The Synergistic Relationship Between Climate Change and the HIV/AIDS Epidemic: A Conceptual Framework

Abstract

Climate change and HIV/AIDS represent two of the greatest threats to human health in the 21st century. However, limitations in understanding the complex relationship between these syndemics continue to constrain advancements in the prevention and management of HIV/AIDS in the context of a rapidly changing climate. Here, we present a conceptual framework that identifies four pathways linking climate change with HIV/AIDS transmission and health outcomes: increased food insecurity, increased prevalence of other infectious diseases, increased human migration, and erosion of public health infrastructure. This framework is based on an in-depth literature review in PubMed and Google Scholar from June 6 to June 27, 2019. The pathways linking climate change with HIV transmission and health outcomes are complex with multiple interacting factors. Food insecurity emerged as a particularly important mediator by driving sexual risk-taking behaviours and migration, as well as by increasing susceptibility to infections that are common among people living with HIV (PLWHIV). Future interventions should focus on decreasing carbon dioxide emissions globally and increasing education and investment in adaptation strategies, particularly in those areas of sub-Saharan Africa and southeast Asia heavily impacted by both HIV and climate change.Environmentally sustainable interventions such as urban gardening and investing in sustainable agriculture technologies also have significant health co-benefits that may help PLWHIV adapt to the environmental consequences of climate change.

Exploring linkages between climate change and sexual health: a scoping review protocol

“…9 Water insecurity and linkages with HIV acquisition and other sexual health outcomes are understudied, 27 as is the nexus of climate change, food and water insecurity, and sexual health outcomes. 5 Both HIV and other sexually transmitted infections (STIs), as well as climate change and extreme weather events, disproportionately affect marginalised persons, including adolescent girls and young women, migrants, sexually and gender diverse persons, and persons living in poverty. 6 28-33 For instance, Burke et al 9 found that in a study of 2000 people across 19 sub-Saharan African countries, a rainfall shock (annual rain less than the 15th percentile of the local area's historical rainfall distribution) was associated with an 11% increase in HIV prevalence among rural populations who had a high HIV prevalence at baseline.…”

“… 4 Emerging literature signals the importance of attending to the linkages between climate change and sexual health outcomes. 5 6 HIV is an illustrative example, with prevalence highest in sub-Saharan Africa, a region that is highly impacted by climate change and associated extreme weather events such as drought, 1 7–9 as well as Caribbean contexts such as Haiti. 10–12 …”

“… 9 Water insecurity and linkages with HIV acquisition and other sexual health outcomes are understudied, 27 as is the nexus of climate change, food and water insecurity, and sexual health outcomes. 5 …”

“…Lieber et al 5 conceptualised four paths from climate change to HIV and AIDS, including increased migration, infectious diseases, infrastructure erosion and food insecurity. For instance, extreme weather events such as drought and flooding have been linked with elevated sexual risk practices including condomless and transactional sex 8 46 and early sexual debut.…”

“… 51 52 Infectious diseases, such as malaria, dengue, chikungunya and Lyme disease, may increase in prevalence and distribution due to changes in season duration, rainfall and rising temperatures. 5 53–55 For people living with HIV, who may be immunocompromised, such infectious diseases could become more harmful and contribute to poorer HIV outcomes. 56–58 Infrastructure erosion can also compromise healthcare access.…”