COVID-19 Pandemic-Related Changes in HIV Access to Care in San Francisco Area

The COVID-19 pandemic caused people living with HIV to report several changes to their mental health and increased substance use.

The COVID-19 pandemic has had adverse effects on mental health, rates of substance use, ability to access medical care, and medication adherence among people living with HIV (PLWH), according to research presented at the Association of Nurses in AIDS Care (ANAC) annual meeting held November 17 to 19, 2022, in Tampa, Florida.

In March 2020, the San Francisco Bay area was one of the first areas to institute shelter-in-place orders. The area is also home to a large population of PLWH, many of whom are older than age 50 years (72% of PLWH) and are virally suppressed (70%). To study investigate how the COVID-19 pandemic affected PLWH, researchers from the University of California, San Francisco, collected survey data between December 2021 and September 2022 from San Francisco-based PLWH.

Out of 93 total respondents, 76 identified as male, 14 identified as female, 2 identified as gender queer, and 1 identified as a transgender man. The mean participant age was 52 years and 42 respondents identified as a racial or ethnic minority.

The majority of respondents (79%) had an undetectable viral load and nearly all (95.5%) stated they were currently taking antiretroviral medications. Twenty of the participants lost their job, insurance, and/or housing during the pandemic, and 80 of the participants received a COVID-19 vaccine.

Participants were asked questions about their mental health, behaviors, and HIV care and provided their answers on a 5-point Likert scale; these responses were then coded into binary variables.

Effects of COVID-19 on Mental Health in People Living With HIV

Participants reported several changes to their mental health during the COVID-19 pandemic:

  • 68.1% reported a decrease in quality of life
  • 64.0% reported experiencing increased anxiety
  • 58.9% reported a decrease in feeling connected to friends
  • 44.8% reported a decrease in connection to family members
  • 42.5% reported a decrease in sleep quality

The mental health effects of the COVID-19 pandemic were felt particularly among respondents who reported loss of their job, insurance, and/or housing, and those who identified as a racial or ethnic minority. Those who reported pandemic-related job, insurance, or housing loss were 16.22 times more likely (P =.02) to report a decreased quality of life independent of racial or ethnic minority status. Participants who indicated they belonged to a racial or ethnic minority group were 3.65 times more likely (P =.008) to report a decreased connection to family members during the pandemic, independent of other factors.

Substance Use Increased

Participants reported changes in substance use as a result of the pandemic; 23.9% stated they had increased their recreational drug usage and 29.2% stated they increased their consumption of alcohol. Respondents who indicated they were experiencing housing instability were 22.52 times more likely (P =.02) to report increased recreational drug use than other respondents, independent of other demographic factors.

The pandemic had a marked impact on access to care for PLWH; 40.5% of respondents reported a decrease in clinical care visits. COVID-19 also affected access and adherence to HIV medication; 23.3% of respondents reported a decrease in medication access, and 24.7% reported a decrease in adherence. Lack of access to medication was most severe among PLWH aged 18 to 39 years, who reported significantly more issues with accessing care than respondents aged 60 years and older (odds ratio, 213.36).

Fewer patients had laboratory testing done during the pandemic with 37.5% of respondents reporting a decrease in assessing their viral loads or other testing. Pandemic-related job, insurance, and/or housing loss was an independent factor for issues accessing laboratory testing by a factor of 4.55 (P =.03).

Researchers noted that increased mental health and substance use care for PLWH is needed to address gaps created by the COVID-19 pandemic, especially among younger patients, racial and ethnic minorities, and PLWH who experienced loss of a job, insurance, or housing during the pandemic.

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This article originally appeared on Clinical Advisor

References:

Broussard J, Dawson-Rose C, Huang E, Cuca Y. COVID-19 Pandemic-related changes in health, wellness, and access to care for people living with HIV in the San Francisco Bay Area. Presented at: ANAC2022; November 17-19, 2022; Tampa, FL.