The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective

Abstract

The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID-19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.

Challenges to HIV Care and Psychological Health During the COVID-19 Pandemic Among People Living with HIV in China

“…In our survey with 703 PLWH in China (data collected in February-March 2020), 60.8% reported depression, 49.8% noted anxiety symptoms, and 38.5% reported recent insomnia. These psychosocial issues may further create a syndemic condition exacerbating adverse health outcomes among PLWH [10], including suboptimal medication adherence, failure to achieve viral suppression, and HIV transmission risk.…”

HIV and Food Insecurity: A Syndemic Amid the COVID-19 Pandemic

“…Subsequently, intending to inform interventions to reduce food insecurity among PLWH, several studies have also examined risk factors for this experience [29]. In addition to behavioural and clinical factors, such as illicit substance use [40,41] and depressive symptoms [41,42] (both of which may be exacerbated by the COVID-19 pandemic [6]), socioeconomic factors, such as low income and unemployment, are consistently identified as important risk factors for food insecurity among PLWH [41][42][43].…”

“…During a time when the economic impacts [4,5] of a pandemic may be propagating the HIV-food insecurity syndemic [6], it is important to reinforce the idea that food assistance, whether it be from food banks or elsewhere, is not necessarily targeting the drivers of food insecurity [44,45]. In other words, if the goal of risk factor epidemiology is to identify unbiased associations, or causes of outcomes, and to intervene on such causes [46], the provision of food does not necessarily act on these determinants (e.g., illicit substance use, depressive symptoms, low income, unemployment [40][41][42][43]).…”

“…While this statement reflects a difficult reality for people living with HIV (PLWH) in Zimbabwe, it is anticipated that there will be challenging economic situations ahead, for many countries, as a result of the COVID-19 pandemic [4,5]. As such, it is not surprising that food insecurity has already been highlighted in a syndemic conceptualization of HIV and COVID-19 among PLWH [6].…”

Prioritizing Community Partners and Community HIV Workers in the COVID-19 Pandemic

“…Globally, the COVID-19 pandemic will also continue to impact those most impacted by HIV [2,3]. Thus, HIV researchers have been prompt to consider the deleterious effects of COVID-19 on populations already burdened by the HIV pandemic [4][5][6]. Others have drawn attention to lessons from HIV research that can apply to a rigorous COVID-19 response, including the importance of dismantling stigma [7], building multidisciplinary research teams to address health inequalities [8], and sustaining our investment in public health systems [9].…”