Addressing Health Inequities Exacerbated by COVID-19 Among Youth With HIV: Expanding Our Toolkit

Abstract

Adolescents and young adults, aged 13e24 years, are disproportionately affected by HIV in the United States. Youth with HIV (YHIV) face many psychosocial and structural challenges resulting in poor clinical outcomes including lower rates of medication adherence and higher rates of uncontrolled HIV. The Johns Hopkins Intensive Primary Care clinic, a longstanding HIV care program in Baltimore, Maryland, cares for 76 YHIV (aged 13e24 years). The multidisciplinary team provides accessible, evidenced-based, culturally sensitive, coordinated and comprehensive patient and family-centered HIV primary care. However, the ability to provide these intensive, in-person services was abruptly disrupted by the necessary institutional, state, and national coronavirus disease 2019 (COVID-19) mitigation strategies. As most of our YHIV are from marginalized communities (racial/ethnic, sexual, and gender minorities) with existing health and social inequities that impede successful clinical outcomes and increase HIV disparities, there was heightened concern that COVID-19 would exacerbate these inequities and amplify the known HIV disparities. We chronicle the structural and logistic approaches that our team has taken to proactively address the social determinants of health that will be negatively impacted by the COVID-19 pandemic, while supporting YHIV to maintain medication adherence and viral suppression.

Disparity in HIV Service Interruption in the Outbreak of COVID-19 in South Carolina

“…In the United States, a Boston health center reported that disruptions in Pre-Exposure Prophylaxis (PrEP) care were more prominent among vulnerable population [ 27 ]. In Maryland, a comprehensive patient and family centered HIV primary care was interrupted among racial, sexual and gender minority youth living with HIV, which might impede their medicine adherence and clinical improvement [ 28 ]. To prevent the further widening of the disparities in existing HIV care system, strengthening and empowering community partners of HIV clinics could be essential for more effective and accountable responses to public health emergencies [ 29 – 31 ].…”

COVID-19’s impact on primary care and related mitigation strategies: A scoping review

“…Impact of COVID-19 on primary care service provision. Fourteen studies identified the impacts of COVID-19 on primary care service provision [19,22,[29][30][31][32][33]35,36,38,42,44,45]. Impacts were classified under the sub-themes: reduced capacity of/access to primary care, reduced quality of primary care, and patients' avoidance or delaying of non-COVID care.…”

“…Reduced capacity of/access to primary care. Ten studies documented reduced capacity of/or access to primary care during the pandemic [22,[29][30][31][32][33]35,36,38,42]. Reduced capacity was owing to overwhelming numbers of COVID-19 patients and staff shortages [29,31,33], restrictions on in-person consultation opportunities [22,33], and personal protective equipment (PPE) shortages [31,32].…”

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

“…Due to discrimination, SGM are overrepresented in essential services and sex work, experience higher poverty rates than the general population, and are less likely to have adequate healthcare and are more vulnerable to poor mental health outcomes[ 72 , 73 ]. When SGM intersect with oppressed intersections of identity, such as race, ethnicity, socioeconomic status, or chronic illness, the compounding nature of these vulnerabilities creates even wider health disparities for communities of SGM[ 68 , 70 , 72 ].…”

“…Due to discrimination, SGM are overrepresented in essential services and sex work, experience higher poverty rates than the general population, and are less likely to have adequate healthcare and are more vulnerable to poor mental health outcomes[ 72 , 73 ]. When SGM intersect with oppressed intersections of identity, such as race, ethnicity, socioeconomic status, or chronic illness, the compounding nature of these vulnerabilities creates even wider health disparities for communities of SGM[ 68 , 70 , 72 ]. For instance, a Hong Kong community sample found stressors beyond those of the COVID-19 pandemic, including family conflict due to sexual orientation and disconnection to the SGM community, likely leading to a combined effect on the one-week prevalence of clinical depression (31.5%) and generalized anxiety disorder (27.9%)[ 73 ].…”