Challenges to HIV Care and Psychological Health During the COVID-19 Pandemic Among People Living with HIV in China
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NOTES FROM THE FIELD
Challenges to HIV Care and Psychological Health During the COVID‑19 Pandemic Among People Living with HIV in China Shufang Sun1,2 · Jianhua Hou3 · Yaokai Chen4 · Yanqiu Lu4 · Larry Brown1,2 · Don Operario5
© Springer Science+Business Media, LLC, part of Springer Nature 2020
The pandemic of coronavirus disease 2019 (COVID-19) has led to unprecedented disruption in people’s lives and healthcare across the globe. In China, where the COVID-19 outbreak was first identified, people living with HIV (PLWH) have experienced critical challenges and barriers to optimal care outcomes. It may be important to note that prior to the COVID-19 outbreak, PLWH in China were already affected by high levels of HIV stigma [1], psychological distress (depression, anxiety) [2–4], and suboptimal adherence [5, 6]. For instance, in two most recent large sample survey studies (conducted in 2013–2015) among PLWH in China, 32.9–38.4% PLWH reported depressive symptoms and 27.4% experienced anxiety symptoms [7, 8]. Among patients who regularly attend clinical care, a meta-analysis found 77.6% PLWH had adequate adherence [9], though this is likely an overestimate of actual adherence in the population due to sample selection and report bias. In a recent report of a northeastern clinic in China that synthesized patients’ data in the past ten years, only 15% of PLWH achieved viral suppression [6]. The COVID-19 outbreak further intensifies existing challenges while highlighting structural barriers. This note is informed by authors’ observations and clinical experience in HIV care in China as well as preliminary findings from a recent survey we conducted among PLWH in China (in February and March 2020, full report in writing). * Shufang Sun [email protected] 1
Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
2
Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
3
YouAn Hospital, Center for Infectious Diseases, Beijing, China
4
Chongqing Public Health Medical Center, Infectious Diseases Clinics, Chongqing, China
5
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
Herein, we describe two significant challenges during the COVID-19 outbreak experienced by PLWH in the China context, including (1) linkage to care and access to medication, and (2) psychosocial consequences including stigma and mental health issues.
Linkage to Care and Access to Medication Due to the city-level centralized management of infectious diseases in China (e.g., PLWH are often assigned to certain hospitals designated for HIV care), strict quarantine enforcement and transportation lockdown in many regions across China beginning in late January 2020 may have caused massive disruption in HIV care. Due to the growing number of COVID-19 cases and the shortage of medical resources, departments of infectious diseases in many hospitals in China were designated for COVID-19 and suspended on taking new patients with H
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