Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries

Rao, Amrita; Rucinski, Katherine B.; Jarrett, Brooke A.; Ackerman, Benjamin; Wallach, Sara; Marcus, Julia L.; Adamson, Tyler; Garner, Alex; Santos, Glenn-Milo; Beyrer, Chris; Howell, Sean; Baral, Stefan

doi:10.1097/qai.0000000000002620

Cited by 73 publications

(67 citation statements)

References 28 publications

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“…This experience is not unique to KPs in India. Emerging data on the impact of COVID‐19 among MSM in various sites illustrate how HIV antibody testing has been harder to access [ 13 , 15 , 16 ], which was also seen in the United States, as the pandemic caused interruptions and declines in HIV/STI testing access [ 17 ]. HIV programs globally saw fewer clients living with HIV complete HIV RNA testing over the initial months of COVID‐19 compared to pre‐pandemic [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

HIV service delivery in the time of COVID‐19: focus group discussions with key populations in India

et al. 2021

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IntroductionThere are limited data on the impact of COVID‐19‐associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low‐ and middle‐income countries. In March 2020, in response to COVID‐19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi‐month dispensing (MMD) of ART for all people living with HIV (PLHIV).MethodsTo assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics.ResultsForty‐four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty‐four participants self‐identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID‐19. Participants accessed HIV antibody testing using transportation arranged by community‐based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID‐19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home‐based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community‐based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient‐rich food and more accessible mental health, HIV, and other health services.ConclusionsCOVID‐19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community‐based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.

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Section: Discussionmentioning

confidence: 99%

HIV service delivery in the time of COVID‐19: focus group discussions with key populations in India

et al. 2021

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“…A large online study of men who have sex with men (MSM) ( n = 2,732) from 103 countries reported that 33% of participants living with HIV lost access to HIV providers due to COVID-19, and nearly one-fifth who were taking antiretroviral therapy reported challenges accessing medication ( Santos et al, 2020 ). In another survey of MSM ( n = 10,654) in 20 countries using geosocial networking apps, interruptions to HIV prevention services were common (e.g., 56% for pre-exposure prophylaxis, 38–55% for HIV testing) and significantly associated with the stringency of national restrictions related to COVID-19 ( Rao et al, 2021 ). LGBT persons may also avoid COVID-19 testing or emergency care due to pre-existing fears of mistreatment in health facilities ( Bauer et al, 2014 ).…”

Section: How Are Gender and Sexual Minorities Impacted By Covid-19?mentioning

confidence: 99%

Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender?

et al. 2021

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Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women’s, men’s, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group “most affected,” but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.

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“…A growing body of literature describes global interruptions to prescriptions for diseases like HIV, increases in depression, and significant losses of job, insurance, and food security as a result of COVID-19 [7][8][9][10][11]. However, recent research has demonstrated that these effects disproportionately burden groups that are already marginalized.…”

Section: Introductionmentioning

confidence: 99%

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

et al. 2021

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Background Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries. Methods We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one’s gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. Results Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36–1.97), 1.61 (95% CI: 1.31–1.97), and 1.74 (95% CI: 1.07–2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not. Discussion The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.

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Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 73 publications

References 28 publications

HIV service delivery in the time of COVID‐19: focus group discussions with key populations in India

HIV service delivery in the time of COVID‐19: focus group discussions with key populations in India

Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender?

Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people

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