Black and Latino Persons Living with HIV Evidence Risk and Resilience in the Context of COVID-19: A Mixed-Methods Study of the Early Phase of the Pandemic

Abstract

The COVID-19 pandemic has great potential to disrupt the lives of persons living with HIV (PLWH). The present convergent parallel design mixed-methods study explored the early effects of COVID-19 on African American/Black or Latino (AABL) long-term survivors of HIV in a pandemic epicenter, New York City. A total of 96 AABL PLWH were recruited from a larger study of PLWH with non-suppressed HIV viral load. They engaged in structured assessments focused on knowledge, testing, trust in information sources, and potential emotional, social, and behavioral impacts. Twenty-six of these participants were randomly selected for in-depth semi-structured interviews. Participants were mostly men (64%), African American/Black (75%), and had lived with HIV for 17 years, on average (SD=9 years). Quantitative results revealed high levels of concern about and the adoption of recommended COVID-19 prevention recommendations. HIV care visits were commonly canceled but, overall, engagement in HIV care and antiretroviral therapy use were not seriously disrupted. Trust in local sources of information was higher than trust in various federal sources. Qualitative findings complemented and enriched quantitative results and provided a multifaceted description of both risk factors (e.g., phones/internet access were inadequate for some forms of telehealth) and resilience (e.g., “hustling” for food supplies). Participants drew a direct line between structural racism and the disproportional adverse effects of COVID-19 on communities of color, and their knowledge gleaned from the HIV pandemic was applied to COVID-19. Implications for future crisis preparedness are provided, including how the National HIV/AIDS Strategy can serve as a model to prevent COVID-19 from becoming another pandemic of the poor.

COVID-19 Burden on HIV Patients Attending Antiretroviral Therapy in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study

“…COVID-19 containment measures taken in Ethiopia had a signi cant contribution in halting the spread of COVID-19 in Ethiopia; however, they had their own implications on HIV care and treatment services as the response from the HIV patients indicated. Transport disruption, partial lockdown that impaired mobility, and income reduction were signi cant factors for missing health care visits, which was in agreement with previous studies conducted in Ethiopia [10, 42, ] and elsewhere in the world [43][44][45][46][47][48][49][50] that COVID-19 containment measure had a signi cant impact on patients' access to healthcare facilities.…”

Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research

“…Studies also investigated factors that may have contributed to increased COVID-19 distress. For example, because of heightened concerns for contracting COVID-19 among PLWH, conflicting public health messaging and misinformation may have fueled COVID-19 stress [48]. One barrier to COVID-19 information messaging was a lack of trust in public health information sources, such as the CDC and health departments.…”

“…One barrier to COVID-19 information messaging was a lack of trust in public health information sources, such as the CDC and health departments. Using the same measures, two independent studies showed that PLWH in New York City [48] and Atlanta, GA [49], demonstrated low levels of trust in COVID-19 information from all public health institutions, with greater trust in local and state health departments than trust in the CDC and other federal agencies. It is important to note that like social isolation, not all studies provide evidence for adverse effects of COVID-19 on emotional distress among PLWH.…”

“…Along with HIV stigma, intersecting sources of social inequality have contributed to and have compounded the stress of COVID-19 for PLWH. In qualitative interviews, Gwadz et al [48] found that experiences of racism and structural inequality often framed PLWH's experiences with COVID-19. Participants in this study saw a direct link between their experiences living with HIV and COVID-19 health disparities.…”

“…Participants in this study saw a direct link between their experiences living with HIV and COVID-19 health disparities. Just as would be true for people not living with HIV, fear of COVID-19 exposure may have also been greater among PLWH in cities and densely populated areas where social distancing is more difficult [48]. Interruptions to health services and medications as well as anticipated and actual loss of income attributed to COVID-19 also contributed to stress experienced by PLWH.…”