Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 pandemic

Background Central to measuring the impact of the COVID-19 pandemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. In this paper, we use a comprehensive list of HIV prevention services in four corridors of the US heavily impacted by HIV, developed as part of a large RCT, to illustrate the potential impact of service closure on LGBTQ+ youth. Methods We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing; PrEP/PEP; HIV treatment and care; and other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV US Census regions: Pacific (San Francisco, CA to San Diego, CA); South-Atlantic (Washington, DC to Atlanta, GA); East-North-Central (Chicago, IL to Detroit, MI); and East-South-Central (Memphis, TN to New Orleans, LA). Results There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0–14.33 per 10,000 youth aged 13–24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p = 0.09), suggesting only a small, non-statistically significant linear relationship between a county’s available LGBTQ+ youth-friendly HIV service providers and their HIV burden. Conclusions As the COVID-19 pandemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and other support services to LGBTQ+ youth.

Widespread closure of HIV prevention and care services places youth at higher risk during the COVID-19 epidemic (Preprint)

BACKGROUND Central to measuring the impact of the COVID-19 epidemic on HIV is understanding the role of loss of access to essential HIV prevention and care services created by clinic and community-based organization closures. OBJECTIVE In this paper, we use data from a large, randomized controlled trial for adolescent GBMSM aged 13-18 to map HIV prevention services in four corridors of the US heavily impacted by HIV METHODS We identified and mapped LGBTQ+ friendly services offering at least one of the following HIV-related services: HIV testing; STI testing, PrEP/PEP; HIV treatment and care; other HIV-related services in 109 counties across four major interstate corridors heavily affected by HIV (US Census regions: Pacific (San Francisco, CA to San Diego, CA; 14 counties); South-Atlantic (Washington, DC to Atlanta, GA; 57 counties). RESULTS There were a total of 831 LGBTQ+ youth-friendly HIV service providers across the 109 counties. There was a range of LGBTQ+ youth-friendly HIV-service provider availability across counties (range: 0-14.33 per 10,000 youth aged 13-24 (IQR: 2.13), median: 1.09); 9 (8.26%) analyzed counties did not have any LGBTQ+ youth-friendly HIV service providers. The Pearson correlation coefficient for the correlation between county HIV prevalence and LGBTQ+ youth-friendly HIV service provider density was 0.16 (p=0.09), suggesting only a small, non-statistically significant linear relationship between a county’s available LGBTQ+ youth-friendly HIV service providers and their HIV burden. CONCLUSIONS As the COVID-19 epidemic continues, we must find novel, affordable ways to continue to provide sexual health, mental health and support services to LGBTQ+ youth. CLINICALTRIAL NA

Learning, Doing and Teaching Together: Reflecting on our Arts Based Approach to Research, Education and Activism with and for Women Living with HIV

Body Mapping has been used for thousands of years by people who want to achieve a better understanding of themselves, their bodies and the world they live in. Artist Jane Solomon and psychologist Jonathan Morgan transformed Body Mapping for the “Long Life Project”, during the Médecins Sans Frontières (MSF) roll-out of antiretrovirals in Khayelitsha township, South Africa in 2001. Body mapping enables participants to tell their stories in the face of intense HIV/AIDS stigma. We adapted Body Mapping for the Women, Art and Criminalizaton of HIV Non-Disclosure (WATCH) study, a community arts based research (CBR) approach to better understand the impact that Canadian laws criminalizing HIV non-disclosure have on women living with HIV. Our national team includes women living with HIV, service providers, and researchers. This reflection illustrates our collective and iterative process of learning, teaching and doing body mapping workshops with women living with HIV in Canada. We share our experiences of coming to Body Mapping as an arts-based approach to CBR, how our roles as researchers stretched to include community-based education, advocacy, and group facilitation, and how we embodied the artist-researcher identity as we disseminate our research in ways that actively engage the general public on laws criminalizing HIV nondisclosure laws vis-à-vis Body Mapping galleries.

A qualitative description of service providers’ experiences of ethical issues in HIV care

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.