Pinto, R.M., Park, S. COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organizations and Frontline Providers. AIDS Behav (2020). https://doi.org/10.1007/s10461-020-02893-3
More quickly and more vividly than they could have anticipated, people living with (PLWH) and those at-risk for HIV felt the impact of the COVID-19 pandemic, as they were asked to shelter in place and distance themselves from others. Over the months of March and April 2020, around the time shelter-in-place orders accelerated, community-based organizations (CBOs) have closed, medical offices have cut hours, and medical personnel have shifted from primary care to COVID-19 hospital units. We assess the extent to which the COVID-19 pandemic has disrupted the HIV Continuum of Care and Prevention—that is, testing, pre-exposure prophylaxis (PrEP), and primary care—and propose a course of action so that we may end the HIV epidemic in this decade.
Implications for Practice and Research
The COVID-19 pandemic presents multifaceted challenges to HIV service CBOs, including but not limited to resource shortages, low staff morale, and disruption to patient-centered service provision. Suspending services creates budgetary shortfalls for CBOs that heavily rely on program revenues. Given the skyrocketing numbers of unemployment claims in the last two weeks of March and two first weeks of April, many vulnerable clients may not be able to make co-payments for services, even after CBO doors are open again. CBOs expect significant declines in private donations, as also observed in the 2008 recession. Now and during the stay-in-shelter period, CBOs are likely to rely on small business and individual donations and government programs. They are likely to strengthen relationships with private and public partners (e.g., other CBOs) in their communities in order to advocate for more effective government responses such as those initiated in response to the Great Depression of the 1930s. The pandemic has created a substantial decline in provider morale. Many have and will continue to lose colleagues and clients to COVID-19. With limited resources and capacities, they are likely to be forced to make difficult choices as to which cases to prioritize for services . CBO staff will likely face layoffs and/or reduced paychecks as organizations struggle to stay open. These factors will continue to impact negatively frontline providers’ sprit, motivation, and mental health. Providers having day-to-day interactions with clients in primary care, outpatient, and prevention settings are poised to help PLWH and vulnerable individuals overcome HIV-related stigma, PrEP stigma, inadequate health insurance, and can help improve HIV testing rates . Provider engagement of clients in referral-making processes seems to improve client access to HIV testing, PrEP, and primary care, even when provider caseloads are high, clients may lack insurance, and CBOs may fear losing clients and revenue to other CBOs . However, in the face of COVID-19, such engaged, face-to-face interactions and referrals might not be feasible.