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Snyman J, Sanders EJ, Ndung’u T. COVID-19 in Africa: preexisting immunity and HIV. AIDS 2021; 35:2391-2393. [PMID: 34723854 PMCID: PMC8567318 DOI: 10.1097/qad.0000000000003079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Jumari Snyman
- Africa Health Research Institute
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Eduard J. Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thumbi Ndung’u
- Africa Health Research Institute
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
- Division of Infection and Immunity, University College London, London, UK
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Pollard R, Gopinath U, Reddy YA, Kumar BR, Mugundu P, Vasudevan CK, Srikrishnan AK, Singh A, McFall AM, Mayer KH, Mehta SH, Solomon SS. HIV service delivery in the time of COVID-19: focus group discussions with key populations in India. J Int AIDS Soc 2021; 24 Suppl 6:e25800. [PMID: 34713583 PMCID: PMC8554214 DOI: 10.1002/jia2.25800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction There are limited data on the impact of COVID‐19‐associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low‐ and middle‐income countries. In March 2020, in response to COVID‐19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi‐month dispensing (MMD) of ART for all people living with HIV (PLHIV). Methods To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics. Results Forty‐four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty‐four participants self‐identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID‐19. Participants accessed HIV antibody testing using transportation arranged by community‐based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID‐19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home‐based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community‐based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient‐rich food and more accessible mental health, HIV, and other health services. Conclusions COVID‐19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community‐based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
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Affiliation(s)
- Rose Pollard
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Usha Gopinath
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Yeruva A Reddy
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bogam R Kumar
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Parthasarathy Mugundu
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Aditya Singh
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.,Fenway Health, The Fenway Institute, Boston, Massachusetts, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Erausquin JT, Tan RKJ, Uhlich M, Francis JM, Kumar N, Campbell L, Zhang WH, Hlatshwako TG, Kosana P, Shah S, Brenner EM, Remmerie L, Mussa A, Klapilova K, Mark K, Perotta G, Gabster A, Wouters E, Burns S, Hendriks J, Hensel DJ, Shamu S, Strizzi JM, Esho T, Morroni C, Eleuteri S, Sahril N, Low WY, Plasilova L, Lazdane G, Marks M, Olumide A, Abdelhamed A, López Gómez A, Michielsen K, Moreau C, Tucker JD. The International Sexual Health And Reproductive Health Survey (I-SHARE-1): A Multi-Country Analysis of Adults from 30 Countries Prior to and During the Initial COVID-19 Wave. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34704103 PMCID: PMC8547535 DOI: 10.1101/2021.09.18.21263630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The COVID-19 pandemic forced billions of people to shelter in place, altering social and sexual relationships worldwide. In many settings, COVID-19 threatened already precarious health services. However, there is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and three months after policy measures to mitigate COVID-19. We used established indicators and analyses pre-specified in our protocol. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Descriptive analyses included 22,724 individuals in 25 countries. Five additional countries with sample sizes <200 were included in descriptive meta-analyses. Results Respondents were mean age 34 years; most identified as women (15160; 66.7%), cis-gender (19432; 86.6%) and heterosexual (16592; 77.9%). Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusion Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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Septarini NW, Hendriks J, Maycock B, Burns S. Psychological Distress and Happiness of Men Who Have Sex With Men and Transgender People During the Coronavirus Disease-19 Pandemic: Is There a Need for Public Health Policy Intervention? Front Public Health 2021; 9:647548. [PMID: 34595147 PMCID: PMC8476851 DOI: 10.3389/fpubh.2021.647548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/20/2021] [Indexed: 12/23/2022] Open
Abstract
Since the global onset of COVID-19 in early 2020, the disease has significantly impacted mental health. This impact is likely to be further exacerbated for groups who were already marginalized. This paper shares results from a broader study of men who have sex with men (MSM) and transgender people in Bali, Indonesia and includes a focus on psychological distress and happiness during the COVID-19 pandemic; applying sociodemographic and epidemiological characteristics as potential mediators. Psychological distress and the level of happiness were measured by The Kessler Psychological Distress (K10) and the Subjective Happiness Scale (SHS). A cross-sectional survey was conducted from July to September 2020. Of the 416 participants, complete data were available for 363 participants. The majority of participants were aged 26-40 years, currently single, were born outside Bali, were currently living in an urban area, and over one-third were living with HIV. While all were MSM, the majority identified as homosexual/tend to be homosexual (71.3%), however 54 (14.9%) identified themselves as heterosexual. The majority (251, 69.1%) reported moderate to very high psychological distress during the COVID-19 pandemic. The binary logistic regression analysis identified five factors to be significantly associated with higher psychological distress: being a student, reporting higher levels of stigma, had ever experienced discrimination, felt better prior to the COVID-19 pandemic, and less happy than the average person. When homosexual were compared with heterosexual participants, those who identified themselves as being homosexual reported significantly lower psychological distress compared to those identified themselves as heterosexual, which may be associated with these participants not disclosing their status as MSM and the stigma around MSM. Those who considered themselves to be less happy than the average person (316, 87.1%) were more likely to live with a partner and to report moderate to very high psychological distress. Based on the findings, interventions should focus on strategies to reduce stigma, provide non-discriminatory services, and improve access to essential health services.
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Affiliation(s)
- Ni Wayan Septarini
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jacqueline Hendriks
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Centre for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
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Barriers and Facilitators to Promoting Resilience to HIV/AIDS: A Qualitative Study on the Lived Experiences of HIV-Positive, Racial and Ethnic Minority, Middle-Aged and Older Men Who Have Sex with Men from Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158084. [PMID: 34360376 PMCID: PMC8345717 DOI: 10.3390/ijerph18158084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/23/2023]
Abstract
Evidence-based research has highlighted the need for exploring factors that support the mental health of men who have sex with men living with HIV/AIDS (MSMLWH), and environmental influences that promote their resilience to HIV/AIDS. This exploratory study utilized a community-based participatory research approach to investigate barriers and facilitators to promoting resilience to HIV/AIDS, specifically among racial and ethnic minority, middle-aged and older MSMLWH, a population that continues to be significantly impacted by HIV/AIDS today. This collaborative, qualitative study recruited participants who identified as racial or ethnic minority MSMLWH, were aged 40 or older, and resided in Ontario, Canada. Participants (n = 24) discussed in their interviews barriers and facilitators to promoting resilience to HIV/AIDS, which they recognized from their lived experiences. Utilizing thematic analysis, themes related to barriers and facilitators to promoting resilience to HIV/AIDS were identified. Themes related to identified barriers included: (1) language proficiency, (2) racism, (3) pernicious norms in North American gay culture, and (4) HIV stigma. Themes related to identified facilitators included: (1) compartmentalization, (2) perseverance, and (3) community-based health and social services. This article discusses the implications of the study’s findings, particularly on how they may influence the development of future services for racial and ethnic minority, middle-aged and older MSMLWH.
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Jarrett BA, Peitzmeier SM, Restar A, Adamson T, Howell S, Baral S, Beckham SW. Gender-affirming care, mental health, and economic stability in the time of COVID-19: A multi-national, cross-sectional study of transgender and nonbinary people. PLoS One 2021; 16:e0254215. [PMID: 34242317 PMCID: PMC8270151 DOI: 10.1371/journal.pone.0254215] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Transgender and nonbinary people are disproportionately affected by structural barriers to quality healthcare, mental health challenges, and economic hardship. This study examined the impact of the novel coronavirus disease (COVID-19) crisis and subsequent control measures on gender-affirming care, mental health, and economic stability among transgender and nonbinary people in multiple countries. METHODS We collected multi-national, cross-sectional data from 964 transgender and nonbinary adult users of the Hornet and Her apps from April to August 2020 to characterize changes in gender-affirming care, mental health, and economic stability as a result of COVID-19. We conducted Poisson regression models to assess if access to gender-affirming care and ability to live according to one's gender were related to depressive symptoms, anxiety, and changes in suicidal ideation. RESULTS Individuals resided in 76 countries, including Turkey (27.4%, n = 264) and Thailand (20.6%, n = 205). A majority were nonbinary (66.8%, n = 644) or transfeminine (29.4%, n = 283). Due to COVID-19, 55.0% (n = 320/582) reported reduced access to gender-affirming resources, and 38.0% (n = 327/860) reported reduced time lived according to their gender. About half screened positive for depression (50.4%,442/877) and anxiety (45.8%, n = 392/856). One in six (17.0%, n = 112/659) expected losses of health insurance, and 77.0% (n = 724/940) expected income reductions. The prevalence of depressive symptoms, anxiety, and increased suicidal ideation were 1.63 (95% CI: 1.36-1.97), 1.61 (95% CI: 1.31-1.97), and 1.74 (95% CI: 1.07-2.82) times higher for individuals whose access to gender-affirming resources was reduced versus not. DISCUSSION The COVID-19 crisis is associated with reduced access to gender-affirming resources and the ability of transgender and nonbinary people to live according to their gender worldwide. These reductions may drive the increased depressive symptoms, anxiety, and suicidal ideation reported in this sample. To improve health of transgender and nonbinary communities, increased access to gender-affirming resources should be prioritized through policies (e.g., digital prescriptions), flexible interventions (e.g., telehealth), and support for existing transgender health initiatives.
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Affiliation(s)
- Brooke A. Jarrett
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Sarah M. Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
| | - Arjee Restar
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Tyler Adamson
- Department of Health, Policy, and Management, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - Sean Howell
- Hornet, San Francisco, CA, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
| | - S. Wilson Beckham
- Department of Health, Behavior, and Society, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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Silhol R, Geidelberg L, Mitchell KM, Mishra S, Dimitrov D, Bowring A, Béhanzin L, Guédou F, Diabaté S, Schwartz S, Billong SC, Njindam IM, Levitt D, Mukandavire C, Maheu-Giroux M, Rönn MM, Dalal S, Vickerman P, Baral S, Alary M, Boily MC. Assessing the Potential Impact of Disruptions Due to COVID-19 on HIV Among Key and Lower-Risk Populations in the Largest Cities of Cameroon and Benin. J Acquir Immune Defic Syndr 2021; 87:899-911. [PMID: 33657058 PMCID: PMC8191475 DOI: 10.1097/qai.0000000000002663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. SETTING Yaoundé (Cameroon) and Cotonou (Benin). METHODS We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19. RESULTS A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. CONCLUSIONS Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.
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Affiliation(s)
- Romain Silhol
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom
| | - Lily Geidelberg
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom
| | - Sharmistha Mishra
- Department of Medicine, Division of Infectious Disease, University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Bowring
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Luc Béhanzin
- National School of Public Health and Epidemiological Surveillance workers, Parakou University, Bénin
| | - Fernand Guédou
- Free STI clinic, Cotonou Communal Health Center, Cotonou, Bénin
| | - Souleymane Diabaté
- Population Health and Optimal Health Practices, Québec University Hospital Research Center, Laval University, Québec, Quebec, Canada
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Serge C. Billong
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Daniel Levitt
- HIV/AIDS Heath Equity and Rights, CARE USA, New York, NY
| | - Christinah Mukandavire
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Shona Dalal
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland; and
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Michel Alary
- Population Health and Optimal Health Practices, Québec University Hospital Research Center, Laval University, Québec, Quebec, Canada
| | - Marie-Claude Boily
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College London, London, United Kingdom
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Morgan R, Baker P, Griffith DM, Klein SL, Logie CH, Mwiine AA, Scheim AI, Shapiro JR, Smith J, Wenham C, White A. Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender? FRONTIERS IN SOCIOLOGY 2021; 6:650729. [PMID: 34212026 PMCID: PMC8239350 DOI: 10.3389/fsoc.2021.650729] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Epidemics and pandemics, like COVID-19, are not gender neutral. Much of the current work on gender, sex, and COVID-19, however, has seemed implicitly or explicitly to be attempting to demonstrate that either men or women have been hardest hit, treating differences between women and men as though it is not important to understand how each group is affected by the virus. This approach often leaves out the effect on gender and sexual minorities entirely. Believing that a more nuanced approach is needed now and for the future, we brought together a group of gender experts to answer the question: how are people of different genders impacted by COVID-19 and why? Individuals working in women's, men's, and LGBTQ health and wellbeing wrote sections to lay out the different ways that women, men, and gender and sexual minorities are affected by COVID-19. We demonstrate that there is not one group "most affected," but that many groups are affected, and we need to move beyond a zero-sum game and engage in ways to mutually identify and support marginalized groups.
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Affiliation(s)
- Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Peter Baker
- Global Action on Men’s Health, London, United Kingdom
| | - Derek M Griffith
- Founder and Director of the Center for Research on Men’s Health and Professor of Medicine, Health and Society, Vanderbilt University, Nashville, TN, United States
| | - Sabra L. Klein
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, Canada and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Amon Ashaba Mwiine
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Janna R. Shapiro
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Julia Smith
- Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, Leeds, United Kingdom
| | - Alan White
- Emeritus Professor of Men’s Health, Leeds Beckett University, Leeds, United Kingdom
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The potential effect of COVID-19-related disruptions on HIV incidence and HIV-related mortality among men who have sex with men in the USA: a modelling study. Lancet HIV 2021; 8:e206-e215. [PMID: 33617783 PMCID: PMC8045548 DOI: 10.1016/s2352-3018(21)00022-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, men who have sex with men (MSM) in the USA have reported similar or fewer sexual partners and reduced HIV testing and care access compared with before the pandemic. Pre-exposure prophylaxis (PrEP) use has also declined. We aimed to quantify the potential effect of COVID-19 on HIV incidence and HIV-related mortality among US MSM. METHODS We used a calibrated, deterministic, compartmental HIV transmission model for MSM in Baltimore (MD, USA) and available data on COVID-19-related disruptions to HIV services to predict effects of reductions in sexual partners (0%, 25%, 50%), condom use (5%), HIV testing (20%), viral suppression (10%), PrEP initiations (72%), PrEP adherence (9%), and antiretroviral therapy (ART) initiations (50%). In our main analysis, we modelled disruptions due to COVID-19 starting Jan 1, 2020, and lasting 6 months. We estimated the median change in cumulative new HIV infections and HIV-related deaths among MSM over 1 and 5 years, compared with a base case scenario without COVID-19-related disruptions. FINDINGS A 25% reduction in sexual partners for 6 months among MSM in Baltimore, without HIV service changes, could reduce new HIV infections by median 12·2% (95% credible interval 11·7 to 12·8) over 1 year and median 3·0% (2·6 to 3·4) over 5 years. In the absence of changes in sexual behaviour, the 6-month estimated reductions in condom use, HIV testing, viral suppression, PrEP initiations, PrEP adherence, and ART initiations combined are predicted to increase new HIV infections by median 10·5% (5·8 to 16·5) over 1 year, and by median 3·5% (2·1 to 5·4) over 5 years. Disruptions to ART initiations and viral suppression are estimated to substantially increase HIV-related deaths (ART initiations by median 1·7% [0·8 to 3·2], viral suppression by median 9·5% [5·2 to 15·9]) over 1 year, with smaller proportional increases over 5 years. The other individual disruptions (to HIV testing, PrEP and condom use, PrEP initiation, and partner numbers) were estimated to have little effect on HIV-related deaths (<1% change over 1 or 5 years). A 25% reduction in sexual partnerships is estimated to offset the effect of the combined service disruptions on new HIV infections (change over 1 year: median -3·9% [-7·4 to 1·0]; over 5 years: median 0·0% [-0·9 to 1·4]), but not on HIV deaths (change over 1 year: 11·0% [6·2 to 17·7]; over 5 years: 2·6% [1·5 to 4·3]). INTERPRETATION Maintaining access to ART and adherence support is of the utmost importance to maintain viral suppression and minimise excess HIV-related mortality due to COVID-19 restrictions in the USA, even if disruptions to services are accompanied by reductions in sexual partnerships. FUNDING National Institutes of Health.
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Brown LB, Spinelli MA, Gandhi M. The interplay between HIV and COVID-19: summary of the data and responses to date. Curr Opin HIV AIDS 2021; 16:63-73. [PMID: 33186229 PMCID: PMC7735216 DOI: 10.1097/coh.0000000000000659] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We examine the interplay between the HIV and COVID-19 epidemics, including the impact of HIV on COVID-19 susceptibility and severe disease, the effect of the COVID-19 epidemic on HIV prevention and treatment, and the influence of the HIV epidemic on responses to COVID-19. RECENT FINDINGS Evidence to date does not suggest that people living with HIV (PLWH) have a markedly higher susceptibility to SARS-CoV-2 infection, with disparities in the social determinants of health and comorbidities likely having a greater influence. The majority of literature has not supported a higher risk for severe disease among PLWH in Europe and the United States, although a large, population-based study in South Africa reported a higher rate of death due to COVID-19. Higher rates of comorbidities associated with COVID-19 disease severity among PLWH is an urgent concern. COVID-19 is leading to decreased access to HIV prevention services and HIV testing, and worsening HIV treatment access and virologic suppression, which could lead to worsening HIV epidemic control. CONCLUSION COVID-19 is threatening gains against the HIV epidemic, including the U.S. Ending the HIV Epidemic goals. The ongoing collision of these two global pandemics will continue to need both study and interventions to mitigate the effects of COVID-19 on HIV efforts worldwide.
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Affiliation(s)
- Lillian B. Brown
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Matthew A. Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
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