, dysplasia, and cancer among Black and White men who have sex with men (MSM) to determine if a racial disparity exists. We searched 4 databases for articles up to March 2014.Studies involving Black MSM are nearly absent from the literature. Of 25 eligible studies, 2 stratified by race and sexual behavior. Both reported an elevated rate of abnormal anal outcomes among Black MSM. White MSM had a 1.3 times lower prevalence of group-2 HPV (P < .01) and nearly 13% lower prevalence of anal dysplasia than did Black MSM.We were unable to determine factors driving the absence of Black MSM in this research and whether disparities in clinical care exist. Elevated rates of abnormal anal cytology among Black MSM in 2 studies indicate a need for future research in this population.Although it is relatively rare in the general US population, anal cancer and its precursors disproportionately affect men who have sex with men (MSM) and people living with HIV. Anal cancer rates have been found to be highest among HIV-infected MSM with an estimated anal cancer incidence of 131 per 100 000 for HIV-infected MSM, 46 per 100 000 for HIV-infected heterosexual men, and 30 per 100 000 in HIV-infected women.1 Furthermore, although the introduction of antiretroviral therapy has led to an increased life expectancy for HIV-infected individuals, a concomitant increase in anal cancer cases has occurred since 1996.2Anal intraepithelial neoplasia is the immediate precursor of anal cancer and presents as a low-grade squamous intraepithelial lesion or as a high-grade squamous intraepithelial lesion. Infection with human papillomavirus (HPV) is thought to cause the majority of anal intraepithelial neoplasia. Group-1 high-risk HPV types (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) are strongly carcinogenic; group-2 high-risk HPV types (HPV 26, 30, 34, 53, 66, 67, 68, 69, 70, 73, 82, 85, and 97) are weaker carcinogens and “probable” or “possible” causes of cancer.3 Although up to 90% of HPV infections are cleared within 2 years in the general population, HPV is much more likely to lead to anal cancer in HIV-infected individuals.4 Furthermore, rates of anal intraepithelial neoplasia have increased markedly among HIV-infected MSM.2Though MSM have been established as a group at high risk for anal cancer, no studies have been designed to study racial differences among MSM in anal HPV, dysplasia, and cancer. A focus on Black MSM is important in light of several factors that may have a differential impact on anal cancer risk in this population. First, oncogenic HPV subtypes have been found to be variably distributed across populations based upon race. For example, in 2 recent studies, Black women were found to have higher rates of HPV (such as 33, 35, 58, and 68) that are not included in the existing HPV vaccines.5,6 Second, transmission of HPV within sexual networks7 may propagate certain subtypes with variable oncogenic potential. Black communities, including Black MSM, are known to have more within-group sexual partners than Whites and other ethnic minorities who are more likely to have sexual mixing patterns involving individuals of other racial groups.7,8 Third, Black MSM have the highest HIV incidence rate compared with other MSM populations9 and thus will increasingly be at risk for anal cancer. Finally, marked disparities across access to care, prevention services, and health insurance10 put Black MSM at increased risk for preventable oncogenic anal HPV, dysplasia, and cancer.Previous reviews of anal HPV infection, dysplasia, and cancer have identified MSM as a high-risk group, highlighted an absence of young MSM from anal HPV studies, offered an explanation for the increase in anal cancer incidence, and explored cost-effectiveness of routine anal screening.11–14 We built upon previous work by comparing anal HPV infection, dysplasia, and cancer among MSM with data from past studies. We had 2 objectives with the systematic review. First, we aimed to determine if a racial disparity exists in anal HPV infection, dysplasia, and cancer screening. Second, we aimed to determine if a racial disparity exists in anal HPV infection, dysplasia, and cancer outcomes. We aimed to inform future research programs and the development of screening and care programs for Black MSM by identifying patterns in anal HPV infection, dysplasia, and cancer from the existing literature.     

HIV Diagnoses Among Men Who Have Sex With Men and Women—United States and 6 Dependent Areas, 2008-2011

Objectives. We sought to describe HIV diagnoses among men who have sex with men and women (MSMW), who have the potential to bridge HIV transmission risk from men who have sex with men (MSM) to women.Methods. Applying National HIV Surveillance System data for persons aged 13 years and older, we examined estimated numbers and percentages of HIV diagnoses among MSMW and MSM only (MSMO) from 2008 to 2011, and estimated the annual percentage change and 95% confidence intervals, by age and race/ethnicity.Results. In 2011, 26.4% of 30 896 MSM diagnosed with HIV infection also had had sex with women. A larger percentage of MSMW were Black/African American (44.5%) compared with MSMO (36.0%), and fewer MSMW were White (26.4%) compared with MSMO (36.2%); similar percentages were classified as either MWMW or MSMO among other racial/ethnic groups. Among MSMW, HIV diagnoses were relatively stable and MSMO increased more than 6% annually among those aged 13 to 29 years.Conclusions. Many MSM diagnosed with HIV infection had also had sex with women. Intensified interventions are needed to decrease HIV infections overall for MSMW and reverse the increasing trends among young MSMO.Men who have sex with men (MSM) constitute the majority of persons diagnosed with HIV in the United States. In 2011, 61.8% of HIV diagnoses were attributed to male-to-male sexual contact.1 Data from the Center for Disease Control and Prevention’s (CDC) National HIV Surveillance System indicate that MSM are the only risk group with significant increases in HIV incidence in recent years,2 and reducing HIV incidence is one of the 3 primary goals in the National HIV/AIDS Strategy.3 Some MSM also have sex with women (MSMW). Scant information compared to MSM exists on the epidemiology of MSMW, who have the potential to bridge HIV transmission risk from MSM to women. Some studies have reported bisexual compared to heterosexual men are more likely to exchange sex, use substances, experience forced sex, and have more sexual partners.4,5 A meta-analysis estimated that MSMW are more than 5 times as likely to be HIV-positive as men who have sex with women exclusively.6 In a previous analysis of National HIV Surveillance System (NHSS) data derived from AIDS cases reported nationally from June 1981 through June 1990, MSMW constituted 26% of all males diagnosed with AIDS, increasing from 23% in 1983 to 26% in 1989. Racial/ethnic distributions for MSMW included 41% Black/African American, 31% Hispanic/Latino and 21% White.7 Because of the unique attributes and behaviors of MSMW, it is important to characterize this population to guide tailored prevention efforts. We described HIV diagnoses among MSMW using NHSS data from 2008 through 2011. In particular, we estimated numbers, percentages, and trends of HIV diagnoses among MSMW.     

HIV Prevalence and Awareness of Positive Serostatus Among Men Who Have Sex With Men and Transgender Women in Bogotá, Colombia

Objectives. We estimated HIV prevalence among men who have sex with men (MSM) and transgender women in Bogotá, Colombia, and explored differences between HIV-positive individuals who are aware and unaware of their serostatus.Methods. In this cross-sectional 2011 study, we used respondent-driven sampling (RDS) to recruit 1000 MSM and transgender women, who completed a computerized questionnaire and received an HIV test.Results. The RDS-adjusted prevalence was 12.1% (95% confidence interval [CI] = 8.7, 15.8), comparable to a previous RDS-derived estimate. Among HIV-positive participants, 39.7% (95% CI = 25.0, 54.8) were aware of their serostatus and 60.3% (95% CI = 45.2, 75.5) were unaware before this study. HIV-positive–unaware individuals were more likely to report inadequate insurance coverage, exchange sex (i.e., sexual intercourse in exchange for money, goods, or services), and substance use than other participants. HIV-positive–aware participants were least likely to have had condomless anal intercourse in the previous 3 months. Regardless of awareness, HIV-positive participants reported more violence and forced relocation experiences than HIV-negative participants.Conclusions. There is an urgent need to increase HIV detection among MSM and transgender women in Bogotá. HIV-positive–unaware group characteristics suggest an important role for structural, social, and individual interventions.Colombia ranks second among countries in Latin America in HIV prevalence, with estimates ranging from 0.7% to 1.1% of the adult population.1 Men who have sex with men (MSM) represent the group most strongly affected, with prevalence of 18% to 20% based on venue-based convenience samples2,3 and 15% based on respondent-driven sampling (RDS).4 Colombia has a long history of armed conflict, and the pervasive conditions of violence, internal displacement, and poverty can be relevant to HIV transmission.5 “Social cleansing” by armed groups has been aimed at MSM and transgender women, as well as people living with HIV,5 and the stigma associated with homosexuality and HIV is widespread and inherent in structural inequalities in Colombia.6,7 Social epidemiological models posit that HIV is influenced by such structural (e.g., civil unrest, migration) and social factors (e.g., social networks, community attitudes), as well as individual characteristics (e.g., psychological characteristics, behavior).8Public health efforts emphasize the importance of detecting and treating undiagnosed HIV as a means of reducing HIV incidence.9–11 In the United States, approximately 20% of HIV-positive individuals are thought to be unaware of their infection, but this group is estimated to be responsible for nearly half of new transmissions.12 There is limited research concerning awareness of serostatus in Latin America. Undiagnosed infection was found to be 89% among HIV-positive MSM sampled in Peru in 2011,13 and rates are likely to be high in Colombia because of low levels of testing,6 including among MSM.4,14 Recent studies of MSM in France, Peru, and the United States have found associations between undiagnosed infection and demographic characteristics such as age, income, and education13,15,16; risk behaviors14,17,18; family or intimate partner violence19; and health insurance coverage.20 We also examined awareness in relation to violence and forced relocation, conditions specific to the Colombian context.Respondent-driven sampling was developed as a means of obtaining unbiased estimates from hidden populations,21–23 and it has been shown to capture a more diverse24,25 and hidden26 group of MSM than time–location or snowball sampling. Research has suggested, however, that biases can occur.27–29Our current study and a study conducted by the United Nations Population Fund and the Colombian Ministry of Health and Social Protection (UNFPA/MSPS) were independently funded at approximately the same time to address the limited information about behavioral risk and HIV prevalence among Colombian MSM. Comparison of findings from the 2 studies provides evidence concerning reliability of the RDS-derived prevalence estimates. We estimated HIV prevalence among MSM and transgender women in Bogotá, Colombia, examined reliability of RDS-derived estimates in relation to the UNFPA/MSPS study,4 and investigated the role of the social and structural context of Colombia in both prevalence and awareness of positive serostatus.     

Are HIV-Negative Men Who Have Sex with Men and Who Bareback Concerned About HIV Infection? Implications for HIV Risk Reduction Interventions

The emergence of barebacking (intentional unprotected anal intercourse in situations where there is risk of HIV infection) among men who have sex with men (MSM) has been partially attributed to a decrease in HIV-related concerns due to improved anti-retroviral treatment. It is important to understand the level of concern these men have regarding HIV infection because it can affect their interest in risk reduction behaviors as well as their possible engagement in risk reduction interventions. As part of a study on MSM who use the Internet to seek sexual partners, 89 ethnic and racially diverse men who reported never having an HIV-positive test result completed an in-depth qualitative interview and a computer-based quantitative assessment. Of the 82 men who were asked about concerns of HIV infection during the qualitative interviews, 30 expressed “significant concern” about acquiring HIV, 42 expressed “moderate concern,” and 10 expressed “minimal concern.” Themes that emerged across the different levels of concern were their perceptions of the severity of HIV infection, having friends who were HIV positive, and their own vulnerability to HIV infection. However, these themes differed depending on the level of concern. Among the most frequently mentioned approaches to decrease risk of HIV infection, participants mentioned avoiding HIV-positive sex partners, limiting the number of partners with whom they barebacked, and not allowing partners to ejaculate inside their rectum. Findings suggest that many MSM who bareback would be amenable to HIV prevention efforts that do not depend solely on condom use.     

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men,Transgender Women,and Transgender Men Who Have Sex with Men: April–May 2020

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n?=?3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β?=?0.90, 95% CI 0.40–1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR?=?1.21), being Black (AOR?=?1.79) or Latinx (AOR?=?1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR?=?1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.