The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave
Authors: Erausquin Jennifer Toller , Tan Rayner K. J. , Uhlich Maximiliane , Francis Joel M. , Kumar Navin , Campbell Linda , Zhang Wei-Hong , Hlatshwako Takhona G. , Kosana Priya , Shah Sonam , Brenner Erica M. , Remmerie Lore , Mussa Aamirah , Klapilova Katerina , Mark Kristen , Perotta Gabriela , Gabster Amanda , Wouters Edwin , Burns Sharyn , Hendriks Jacqueline , Hensel Devon J. , Shamu Simukai , Strizzi Jenna Marie , Esho Tammary , Morroni Chelsea , Eleuteri Stefano , Sahril Norhafiza , Low Wah Yun , Plasilova Leona , Lazdane Gunta , Marks Michael , Olumide Adesola , Abdelhamed Amr , López Gómez Alejandra , Michielsen Kristien , Moreau Caroline , Tucker Joseph D. ,   I-SHARE research consortium
Published: September 2021

Background

The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, 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 utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses.

Results

Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% 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.

Conclusion

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.