Abstract
Background
COVID-19 profoundly and uniquely impacted people with HIV. People with HIV experienced significant psychosocial and socioeconomic impacts, yet a limited amount of research has explored potential differences across gender and racial/ethnic groups of people with HIV.
Objective
The objective of this study was to examine psychosocial and socioeconomic stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of stressors varied across gender and racial/ethnic groups.
Methods
We analyzed data from a cross-sectional survey with Miami-Dade County, Ryan White Program recipients. Outcomes included mental health, socioeconomic, drug/alcohol, and care responsibility/social support changes. Weighted descriptive analyses provided an overview of stressors by gender and racial/ethnic group and logistic regressions estimated associations between demographics and stressors.
Results
Among 291 participants, 39% were Non-Hispanic Black, 18% were Haitian, and 43% were Hispanic. Adjusting for age, sex, language, and foreign-born status, Hispanics were more likely to report several worsened mental health (i.e. increased loneliness, anxiety) and socioeconomic stressors (i.e. decreased income). Spanish speakers were more likely to report not getting the social support they needed. Women were more likely to report spending more time caring for children.
Conclusions
Findings highlight ways in which cultural and gender expectations impacted experiences across people with HIV and suggest strategies to inform interventions and resources during lingering and future public health emergencies. Results suggest that public health emergencies have different impacts on different communities. Without acknowledging and responding to differences, we risk losing strides towards progress in health equity.
Introduction
The COVID-19 pandemic rapidly and profoundly affected individuals and communities across the globe and continues to warrant investigation regarding prolonged physical and emotional effects on wellbeing [Citation1]. In the United States, individuals from all backgrounds were affected, yet disparities were noted in COVID-19 incidence and mortality among certain groups. Older individuals, those with underlying health conditions, those from racial/ethnic minority groups, and those living in poverty were disproportionately affected [Citation2,Citation3]. Similarly, people with existing immunocompromised conditions, including HIV, have been at increased risk of severe consequences [Citation4]. For many people with HIV, their HIV status and potential comorbidities required them to take serious and prolonged precautions, including social distancing and sheltering in place to avoid exposure to SARS-CoV-2.
People with HIV faced unique challenges during the COVID-19 pandemic, beyond the need to avoid physical risks of possible COVID-19 infection. Mandated closure of HIV clinics, lack of community health workers, and the shortage of protective equipment for health care providers presented significant barriers towards the continuation of their routine HIV care [Citation5]. Service interruptions included disruptions in routine HIV care appointments and diminished access to antiretroviral medication refills. Pandemic related changes resulted in rapid shifts to telehealth services for communicating with providers and alternative ways to receive antiretroviral medications, such as through at-home mail delivery options. Service interruptions also included disruptions in routine mental health and social support services that are commonly provided in HIV care clinics. In a study that examined service disruptions experienced by people with HIV during the COVID-19 pandemic, researchers found that most clinics were able to maintain core HIV services, such as medication refills, but services most affected during the pandemic were counselling and social support group services [Citation6]. In a scoping review that examined the social impact of COVID-19 on people with HIV, a major finding was the impact of COVID-19 on client’s mental health, including increased experiences of stress, anxiety, and depression [Citation7].
Disruptions in jobs and unemployment also rose due to the precautions around COVID-19 exposure for people with HIV. Several studies have documented the impact of COVID-19 on employment and income for people with HIV [Citation7,Citation8]. Food insecurity, housing instability, and unemployment increased significantly in 2020 among a sample of low-income people with HIV who received Ryan White HIV/AIDS Program services in an HIV clinic in the southern US [Citation9]. People with HIV were also likely to indicate increases in financial stress and that they had recently gone hungry due to not having enough food [Citation8]. Issues around food security contributed to potential challenges towards the maintenance of care for people with HIV [Citation10] as lack of adequate food has long been associated with lack of adherence, non-viral suppression, and higher rates of mortality among people with HIV [Citation11–13]. Finally, changes in employment contributed to, not only economic consequences, but also, had potential social and emotional consequences, exacerbating the existing high prevalence of social isolation among people with HIV [Citation14].
While these psychosocial and socioeconomic impacts of COVID-19 among people with HIV have been documented, a limited amount of research has explored potential variations across gender and racial/ethnic groups of people with HIV. One study suggested that women living with HIV experienced higher levels of stress and loneliness during the COVID-19 pandemic, compared to their male counterparts living with HIV [Citation15]. In another study that examined social support and mental health, researchers compared the experiences of people with HIV in the US and Argentina and found that social support was negatively associated with depressive symptoms [Citation16]. For people with HIV in Argentina, depressive symptoms were the lowest when having high levels of social support and resilient coping. Alternatively, in the US, the association between depressive symptoms and social support was observed but was not strengthened by resilient coping. Although ethnicity was not assessed in their study, researchers attribute cultural norms among communities of people with HIV as a potential explanation for differences in psychosocial experiences [Citation16].
Understanding the relationship between the COVID-19 pandemic and changes in psychosocial and socioeconomic stressors is necessary to shed light on strategies to preserve the health of people with HIV during long-term consequences of the COVID-19 pandemic, prevent further exacerbation of existing disparities, as well as to inform pandemic related response efforts for future public health emergencies. The objective of this exploratory study was to examine psychosocial (e.g. mental health, social support, and drug and alcohol use) and socioeconomic (e.g. job loss, food insecurity) stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of psychosocial and socioeconomic stressors varied across gender and racial/ethnic groups.
Methods
Study design and participants
We conducted a cross-sectional survey from November 2020 to March 2021 in Miami-Dade County, FL. We recruited people with HIV who received medical case management through Ryan White Program (RWP) and were 18 years of age or older. Eligibility for the RWP Part A Program includes having a household income of less than 400% of the federal poverty level and not having another source of health insurance. Because we were interested in understanding gender as well as racial/ethnic differences in effects of the pandemic, we used quota sampling to recruit individuals who self-identified as belonging to one of the three major racial/ethnic groups in the community: non-Hispanic (non-Haitian) African American/Black (from now on referred to as Non-Hispanic Black), Hispanic/Latinx, or Haitian. These three groups make up 93% of the Miami-Dade Ryan White population [Citation17]. We targeted a quota sample of 100 Non-Hispanic Blacks, 130 Hispanics, and 70 Haitians, roughly half women and half men, to ensure that we obtained large enough numbers in each group to be able to describe their experiences. We recruited individuals based on RWP contact lists of individuals who had previously provided consent to be contacted for research studies and from clients who had participated in a quality improvement survey that was being administered around the same time.
Survey instruments were designed by a team of researchers with experience in culturally sensitive data collection as well as prior research experience with people with HIV from the Miami-Dade RWP. Survey questions included demographic questions as well as self-reported experiences of access to care and adherence to antiretroviral medication. The survey included a series of questions related to self-reported changes in mental health, drug and alcohol use, employment/income, and caring responsibility/social support as a result of the pandemic, which was the focus of this analysis. Survey instruments were designed in English and were also translated into Spanish and Haitian Creole. During survey development, the instrument was piloted in all three languages (English, Spanish and Haitian Creole) and revised as needed. Participants completed the survey by telephone in their preferred language and received a $50 electronic gift card for their time.
Ethical Approval and Informed Consent: Our study was approved by University’s Social Behavioral Institutional Review Board (approval no. IRB-17-0234). All participants provided verbal informed consent to participate in this research. All participant interactions were over the telephone due to the COVID-19 Pandemic safety concerns. The extensive informed consent process was conducted prior to the interview, and the interviewer documented the consent.
Survey instrument
Demographic variables considered in this analysis included gender, race/ethnicity, age, language, and foreign-born status. Gender was categorized as cis-gender women, cis-gender men, or transgender/non-binary. Because transgender/non-binary individuals represented such a small part of the sample (n = 7, 2.3%), they were excluded from the current analysis. Race/ethnicity was categorized into Non-Hispanic Black (NHB), Hispanic/Latinx, and Haitian. Age was categorized as between 18-34, 35-54, and 55+ years of age. Language included English, Spanish, and Creole. Foreign-born status was categorized as born in the US or born somewhere other than the US.
Outcomes assessed included self-reported mental health changes, COVID-19 related worry, socioeconomic changes, alcohol and drug use changes, and care responsibility/social support changes. Mental health changes included, compared to before the Pandemic, feeling sadder, lonelier, more anxious, and more stressed. COVID-19 related worry included worrying about getting COVID-19 or worrying about family or friends getting COVID-19. Socioeconomic changes included job loss due to the pandemic and, compared to before the pandemic, decreased household income, inability to buy needed food, more difficulty paying for housing, and being at risk of losing current housing. Drug and alcohol use changes included, compared to before the pandemic, drinking more alcohol or using more illegal drugs. Care responsibility/social support changes included, compared to before the pandemic, more time spent caring for children, more time spent caring for family members or other adults, and not getting the support needed from family and friends. Participants could respond to questions on a 5-point Likert scale from ‘strongly agree’ to ‘strongly disagree’. Responses were then dichotomized into an ‘agree or strongly agree’ group or a ‘disagree, strongly disagree, or neither agree nor disagree’, group for analysis. Job loss was categorized as ‘yes’, ‘no’, or ‘no job prior to COVID-19’. Two questions regarding increases in drug and alcohol use due to COVID-19 were categorized as ‘yes’, ‘no’, or ‘no use of drugs/alcohol prior to COVID-19’. We include the survey questions, as they were asked to participants, in Appendix A.
Analysis
Logistic regression models were used to assess the association between demographic variables and socioeconomic and psychosocial stressors as separate outcomes. To more accurately reflect the distribution of race/ethnicity by sex of the priority population, inverse probability weights were calculated based on the sex and racial/ethnic composition of all RWP clients in Miami-Dade County. Weighted descriptive analyses using chi-squared tests provided an overview of stressors by gender and racial/ethnic groups. Weighted logistic regression analyses were then conducted to estimate the association between demographic variables and key socioeconomic, social support, and psychosocial stressors, separately, using adjusted odds ratios (aORs) with 95% confidence intervals (CIs). For the regression analysis regarding lost job, those who had no job prior to the pandemic were excluded from the analysis. Similarly, for the alcohol use and illegal drug use analysis, those who reported no alcohol use or illegal drug use even prior to the pandemic were excluded from the respective analysis. We included client demographic characteristics (i.e. age, gender, race/ethnicity, language, and foreign-born status) as covariates. All data analyses were performed in SAS version 9.4.
Results
Among the 291 participants included in this analysis, 38 (13.1%) were between 18-34 years old; 142 (48.8%) were between 35-54 years old; and 111 (38.1%) were 55 years of age or older. 113 (39% [unweighted percent]) were Non-Hispanic Black, 53 (18%) were Haitian, and 125 (43%) were Hispanic. 148 individuals (51.0%) identified as cis-gender women and 143 (49%) identified as cis-gender men. 121 participants (41.6%) were born in the US, and 169 participants (58.1%) were born somewhere other than the US. Among the sample, 38 (13.1%) conducted their interview in Creole; 147 (50.5%) conducted their interview in English; and 106 (36.4%) conducted their interview in Spanish.
provides a weighted descriptive analysis of changes in psychosocial and socioeconomic factors by gender and racial/ethnic group. show weighted adjusted odds ratios and 95% confidence intervals to estimate the association between demographic characteristics and reported changes in mental health, COVID-19 worry, socioeconomic, drug and alcohol use, and care responsibility/social support changes due to the COVID-19 pandemic, respectively.
Table 1. Psychosocial and socioeconomic changes during the COVID-19 pandemic by sex and race/ethnicity.
Table 2. COVID-19 mental health changes: weighted adjusted odds ratios and 95% confidence intervals for reported changes in mental health variables compared to before the COVID-19 pandemic.
Table 3. COVID-19 worry: weighted adjusted odds ratios and 95% confidence intervals for reported changes in COVID-19 worry variables compared to before the COVID-19 pandemic.
Table 4. COVID-19 socioeconomic changes: weighted adjusted odds ratios and 95% confidence intervals for reported changes in mental health variables compared to before the COVID-19 pandemic.
Table 5. COVID-19 drug and alcohol use changes: weighted adjusted odds ratios and 95% confidence intervals for reported changes in drug and alcohol use compared to before the COVID-19 pandemic.
Table 6. COVID-19 related caring responsibilities and social support: weighted adjusted odds ratios and 95% confidence intervals for reported changes in caring responsibility/ social support variables compared to before the COVID-19 pandemic.
Adjusting for age, gender, language, and foreign-born status, Hispanics had significantly higher odds of feeling lonelier during the pandemic (adjusted odds ratio [aOR] 4.20; 95% confidence interval [CI]: 1.67- 10.55), compared to Non-Hispanic Blacks. Hispanics were also significantly more likely to report feeling more anxious (aOR 11.55; CI: 3.68- 36.26) and more stressed (aOR 3.50; CI: 1.31- 9.35), compared to Non-Hispanic Blacks. Regarding COVID-19 worry, Hispanics were also significantly more likely to report worrying about getting COVID-19 infection (aOR 3.73; CI: 1.37- 10.14), compared to Non-Hispanic Blacks.
Participants ages 35- 54 years old were significantly less likely to report being lonelier (aOR 0.56; CI: 0.32- 0.98) or more anxious (aOR 0.41; CI: 0.22- 0.75), compared to those 55 years of age or older during the pandemic. Conversely, participants ages 35- 54 years old were significantly more likely to report worrying about family or friends getting COVID-19 (aOR 4.33; CI: 1.76- 10.63), compared to those 55 years of age or older.
Regarding socioeconomic changes, Hispanics had significantly higher odds of reporting decreased household income (aOR 2.75; CI: 1.08- 6.99), compared to Non-Hispanic Blacks. Moreover, those who were foreign born were significantly more likely to be unable to buy the food they needed (aOR 4.00; CI: 1.55- 10.31), compared to US born individuals. Those who were 35-54 years old were less likely to report adverse socioeconomic impacts such as having decreased household income (aOR 0.42; 0.22- 0.79), inability to buy food needed (aOR 0.53; CI: 0.30- 0.95), risk of losing housing (aOR 0.48 (0.26 − 0.88), or difficulty paying for housing (aOR 0.45; CI: 0.25- 0.80), compared to those aged 55 years or older.
Regarding alcohol use, there were no statistically significantly differences in drug and alcohol use changes compared to before the COVID-19 pandemic across age, gender, and race/ethnic groups (We were unable to include language or foreign-born variables in these models due to small cell sizes). Very few individuals reported drinking more alcohol or using more illegal drugs compared to before the pandemic. In fact, the majority of participants reported not drinking alcohol (n = 159; 54.6%) or using illegal drugs even before the pandemic (n = 197; 67.7%).
In terms of care responsibility/social support, Spanish speakers were significantly more likely to report not getting the support needed from family members or friends (aOR 5.56; CI: 1.10-28.03), compared to English speakers. Last, gender was not significantly associated with changes across psychosocial and socioeconomic variables except on one social support/care responsibility variable. When adjusting for age, race/ethnicity, language, and foreign-born status, women were significantly more likely to report spending more time caring for children throughout the COVID-19 pandemic (aOR: 2.86; CI: 1.36- 6.04), compared to men.
Discussion
This study enrolled a diverse sample of racial/ethnic minority people with HIV and identified high percentages of adverse outcomes including decreased household income, inability to buy food, and increased mental health stressors during the COVID-19 pandemic. While these adverse experiences among people with HIV have been documented, this study contributes to the existing literature because this study found that increases in psychosocial and socioeconomic stressors varied significantly by race/ethnicity and gender among people with HIV. Hispanic people with HIV were significantly more likely to report several worsened mental health and socioeconomic stressors including feeling more lonely, more anxious, more stressed, and being more likely to experience a decrease in household income, compared to Non-Hispanic Blacks. Foreign-born people with HIV were more likely to report having an inability to buy needed food. Spanish speakers were more likely to report not receiving the support they needed from friends and family. Moreover, women were more likely to report spending more time caring for children throughout the COVID-19 pandemic. As a whole, these stressors seem to fit with cultural and gender understandings and can be used to inform planning and intervention efforts for other public health emergencies. In our discussion, we provide context for our findings and offer recommendations to promote targeted, health equity interventions during future public health emergencies.
First, several other studies found a disproportionate impact of COVID-19 pandemic on Hispanic communities in the US. Nationally representative survey data with adults in the US have indicated that low-income families and Hispanic adults were the hardest hit by economic consequences during COVID-19 [Citation18]. In addition to economic impacts, in a study conducted among Hispanics in New York, researchers found that Hispanics reported numerous unique challenges to social distancing and quarantining, such as living in crowded, multi-generational households, which impacted both physical and emotional well-being during the pandemic [Citation19]. Another study indicated that Hispanics tended to have low awareness of public health messaging, low knowledge regarding COVID-19 infection, and reported being unaware of or unsure how to access support services in their local communities throughout the pandemic [Citation20].
Hispanic people with HIV, specifically, are a unique subgroup that require culturally relevant health messages, have barriers to accessing necessary services, and often have distrust of governmental and health care systems due to a variety of factors including immigration status and experiences of stigma and discrimination around their HIV status. These issues likely compounded adverse experiences during the pandemic and contributed to several worse psychosocial outcomes. During the time this study was conducted, inconsistent guidance from public and federal agencies could have perpetuated confusion about trustworthy sources of information, fuelling existing mistrust and distress among this group [Citation21]. Similarly, lack of access to relevant information regarding where to acquire necessary items such as food may have contributed to foreign born individuals being more likely to report not having necessary food. Furthermore, in a study utilizing data from a nationally representative survey in December 2020, researchers found that approximately 41% of adults in low-income immigrant families experienced food insecurity yet, these immigrant families avoided assistance programs because of concerns about immigration status during the pandemic [Citation22]. Uncertainty and fear around the impact of utilizing public resources and its effect on future immigration status, for example, as outlined by the U.S. Department of Homeland Security [Citation23] in public charge policies, may contribute to this lack of utilizing public resources.
Psychosocial challenges experienced by Hispanic people with HIV need to be continually and carefully monitored during lingering stages of the pandemic. Psychological distress has consistently been shown to be associated with poor antiretroviral therapy adherence [Citation21]. HIV care access during the COVID-19 pandemic was analysed in another reported study that utilized the same participants from this study and it was found that while, in general, participants reported high levels of HIV care engagement and use of antiretroviral medications during the pandemic, Hispanics were most likely to report difficulty in obtaining HIV medications [Citation24]. This is important to monitor and explore, as the intersection of these issues will likely continue to play a role in future public health emergencies and related medical care behaviours. Similarly, access to food is necessary for all, but targeted outreach and interventions for foreign born people with HIV who may lack access to or awareness of food bank services during emergencies or are reluctant to utilize formal assistance programs are critically needed. Again, lack of adequate food has long been associated with lack of adherence, non-viral suppression, and higher rates of mortality among people with HIV [Citation11–13].
Regarding social support, Spanish speakers were more likely to report not getting the support needed from friends and family throughout the pandemic. Future emergencies that require quarantine or sheltering in place orders should consider how cultural realities impact unique groups. For example, our findings suggest that cultural and linguistic differences in social relationships may have had varied impacts across different groups. Spanish speaking people with HIV may be particularly vulnerable to the adverse effects of social isolation given the limited social support they often already receive due to HIV stigma and rejection and language status [Citation25]. This is an area that is important to further investigate to inform future pandemics that may also require quarantine restrictions. Many services were eliminated as social service agency capacities were diminished during COVID-19 in order to address immediate pandemic related priorities. This may have affected the availability of social support services for Spanish speakers. Future interventions should focus on increasing linguistically appropriate community resources designed to increase social support for those with limited social support. Proactive approaches that provide tailored and acceptable community-based intervention strategies can be deployed during future public health emergencies to alleviate potential exacerbation of existing burdens.
Next, our study findings add to the ever-growing body of knowledge regarding COVID-19 impacts on substance use among people with HIV. In our study, we found no statistically significant differences among age, gender, or racial/ethnic groups related to increases in alcohol or illegal drug use. In fact, a small percentage of participants in our sample reported using alcohol or illegal drugs, even prior to the pandemic. Although other studies have reported on the impact of COVID-19 on substance use among people with HIV, results vary and are inconsistent [Citation25]. Yet, our study is largely consistent with another study conducted in Miami, FL that assessed drug and alcohol use changes among a group of people with HIV and a group of individuals with similar racial/ethnic and socioeconomic backgrounds who were not living with HIV [Citation26]. Researchers found that before the COVID-19 pandemic, HIV-uninfected participants were more likely to use cocaine and showed a trend towards higher alcohol misuse compared to people with HIV during the pandemic. Researchers also found no significant changes in alcohol consumption, but alcohol misuse was more prevalent among the HIV-uninfected participants during the pandemic [Citation26]. Researchers attributed potential resilience of having an existing chronic condition such as HIV as a protective factor that may have prevented people with HIV from worse pandemic related consequences.
Lastly, consistent with other national studies, women with HIV were more likely to report increased time taking care of children at home. Other studies provide consistency in this finding, even in instances when women were the sole providers of their homes [Citation27]. The pandemic highlighted inequities around time and responsibility expectations for women with children as childcare fell more heavily on women than men throughout the pandemic [Citation28]. This is likely due to traditional gender roles and the structure of women’s jobs which tend to be more flexible and less lucrative [Citation29]. These realities likely impacted stress for women, particularly women with HIV who had increased unpaid care giving responsibilities while engaging in paid work [Citation30]. This creates an additional burden for women living with HIV as they not only had to manage their own health and wellbeing, but also navigate the challenges of caring for their children during the pandemic when children were home schooled. The short and long-term consequences should be monitored to ensure progress made towards gender equity is not lost, for example, monitoring promotion and retention in employment among women with HIV, post pandemic.
Our findings suggest that increased efforts which focus on monitoring and addressing the unique needs of people with HIV are warranted in long-term follow up of the pandemic and in future emergency responses. Culturally and linguistically tailored intervention strategies are critical and should be deployed early on during public health emergencies to prevent inequities and limited accessibility of health information across diverse groups of people with HIV. Efforts that focus on appropriate and relevant health education, tailored social support options, culturally congruent mental health services, and access to charitable or community-based services, as opposed to formal government assistance programs are needed, particularly for Hispanic and foreign born people with HIV.
Limitations
Several limitations of this study should be noted. First, this study focused on data from cross sectional, self-reported changes in psychosocial and socioeconomic stressors and thus, do not establish casual relationships between the COVID-19 pandemic and reported outcomes. Additionally, our study is not reflective of differences in existing burden related to these domains prior to the pandemic. Hispanics report experiencing changes at higher rates than Non-Hispanic Blacks and Haitians for several variables, but it is possible that Non-Hispanic Blacks and Haitians already experienced significant psychosocial and socioeconomic challenges prior to the COVID-19 pandemic, and, thus, did not experience as many changes due to the global crisis. Further, the survey was collected during a time period when COVID-19 vaccines would have become available to participants, potentially reducing stress and worry among participants who were vaccinated. Yet, we found in another study, that 16% of people with HIV in the Miami-Dade Ryan White Program were not fully vaccinated at any point [Citation31]. Nonetheless, our findings suggest that significant changes among unique racial/ethnic groups of people with HIV need to be addressed and monitored in more detail. Additionally, our study is based on self-reported data and does not reflect clinical assessments of indicators such as mental health status. Next, because this study focuses on a sample of individuals who receive services from the RWP in Miami-Dade County, results may not be generalizable to clients of RWP outside of Miami-Dade County or those who do not receive services from RWP. Moreover, we recruited from a pool of participants who had previously given consent to participate in research and who had a working telephone number, thus utilizing a convenience quota sample. Furthermore, our sample was small which limited comparisons between the three racial/ethnic groups, and because other ethnic groups such as Non-Hispanic Whites and Asians, were not included, results may not be generalizable to those groups. Additionally, the small number of people who reported any alcohol or illegal drug use limited the ability to detect changes in particular groups. Finally, we were not able to include transgender individuals in this analysis due to low sample sizes and these individuals may have unique experiences as a result of the pandemic.
Conclusions
This study allowed us to quantitatively estimate changes in socioeconomic and psychosocial stressors experienced by a group of people with HIV, stratified by gender and racial/ethnic groups. Our findings provided confirmation that these stressors have been exacerbated by the COVID-19 pandemic and that certain groups were more affected by certain stressors, such as Hispanic people with HIV and women with HIV. Moreover, our findings have implications for understanding the way that cultural and gender expectations may have impacted unique experiences across gender and racial/ethnic groups, as well as point to potential areas of concern during current and future public health emergencies that may require tailored interventions and appropriate resource/funding allocations. Understanding differences in stressors across gender and racial/ethnic groups allows for research-informed efforts to support the health and wellbeing of people with HIV and allows us to identify needs that have been previously associated with lack of engagement in HIV care.
Finally, significant changes across both socioeconomic and psychosocial stressors experienced by people with HIV during the COVID-19 pandemic pose substantial challenges towards plans to end the HIV epidemic. Beyrer et al. [Citation32] outline the need for holistic strategies to ensure progress towards ending the epidemic goals, which could be further out of reach, given the unexpected and profound challenges associated with COVID-19. To ensure this is not the case, providers must actively assess and address the psychosocial influences that affected well-being by identifying those at disproportionate risk of poor outcomes and designing targeted interventions to promote health equity [Citation33]. Cultural and contextual differences in experiences of COVID-19 should be taken into consideration when providing services during lingering stages of the pandemic and when making decisions in future public health emergencies. Health and service providers should take a nuanced approach to screening, monitoring, and providing tailored services to people with HIV from different background while addressing issues that arise in order to mitigate the exacerbation of inequities experienced after the pandemic [Citation34]. Without doing so, we fail to acknowledge that the pandemic had different impacts on different communities and risk losing strides towards progress in health equity.
Ethics Approval
Our study was approved by the Florida International University Social Behavioral Institutional Review Board (approval no. IRB-17-0234). All participants provided verbal informed consent prior to enrollment in the study.
Appendix A.docx
Download MS Word (17.6 KB)Acknowledgments
We gratefully acknowledge Carla Valle-Schwenk, Ryan White Administrator, and the entire Ryan White Part A Program in the Miami-Dade County Office of Management and Budget, for their assistance in the study’s implementation as well as the participants themselves, without which this work would not be possible.
Disclosure statement
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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