(P205) IMPACT OF COVID-19 SCHOOL LEARNING MODALITY POLICIES ON ADOLESCENT SEXUAL BEHAVIORS, HIV/STI TESTING, AND STI DIAGNOSIS RATES

Background:
The COVID-19 pandemic and associated changes in school learning modality reshaped students’ lives and may have impacted sexual behaviors and healthcare access.

Methods:
We used a difference-in-differences (DID) approach to compare changes in sexual behaviors, HIV/STI testing, and STI diagnosis rates from 2019 (pre-intervention) to 2021 (post-intervention) between jurisdictions where high school students attended school primarily virtually (intervention) vs. in-person (control) for the 2020-2021 academic year. We used sexual behavior and HIV/STI testing data from local jurisdictions administering the Youth Risk Behavior Survey (YRBS) and reported chlamydia and gonorrhea diagnosis rates for 15-19-year-olds in corresponding counties from AtlasPlus. Intervention and control groups were defined using data from the COVID-19 School Data Hub and school/governmental policies, news, or other documentation. We used survey-weighted logistic regression for behavioral data and Poisson regression for diagnosis rates. DID estimates were parameterized as the interaction between year and learning modality.

Results:
Twenty-four local jurisdictions (16 virtual, 8 in-person) with a total 88,308 YRBS respondents across both years were included. Compared to in-person learning, virtual learning was associated with a significant relative increase in condom use from 2019 to 2021 [DID odds ratio (DID-OR)=1.42, 95%CI=1.12-1.79] and significant relative decreases in STI testing [DID-OR=0.75, 95%CI=0.59-0.96], chlamydia diagnoses [DID incidence rate ratio (DID-IRR)=0.86, 95%CI=0.84-0.88], and gonorrhea diagnoses [DID-IRR=0.83, 95%CI=0.79-0.87]. Learning model was not significantly associated with changes in sexual intercourse ever or in the past 3 months, multiple sex partners in the past 3 months, alcohol/drug use before last sex, or ever HIV testing (p>0.05).

Conclusion:
Virtual learning was associated with significant relative decreases in reported STI diagnoses, potentially in part due to documented reductions in STI testing. Efforts are needed to maintain access to sexual health services during public health emergencies involving schools and to increase STI testing access for students, especially those attending school virtually.