COVID/HIV Co-Infection: A Syndemic Perspective on What to Ask and How to Answer

Abstract

The present commentary explored the intersecting nature of the COVID-19 and HIV pandemics to identify a shared research agenda using a syndemic approach. The research agenda posits the following questions. Questions around HIV infection, transmission, and diagnosis include: (i) molecular, genetic, clinical, and environmental assessments of COVID-19 in people living with HIV, (ii) alternative options for facility-based HIV testing services such as self- and home-based HIV testing, and (iii) COVID-19 related sexual violence and mental health on HIV transmission and early diagnosis. These and related questions could be assessed using Biopsychosocial and socio-ecological models. Questions around HIV treatment include: (i) the effect of COVID-19 on HIV treatment services, (ii) alternative options for facility-based treatment provision such as community-based antiretroviral therapy groups, and (iii) equitable distribution of treatment and vaccines for COVID-19, if successful. Bickman's logic model and the social determinants of health framework could guide these issues. The impact of stigma, the role of leveraging lessons on sustained intra-behavioral change, the role of medical mistrust and conspiracy beliefs, and the role of digital health on integrated management of HIV care and spectrum of care of COVID-19 need assessment using several frameworks including Goffman's stigma framework, Luhmann's Trust theory, and Gidden's theory of structuration. In conclusion, the potential research agenda of this commentary encompasses a variety of research fields and disciplinary areas—clinicians, laboratory scientists, public health practitioners, health economists, and psychologists—, and suggests several theoretical frameworks to guide examination of complex issues comprehensively.

Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research

“…COVID-19 therefore amplifies existing social and health disparities in populations affected by HIV, including those attributed to race, gender, and geographic region [32]. Recognizing that HIV occurs in conjunction with multiple co-occurring epidemics informs clinical and social services as well as creates a framework for research [33]. Our review therefore conceptualizes COVID-19 from the perspective of HIV syndemics by recognizing the synergism of social and behavioral determinants of health that complicate both HIV infection and COVID-19.…”

Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review

“…The effects of COVID-19 have penetrated HIV care and have affected MLWH in diverse ways. [125][126][127][128] Economic disruptions, social and physical isolation, vaccine and care access hesitancy, overburdened health systems, shifts in clinical and funding priorities from HIV care to COVID-19, among many other challenges, have fed into the impact the pandemic has had (and continues to have) on MLWH. Future studies should thoroughly explore the challenges faced by MLWH during the COVID-19 pandemic.…”

Response of Care Services for Patients with HIV/AIDS during a Pandemic: Perspectives of Health Staff in Bolivia

“…The COVID-19 pandemic has caused unprecedented global health, economic, and social impacts [ 22 ]. The present qualitative study was carried out in Cochabamba-Bolivia, including the points of view of the key health staff.…”