The COVID-19 pandemic has increased levels of stress, fear and social disconnection among people living with HIV, as well as among their health care providers, presenters said at a Wednesday APHA Annual Meeting session on “HIV and COVID-19.”

Providers, staff and administrators at Ryan White HIV/AIDS clinics in the Southeast U.S. described in interviews that their patients were feeling fear, vulnerability and social isolation, particularly among those who rely on the clinic for emotional support. Furthermore, people with HIV were experiencing retraumatization, said psychologist Jessica Sales, a researcher at the Emory Center for AIDS Research at Emory University Rollins School of Public Health in Atlanta. 

Sales said the interviewees noted “how the uncertainty and lack of information about COVID-19 triggered feelings of trauma similar to when their patients were first diagnosed with HIV (and how) COVID-19 is retraumatizing, particularly among older people living with HIV because of similarities they observed between the start of the COVID epidemic (and) the beginning of the HIV epidemic in the U.S.”

Survey participants described trauma-informed strategies their clinics employed to address fear and social isolation. Those included expanding or adding online services, connecting clients to external services such as food delivery or food pantry pickup sites, helping with phone bills so they could participate in telehealth visits, and implementing online social support groups. 

The interviews also focused on how the providers were feeling. A major theme was fear. Providers worried about getting COVID-19 and about their patients’ well-being, their own job stability and the ongoing uncertainty related to the pandemic.

Everyone said their job-related stress had increased, whether they were working at the clinic or at home. Many said they were feeling burnt out due to the pandemic. 

“They often felt like they needed a break and couldn’t take one because there was no one to replace them,” Sales told attendees. “They had to do more with less, and this was added on top of the emotional stress.” 

They also felt disconnected even after they returned to the clinic because physical distancing protocols limited interactions with colleagues. 

Another presentation showed preliminary data examining mental health and economic impacts of the pandemic among people living with HIV. Researchers conducted phone interviews of 100 people living with HIV in Miami-Dade County, Florida, and divided the responses into those 50 and older and those younger than 50.

They found that those older than 50 were less likely to experience disruption during the pandemic. They were 64% less likely to have lost a job, 76% less likely to have lost access to their usual medication, and 77% less likely to have trouble affording medical care. 

Older age may be a protective factor against such problems because older adults are more likely to be retired and enrolled in the Ryan White program, said presenter Paola Martinez, a second-year MD/MPH student at the University of Miami Miller School of Medicine. She noted that the Ryan White program, which provides assistance to low-income people with HIV, offers access to medical care, medications, mental health services, nutrition programs and support services that can help with transportation, food access and housing. 

The data also showed that Black women younger than 50 living with HIV experienced higher rates of depression than older Black women, while older Black men were more likely to have depression than their younger counterparts. Among white men, depression rates were the same for both age groups. Older white women with HIV reported higher levels of depression than younger white women. 

There was a correlation between perceived stress and depression and perceived stress and loneliness. 

“We think that this can be an important area for intervention, especially as we continue through the pandemic,” Martinez  said. “If we’re somehow able to target an individual’s perceived stress, then we could potentially see a decrease within the loneliness levels as well as the depression levels.”