The Impact and Responses to Disruptions to HIV Services Due to the COVID Pandemic: A State-Level Stakeholder Perspective

BACKGROUND: The United States envisions a 90% reduction in HIV infections by the end of this decade. But, the COVID pandemic severely disrupted the HIV Continuum of Prevention and Care (“HIV continuum”) that connects people living with HIV (PLWH) and high-risk individuals to appropriate prevention and care (e.g., from diagnosis to maintaining undetectable level of HIV in the body). Preliminary studies and anecdotal accounts show that the pandemic disproportionately impacted people of color (POC), Men Who Have Sex with Men (MSM), People who Inject/Use Drugs (PWID), and Transgender and Non-Binary Persons and their connection to the HIV continuum. This study aimed to uncover (1) how COVID disrupted the HIV Continuum, (2) how disruptions were handled, and (3) recommendations for future emergencies.

METHODS: Following a community-engaged approach to research, we approached the Michigan HIV/AIDS Council (MHAC) – a collective of practitioners, researchers, and community members across Michigan guiding the service planning, capacity improvement, and resource allocation decisions of the state. Out of 42 MHAC members, we interviewed 33 (79% of the Council) reflecting diverse membership – 52% White, 30% Black, 9% multiracial, 6% Latinx, and 3% Asian; average age 42 (range: 19-62); majority female (58%); and 10 PLWH. We conducted interviews (30-60 minutes) using Zoom. Participants (1) describe how the pandemic disrupted the HIV continuum – HIV testing, PreP, primary care, etc. – with an emphasis on health inequities, (2) how they handled disruptions, and (3) recommendations. We measured group cohesivenessindividual opinions reflected those of the council as a group. Three coders independently read and developed initial codes using open coding based on six randomly selected interviews. We then used a coding scheme to code the remaining interviews. Saturation occurred after about half of the interviews.

RESULTS: We found a high degree of cohesiveness (5.73; SD =0.57), suggesting that qualitative data reflect the opinions/sensibilities of the council as a body that oversees HIV service provision in the state. While the pandemic disrupted all HIV continuum services (e.g., HIV testing, PreP education, referrals to primary care, etc.), the participants identified issues that predated the pandemic (e.g., lack of public transportation and food insecurity) exacerbated the disruption to the HIV continuum disproportionately for POC. Responses to disruptions included virtual video conferences and taking temperature and health screenings via phone or at clients’ vehicles. The main recommendation from participants is to overhaul all means of communication between funding agencies (e.g., Centers for Disease Control and Prevention, state and local health departments) and HIV stakeholders, especially community agencies offering HIV services across the state.

CONCLUSION: Our findings reflect a burgeoning literature showing that COVID has diminished community-based organizations’ ability to sustain the HIV continuum, making it doubtful that HIV infections in the United States will decrease by 90% within the current decade. Respondents contended that communication that clarifies specific orders and procedures administrators and providers should follow in emergencies like the pandemic might abate the disruptions that threaten the HIV continuum.