When the COVID-19 pandemic emerged in Australia in early 2020, it was expected to have a profound impact on HIV prevention. So, the Kirby Institute at UNSW Sydney asked hundreds of gay and bisexual men (GBM) in Australia to fill in diaries every week, to monitor how COVID-19 was affecting their lives; and they did, every week for the past year.
The Flux Study has been running since 2014 with a particular focus on the use of drug and HIV pre-exposure prophylaxis (PrEP) among Australian GBM. When the pandemic emerged, Flux was uniquely placed to monitor behavioural changes prior to and throughout the COVID-19 pandemic and during the period after its most significant impacts, and to provide insights into how GBM experience, engage with, and will emerge from, COVID-19.
Led by Kirby Institute’s Dr Mohamed A. Hammoud and Associate Professor Garrett Prestage, the Flux study was quickly adapted to address the COVID-19 pandemic, with funding support from NSW Health. Participants were asked to complete surveys, or ‘diary entries’, each week, to monitor any changes in their behaviours amid the pandemic. Weekly questions ranged from HIV and STI testing and diagnosis, taking PrEP and HIV treatments, sexual and social contact, to COVID-19 testing and vaccination.
The study has reached the milestone of one year of weekly data collection. This incredible achievement is a testament to the commitment of the study participants. Over 700 men participated, far beyond the study leaders’ initial expectations.
“This was a globally unique endeavour, but also a big ask of the participants in the study,” says Dr Hammoud. “We want to extend our deepest gratitude to every person who participated in this study. This commitment has been crucial for the study’s success and its capacity to help our communities.”
What have we learned?
The findings have provided powerful insight into how Australian GBM have responded as a community to the pandemic. Initially, major declines in sexual contacts were observed, corresponding with declines in the use of PrEP. In an interview with ABC News, Dr Hammoud spoke about how GBM in the Flux study adapted their behaviours as local epidemics evolved. Many men were avoiding sex to help reduce the risk of COVID-19 transmission. To date, findings from the Flux Study have been disseminated at 2 international conferences, 3 community presentations, with 35 unique news stories across the globe.
Study findings have informed the development of key HIV policy such as the recently-launched NSW HIV Strategy 2021-2025 and assisted with quarterly HIV reporting in NSW; an essential component of monitoring the effectiveness and impact of HIV prevention and testing initiatives.
Throughout the study, the participants had the opportunity to describe their experiences of taking part on a weekly basis. For many, it was an opportunity for personal reflection and a sense of community. One participant wrote:
“I am really going to miss these diaries when they end. This has been a really good opportunity for me to take stock of my feelings as the weeks pass and I'm not sure what I'll do to replace it. I like knowing that someone has read my weekly diary and acknowledged that somewhere, someone has felt these feelings.”
“These weekly contributions from the Flux study participants are impressive”, says A/Prof Prestage. “We were able to see how gay and bisexual men adjusted their sexual behaviours even before COVID-19 restrictions were imposed, presumably in response to their own observations of the daily number of new COVID-19 cases.”
“Throughout history, we’ve seen our community come together to find ways to protect themselves and each other. The COVID-19 pandemic is no exception. We see this through the surveys and interviews conducted over the past 52 weeks, and this is a testament to the commitment and support of our community to the health and wellbeing of themselves and others.”
“The contribution that participants have made every week for the past year is helping to shape the way government and community organisations respond to health concerns among gay and bisexual men,” says the Kirby Institute’s Daniel Storer, who works on the study. “We are grateful for their commitment to making a significant impact on the health and wellbeing of our communities.”
In response to the reduced risk that COVID-19 poses in Australia, the study has now moved from weekly to quarterly data collection, as researchers also monitor the community’s response to COVID-19 vaccines.