Same script, different viruses: HIV and COVID-19 in US Black communities

Abstract

The Lancet Series on HIV in the USA describes the current state of the nation's HIV epidemic, including ongoing inequities and challenges for key populations and comorbidities. [1][2][3][4][5][6] Black Americans have consistently shouldered many of these HIV inequities, a pattern also seen in the COVID-19 pandemic. The overlapping racial disparities related to COVID-19 and HIV 7,8 highlight lessons that policy makers, public health practitioners, providers, and communities can leverage in their strategies to eliminate the Same script, different viruses: HIV and COVID-19 in US Black communities in subgroups of patients including SMuRF-less patients and women is mandatory.However, the success of risk stratification and treatment depends on accurate diagnosis and identification of the underlying disease mechanisms. Several different disease mechanisms have been identified in STEMI. Atherosclerotic coronary artery occlusion is the most common finding in patients with STEMI. 1 However, in myocardial infarction with non-obstructive coronary arteries, which is particularly common in women, several other disease mechanisms have been identified. These include non-obstructive coronary artery atherosclerosis and plaque rupture, coronary artery embo lism, vasospasm, and spontaneous coronary artery dissection (SCAD). 11,12 In female patients with SCAD, Figtree and colleagues observed a lower 30-day mortality rate than for female patients without SCAD; however, SCAD is particularly common among young and middle-aged women (≤50 years) and associated with underlying systemic arteriopathy with a recurrence rate of 10-30% and a reduction in quality of life. 12 A further consideration is that Takotsubo cardiomyopathy or stress cardiomyopathy might mimic STEMI. 13 Therefore, a detailed assessment is indicated in select patients with STEMI, supplementing invasive coronary angiography with cardiac MRI, to exclude myocarditis and detect myocardial necrosis, and an intravascular assessment of coronary flow and structure, possibly also including functional testing. Such a comprehensive assessment would secure correct diagnosis, risk assessment, and treatment, particularly in women with STEMI and nonobstructive coronary arteries.Without consideration of risk, there cannot be gain, and thus new sex-specific risk factors and risk markers should be implemented in clinical risk models that can identify high-risk individuals among SMuRF-less patients with STEMI. Improvement in risk stratification and accurate diagnosis would help to tailor treatment in SMuRF-less patients, reducing the excess mortality and avoiding undertreatment in this subgroup.I declare no competing interests.

Experience of discrimination during COVID-19 pandemic: the impact of public health measures and psychological distress among refugees and other migrants in Europe

“…In other infectious disease epidemics, social stigma and self-perceived discrimination have been found to amplify the dangers related to infection and engagement with preventative measures, treatment, and care. For example, people who perceived more HIV-related stigma had a two-fold probability of delayed treatment seeking and higher viral load at first healthcare contact [ 22 – 24 ]. Qualitative studies in the field of HIV continue to find different forms of stigma to negatively affect engagement with medical care [ 25 ].…”

COVID-19–Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA

“…Less is known about the impacts of COVID-19 on racial and sexual minority groups, although other disparities research has shown that public health problems are often compounded in people with multiple minority statuses, including BMSM (Black men who have sex with men) and BTW (Black transgender women) that bear the heaviest burden of HIV in the United States. 3–5…”

Racial disparities in COVID-19 test positivity among people living with HIV in the United States

“…Inequities in both COVID-19 and HIV morbidity and mortality have been attributed to a synergy of social conditions that put socially disadvantaged groups at heightened risk of infection. 12 , 14 For example, data show that the most effective strategy to curbing the spread of the COVID-19 pandemic and reducing risk of exposure is through social distancing. However, as described by Yancy early in the pandemic, 15 the ability to maintain social distance from others while working from home or leveraging internet-based options for everyday activities are privileges not afforded by certain communities.…”