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.