Journal of Homosexuality

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjhm20

Associations Between Physical Distancing and

Mental Health, Sexual Health and Technology Use
Among Gay, Bisexual and Other Men Who Have
Sex With Men During the COVID-19 Pandemic

Ian W. Holloway, Alex Garner BA, Diane Tan, Ayako Miyashita Ochoa, Glen
Milo Santos PhD, MPH & Sean Howell BS

To cite this article: Ian W. Holloway, Alex Garner BA, Diane Tan, Ayako Miyashita Ochoa, Glen
Milo Santos PhD, MPH & Sean Howell BS (2021) Associations Between Physical Distancing and
Mental Health, Sexual Health and Technology Use Among Gay, Bisexual and Other Men Who
Have Sex With Men During the COVID-19 Pandemic, Journal of Homosexuality, 68:4, 692-708,
DOI: 10.1080/00918369.2020.1868191

To link to this article: https://doi.org/10.1080/00918369.2020.1868191

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JOURNAL OF HOMOSEXUALITY
2021, VOL. 68, NO. 4, 692–708
https://doi.org/10.1080/00918369.2020.1868191

Associations Between Physical Distancing and Mental

Health, Sexual Health and Technology Use Among Gay,
Bisexual and Other Men Who Have Sex With Men During
the COVID-19 Pandemic
Ian W. Holloway, PhD, MPH, MSWa,b, Alex Garner, BAb,c, Diane Tan, MSPHd,
Ayako Miyashita Ochoa, JDa, Glen Milo Santos, PhD, MPHe,f, and Sean Howell, BSg
a
Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA; bGay
Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs, Los Angeles, California, USA;
c
Hornet Social Network, Los Angeles, California, USA; dDepartment of Health Policy and Management,
UCLA Fielding School of Public Health, Los Angeles, California, USA; eCommunity Health Systems
Department, University of California San Francisco, San Francisco, California, USA; fSan Francisco
Department of Public Health, Center of Public Health Research, San Francisco, California, USA; gLGBT
Foundation, San Francisco, California, USA

ABSTRACT KEYWORDS
Physical distancing measures, designed to limit the spread of COVID-19; MSM; physical
COVID-19, have been implemented globally. We sought to distancing; mental health;
understand how physical distancing impacts gay, bisexual and sexual health
other men who have sex with men (GBMSM), a group dispro­
portionately affected by poor health outcomes. A cross-
sectional online survey on Hornet, a networking application
(N = 10,079), measured sociodemographics, physical distancing,
mental health outcomes, and sexual behavior. Nearly two-thirds
of participants (63%) reported only leaving their home for
essentials. Those who practiced physical distancing were more
likely to feel anxious (aOR = 1.37), feel lonely (aOR = 1.36), to
report their sex life being impacted (aOR = 2.95), and less likely
to be satisfied with their current sex life (aOR = 0.76). Those who
practiced physical distancing were more likely to use social
technologies to stay in touch with others. Risk reduction and
telehealth opportunities may alleviate health challenges for
GBMSM in the COVID-19 era.

As millions of confirmed cases of COVID-19 spread worldwide (World Health

Organization, 2020), recent literature suggests that COVID-19 may dispro­
portionately impact sexual minority men, such as gay, bisexual and other men
who have sex with men (GBMSM) (Harkness, Behar-Zusman, & Safren, 2020).
The mechanisms for disparities in COVID-19 diagnosis and death among
sexual and gender minorities are thought to stem from higher rates of poverty
and greater dependence on the gig economy, limited access to healthcare,
homophobia in health-care settings, and other forms of stigma and discrimi­
nation (Badgett, Choi, & Wilson, 2019; Dean, Victor, & Guidry-Grimes, 2016;

CONTACT Ian W. Holloway holloway@luskin.ucla.edu 3250 Charles E Young Drive East, Los Angeles, CA
90095, USA.
© 2021 Taylor & Francis Group, LLC
 JOURNAL OF HOMOSEXUALITY 693

Herek, 2008; Meyer & Frost, 2013; Sanchez, Zlotorzynska, Rai, & Baral, 2020).
One of the key strategies for limiting the spread of COVID-19 is physical
distancing (also called “social distancing,” “social isolation,” “safer-at-home,”
“shelter-in-place,” “lockdown”). In many jurisdictions, physical distancing
policies dictate leaving home only for essential activities, such as purchasing
groceries. However, these policies which vary by location and are continuously
updated to reflect economic, political, and public safety needs, may also
exacerbate underlying health disparities among GBMSM, and “physical dis­
tancing fatigue” could undermine efforts to slow COVID-19 transmission and
cause further emotional distress.
Fear, loneliness, social isolation, and lack of access to social and community
support networks during the COVID-19 pandemic may contribute to worsen­
ing mental health outcomes, such as anxiety, depression, suicidal ideation, and
self-harm among populations already at-risk (Banerjee & Rai, 2020; Beima-
Sofie et al., 2020; Sahoo et al., 2020; Sanchez et al., 2020; Thakur & Jain, 2020).
GBMSM experience higher prevalence of mood and anxiety disorders, major
depression, panic disorder, substance use, post-traumatic stress disorder, and
dysthymia than their heterosexual counterparts (Bostwick, Boyd, Hughes, &
McCabe, 2010; Cochran, Mays, & Sullivan, 2003; Hatzenbuehler, Keyes, &
Hasin, 2009; Pakula, Shoveller, Ratner, & Carpiano, 2016). Numerous authors
have found correlations between health outcomes and perceived and experi­
enced discrimination related to homophobia, racism, and sexism, and other
minority stressors among GBMSM (Bostwick et al., 2010; Hatzenbuehler et al.,
2009; Mays & Cochran, 2001; Meyer & Frost, 2013). These unique vulner­
abilities of GBMSM highlight the importance of examining the impact of
physical distancing guidelines on their mental health and well-being.
Furthermore, there is a lack of information on compliance with physical
distancing guidelines (e.g., staying in) and their effects on GBMSM’s social
behaviors. Boredom, family conflict and physical distancing fatigue may drive
some GBMSM to ignore physical distancing guidelines to engage in sexual
activities that heighten the risk of COVID-19 acquisition. In response to
physical distancing measures, GBMSM have increased their dating and social
networking app usage (Brennan, Card, Collict, Jollimore, & Lachowsky, 2020).
Since homosexuality remains stigmatized in many countries, GBMSM rely on
social networking platforms to socialize without fear of stigma (Lemke &
Weber, 2017; Schrimshaw, Downing, & Cohn, 2018). While some research
shows that GBMSM have adapted to physical distancing policies by having
fewer sexual partners and engaging in more virtual dating and sexual activity,
others argue that these new practices are not sustainable and may result in
compliance challenges with future physical distancing measures, especially as
stay-at-home orders become protracted, or are re-issued to confront addi­
tional waves of the pandemic (McKay, Gonzalez, Quarles, Gavulic, & Gallegos,
In press; Sanchez et al., 2020).
694 I. W. HOLLOWAY ET AL.

We sought to understand the association between physical distancing and

mental health, sexual health and technology usage among a global sample of
GBMSM recruited via a popular social networking application (app).
Specifically, we hypothesized that adherence to physical distancing measures
would be correlated with poorer mental health outcomes, sexual dissatisfac­
tion, and increased social technology use.

Methods
Participants and procedures

A description of methods from the parent study has been presented elsewhere
(Santos et al., 2020). Briefly, recruitment and data collection occurred from
April 16, 2020 to May 24, 2020 as part of a cross-sectional study on the impact
of COVID-19 among users of Hornet, a smart-phone-based social networking
app for GBMSM with over 25 million users worldwide. Countries were
included in the dataset if they had had 50 or more individual-level responses
and included Australia, Belarus, Belgium, Brazil, Canada, Egypt, France,
Germany, Indonesia, Italy, Kazakhstan, Malaysia, Mexico, the Russian
Federation, Taiwan, Thailand, Turkey, Ukraine, the United Kingdom, and
the United States (Rao et al., In press).
Hornet users were invited to participate in a 58-question online survey
regarding the impact of COVID-19 on a variety of health and mental health
outcomes. Potential participants received an inbox message via Hornet; inter­
ested users clicked on a link which directed them to a Qualtrics survey, which
prevented survey responses from duplicate IP addresses. Hornet users were
eligible to participate if they were at least 18 years old and provided informed
consent. A total of 12,589 participants responded to the survey; however, for
this study, we only included participants who reported being assigned male sex
at birth, self-identified as male and had available data on our outcomes and
characteristics of interest (N = 10,079). Study procedures were reviewed by the
Johns Hopkins School of Public Health Institutional Review Board, which
determined that the protocol qualified for Exempt status under Category 4.
Secondary data analysis was approved by the UCLA North Campus
Institutional Review Board (Protocol #20-001678).

Measures
Eligible, consenting participants responded to general demographic ques­
tions on age and sexual orientation; HIV serostatus; relationship status;
cohabitation/living arrangement; migrant status (e.g., “Are you, or is one
or more of your parents, a migrant to the country in which you currently
live?”); citizenship/legal resident status, socioeconomic status; educational
 JOURNAL OF HOMOSEXUALITY 695

attainment; employment status; healthcare coverage; and urbanicity.

Additionally, participants were asked questions regarding the effects of
COVID-19 on the following areas: (1) physical distancing; (2) mental
health; (3) sexual behavior and satisfaction; and (4) social technology use.

Physical distancing
Participants were asked the following questions regarding physical distan­
cing: “Since the COVID-19 crisis began, have you been staying in?” (Yes,
I do not go out; Yes, I only go out for essentials, like groceries; No, I go out
for work; No, I go out the same as I did before the crisis; I am a healthcare or
crisis response worker and am required to go out). Those who reported not
going out or only going out for essentials were categorized as staying in while
everyone else was categorized as not staying in. Because local governments
were responding to the pandemic differently, we also asked “Is the govern­
ment in your country, or in the part of the country where you live, restricting
your movement during the COVID-19 crisis?” (yes/no), which we used as
a covariate to adjust for differences in policy responses regarding physical
distancing.

Mental health
Participants were asked questions regarding the impact of COVID-19 on their
mental health: (1) “Have you been feeling lonely since the COVID-19 crisis
began?” and (2) “Have you been feeling anxious since the COVID-19 crisis
began?” Both items were recoded to reflect a binary outcome. Participants
were also asked, “In the six months prior to the COVID-19 crisis, how often
have you thought about taking your own life?” (never, seldom, quite often,
very often, all the time). Responses were dichotomized to reflect suicidality
prior to the COVID-19 crisis (any/never); this variable was used as a covariate
in mental health analyses.

Sexual behavior and sexual satisfaction

Participants were asked “How has the COVID-19 crisis impacted your sex life
(physical sexual contact)?” Response categories included “I have not been
having sex”; “I restrict sex to those I live with”; “I have only been having sex
with people I know”; “I have been having more sex”; “COVID-19 has not
impacted my sex life” and were recoded to reflect a binary outcome (yes/no).
Those who reported “COVID-19 has not impacted my sex life” were coded as
“no” while all other responses were coded as “yes.” Participants were also
asked to indicate “How satisfied are you with your sex life currently?” (extre­
mely dissatisfied, somewhat dissatisfied, neither satisfied nor dissatisfied,
somewhat satisfied, extremely satisfied). These categories were collapsed into
being extremely or somewhat satisfied versus not.
696 I. W. HOLLOWAY ET AL.

Social technology use

Participants were asked to indicate the ways in which they were maintaining
contact with their social networks during the COVID-19 pandemic by asking:
“How are you connecting with others while staying in?” (texting, telephone
calls, chatting on social networking apps or websites, video calls, other
method). Each response choice was binary (yes/no).

Data analysis

First, bivariate associations between the independent variable (physical dis­

tancing), outcome variables (mental health, sexual behavior/satisfaction, social
technology use), and covariates were assessed using chi-squared tests for
categorical variables. To account for multiple comparisons and reduce type
I error, we adjusted p-values using the Benjamini–Hochberg (BH) method
(Benjamini & Hochberg, 1995). Covariates that were significant at the alpha =
0.05 significance level after this adjustment were included in the multivariable
models along with covariates.
Next, we ran separate models for each analysis examining the association
between physical distancing and the following outcome categories: mental
health, sex life, and social technology use. Covariates included: age; sexual
orientation; migrant status; citizenship/legal resident status; socioeconomic
status; highest level of education completed; current employment status;
healthcare coverage; urbanicity; relationship status; cohabitation/living
arrangement; and HIV status. In addition, we included covariates regarding
lockdown/stay-at-home status (see physical distancing measures section
above) and survey week to account for differences in policy responses regard­
ing physical distancing. These covariates were used in place of geographic
location (i.e., country of residence). For the mental health analyses, we also
included whether the participant had any suicidal thoughts six months prior to
the COVID-19 pandemic as additional covariates which served as proxy for
preexisting mental health conditions. We ran multivariable logit regressions to
estimate the effect of physical distancing on these outcomes. All analyses we
used were run using R (R Core Team, 2013).

Results
Participant characteristics
Nearly two-thirds of the sample indicated staying in or only going out for
essentials since the COVID-19 crisis began (Table 1). Most participants were
between the ages of 18–34, identified as gay, were not migrants, were citizens
or legal residents of their country, were currently employed, had healthcare
coverage, lived in a large urban center, were not in a relationship, were not
 JOURNAL OF HOMOSEXUALITY 697

Table 1. Demographics of global sample of GBMSM, including the impact of COVID-

19 on mental health, living environment, sex life, and social tech use, 2020
(N = 10,079).
Variables n %
Practiced physical distancing 6,307 62.7
Age
18–34 5,596 55.5
35+ 4,483 44.5
Sexual orientation
Gay 7,688 78.6
Bisexual 1,708 17.5
Other 389 4.0
Migrant status
Parents are natural born citizens 7,841 83.8
Respondent or at least one parent is a migrant 1,515 16.2
Citizenship/Legal resident status
Other 916 9.5
Yes 8,725 90.5
Socioeconomic status
Lower 786 7.8
Lower Middle 3,890 38.7
Upper Middle 4,803 47.8
Upper 569 5.7
Highest level of education completed
Less than 6 years 614 6.1
6–12 years 1,294 12.9
Trade School or vocational Training 1,139 11.3
Some University, no Degree 1,853 18.4
University Degree or more 5,160 51.3
Employment status
Unemployed 2,748 27.6
Employed 6,728 67.7
Retired/Unable to work due to disability 464 4.7
Has healthcare coverage
No 1,455 14.6
Yes 8,507 85.4
Urbanicity
No 3,037 30.2
Yes, in a capital or large city 7,004 69.8
Relationship status
Not in a relationship 6,635 67.4
In a relationship 3,208 32.6
Cohabitation
No 7,980 81.1
Yes, lives with Partner* 1,863 18.9
HIV status
Else 8,820 87.9
Reported positive 1,219 12.1
Under a lockdown/stay-at-home order
No 2,532 25.2
Yes 7,511 74.8
Survey Week Response
Week 1 1,339 13.3
Week 2 956 9.5
Week 3 569 5.6
Week 4 5,913 58.7
Week 5 1,302 12.9
Mental health
Has felt anxious since the COVID-19 crisis began 6,958 69.6
Has felt lonely since the COVID-19 crisis began 6,202 62.1
Suicidal thoughts in the six months prior to the COVID-19 crisis 2,620 27.2
Suicidal thoughts since the COVID-19 crisis began 2,326 23.6
(Continued)
698 I. W. HOLLOWAY ET AL.

Table 1. (Continued).
Variables n %
Sex life
COVID-19 crisis has impacted sexual activity 8,801 87.7
Currently satisfied with sex life 3,056 30.4
Social tech use
Texting 7,221 71.8
Telephone calls 6,995 69.5
Chatting on social networking apps/websites 8,167 81.2
Video calls 5,915 58.8
Other 1,891 18.8
Used Hornet app to ease loneliness during the COVID-19 crisis 9,372 94.7

cohabitating with a partner, did not report being HIV-positive, were under
a lockdown or stay-at-home order, and participated during mid-May of 2020
—about two months after the WHO officially declared COVID-19
a pandemic. Less than 10% of participants reported being of lower socio­
economic status (SES), while over one-third reported lower-middle SES,
nearly half reported upper middle SES, and a small percentage reported
upper SES. Half had received a university degree or more.
In terms of mental health, most participants in the sample reported feeling
anxious and feeling lonely since the COVID-19 crisis began. A substantial
proportion reported having suicidal thoughts six months prior to the COVID-
19 crisis and a slightly lower percentage reported having suicidal thoughts
since the COVID-19 crisis began. Most participants reported that the public
health crisis has impacted their sexual activity and they were not satisfied with
their current sex life. The majority of participants indicated that they stayed in
touch with others while staying in by texting, telephone calls, chatting on
social networking apps/websites, and video calls. Additionally, almost all
participants indicated using the Hornet app to ease loneliness during the
COVID-19 crisis, and nearly three-quarters reported using apps in general
to “hook up” with people since the COVID-19 crisis.

Bivariate analyses

In bivariate analyses, participants who practiced physical distancing, com­

pared to those who did not, were more likely to report feeling anxious
(65.5% vs. 34.5%, Χ2(1, n = 9,984) = 79.19, p <.001) and lonely (67% vs.
33%, Χ2(1, n = 9,973) = 133.41, p > .001). Practicing physical distancing (vs.
not) was also associated with higher percentage of participant endorsement
of statements that the pandemic impacted sex life (66.4%% vs. 33.6%, Χ2(1,
n = 10,033) = 416.70, p < 00.1) and a reduced endorsement of statements
indicating satisfaction with current sex life (56.4% vs. 43.6%, Χ2(1,
n = 10,052) = 73.93, p < .001). Practicing physical distancing was also
 JOURNAL OF HOMOSEXUALITY 699

positively associated with using all forms of technology to connect with

others relative to participants not practicing physical distancing, including
text (64.8% vs. 35.2%, Χ2(1, n = 10,049) = 51.43, p < .001), telephone calls
(63.8% vs. 36.2%, Χ2(1, n = 10,049) = 11.94, p < .001), social networking
apps/websites (63.3% vs. 36.7%, Χ2(1, n = 10,049) = 7.23, p < .012) and video
calls (67.2% vs. 32.8%, Χ2(1, n = 10,049) = 128.73, p > .001). (Tables with full
bivariate results between the outcomes and covariates are available from lead
author by request).

Multivariable analyses

Mental health
After accounting for other contributing factors, physical distancing was posi­
tively associated with feeling anxious and feeling lonely (See Table 2). The
odds of feeling anxious since the COVID-19 crisis began was 37% higher for
those who practiced physical distancing than for those who did not. Feeling
anxious since the crisis began was also positively associated with being under
a lockdown or stay at home order, having had suicidal thoughts before
COVID-19, later weeks of the pandemic (e.g., week 2 and 4 vs. week 1),
being a citizen/resident (vs. those who were not), and having a university
degree or more (vs. completing less than six years of education). Upper SES
(compared to lower SES) was protective against anxiety.
Similarly, the odds of feeling lonely since the crisis began was 36% higher
for those who practiced physical distancing compared to those who did not.
Feeling lonely since the crisis began was also positively associated with being
a migrant or having at least one parent who is a migrant, being under
a lockdown or stay-at-home order, later survey weeks (weeks 4 or 5 vs.
week 1), and reporting having suicidal thoughts in the six months prior to
the COVID-19 pandemic. Several factors were protective against reporting
feeling lonely including higher socioeconomic status (upper or upper middle
vs. lower), any college education, being employed, having healthcare coverage,
being in a relationship, and cohabitating with a partner.

Sexual behavior and sexual satisfaction

Those who practiced physical distancing were more likely to report that their
sex life had been impacted by the public health crisis and less likely to report
being satisfied with their current sex life (See Table 2). Those who practiced
physical distancing were nearly three times as likely to report their physical sex
life being impacted by the COVID-19 crisis than those who did not. The odds
of reporting an impacted physical sex life was also higher for those ages 35 or
older (vs. those ages 18–34), those bisexual (vs. gay), and those who reported
being on lockdown status (vs. those not). However, the odds were lower for
citizens/residents (vs. non-citizens/residents), those who completed trade
700 I. W. HOLLOWAY ET AL.

Table 2. Multivariate logit regressions of staying in on anxiety, loneliness, and sex life satisfaction
since the COVID-19 crisis among a global sample of GBMSM, 2020.
Mental Health Outcomes Sex Life Outcomes
Anxious since the Lonely since the COVID-19 crisis Satisfied with
COVID-19 crisis COVID-19 crisis impacted sex life current sex life
(n = 8,209) (n = 8,194) (n = 8,467) (n = 8,480)
Variables OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Practices physical distancinga 1.37 (1.23, 1.53) 1.36 (1.22, 1.51) 2.95 (2.54, 3.43) 0.76 (0.68, 0.85)
Ageb 1.06 (0.96, 1.18) 0.94 (0.85, 1.04) 1.30 (1.12, 1.50) 0.92 (0.83, 1.02)
Sexual orientationc
Bisexual 0.88 (0.77, 1.00) 1.02 (0.90, 1.16) 1.34 (1.11, 1.61) 0.88 (0.77, 1.00)
Other 0.92 (0.72, 1.18) 0.96 (0.75, 1.22) 0.91 (0.65, 1.27) 0.92 (0.72, 1.18)
At least one parent or respondent 1.14 (0.99, 1.31) 1.17 (1.03, 1.34) 0.94 (0.77, 1.14) 1.07 (0.93, 1.22)
is a migranta
Is a citizen or legal residenta 1.22 (1.03, 1.45) 1.15 (0.97, 1.36) 0.74 (0.56, 0.97) 0.95 (0.80, 1.13)
Socioeconomic statuse
Lower middle 1.01 (0.83, 1.24) 0.95 (0.77, 1.16) 0.95 (0.72, 1.26) 1.04 (0.84, 1.27)
Upper middle 0.84 (0.69, 1.04) 0.79 (0.65, 0.97) 1.03 (0.78, 1.37) 1.10 (0.89, 1.35)
Upper 0.61 (0.46, 0.80) 0.72 (0.55, 0.95) 0.83 (0.56, 1.23) 1.22 (0.92, 1.63)
Highest level of education
completedf
6–12 years 1.00 (0.78, 1.27) 0.89 (0.69, 1.14) 0.98 (0.70, 1.39) 1.00 (0.79, 1.27)
Trade school or vocational 0.98 (0.77, 1.25) 0.78 (0.61, 1.01) 0.70 (0.50, 0.98) 0.87 (0.68, 1.12)
training
Some University, no degree 1.07 (0.85, 1.34) 0.75 (0.59, 0.95) 0.94 (0.68, 1.31) 0.86 (0.68, 1.09)
University degree or more 1.31 (1.06, 1.62) 0.77 (0.62, 0.96) 0.86 (0.63, 1.16) 0.87 (0.71, 1.08)
Employment statusg
Employed 0.95 (0.84, 1.08) 0.85 (0.75, 0.95) 1.16 (0.98, 1.38) 0.84 (0.74, 0.95)
Retired/Unable to work due to 0.94 (0.72, 1.22) 0.95 (0.73, 1.23) 1.15 (0.75, 1.78) 0.91 (0.70, 1.19)
disability
Has healthcare coveragea 0.89 (0.77, 1.03) 0.82 (0.71, 0.95) 0.90 (0.74, 1.10) 0.78 (0.67, 0.89)
Lives in a large urban centera 1.11 (0.99, 1.23) 1.03 (0.93, 1.15) 0.98 (0.84, 1.13) 1.26 (1.13, 1.40)
In a relationshipa 1.07 (0.94, 1.22) 0.68 (0.60, 0.78) 0.94 (0.79, 1.12) 2.42 (2.13, 2.75)
Lives with a partnera 1.04 (0.89, 1.22) 0.58 (0.50, 0.67) 1.06 (0.86, 1.32) 1.44 (1.24, 1.66)
HIV statusd 0.97 (0.84, 1.13) 0.88 (0.76, 1.02) 0.83 (0.68, 1.02) 1.16 (0.99, 1.35)
Under a lockdown/stay-at-home 1.24 (1.11, 1.39) 1.78 (1.60, 1.99) 1.74 (1.51, 2.01) 0.76 (0.68, 0.85)
ordera
Survey Week Responseh
Week 2 1.28 (1.04, 1.58) 1.03 (0.85, 1.26) 0.94 (0.67, 1.32) 1.47 (1.18, 1.84)
Week 3 0.88 (0.69, 1.11) 1.01 (0.80, 1.27) 1.07 (0.72, 1.61) 1.07 (0.82, 1.41)
Week 4 1.18 (1.01, 1.38) 1.53 (1.32, 1.78) 0.64 (0.50, 0.82) 1.64 (1.38, 1.94)
Week 5 1.19 (0.98, 1.44) 1.50 (1.25, 1.81) 0.76 (0.56, 1.02) 1.80 (1.46, 2.21)
Had any suicidal thoughts 1.38 (1.24, 1.55) 1.73 (1.55, 1.93) – –
6 months prior to COVID-19
crisisa
a
Reference Group: Responded no to question: “Since the COVID-19 crisis began, have you been staying in?”
b
Reference Group: Age 18–34
c
Reference Group: Gay (sexual orientation)
d
Reference Group: Not HIV+ (HIV-, unknown status)
e
Reference Group: Lower socioeconomic status
f
Reference Group: Completed less than 6 years of education
g
Reference Group: Unemployed
h
Reference Group: Survey Week

school or vocational training (vs. those with less than six years of schooling),
and later survey week (week 4 vs. week 1).
The odds of being satisfied with one’s current sex life was 24% lower for
those who practiced physical distancing than those who did not. Satisfaction
with one’s current sex life was also negatively associated with being employed
(vs. unemployed), having healthcare coverage (vs. not), and being under
 JOURNAL OF HOMOSEXUALITY 701

a lockdown order (vs. not), but positively associated with living in a large
urban center (vs. not), being in a relationship (vs. not), living with a partner
(vs. not), and certain survey weeks (weeks 2, 4, and 5 vs. week 1).

Social technology use

Physical distancing was positively associated with higher use of all forms of
social technologies to stay connected with others (See Table 3). The odds of
using text messages to stay connected with others while staying in was 28%
higher for those who practiced physical distancing than those who did not.
Citizens/residents (vs. non-citizens/residents), those with healthcare coverage
(vs. those without), those living in a large urban center (vs. not), and those
under a lockdown order (vs. not) were also more likely to use text messages to
stay connected with others while staying in. Those ages 35 and older (vs. those
ages 18–34), not gay (vs. gay), and those who participated in the survey after
week 1 of the survey period were less likely to stay connected with others over
text.
The odds of connecting with others over telephone calls during this period
was 15% higher for those who practiced physical distancing compared to those
who did not. Citizens/residents (vs. non-citizens/residents), those with health­
care coverage (vs. those without), those under a lockdown order (vs. not), and
participating in the survey during the fourth week of the survey period (vs.
week 1) were more likely to stay connect with others over telephone calls.
Migrants and those with a migrant parent (vs. non-migrants), those who
participated in the survey during the second and third week of the survey
period (vs. week 1), and those not gay (vs. gay) were less likely to stay
connected with others over telephone calls.
The odds of connecting with others over social media apps and websites
during this time was also 15% higher for those who practiced physical distan­
cing than those who did not. Citizens/residents (vs. non-citizens/residents),
those who completed any college (vs. those with less than a college education),
those with healthcare coverage (vs. those without), those in a relationship (vs.
not), and those under a lockdown order (vs. not) were more likely use social
media to stay connected with others during the crisis. Those ages 35 and older
(vs. those ages 18–34), those bisexual (vs. gay), migrants and those with
a migrant parent (vs. non-migrants), those retired or unable to work due to
a disability (vs. unemployed), and those living with a partner (vs. not) were less
likely to use social media to stay connected with others during this time.
The odds of connecting with others over video calls was 54% higher for
those who practiced physical distancing than those who did not. Those with an
upper-middle socioeconomic status (vs. those with lower), those with
a university degree or more (vs. those with less), those with healthcare cover­
age (vs. those without), those living in large urban centers (vs. not), and those
under a lockdown order (vs. not) were more likely to use video calls to stay
702 I. W. HOLLOWAY ET AL.

Table 3. Multivariate logit regressions of technology use since the COVID-19 crisis among a global
sample of GBMSM, 2020.
Technology Use
Connects with Connects with
Connects with Connects with others via others via social others via video
others via text telephone calls media calls
(n = 8,482) (n = 8,482) (n = 8,482) (n = 8,482)
Variables OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Practices physical 1.28 (1.15, 1.43) 1.15 (1.03, 1.28) 1.15 (1.01, 1.31) 1.54 (1.39, 1.70)
distancinga
Ageb 0.80 (0.72, 0.89) 1.08 (0.98, 1.20) 0.77 (0.68, 0.86) 0.81 (0.73, 0.89)
Sexual orientationc
Bisexual 0.84 (0.74, 0.96) 0.78 (0.69, 0.89) 0.72 (0.62, 0.83) 0.83 (0.73, 0.93)
Other 0.71 (0.56, 0.90) 0.77 (0.61, 0.98) 0.82 (0.62, 1.09) 0.70 (0.56, 0.88)
At least one parent or 0.89 (0.78, 1.02) 0.81 (0.71, 0.92) 0.83 (0.71, 0.96) 1.04 (0.92, 1.18)
respondent is
a migranta
Citizen or legal 1.33 (1.13, 1.57) 1.24 (1.05, 1.45) 1.35 (1.13, 1.63) 1.11 (0.95, 1.30)
residenta
Socioeconomic statuse
Lower middle 0.93 (0.76, 1.14) 0.87 (0.72, 1.06) 1.03 (0.82, 1.30) 0.96 (0.80, 1.15)
Upper middle 1.07 (0.88, 1.32) 1.01 (0.83, 1.23) 1.00 (0.79, 1.26) 1.24 (1.03, 1.49)
Upper 0.94 (0.71, 1.25) 0.84 (0.64, 1.11) 0.97 (0.70, 1.34) 1.23 (0.95, 1.60)
Highest level of
education
completedf
6–12 years 0.87 (0.69, 1.11) 0.92 (0.73, 1.17) 0.90 (0.70, 1.16) 0.95 (0.76, 1.18)
Trade school or 0.93 (0.73, 1.19) 1.03 (0.81, 1.31) 1.29 (0.99, 1.69) 0.99 (0.79, 1.24)
vocational training
Some University, no 1.04 (0.83, 1.31) 1.03 (0.82, 1.28) 1.36 (1.06, 1.75) 1.10 (0.89, 1.36)
degree
University degree or 1.15 (0.93, 1.42) 1.20 (0.98, 1.48) 1.51 (1.20, 1.90) 1.24 (1.02, 1.50)
more
Employment statusg
Employed 0.98 (0.87, 1.11) 1.05 (0.93, 1.18) 0.95 (0.82, 1.10) 1.12 (0.99, 1.25)
Retired/Unable to 0.97 (0.75, 1.27) 1.12 (0.86, 1.46) 0.66 (0.50, 0.86) 0.75 (0.59, 0.95)
work due to disability
Has healthcare 1.32 (1.15, 1.51) 1.27 (1.11, 1.46) 1.25 (1.07, 1.47) 1.30 (1.14, 1.48)
coveragea
Lives in a large urban 1.14 (1.03, 1.27) 1.10 (0.99, 1.22) 0.96 (0.85, 1.08) 1.20 (1.09, 1.32)
centera
In a relationshipa 1.06 (0.93, 1.22) 1.10 (0.96, 1.25) 1.31 (1.11, 1.54) 1.07 (0.95, 1.22)
Lives with a partnera 0.95 (0.81, 1.12) 0.91 (0.78, 1.07) 0.81 (0.68, 0.98) 0.98 (0.85, 1.13)
HIV statusd 0.95 (0.82, 1.11) 1.01 (0.87, 1.17) 0.98 (0.82, 1.16) 1.10 (0.96, 1.26)
Under a lockdown/ 1.38 (1.23, 1.55) 1.22 (1.09, 1.36) 1.18 (1.03, 1.35) 1.44 (1.29, 1.60)
stay-at-home ordera
Survey Week
Responseh
Week 2 0.64 (0.52, 0.80) 0.71 (0.58, 0.86) 0.88 (0.69, 1.13) 0.79 (0.65, 0.96)
Week 3 0.57 (0.45, 0.73) 0.76 (0.60, 0.95) 0.80 (0.61, 1.06) 0.90 (0.72, 1.13)
Week 4 0.70 (0.59, 0.83) 1.20 (1.03, 1.41) 0.87 (0.72, 1.05) 0.84 (0.72, 0.97)
Week 5 0.51 (0.42, 0.63) 0.89 (0.74, 1.08) 0.87 (0.69, 1.10) 0.83 (0.69, 0.99)
a
Reference Group: Responded no to question: “Since the COVID-19 crisis began, have you been staying in?”
b
Reference Group: Age 18–34
c
Reference Group: Gay (sexual orientation)
d
Reference Group: Not HIV+ (HIV-, unknown status)
e
Reference Group: Lower socioeconomic status
f
Reference Group: Completed less than 6 years of education
g
Reference Group: Unemployed
h
Reference Group: Survey Week 1

connected with others during this time. Older age (ages 35 and older vs. age
18–34), not being gay (vs. gay), being retired or unable to work due to
 JOURNAL OF HOMOSEXUALITY 703

a disability (vs. being unemployed), and certain survey weeks (weeks 2, 4, and
5 vs. 1) were negatively associated with using video calls to stay connected with
others.

Discussion
We sought to understand the associations between physical distancing and
mental health, sexual health and technology use among a global sample of
GBMSM during the COVID-19 pandemic. Overall, adherence to physical
distancing recommendations was high with the majority of participants stay­
ing in to prevent the spread of COVID-19. These findings are consistent with
a Gallup poll conducted in the U.S. in mid-May of this year (Jones, 2020 May,
p. 15). In addition, we found that physical distancing was associated with poor
mental health and sexual dissatisfaction, which lends support to concerns
about the long-term sustainability of physical distancing measures (McKay
et al., In press; Sanchez et al., 2020).
The majority of participants reported increased anxiety and loneliness since
the COVID-19 pandemic began. GBMSM are already disproportionately
impacted by negative mental health outcomes when compared to their hetero­
sexual counterparts (Bostwick et al., 2010; Cochran et al., 2003; Hatzenbuehler
et al., 2009; Pakula et al., 2016). In our sample, nearly a quarter of participants
indicated suicidality prior to the COVID-19 pandemic. There is emerging
literature and media attention on the increase in suicides during the COVID-
19 pandemic, with social isolation, loss of employment and financial stressors
exacerbating known predictors of suicide, such as psychiatric disorders,
domestic violence, alcohol, and other substance use (Gunnell et al., 2020).
Further research on suicidality among GBMSM and suicide prevention with
GBMSM during the COVID-19 pandemic is warranted.
A recent study found that the prevalence of anxiety and depression among
GBMSM was associated with diverse types of stigma and discrimination
related to sexual orientation (Bostwick et al., 2010). Our findings highlight
the ways in which the COVID-19 pandemic may exacerbate underlying
mental health issues faced by GBMSM. This is especially important given
that access to supportive mental health resources for GBMSM was severely
limited prior to the COVID-19 pandemic (Batchelder, Safren, Mitchell,
Ivardic, & O’Cleirigh, 2017; Choi et al., 2016; Storholm et al., 2013; Sun,
Pachankis, Li, & Operario, 2020). More country-specific research on the
ways in which COVID-19 and the accompanying physical distancing mea­
sures impact mental health among GBMSM is warranted. Furthermore, tele­
health solutions for mental health treatments that are specifically targeted to
GBMSM are warranted (Whaibeh, Mahmoud, & Vogt, 2019).
Technology is an important way in which GBMSM are connecting with
their health and social networks during the COVID-19 pandemic (Rao et al.,
704 I. W. HOLLOWAY ET AL.

In press). In our analyses, those participants staying-in were more likely to use
text and video calls in order to connect with others compared to those who
were not. While this is the case generally, as demonstrated by recent report on
the use of technology during the COVID-19 pandemic (Vogels, Perrin, Rainie,
& Anderson, 2020), our findings have specific implications for GBMSM, who
use technology and social networking apps, like Hornet, to connect with other
GBMSM. Nearly all of our participants indicated using Hornet to ease lone­
liness during the COVID-19 pandemic. Hornet, and other gay social network­
ing apps, have been providing resources related to COVID-19 in the form of
health advisories (Greenhalgh, 2020). These apps may do more to address
some of the explicit concerns related to mental health and sexual health during
this public health crisis.
Over three-quarters of participants indicated that the COVID-19 pandemic
had impacted their sex lives and sexual satisfaction was lower among partici­
pants who adhered to physical distancing measures compared to those who
did not. Since the pandemic began several public health agencies have put
forward recommendations for GBMSM in order to reduce the spread of
COVID-19 in the context of sex (Cook County Department of Public
Health, n.d.; Los Angeles County of Public Health, 2020; New York City
Department of Health and Mental Hygiene, 2020). These include limiting
sexual relationships to partners with whom they live, reducing number of
sexual partners and increasing hygiene measures to reduce the likelihood of
COVID-19 transmission.
GBMSM have been the focus of numerous harm reduction campaigns
related to HIV and other sexually transmitted infections (STIs) since the
beginning of the HIV epidemic in the 1980s (French, Bonell, Wellings, &
Weatherburn, 2014; Romer et al., 2009; Studwick, 2015). While information
related to COVID-19 transmission is evolving, the need for clear science-based
guidance for GBMSM is critical. As others have noted, long-term abstinence
from sexual activity and strict restrictions on partnering may not be feasible
(Sanchez et al., 2020). Community-based organizations and public health
agencies working with GBMSM must work to offer resources that are cultu­
rally tailored and balance individual choice about sexual activity with best
practices for public health. This is especially crucial given interruptions in HIV
prevention and treatment that have been documented by recent research
(Santos et al., 2020). Finally, it is important not to stigmatize the sexual
behavior of gay men during the COVID-19 pandemic, as increased stigma
levied at already marginalized communities may exacerbate mental health
issues.
Our study findings should be interpreted in light of some limitations. Data
relied on self-report, which may over- or under-represent mental health and
sexual health outcomes. We were limited in this secondary data analysis from
teasing apart the nuances of type of sexual behavior and type of technology-
 JOURNAL OF HOMOSEXUALITY 705

based communication with regard to physical distancing protocols. Future

research should seek to more thoroughly capture information regarding sexual
partnering and social technology use, including motivations for use. In addition,
the survey was translated into several languages and interpretations of individual
questions may have differed based on language and cultural factors. The data are
cross-sectional and cannot be used to establish causality. Further longitudinal
research is needed to understand the relationship between physical distancing
and mental health, sexual health and technology use among GBMSM.
Despite these limitations, our study offers important insights for how
GBMSM may be negatively impacted by the COVID-19 pandemic and the
accompanying physical distancing measures. Findings point to the need for
additional efforts to confront loneliness and anxiety among GBMSM,
a population already disproportionately burdened by mental health chal­
lenges, and the need for tailored sexual harm reduction messaging for
GBMSM in response to the COVID-19 pandemic. Technology may be a key
tool to achieve both these goals. Our data demonstrate widespread use of text,
phone, social networking apps and video calls among GBMSM to connect
others during the COVID-19 pandemic. Telehealth for counseling and health
messaging delivered via platforms already popular with GBMSM may be
promising avenues for intervention.

Acknowledgments
This research was a collaborative effort that included a number of research staff, including
Elizabeth S.C. Wu, Katherine Maxwell, Maynard Hearns, Sharon Lau, Arthur Sun, and Nina
Young. Funding: Dr. Holloway is supported by the California HIV/AIDS Research Program
(RP15-LA-007) and the UCLA Center for HIV Identification, Prevention and Treatment
Services (P30 MH058107).

Disclosure statement
The authors declare no competing interests.

References
Badgett, M. V. L., Choi, S. K., & Wilson, B. D. M. (2019). LGBT Poverty in the United States:
A study of differences between sexual orientation and gender identity groups. Retrieved from
https://williamsinstitute.law.ucla.edu/wp-content/uploads/National-LGBT-Poverty-Oct
-2019.pdf
Banerjee, D., & Rai, M. (2020). Social isolation in Covid-19: The impact of loneliness.
International Journal of Social Psychiatry, 66(6), 525–527. Advance online publication.
doi:10.1177/0020764020922269
706 I. W. HOLLOWAY ET AL.

Batchelder, A. W., Safren, S., Mitchell, A. D., Ivardic, I., & O’Cleirigh, C. (2017). Mental health
in 2020 for men who have sex with men in the United States. Journal of Sexual Health, 14(1),
59–71. doi:10.1071/SH16083
Beima-Sofie, K., Ortblad, K. F., Swanson, F., Graham, S. M., Stekler, J. D., & Simoni, J. M.
(2020). “Keep it going if you can”: HIV service provision for priority populations during the
COVID-19 pandemic in Seattle, WA. AIDS and Behavior, 24(10), 2760–2763. doi:10.1007/
s10461-020-02902-5
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and
powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B, 57(1),
289–300. doi:10.1111/j.2517-6161.1995.tb02031.x
Bostwick, W. B., Boyd, C. J., Hughes, T. L., & McCabe, S. E. (2010). Dimensions of sexual
orientation and the prevalence of mood and anxiety disorders in the United States. American
Journal of Public Health, 100(3), 468–475. doi:10.2105/ajph.2008.152942
Brennan, D. J., Card, K. G., Collict, D., Jollimore, J., & Lachowsky, N. J. (2020). How might
social distancing impact gay, bisexual, queer, trans and two-spirit men in Canada? AIDS and
Behavior, 24(9), 2480–2482. doi:10.1007/s10461-020-02891-5
Choi, S. K. Y., Boyle, E., Cairney, J., Gardner, S., Collins, E. J., Bacon, J., . . . Group, O. C. S.
(2016). Adequacy of mental health services for HIV-positive patients with depression:
Ontario HIV treatment network cohort study. PloS One, 11(6), Article e0156652.
doi:10.1371/journal.pone.0156652
Cochran, S. D., Mays, V. M., & Sullivan, J. G. (2003). Prevalence of mental disorders,
psychological distress, and mental health services use among lesbian, gay, and bisexual
adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53–61.
doi:10.1037//0022-006x.71.1.53
Cook County Department of Public Health. (n.d.). Practice safer sex. Retrieved from https://
www.cookcountypublichealth.org/communicable-diseases/sexually-transmitted-diseases
/practice-safer-sex/
Dean, M. A., Victor, E., & Guidry-Grimes, L. (2016). Inhospitable healthcare spaces: Why
diversity training on LGBTQIA issues is not enough. Journal of Bioethical Inquiry, 13(4),
557–570. doi:10.1007/s11673-016-9738-9
French, R. S., Bonell, C., Wellings, K., & Weatherburn, P. (2014). An exploratory review of HIV
prevention mass media campaigns targeting men who have sex with men. BioMed Central
Public Health, 14, Article 616. doi:10.1186/1471-2458-14-616
Greenhalgh, H. (2020, March 12). Gay dating apps warn over coronavirus as online meetings
expected to rise. Reuters. Retrieved from https://www.reuters.com/article/us-health-
coronavirus-dating/gay-dating-apps-warn-over-coronavirus-as-online-meetings-expected-
to-rise-idUSKBN20Z31O
Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., . . . Yip, P. S. F. (2020).
Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, 7(6),
468–471. doi:10.1016/S2215-0366(20)30171-1
Harkness, A., Behar-Zusman, V., & Safren, S. A. (2020). Understanding the impact of
COVID-19 on Latino sexual minority men in a US HIV hot spot. AIDS and Behavior, 24
(7), 2017–2023. doi:10.1007/s10461-020-02862-w
Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric
morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99
(12), 2275–2281. doi:10.2105/ajph.2008.153510
Herek, G. M. (2008). Hate crimes and stigma-related experiences among sexual minority adults
in the United States: Prevalence estimates from a national probability sample. Journal of
Interpersonal Violence, 24(1), 54–74. doi:10.1177/0886260508316477
 JOURNAL OF HOMOSEXUALITY 707

Jones, J. M. (2020, May 15). Social distancing eases as some states lift restrictions. Gallup.
Retrieved from https://news.gallup.com/poll/311018/social-distancing-eases-states-lift-
restrictions.aspx
Lemke, R., & Weber, M. (2017). That man behind the curtain: Investigating the sexual online
dating behavior of men who have sex with men but hide their same-sex sexual attraction in
offline surroundings. Journal of Homosexuality, 64(11), 1561–1582. doi:10.1080/
00918369.2016.1249735
Los Angeles County Department of Public Health. (2020). Guidance for sex. Retrieved from
http://publichealth.lacounty.gov/media/Coronavirus/docs/people/GuidanceSex.pdf
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination
among lesbian, gay, and bisexual adults in the United States. American Journal of Public
Health, 91(11), 1869–1876. doi:10.2105/ajph.91.11.1869
McKay, T., Gonzalez, G., Quarles, R., Gavulic, K. A., & Gallegos, S. G. (In press). The
COVID-19 pandemic and sexual behavior among gay and bisexual men in the United
States. SocArXiv. doi:10.31235/osf.io/8fzay
Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. In
C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of Psychology and Sexual Orientation (pp.
252–266). New York, NY: Oxford University Press.
New York City Department of Health and Mental Hygeine. (2020). Safer sex and COVID-19.
Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.
pdf
Pakula, B., Shoveller, J., Ratner, P. A., & Carpiano, R. (2016). Prevalence and co-occurrence of
heavy drinking and anxiety and mood disorders among gay, lesbian, bisexual, and hetero­
sexual Canadians. American Journal of Public Health, 106(6), 1042–1048. doi:10.2105/
ajph.2016.303083
R Core Team. (2013). R: A language and environment for statistical computing. Vienna, Austria:
R Foundation for Statistical Computing.
Rao, A., Rucinski, K., Jarrett, B., Ackerman, B., Wallach, S., Marcus, J., . . . Baral, S. (In press).
Potential interruptions in HIV prevention and treatment services for gay, bisexual, and other
men who have sex with men associated with COVID-19. medRxiv. doi:10.1101/
2020.08.19.20178285
Romer, D., Sznitman, S., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., . . .
Juzang, I. (2009). Mass media as an HIV-prevention strategy: Using culturally sensitive
messages to reduce HIV-associated sexual behavior of at-risk African American youth.
American Journal of Public Health, 99(12), 2150–2159. doi:10.2105/ajph.2008.155036
Sahoo, S., Rani, S., Parveen, S., Pal Singh, A., Mehra, A., Chakrabarti, S., . . . Tandup, C. (2020).
Self-harm and COVID-19 Pandemic: An emerging concern - A report of 2 cases from India.
Asian Journal of Psychiatry, 51, Article 102104. doi:10.1016/j.ajp.2020.102104
Sanchez, T. H., Zlotorzynska, M., Rai, M., & Baral, S. D. (2020). Characterizing the impact of
COVID-19 on men who have sex with men across the United States in April, 2020. AIDS
and Behavior, 24(7), 2024–2032. doi:10.1007/s10461-020-02894-2
Santos, G.-M., Ackerman, B., Rao, A., Wallach, S., Ayala, G., Lamontage, E., . . . Howell, S.
(2020). Economic, mental health, HIV prevention and HIV treatment impacts of COVID-19
and the COVID-19 response on a global sample of cisgender gay men and other men who
have sex with men. AIDS and Behavior. Advance online publication. doi:10.1007/s10461-
020-02969-0
Schrimshaw, E. W., Downing, M. J., & Cohn, D. J. (2018). Reasons for non-disclosure of sexual
orientation among behaviorally bisexual men: Non-disclosure as stigma management.
Archives of Sexual Behavior, 47(1), 219–233. doi:10.1007/s10508-016-0762-y
708 I. W. HOLLOWAY ET AL.

Storholm, E. D., Siconolfi, D. E., Halkitis, P. N., Moeller, R. W., Eddy, J. A., & Bare, M. G.
(2013). Sociodemographic factors contribute to mental health disparities and access to
services among young men who have sex with men in New York City. Journal of Gay &
Lesbian Mental Health, 17(3), 294–313. doi:10.1080/19359705.2012.763080
Studwick, P. (2015, December 1). These posters show what AIDS meant in the 1980s. Buzzfeed
News. Retrieved from https://www.buzzfeednews.com/article/patrickstrudwick/these-
1980s-aids-posters-show-the-desperate-fight-to-save-li
Sun, S., Pachankis, J. E., Li, X., & Operario, D. (2020). Addressing minority stress and mental
health among men who have sex with men (MSM) in China. Current HIV/AIDS Reports, 17
(1), 35–62. doi:10.1007/s11904-019-00479-w
Thakur, V., & Jain, A. (2020). COVID 2019-suicides: A global psychological pandemic. Brain,
Behavior, and Immunity, 88, 952–953. doi:10.1016/j.bbi.2020.04.062
Vogels, E. A., Perrin, A., Rainie, L., & Anderson, M. (2020). 53% of Americans say the internet
has been essential during the COVID-19 outbreak. Pew Research Center. Retrieved from
https://www.pewresearch.org/internet/2020/04/30/53-of-americans-say-the-internet-has-
been-essential-during-the-covid-19-outbreak/
Whaibeh, E., Mahmoud, H., & Vogt, E. L. (2019). Reducing the treatment gap for LGBT mental
health needs: The potential of telepsychiatry. Journal of Behavioral Health Services and
Research, 47, 424–431. doi:10.1007/s11414-019-09677-1
World Health Organization. (2020, August 23). Coronavirus disease (COVID-19): Weekly
epidemiological update. Retrieved from https://www.who.int/docs/default-source/coronavir
use/situation-reports/20200824-weekly-epi-update.pdf?sfvrsn=806986d1_4