COVID-19 related stressors, sex behaviors, and HIV status neutral care among Black men who have sex with men and transgender women in Chicago, USA

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J Acquir Immune Defic Syndr. 2021 Jul 22. doi: 10.1097/QAI.0000000000002770. Online ahead of print.


BACKGROUND: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW.

METHODS: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multi-level COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access.

RESULTS: Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 (aPR=2.1; CI 1.3-3.5) and being in close proximity with someone diagnosed with COVID-19 (aPR=1.7; CI 1.1-2.8]) were associated with current PrEP use. Intimate partner violence (aPR=2.7; CI 1.0-7.2) and losing health insurance (aPR=3.5; CI 1.1-10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR=3.2; CI 1.0-10.1) and ART (aPR=6.2; CI 1.6 -24.3).

CONCLUSION: Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (e.g., promoting telehealth, decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.

PMID:34310447 | DOI:10.1097/QAI.0000000000002770