Exploring intersectional stigma and COVID‐19 impact on human immunodeficiency virus service provision for African Americans in a Southern city

Abstract

Aims/objectives Through interviews with clinical service providers, we explored stigma's impact on HIV service provision for African Americans during COVID‐19. Background African Americans experience disproportionate rates of HIV and COVID‐19. We explored COVID‐19's impact on HIV services for African American adults in a Southern city. Design The study was qualitative and observational. Methods Key informant interviews were conducted ( n = 11) across two healthcare centres and two community‐based organisations and thematically analysed using phenomenological approaches by two coders. Interviews explored pre‐ and post‐COVID‐19 service provision and parallels between COVID‐19 and HIV, particularly as related to stigma. The COREQ checklist was utilised to ensure research quality. Results According to the providers interviewed, all providers offered HIV prevention/treatment, but PrEP and preventive services diminished greatly early in the COVID‐19 pandemic. Successful transition to telehealth depended on existing telehealth use. Challenges exacerbated by COVID‐19 included food/housing insecurity and physical distancing constraints. Clients' COVID‐19 informational needs shifted from concerns to vaccine requests over time. Interviewees stated HIV and COVID‐19 both carry ‘risk taking’; however, HIV risk was more physically intimate than COVID‐19. Notably, some providers used stigmatising language referring to clients with HIV/COVID and omitted person‐centred language. Conclusions Findings suggest need to address challenges in telehealth to improve client experiences now and for future pandemics. More research is needed to examine intersectional stigmatisation of COVID‐19 and HIV for African Americans to design person‐centred counselling interventions. Relevance to Clinical Practice Results demonstrate need for provider training to reframe stigma discussions using client centeredness, educating African Americans on HIV and COVID‐19 prevention, and coordination with local organisations to address multiple care needs. Patient/Public Contribution This research highlights needs of clients based on the views of healthcare providers caring for predominantly African American communities in a Southern city. However, no patients, service users, caregivers or members of the public were directly involved in this study.

Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color

“…Future research and programs need to address structural stigmatization and discrimination experienced by YMSM of color so that inequities they already experienced do not widen the gaps in HIV prevention outcomes that we have already seen during COVID-19 (Ferraz et al, 2023; Maragh-Bass et al, 2022). Multilevel interventions and solutions should focus on resilience-affirming care and destigmatizing approaches which could include (a) include remote telehealth PrEP navigators employed at the regional level to assist clients with LAI PrEP medication assistance programs; (b) stigma-informed LGBTQ health training mandates for providers who care for YMSM of color, and (c) reexamination of HIV prevention counseling approaches to utilize destigmatizing frameworks which move away from risk-based counseling and instead promote resilience-based and sex-positive communication with providers (Maragh-Bass et al, 2023).…”

“…The global coronavirus disease 2019 (COVID-19) pandemic also exacerbated these barries to care experiences by YMSM of color, and impeded progress toward the goals set forth in the United States Department of Health and Human Services' Ending the HIV Epidemic (EHE) initiative. For instance, in some areas of the country, HIV preventive services like HIV testing and PrEP appointments halted completely when the pandemic began (Maragh-Bass et al, 2022). In other cases, YMSM and other sexual minority groups who had sexual encounters during the pandemic reported lower PrEP adherence and attendance at follow-up consultations (Ferraz et al, 2023).…”

Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study

“…We hypothesized that a HIV-positive status may introduce additional concerns, including uncertainty about vaccine safety and efficacy, and the possibility of vaccine interactions with HIV medications, which may affect the immune system [18,19]. Additionally, PWH may have negative experiences, including stigmatization, while navigating the healthcare system, which can contribute to their mistrust of the system and an erosion of confidence in healthcare authorities [20,21]. The combined influence of these intersectional factors, along with misinformation and conspiracy theories, may contribute to vaccine hesitancy among PWH.…”

Southern Care: A Rapid Response to Supporting Southern CBOs at the onset of COVID-19

“…3 The lack of clear policies and procedures for addressing COVID-19, the enforcement of social distancing protocols, and challenges providing care to patients simultaneously diagnosed with COVID-19 and HIV were all factors that complicated service provision during COVID-19. 4,5 REPORT FROM THE FIELD The transition from in-person services (e.g., case management, lab work, medical visits, testing, and counseling) to telehealth was difficult for organizations that lacked the staff capacity, 6 technological skills, and additional equipment 7 that telehealth services required. Adopting COVID-19 safety practices and new safety protocols required financial resources that were unavailable due to decreased revenue resulting from decreased donations, canceled fundraisers, and reductions in reimbursable services.…”

“…Adopting COVID-19 safety practices and new safety protocols required financial resources that were unavailable due to decreased revenue resulting from decreased donations, canceled fundraisers, and reductions in reimbursable services. 4,7 In addition to maintaining HIV services, CBOs were often called to support COVID-19 mitigation efforts in their communities 8 due to their position as trusted partners that were effective at disseminating culturally relevant public health information to community members. 9,10 Additionally, many PLWHA who work for and/or volunteer for HIV service CBOs were placed at additional personal risk for COVID-19 while serving in their communities.…”