COVID-19 Disruptions in HIV-Related Services Are Associated with Diminished Intention to Engage in HIV Prevention Peer Outreach Among Sexual and Gender Diverse Persons in Kazakhstan

BACKGROUND AND PURPOSE: HIV incidence in Kazakhstan increased by 85% between 2010 and 2019. The rapidly growing epidemic has affected sexual and gender diverse (SGD) persons at disproportionately higher rates, warranting efforts of increasing engagement in HIV prevention and care among these key populations. Since March 2020, however, these efforts may have been interrupted by the COVID-19 pandemic. Emerging literature have documented disruptions to engagement in HIV-related services among SGD populations globally—including in Kazakhstan—due to the novel pandemic and measures to mitigate its spread. Moreover, these disruptions may extend to such vital social network-based strategies of HIV prevention as peer-led outreach. In this study, we examined the relationship between COVID-19 disruptions in HIV-related services and intention to engage in HIV prevention peer outreach in a sample of Kazakhstan-based SGD persons.

METHODS: Data for this study came from an ongoing clinical trial of a social network-based intervention for increasing engagement in HIV prevention and care among SGD persons in three Kazakhstan cities: Almaty, Nur-Sultan, and Shymkent. Participants were followed up every six months to complete assessment of HIV risk-associated behaviors, psychosocial health conditions, peer outreach experiences, and sociodemographic characteristics. In the early phases of COVID-19 lockdowns, we added a questionnaire assessing whether participants experienced any disruption to accessing HIV-related services (1=yes, 0=no). We also probed willingness and likelihood of engaging in HIV-related communication with peers for the purposes of encouraging their HIV testing or treatment in the next six months to assess peer outreach intention levels (1=higher, 0=lower). Accounting for the nested structure of the data, we conducted a multilevel logistic regression analysis of the association of COVID-19 disruptions with peer outreach intention. For this study, we considered data from 455 participants who remotely completed the COVID-19 disruptions questionnaire in May–October 2020.

RESULTS: About one-fifth (22.2%) of the participants in the sample reported experiencing disruptions to accessing HIV-related services at any time due to COVID-19. Over half (53.4%) endorsed the higher level of intention of engagement in HIV prevention peer outreach in the next six months. In the multivariable analysis that adjusted for sociodemographic characteristics, ever experiencing COVID-19 disruptions was significantly associated with reduced odds of the higher intention for HIV prevention peer outreach (AOR=0.56, 95%CI=0.45-0.70).

CONCLUSIONS AND IMPLICATIONS: In this study, we found that COVID-19 disruptions to accessing HIV-related services and intention of engaging in HIV prevention peer outreach were inversely related. Given the promise of peer outreach for HIV prevention and harm reduction, our findings warrant renewed efforts of protecting and mobilizing community-level interventions with Kazakhstan-based SGD persons in the context of a double pandemic.