New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Abstract

Introduction The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative’s implementation. SARS‐COV‐2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID‐19 and HIV, and assesses challenges to EHE in a post‐COVID‐19 universe. Discussion One of the many common threads between HIV and COVID‐19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio‐economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re‐emerged in epidemiological studies of disproportionate COVID‐19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID‐19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID‐19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID‐19 (i.e. diverting HIV resources to address COVID‐19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID‐19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long‐term viability of EHE). Conclusions Racism and discrimination place communities of colour at greater risk for COVID‐19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.

Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review

“…Many inequalities related to poor health outcomes, stigma and discrimination have been magnified through COVID-19 and highlighted in editorials, particularly those penned in the US [2,[56][57][58][59]. Authors drew attention to African American PLHIV, who have been disproportionately affected by COVID-19 and are more likely to develop health complications, experience homelessness, unemployment, poverty and/or disadvantage associated with the costs of health care [2,17,42,[56][57][58][59]. The challenges faced by women living with HIV (WLHIV) were rarely explored within the primary research literature; however Closson et al's [60] editorial sought to draw attention to WLHIV's increased risk of domestic violence as a result of stay-at-home measures.…”

COVID-19 and HIV testing: different viruses but similar prejudices and psychosocial impacts

“…14,[20][21][22] In support of our findings, parallels between HIV and COVID-19 have also been mentioned elsewhere. 23 It could easily be that this kind of COVID-19 diagnosis impact is currently underestimated.…”

What does a pandemic proof health system look like?

“…Stress and mental health issues related to lockdowns affect everyone but tend to affect the weaker segments of the society more severely. The poor often have limited space to accomodate homeoffice and home schooling, not to mention the additional weight of economic effects and job insecurities [23,24] . Long COVID Some people that recovered from COVID-19 are still experiencing its effects-long covid with some now in need of dialysis and others developing diabetes.…”