The best approach to HIV prevention is a combination of condom distribution, health education, syringeexchange services, and initiation of and continued adherence to pre-exposure prophylaxis (PrEP; HIVprevention medication). Prior to the pandemic, these services were delivered primarily in person throughclinics, hospitals, community centers, and outreach events in social spaces frequented by the targetpopulation (clubs, bars, bookstores, etc). Stay-at- home orders and widespread closings of social spacesdue to the COVID-19 pandemic significantly affected access to HIV prevention services, and face- to-faceclient interactions were suddenly halted and transitioned to virtual spaces. These transitions, whileseamless for some, have been difficult for others. For example, a community- and primary care-basedHIV prevention program for sexual minority men in New York went from servicing 2000 patients/day inperson visits to under 100 through May 2020 . During this time, telemedicine visits became andremains the norm for seeing clients. There were mixed results in how the COVID-19 pandemic hasimpacted engagement in HIV prevention services.
A study conducted in three states found an increase in male PrEP visits during the pandemic compared topre-pandemic period, a vast majority of them being telehealth visits . Another study of a community basedclinic in Boston, MA found a 72% decrease in new PrEP initiations and 3-fold increase in lapses inPrEP refills among existing PrEP patients since the beginning of the pandemic .
In our interviews, we heard the surge of public health information around COVID-19 overshadowed otherimportant topics and health issues, including prevention of HIV transmission. Comparatively, people wespoke to in our qualitative interviews remarked that PrEP messaging directed at affected communitiesdecreased as COVID-19 messages filled the public discourse.
These findings underscore the immense effects of the COVID-19 pandemic on access to HIV preventionservices and the implications for those with limited access to these services pre-pandemic. Ensuringfunding to keep PrEP low cost or free to patients is a long-term need. Without it, prevention of new HIVtransmission could be in jeopardy. And, continued education about access to preventative medication likePrEP is needed, and could be incorporated into public health messages about COVID-19.