Impact of COVID-19 on HIV Testing and Treatment Among Sexual and Gender Diverse Persons in Kazakhstan: Who Is Most Affected?

BACKGROUND AND PURPOSE: Kazakhstan has experienced one of the largest increases in HIV transmission rate over the last decade. Mirroring global trends, sexual and gender diverse (SGD) persons—such as men who have sex with men (MSM)—in Kazakhstan bear a disproportionate burden of this increase and HIV infections overall in Kazakhstan. Recent efforts underway in Kazakhstan to increase the engagement of SGD persons into the HIV care continuum have overlapped with the onset of the COVID-19 pandemic. We investigated whether COVID-19 and the consequent public health responses impacted SGD men’s engagement in HIV testing and treatment in Kazakhstan.

METHODS: SGD persons in Almaty, Nur-Sultan, and Shymkent were recruited into a stepped-wedge clinical trial of a social network-based HIV prevention intervention for substance-involved SGD persons. Participants provided data every 6 months to a standardized battery of sociodemographic, substance use, and HIV risk assessment instruments. The clinical trial commenced in January 2019 but was temporarily halted in March 2020 as COVID-19 emerged in Kazakhstan. Follow-up assessments resumed in May 2020, with the following question added: “Has COVID or the response to COVID limited your ability to get HIV testing or treatment?” In the first 6 months of data collection since resumption after the pause due to COVID-19, there were 455 SGD persons who completed follow-up interviews; this represents the sample for the analyses and findings presented herein. Multi-level (respondents nested within geographical cities) logistic regression was used to identify factors significantly associated with responses to the question regarding negative impact of COVID-19 on engagement in the HIV care continuum.

RESULTS: Among this sample of 455 SGD persons, 101 (22.2%) reported that either COVID-19 or the response to COVID-19 in Kazakhstan limited their ability to be tested or receive treatment for HIV. The odds of being negatively impacted by COVID-19 or the COVID-19 response on engagement in the HIV care continuum was significantly associated with the following: living in one’s own place (OR=0.61, 95%CI=0.54-0.69), being a cisgender man (OR=0.49, 95%CI=0.28-0.86), and use of opioids (OR=2.00, 95%CI=1.10-3.63), cocaine (OR=6.67, 95%CI=1.67-26.60), and/or club drugs (OR=5.3, 95%CI=2.71-11.26) in the past 6 months. The significant associations in multivariable analyses remained [in the same direction] for living in one’s own place, being a cisgender man, and club drug use.

CONCLUSIONS AND IMPLICATIONS: COVID-19 and/or the consequences from the country’s response negatively impacted the ability of a significant proportion of SGD persons to receive HIV testing and treatment. Findings also suggest that COVID-19 is exacerbating the adversity experienced by subgroups within this key population: trans/gender non-conforming individuals, those dependent on others for housing, and substance involved (specifically club drugs) individuals. Notably, these subgroups generally experience other social and structural harms. Thus, efforts to ameliorate COVID-19 and HIV in Kazakhstan need to attend to compounded and multiple forms of interpersonal, social, structural, and institutional discrimination and marginalization.