Health-care access and utilization among HIV-infected men who have sex with men in two Chinese municipalities with or without lockdown amidst early COVID-19 pandemic

ABSTRACT

City lockdown is critical to successfully contain the COVID-19 pandemic. The impact of lockdown and COVID-19 pandemic on healthcare among vulnerable population has yet to be explicated. A cross-sectional survey was conducted among HIV-infected men who have sex with men (MSM) in Wuhan with city lockdown and Shanghai without lockdown, and healthcare interruptions were evaluated and compared. A logistic regression analysis was employed to examine associates of HIV-related healthcare interruptions and compromised mental health. Compared to participants in Shanghai (N = 440), HIV-infected MSM in Wuhan (N = 503) had significantly higher proportion of untimely availability of antiretroviral drugs (ARVs) (20.6% vs. 8.4%), obtaining ARVs from outside institutions (29.1% vs. 8.1%), postponed non-AIDS treatment (6.4% vs. 2.8%) and untimely follow-up appointments (33.4% vs. 14.5%). HIV-related healthcare interruptions were positively associated with lockdown (OR = 4.89, 95% CI: 3.49–6.85) and non-local residence (OR = 1.91, 95% CI: 1.37–2.64). Compromised mental health, including insomnia and generalized anxiety disorders, was associated with non-local residence (OR  = 1.35, 95% CI: 1.01–1.81) and healthcare interruptions (OR = 1.34, 95% CI: 1.01–1.79). HIV-infected MSM are vulnerable to healthcare interruptions and mental health problems during the COVID-19 pandemic, underscoring the need for tailored intervention strategies to minimize deleterious health consequences.

KEYWORDS:

• HIV
• MSM
• health care
• mental health
• lockdown
• COVID-19

Acknowledgements

The authors thank study participants and fieldworkers who collected study data. NH conceived and generally supervised the study. YD developed the questionnaire and contributed to patient recruitment, data collection, analysis, and interpretation. JH managed and analyzed the data and wrote the first draft of the manuscript. FYW critically reviewed and edited the manuscript. All authors critically reviewed the manuscript and gave the final approval of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available upon reasonable request.

Additional information

Funding

This work was supported by Emergency Research Funding for COVID-19 of Natural Science Foundation of China [grant number 82041028] and Fudan University [grant number IDF201007], and Shanghai Municipal Health Commission [grant number GWV-10.1-XK16].