HEALTH TIPS: The Impact of COVID-19 on HIV/AIDS – Part 2

Dr. Tariq Jagnarine
Programme Manager
National AIDS Programme Secretariat

PSYCHOLOGICAL IMPACT OF COVID-19 ON HIV TREATMENT
Given the unprecedented nature of the COVID-19 outbreak, an increase in anxiety has been prevalent worldwide. Furthermore, the CDC has noted that individuals with chronic health conditions, such as HIV, may develop a stronger stress response than the rest of the population. This strong stress response is due to an increased risk of contracting COVID-19 as a result of a compromised immune system. The compounded stigma associated with HIV-positive status and SARS-CoV-2 may lead to an array of mental health issues comprising psychological disorders such as depression, sleep disorder, substance abuse, anxiety, schizophrenia, and personality disorders, which may trigger somatoform disorders which may lead to failure to seek care. Alcohol can lead to impaired judgment, such as engaging in risky sexual behaviours. Risky behaviours paired with an increased viral load may result in people living with HIV/AIDS (PLHIV) passing on the virus through unprotected sex. Although people are practising physical distancing, individuals who are quarantined with a romantic partner may be engaging in sexual activities more often, which may be problematic for PLHIV whose viral loads are suppressed and who do not engage in protective behaviours e.g., condom use, or whose sexual partners are not using pre-exposure prophylaxis (PrEP). It is important to note, however, that the mental health effects of COVID-19 may not be apparent for every individual immediately following the pandemic. For this reason, it is also possible that in the coming years, there will be an even greater need for health and mental health care providers to support the economic and psychological impacts of COVID-19.

SOCIAL IMPACT OF COVID-19 ON HIV TREATMENT
Although physical distancing guidelines serve to benefit one’s physical health, these guidelines may be detrimental to one’s social and emotional health. PLHIV may be even more reluctant to engage in physical interaction with others. This may be especially true for newly diagnosed PLHIV who do not have a full understanding of the ways in which HIV is transmitted.
Because many PLHIV are part of marginalised communities, other social impacts also exist, such as:
• Increased risk exists for PLHIV whose domestic arrangements may be risky or violent-Prone to gender-based violence
• Reduced access to drugs normally bought on the street
• Reduced access to needle exchange schemes, which are important for secondary HIV prevention
• Increased risk of underemployment
• Increased conditions for the homeless, or having unstable housing
• Reduced access to food banks
• Reduced access to medical or pharmacy services as a result of reduced public transport services.
COVID-19 has brought the issue of low health literacy to the forefront, especially during the efforts to ensure that the information can be understood by all, and spread of the disease can be stopped.

RECOMMENDATIONS
HIV services must continue to be made available for people living with, and at risk of contracting, HIV. This includes ensuring the availability of condoms, lubricants, ARVs, sterile needles and syringes, harm reduction, pre-exposure prophylaxis (PrEP) and HIV testing.
To prevent people from running out of medicines, and to reduce the need to access the health system, countries should move to the full implementation of multi-month dispensing of three months or more of HIV treatment, telemedicine, enhanced virtual support groups, food hamper delivery, increase mobile testing, etc. There must be access to COVID-19 services for vulnerable people, including a targeted approach to reach those most left behind, and removing financial barriers, such as user fees or subsidies.

ADVICE FOR PEOPLE LIVING WITH HIV
• People with a CD4 count of over 200, who are taking HIV treatment and have an undetectable viral load, are considered at no greater risk than the general population. They should follow general advice to observe the curfew hours and maintain social distancing.
• People with a CD4 count below 200, or who are not taking HIV treatment, or who have a detectable viral load, may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
• People with a very low CD4 count, below 50, or who have had an opportunistic illness in the last six months, should follow the Ministry of Health’s guidelines: wear a mask, wash hands regularly, and avoid crowded spaces with social distancing practices.
COVID-19 is a serious disease, and all people living with HIV should take all recommended preventive measures to minimise exposure to, and prevent infection by, the virus that causes COVID-19. As in the general population, older people living with HIV, or people living with HIV with heart or lung problems, may be at a higher risk of becoming infected with the virus and of suffering more serious symptoms. All people living with HIV should reach out to their health-care providers to ensure that they have adequate stocks of essential medicines. Until more is known, people living with HIV – especially those with advanced or poorly controlled HIV disease – should be cautious and pay attention to the prevention measures and recommendations by the Ministry of Health.