The healthcare system is not prepared to tackle COVID-19 and protect vulnerable populations
As public health scholars and practitioners grapple with the rapidly changing landscape and current events related to the COVID-19 pandemic, I cannot help but think about those who are also actively managing other stigmatized and chronic conditions, namely HIV/AIDS. Many older people living with HIV/AIDS have lived through the tumultuous history of the epidemic here in the United States—they’ve lost numerous friends, lovers, and community members. Their individual and collective resilience have gotten them to this point in time, but we cannot ignore the potential repercussions of ignoring their needs even in this time of social distancing and inevitable self-isolation.
The U.S. healthcare system is clearly not prepared to tackle the current COVID-19 pandemic. With hospitals running low on critically important supplies like masks and ventilators, there is reason to be uneasy, but our concern shouldn’t stop there. Currently, very little is known about the impact COVID-19 can have on people living with HIV/AIDS. An educated assumption is those who are adherent to antiretroviral treatment (ART) and are virally suppressed will not face greater health implications from COVID-19 compared to the general population. However, if these individuals are not virally suppressed and are thus more immunocompromised, the impact could be more drastic.
This is especially concerning in China where those living with HIV/AIDS are struggling to find HIV medication during this outbreak due to the stigma and discrimination facing HIV/AIDS. Moreover, in the last few years, there has been a push to ‘End the HIV Epidemic’ by 2030. The main way for this to happen is to curtail the spread through treatment as prevention, meaning those living with HIV/AIDS maintain viral suppression by remaining adherent to ART and those at risk for HIV/AIDS. If these individuals cannot access their medication, they cannot be virally suppressed. If they cannot be virally suppressed, they (1) are more likely to transmit HIV/AIDS through sexual behaviors or sharing needles/syringes and (2) may face substantial health outcomes or even death if they contract COVID-19.
Concerning reports from my own personal network indicate that some physicians in New York City are canceling or postponing appointments for managing HIV-related care. Gay Men’s Health Crisis is closing its building operations. Although arrangements have been made to provide some services remotely through phone and video conferencing, there is a strong likelihood that many of their clients may not be able to access these services without adequate internet access. While these may be necessary steps to take in the interim, there will inevitably be long-term implications on the health and well-being of those living with HIV/AIDS.
Moving forward, there are critical questions to take into consideration:
- How do we ensure those living with HIV/AIDS have access to necessary health services including regularly scheduled doctor’s appointments and can access their medications and other treatments?
- How do we balance the need for social distancing with the negative physical and mental health impacts that social isolation can have on people living with HIV/AIDS, especially those who are older?
- How do we take the lessons learned from this crisis and apply it to future pandemics?
These are complex questions that do not have simple answers yet, but here are some necessary steps we can and should take now and in the future:
Check-in on your loved ones, friends, family, and community members living with HIV/AIDS. Make sure they are taking care of themselves—this includes taking their medications and have access to nutritious food.
Continue to reduce the stigma of infectious/chronic diseases like COVID-19 and HIV/AIDS—don’t be xenophobic, racist, or homophobic.
The United Kingdom’s National Health Service has set-up a special helpline for PLWHA worried about COVID-19 and something similar needs to be enacted in the US.
When more readily available, people at heightened risk of COVID-19 outcomes, such as PLWHA should have access to testing.
Americans deserve a more stabilized healthcare system that can handle multiple public health challenges at once. The COVID-19 pandemic has demonstrated just how fragile and inequitable our current system is.
Collectively and individually, we will bounce back from this pandemic—we may not know how or when, but it will happen. If history has provided us with indication on how it can be done, we can turn to people living with HIV/AIDS and LGBTQ+ communities to show us the way. In that light, it is vital that we do not leave anyone behind—they need our support, engagement, and advocacy now more than ever.
Kristen D. Krause, PhD, MPH is a researcher and center manager at the Center for Health, Identity Behavior & Prevention Studies (CHIBPS) at the Rutgers School of Public Health
Follow Kristen D. Krause, PhD, MPH @kristendkrause