Compounding vulnerabilities: victimization and discrimination is associated with COVID-19 disruptions to HIV-related care among gay, bisexual, and other men and transgender and nonbinary people who have sex with men in Kazakhstan

ABSTRACT

Gay, bisexual, and other men and transgender and nonbinary people who have sex with men (MSM and TSM) are disproportionately impacted by the HIV epidemic in Kazakhstan. MSM and TSM in Kazakhstan also face high levels of discrimination and victimization, known barriers to engagement in HIV prevention and care. We examined data from surveys with 455 MSM and TSM collected May -- October 2020 to determine whether access to HIV testing and treatment was disproportionately limited among those exposed to victimization and discrimination during the early COVID-19 pandemic. Odds of reporting COVID-19 disruptions to HIV-related care access were significantly higher (OR: 1.96; 95% CI: 1.25–3.06; P = .003) among those who experienced recent sexual or gender-based victimization, and recent discrimination (OR: 2.93; 95% CI: 1.65–5.23; P < .001), compared to those who did not experience victimization or discrimination, respectively. Odds of reporting disruptions among those who experienced both victimization and discrimination were significantly higher (OR: 3.59; 95% CI: 1.88–6.86; P < .001) compared to those who experienced neither . Associations remained significant after adjustment for potentially confounding factors. Findings suggest the COVID-19 pandemic is compounding vulnerability among MSM and TSM in Kazakhstan – highlighting need for intervention efforts targeting the most marginalized groups.

KEYWORDS:

• COVID
• HIV testing
• HIV treatment
• Kazakhstan
• MSM
• transgender
• discrimination
• victimization
• stigma

Acknowledgements

We thank the participants, whose time, trust, and commitment made this study possible. We also thank the team members who contributed to this study, including Karina Alipova, Farruh Aripov, Olga Balabekova, Daniyar Bekishev, Dilara Belkesheva, Valeriya Davydova, Ferangiz Hasanova, Sultana Kali, Saltanat Kuskulova, Aitkul Nazarova, Syrym Omirbek, Svyatoslav Suslov, Aizhan Toleuova, Aidar Yelkeyev, and Saida Yessenova. Finally, we thank Susie Hoffman for her helpful comments.

Disclosure statement

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

Additional information

Funding

This research was supported by grants R01DA040513 (PI: Wu) from the National Institute on Drug Abuse and K01MH128117 (PI: Paine), P30MH43520 (PI: Remien) and T32MH019139 (PI: Sandfort) from the National Institute of Mental Health.