Diseases and Disparities: The Impact of COVID-19 Disruptions on Sexual and Reproductive Health Services Among the HIV Community in India

Abstract

People with HIV navigate numerous challenges to access healthcare in India. The lockdown in response to the COVID-19 pandemic presents further challenges in accessing sexual and reproductive health (SRH) services. This research explored the impact of the pandemic on SRH services, and the depth of disruptions faced by people living with HIV (PLHIV) in accessing treatment. Using purposive sampling with maximum variation technique, we recruited and conducted 150 telephonic in-depth interviews with PLHIV and HIV care providers (HCPs) from five states in India (Karnataka, Tamil Nadu, Maharashtra, Andhra Pradesh, and Telangana). The interviews were recorded, transcribed, coded, and analyzed using interpretative phenomenological analysis. Five main themes were identified: the effect of COVID-19 on (1) access to care, (2) quality of care, (3) social determinants of health, (4) system and community resilience, and (5) support required to address population-specific vulnerabilities. Despite the availability of free government treatment services during the pandemic, profound disruptions in the SRH services, particularly antiretroviral therapy and HIV care, were reported by PLHIV and HCPs. This qualitative study revealed how existing inequities in HIV treatment and care are exacerbated by the pandemic. These findings highlight that the pandemic response should be community-centered to prevent extreme disruptions in healthcare which will have a disastrous effect on the lives of PLHIV.

Syndemic effect of COVID-19 outbreak on HIV care delivery around the globe: A systematic review using narrative synthesis

“…Despite of considerable heterogeneity of settings and services, 14 out of the 31 included studies (45%) reported decreased testing or reduced lab monitoring during the COVID-19 pandemic resulting in delay in diagnosis. 15 , 22 , 25 , 26 , 28 , 29 , 33 , 35 …”

Análisis de la hospitalización y la mortalidad por VIH en Brasil, 2016-2020

“…A despeito das políticas de prevenção e manejo do agravo implementadas ao longo das últimas décadas, a crise social e econômica pela qual o país passa desde 2014, acrescida ao advento da pandemia da COVID-19desde 2020, faz com que os serviços de saúde sofram uma sobrecarga e sérias instabilidades, obstaculizando o acesso e a continuidade do cuidado (15) . dificuldade no acesso e vinculação (16) , redução dos recursos humanos e materiais (17) , sobrecarga dos profissionais que atuam nos serviços assistenciais e de vigilância em saúde, entre outros (18) .…”

Fostering Resilient Health Systems in India: Providing Care for PLHIV Under the Shadow of COVID-19

“…Therefore in-depth interviews using a semi-structured guide were used as the primary method of investigation in our study. The provider interviews were conducted as part of a larger study exploring the disruptions experienced by PLHIV while accessing sexual reproductive health rights and services during the COVID-19 pandemic and subsequent lockdown in India which occurred from March to May 2020 ( 12 ).…”