Data for the current study were drawn from International Sexual Health And REproductive Health Survey (I-SHARE-1), a multi-country, cross-sectional, online study conducted to assess the impact of the pandemic on adult sexual health across the globe. Participants were recruited through local, regional, and national networks (e.g. listservs of professional organizations and international health organizations, social media, etc.) of each country’s research team. AYA participants (N=7527; 18-26 years; 32.3% of total-sample; 60.1% female, 86.1% cisgender, 77.1% heterosexual) were retained. LCA was used to identify and classify patterns (i.e., classes) of changes (increased, stayed the same, or decreased) in seven solo and partnered sexual behaviors (cuddling/kidding/hugging a main partner, sex with a main partner, solo masturbation, sex with a casual partner, sexting, viewing pornography, and cybersex). Random intercept mixed effects multinomial regression (gllamm; Stata 17.0; all p<.05) adjusted for country-level clustering was used understand how demographic (age, gender identity, sexual identity, employment status during COVID-19, mental health, distancing or isolation during COVID-19) and country-level predictors (income group, Oxford Stringency Index [national response to COVID-19], Palma Ratio [country-income inequality) and Gender Inequality Index (country-gender) were associated with changes in sexual behaviors.
LCA results suggested a six-class solution: increased solo masturbation and porn + all others stable (11.8%), increased cuddles/hugging and sex with main partner + all others no-change (10.5%), increased cuddles/hugging and sex with main partner + increased solo masturbation and porn use + all others stable (18.8%), all decreased (13.1%), decreased cuddles/hugging and sex with main partner + all others no-change (19.5%) and all no-change (24.3%). Older age (RRR=0.86-0.94), being female (OR=0.39-0.67) and higher mental health scores (RRR=0.68-0.81) were associated with a lower likelihood of increased masturbation/porn, increased bonding/sex with main partner + increased masturbation/porn and a decrease in all behaviors relative to no behavior change. Being a sexual minority (OR=1.40-1.70), ever being in isolation for COVID-19 (RRR=1.21-1.45), having stable employment (RRR=1.25-1.32), being in a country with more stringent lockdown (RRR=1.02-1.07) or with a greater wealth inequality (RRR=1.17-1.55) were positively associated with increased masturbation/porn, increased bonding/sex with main partner + increased masturbation/porn, and a decrease in all behaviors relative to no behavior change. Greater distancing (RRR=1.16) was significantly associated with increased bonding/sex with main partner vs. all behaviors stable.
The initial wave of COVID-19 impacted AYA solo sexual behaviors, partnered bonding behaviors, in-person sexual behaviors and virtual sexual behaviors. Evidence of individual differences in these classes should inform SRH preparation efforts for future public health emergencies.