Social and economic marginalization in the context of a public health emergency: HIV care disruptions experienced by black sexual minority men (BSMM).

BACKGROUND

HIV in the United States disproportionately affects Black sexual minority men (BSMM), including disparities in HIV care engagement and outcomes. During public health emergencies, such as the COVID-19 pandemic, marginalized populations such as BSMM may face additional barriers to HIV care engagement.

METHODS

We examined associations between HIV care engagement (current antiretroviral therapy use, healthcare visits for HIV, viral load testing, viral load suppression) and experiencing COVID-19-related disruptions to HIV care in a sample of BSMM living with HIV in 2022 (n = 172). We then examined correlates of having experienced a COVID-19-related disruption to HIV care, spanning multiple variable groups: socioeconomic, substance use, mental health, social and structural, and strength and resilience.

RESULTS

Social and structural variables, including transportation, intimate partner violence victimization, and experiences of discrimination showed the strongest associations with experiencing a COVID-19-related disruption to HIV care, followed closely by internalized HIV stigma, and strengths and resilience (treatment adherence self-efficacy, HIV social support). Socioeconomic variables and substance use variables, overall, had less robust associations with COVID-19-related care disruptions than these other variable groups.

CONCLUSION

Lived experiences and resources that reflect social marginalization are associated with disruptions to HIV care during a period of intense social and economic upheaval. These findings point to important areas for future research, as well as considerations for building more robust, adaptable, accessible, and holistic HIV care systems that promote greater engagement and improved outcomes both during times of relative stability as well as during periods of significant upheaval.