The intersection between the HIV epidemic and COVID-19 pandemic, especially as it relates to communities that are most vulnerable to transmission and death, cannot be overstated. The HIV epidemic in the U.S. has disproportionately affected marginalized communities including racial/ethnic minorities, young people, sexual minorities (specifically gay and bisexual cisgender men and transgender women), and people who inject drugs. The same societal-level systems of oppression and marginalization that increase vulnerability to HIV such as racism, stigma, economic disenfranchisement, and neighborhood disadvantage have been implicated in the disproportionate impact of the COVID-19 pandemic [13]. For example, a study conducted in Wisconsin found that African Americans and those impacted by poverty were more likely to be hospitalized due to COVID-19 [14]. Another study conducted among patients admitted to the hospital with COVID-19 in Michigan found that neighborhood disadvantage (i.e. poverty rate, median income, and access to healthy foods), which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19 (i.e. intensive care unit admissions and need for invasive mechanical ventilation) [15]. Additionally, studies found racial minority and poorer communities were less able to engage in the necessary COVID-19 mitigation strategies such as social distancing [16], quarantining [17], and remote work [18]. Lastly, while the COVID-19 response, especially the rapid development of the COVID-19 vaccine, leveraged advances made within the field of HIV research and programming, there is still no viable HIV vaccine. All in all, the COVID-19 pandemic coupled with the existing HIV epidemic has disproportionately affected already marginalized communities, fueled by institutionalized structures of oppression that propagate inequity on the basis of race, gender identity, sexual orientation, socioeconomic status and also minoritized identities.
Effects of COVID-19 on HIV
The most recent CDC annual HIV surveillance report showed a 17% decrease in HIV diagnoses in 2020compared to 2019 [CDC]. This downward trend was attributed to disruptions in HIV testing and clinicaloperations caused by the COVID-19 pandemic. Dr. Demetre Daskalakis, the director of the CDC Divisionof HIV/AIDS Prevention, described 2020 as ‘a lost year’ for the fight towards ending the HIV epidemic andadded that “We don’t really know where HIV transmission is going to land, but it’s something that weobviously are concerned about.” [NBC News]. The COVID-19 pandemic has upended the delivery of HIVtesting, treatment, and care services, with consequences that will likely be felt for decades.
