COVID‐19, HIV and key populations: cross‐cutting issues and the need for population‐specific responses

Abstract

Introduction Key populations at elevated risk to contract or transmit HIV may also be at higher risk of COVID‐19 complications and adverse outcomes associated with public health prevention measures. However, the conditions faced by specific populations vary according to social, structural and environmental factors, including stigma and discrimination, criminalization, social and economic safety nets and the local epidemiology of HIV and COVID‐19, which determine risk of exposure and vulnerability to adverse health outcomes, as well as the ability to comply with measures such as physical distancing. This commentary identifies common vulnerabilities and cross‐cutting themes in terms of the impacts of COVID‐19 on key populations before addressing issues and concerns specific to particular populations. Discussion Cross‐cutting themes include direct impacts such as disrupted access to essential medicines, commodities and services such as anti‐retroviral treatment, HIV pre‐exposure prophylaxis, opioid agonist treatment, viral load monitoring, HIV and sexually transmitted infections testing, condoms and syringes. Indirect impacts include significant collateral damage arising from prevention measures which restrict human rights, increase or impose criminal penalties, and expand police powers to target vulnerable and criminalized populations. Significant heterogeneity in the COVID‐19 pandemic, the underlying HIV epidemic and the ability of key populations to protect themselves means that people who inject drugs and sex workers face particular challenges, including indirect impacts as a result of police targeting, loss of income and sometimes both. Geographical variations mean that transgender people and men who have sex with men in regions like Africa and the middle east remain criminalized, as well as stigmatized and discriminated against, increasing their vulnerability to adverse outcomes in relation to COVID‐19. Conclusions Disruptions to both licit and illicit supply chains, loss of income and livelihoods and changes in behaviour as a result of lockdowns and physical distancing have the potential to exacerbate the impacts of the COVID‐19 pandemic on key populations. While these impacts will vary significantly, human‐rights approaches to COVID‐19 emergency laws and public health prevention measures that are population‐specific and sensitive, will be key to reducing adverse health outcomes and ensuring that no one is left behind.

Social, economic, and health effects of the COVID-19 pandemic on adolescents retained in or recently disengaged from HIV care in Kenya

“…As was the case before the COVID-19 pandemic, strategies are needed to support engagement in care and positive mental health among PLHIV across settings. Important areas of intervention include provision of social, economic, nutritional, and mental health support, upholding human rights, and addressing health disparities [3,14,54]. There may be important roles for mobile strategies for provision of HIV or mental health care, as well as for decentralized HIV care and multi-month ART refills [14,15,17].…”

COVID‐19 vaccination among people who inject drugs: Leaving no one behind

“…For many vulnerable communities, including PWID, COVID-19 represents a pandemic on top of one or more epidemics [31], and the constant need for vigilance and risk reduction on multiple fronts is challenging and exhausting. In times of crisis, these communities face challenges such as being unable to access health services or receiving the same quality of health care as others due to high rates of social and economic disadvantage, homelessness and criminalisation, as well as low health literacy and stigma and discrimination from health-care providers [10].…”

Municipal police support for harm reduction services in officer-led referrals of people who inject drugs in Tijuana, Mexico

“…There are an estimated 15.6 million people who inject drugs (PWID) worldwide, the global prevalence of HIV among PWID is 18%, and localized HIV outbreaks among PWID have been observed in numerous settings [4,5]. Colliding syndemics of IDU, HIV, HCV and overdose have been further exacerbated by social and economic harms caused by the COVID-19 pandemic and mitigation strategies [6][7][8][9]. Resultant shifts in drug distribution and consumption patterns, in addition to augmented barriers to health and social services, make access to essential care for PWID a timely priority [6][7][8][9].…”

“…Colliding syndemics of IDU, HIV, HCV and overdose have been further exacerbated by social and economic harms caused by the COVID-19 pandemic and mitigation strategies [6][7][8][9]. Resultant shifts in drug distribution and consumption patterns, in addition to augmented barriers to health and social services, make access to essential care for PWID a timely priority [6][7][8][9]. While the global burdens of substance use and related risk remain high, effective evidence-based public health interventions exist to reduce drug-related harms among people who inject drugs (PWID) [10].…”