LGBTQ people living with HIV: considerations during COVID-19

Coronavirus disease 2019 (COVID-19) has spread rapidly around the world since the first reports from China in 2019, and the outbreak was characterized as a pandemic. COVID-19 does not affect everyone equally. COVID-19 has disproportionately impacted LGBTQ Americans and may continue to. Prior studies have noted significant health disadvantages experienced by LGBTQ populations in the U.S. Some of the biggest health care issues for LGBTQ people place the community at higher risk for COVID-19 with sexual and gender minorities have higher rates of smoking and substance use disorders, as well as a higher prevalence of chronic illnesses, including asthma, type 2 diabetes, eating disorders, anxiety and depression (largely from stigma and discrimination), and increased rates of HIV. People living with HIV (PLWH) are at risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes COVID-19. Although some institutions, in collaboration with governments and community partners, are working to sustain HIV service provision for PLWH, the COVID-19 pandemic presents several barriers and challenges to the HIV care continuum.

Early in the COVID-19 pandemic, it was common to hear, “the virus is the great equalizer.” The crisis quickly illuminated the deep inequities in obtaining access to necessary building blocks of health. As access to essential services becomes increasingly scarce. Implementation of quarantine, social distancing, and community containment measures have reduced access to routine HIV testing, which challenges people knowing their status. HIV testing is the vital first step towards initiation into HIV care. Even with availability of at-home HIV self-testing kits, testing remains a large challenge in settings with scarce access to these kits. Increased efforts are needed to augment access and facilitate testing.

Timely linkage to HIV care is hindered during COVID-19. PLWH who should have initiated antiretroviral treatment (ART) in a physician’s office or hospital might be deterred because during a pandemic, many of the LGBTQ community faces substantial losses in employment and health insurance, furthering their inability to obtain basic health services. These challenges are also occurring alongside numerous legal and interpersonal challenges and attacks on LGBTQ rights. Locations that would usually be available as a walk-in service to provide testing and prevention supplies (e.g., condoms, post-exposure prophylaxis, and pre-exposure prophylaxis) are temporarily closed or are offering limited appointments. Plus, because many public health workers are focused on COVID-19 control, allocation of resources for HIV prevention could be diminished, and circumstances surrounding HIV care could worsen quickly.

The COVID-19 pandemic hinders ART continuation. Of most concern is PLWH who are not treatment-adherent and virally suppressed. PLWH who are faced with ART discontinuation not only could undergo physical health trauma but might suffer psychological pressure. Plus, hospital visits could be restricted because of city lockdowns and hospital beds being unavailable. In addition to adhering to safety guidelines, PLWH should make every effort to adhere to their treatment regimen by taking their HIV medication daily and engaging in other activities to remain healthy such as eating well, exercising, and avoiding tobacco and other substances. The U.S. Department of Health and Human Services released guidance for COVID-19 and PLWH, which emphasized that PLWH should maintain at least a 30-day supply and ideally a 90-day supply of ART and all other drugs by mail-order delivery if possible. Successful responses to the COVID-19 pandemic, such as virtual courses and conferences, may set precedents for future innovations in the HIV research field.

As COVID-19 continues to spread around the globe, many areas are facing the serious risk of SARS-CoV-2 and barriers and challenges for maintaining HIV prevention and care. This situation could be worsened in communities with limited resources and a weak health-care system. It is recommended that scientists, governments, community-based organizations, and community partners should continue to work together to maintain the HIV prevention and care plan during the COVID-19 pandemic, with a particular focus made to ensure timely access to routine HIV services and vaccine roll out to high-risk populations.

Kimberly Levitt is a health programs and supportive services manager. Connie Ticho is a health programs intern.

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