Objectives: To investigate how differential access to key interventions to reduce sexually transmitted infections (STI), HIV, and their sequelae changed during the COVID-19 pandemic. Methods British participants (18-59y) completed a cross-sectional web survey one year (March to April 2021) after the initial lockdown in Britain. Quota-based sampling and weighting resulted in a quasi-representative population sample. We compared Natsal-COVID data with Natsal-3, a household-based probability sample cross-sectional survey (16-74y) conducted in 2010-12. Reported unmet need for condoms because of the pandemic and uptake of chlamydia testing/HIV testing/cervical cancer screening were analysed among sexually-experienced participants (18-44y) (n=3869, Natsal-COVID; n=8551, Natsal-3). Odds ratios adjusted for age (aOR) and other potential confounders (AOR) describe associations with demographic and behavioural factors. Results: In 2021, 6.9% of women and 16.2% of men reported unmet need for condoms because of the pandemic. This was more likely among participants: aged 18-24 years, of Black or Black British ethnicity, and reporting same-sex sex (past five years) or one or more new relationships (past year). Chlamydia and HIV testing were more commonly reported by younger participants, those reporting condomless sex with new sexual partners, and men reporting same-sex partners; a very similar distribution to 10 years previously (Natsal-3). However, there were differences during the pandemic, including stronger associations with chlamydia testing for men reporting same-sex partners; with HIV testing for women reporting new sexual partners; and with cervical screening among smokers. Conclusions: Our study suggests differential access to key primary and secondary STI/HIV prevention interventions continued during the first year of the COVID-19 pandemic. However, the available evidence does not suggest substantial changes in differential access since 2010–12. While the pandemic might not have exacerbated inequalities in access to primary and secondary prevention, it is clear that large inequalities persisted, typically among those at greatest STI/HIV risk.


This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Cite as

Dema, E., Sonnenberg, P., Gibbs, J., Conolly, A., Willis, M., Riddell, J., Bosó Pérez, R., Copas, A., Tanton, C., Bonell, C., Oeser, C., Clifton, S., Unemo, M., Mercer, C., Mitchell, K. & Field, N. 2022, 'How did the COVID-19 pandemic affect access to condoms, chlamydia and HIV testing, and cervical cancer screening at a population level in Britain? (Natsal-COVID)', Sexually Transmitted Infections. https://doi.org/10.1136/sextrans-2022-055516

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Last updated: 01 April 2023
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