How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey

Gabster, Amanda; Erausquin, Jennifer Toller; Michielsen, Kristien; Mayaud, Philippe; Pascale, Juan Miguel; Pericas, Carles; Marks, Michael; Katz, Jennifer; Talavero, Gonzalo Cabezas; Argote, Marilu de; Murillo, Anet; Tucker, Joseph D.

doi:10.1136/sextrans-2021-054985

Cited by 18 publications

(12 citation statements)

References 21 publications

(21 reference statements)

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“…At the same time, data from one of the convenience samples included in this analysis suggested that the convenience sample included similar proportions of adults within subnational geographic areas compared to census data. 30 Fourth, our study had fewer studies from low-income countries which may have been due to later COVID-19 initial waves and less capacity for research alongside the pandemic. At the same time, our main findings were robust when stratifying based on country income level.…”

Section: Discussionmentioning

confidence: 96%

“…Third, our sample included more women, people with higher education, and people living in high-income countries compared with populations in respective countries. At the same time, data from 1 of the convenience samples included in this analysis suggested that the convenience sample included similar proportions of adults within subnational geographic areas compared with census data [ 34 ]. Fourth, our study had fewer studies from low-income countries, which may have been due to later COVID-19 initial waves and less capacity for research alongside the pandemic.…”

Section: Discussionmentioning

confidence: 99%

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The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

Erausquin

Tan

Uhlich

et al. 2022

Clinical Infectious Diseases

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Background There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium. Methods Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods. Results Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. Conclusions Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

Erausquin

Tan

Uhlich

et al. 2022

Clinical Infectious Diseases

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“…A major structural barrier related to ART access was influenced by cost and distance to travel to the clinic. This barrier was, without a doubt, exasperated by the COVID-19 pandemic in 2020 and 2021, where the Covidization of healthcare significantly influenced HIV care [ 35 ]. Prior to the pandemic, we found that patients were expected to retrieve ART monthly and participate in biannual CD4 count and/or HIV plasma viral load check-ups during our data collection.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to antiretroviral adherence and retention in HIV care among people living with HIV in the Comarca Ngäbe-Buglé, Panama

Gabster

Socha²,

Pascale

et al. 2022

PLoS ONE

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Introduction Panama’s HIV epidemic is far from under control. One of the populations with the fastest-growing epidemic among the Indigenous peoples of the Comarca Ngäbe-Buglé (CNB). The CNB is an administratively autonomous Indigenous region in Western Panama that is home to over 200,000 individuals of Ngäbe and Buglé ethnicities. This population is unique and, in several ways, represents the early stages of the AIDS epidemics in high-income countries. The CNB is the most impoverished region in Panama and is relatively isolated from outside influences, with limited roads, electricity, and an internet connection, including medical assistance. Around 1.5% of all rapid HIV tests are positive, compared to a national prevalence of 0.9%; in CNB, diagnosis tends to be late. In CNB, 56.3% of individuals had an initial CD4 count of <350 cells/mm3. Antiretroviral treatment (ART) dropout in this region is five times higher than the national average; there is high early mortality due to opportunistic infections. Using the Social-Ecological Theory for Health as a framework, this study aims to describe the facilitators and barriers associated with ART adherence and retention in HIV care among people living with HIV (PLHIV) in the CNB. A better understanding of factors that obstruct adherence could lead to more effective HIV care and prevention in CNB. Methods We conducted 21 semi-structured interviews with PLHIV who reside across all three regions of the CNB and have attended an antiretroviral (ART) clinic at least once. Deductive thematic analysis was used to uncover themes related ART adherence and retention in HIV care at the individual, social and structural levels. Discussion This unique, isolated population of rural Indigenous peoples has high infection rates, late diagnosis, poor ART adherence, and high AIDS-related death rates. The CNB is an important region to examen ART adherence and retention in care. We determined that psychological health, social support, and discrimination acted as individual-level facilitators and barriers to adherence and retention. Notably, structural barriers included difficult access to ART care due to travel costs, ART shortages, and uncooperative Western/Traditional medical systems. Recommended interventions used in other Low- and Middle-Income settings include increasing peer and family-level support and community knowledge and understanding of HIV infection. Additionally, our study suggests structural interventions, including decreasing the cost and distance of traveling to the ART clinic, by decentralizing services, decreasing food scarcity, and increasing collaboration between Western and Traditional providers.

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“…Service interruptions caused by COVID-19 are hurting efforts around the world to end the HIV, TB, and malaria epidemics. According to simulations done by the HIV Modelling Consortium, in collaboration with the World Health Organisation (WHO) and UNAIDS, a 50 percent disruption in HIV treatment for six months could cause 300,000 more AIDS related deaths in sub-Saharan Africa over the course of a year [14,39]. In 2019, 440, 000 people in this region died from AIDS related illnesses, so this brings us back to AIDS related mortality levels in 2011.…”

Section: Impact Of Covid-19 On Access To Hiv Servicesmentioning

confidence: 99%

A Review of the Efforts Made by Several African Countries to Reach UNAIDS Targets and the Effects of the Covid-19 on People Living with HIV

Willie¹

2022

JQHE

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Even though COVID-19 has spread faster than any other health problem in the last 100 years, it is not the first pandemic that the modern world has had to deal with. As countries try to deal with the COVID-19 pandemic, which is getting worse and worse, they are already using what they have learnt and invested in while dealing with HIV by putting systems to use, and figuring out what dynamic changes are needed to build a new way forward towards health systems that are optimally effective, accountable, inclusive, fair, and well-resourced, with services that are accessible, integrated, tailored, and people-centred. The COVID-19 pandemic has had a lot of terrible effects on people, communities, and societies all over the world. People with long-term health problems may be more likely to get COVID-19 or have complications from it. People who get the virus can get sick or die, and the physical distance needed to flatten the curve of new cases is hurting the economy. This hurts the economy in ways that affect mental health and other health problems, which particularly hurts marginalised communities. COVID-19 is affecting people with HIV (PWH) in unique ways, and it will continue to influence HIV research and treatment after the COVID-19 crisis is over. This is because HIV affects marginalised communities more than other groups.

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How did COVID-19 measures impact sexual behaviour and access to HIV/STI services in Panama? Results from a national cross-sectional online survey

Cited by 18 publications

References 21 publications

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave

Barriers and facilitators to antiretroviral adherence and retention in HIV care among people living with HIV in the Comarca Ngäbe-Buglé, Panama

A Review of the Efforts Made by Several African Countries to Reach UNAIDS Targets and the Effects of the Covid-19 on People Living with HIV

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