J Acquir Immune Defic Syndr. 2021 Dec 21. doi: 10.1097/QAI.0000000000002901. Online ahead of print.
ABSTRACT
BACKGROUND: The COVID-19 pandemic and its associated socio-economic disruptions has disproportionally affected marginalized populations including people living with HIV (PLHIV). Little is known about how the pandemic has impacted populations experiencing multiple forms of stigma, discrimination and violence such as female sex workers (FSW) living with HIV.
METHODS: We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic (DR) to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use and partner abuse on engagement in HIV care and ART adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.
RESULTS: Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one third (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (aOR=1.14, 95% CI: 1.02-1.27), mental health challenges (aOR=1.38, 95% CI: 1.06-1.79) and partner emotional abuse (aOR=2.62, 95% CI: 1.01-6.79) were associated with higher odds of negatively impacted HIV care, respectively. The relationship between increased emotional partner abuse and negatively impacted HIV care was mediated by greater COVID-19-related mental health challenges.
CONCLUSION: FSW living with HIV in the DR have been significantly impacted by the COVID-19 pandemic. Targeted interventions that address structural (financial security, partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.
PMID:34974474 | DOI:10.1097/QAI.0000000000002901
