Testing in two pandemics: community perspectives on HIV testing during COVID-19 in NYC.

The COVID-19 pandemic significantly disrupted healthcare systems, including access to HIV testing services. In 2021, community organizations participating in a NYC HIV testing initiative reported a substantial decline in HIV testing between 2019 and 2020. To examine how providers adapted during this period, Health Department staff conducted stakeholder interviews and focus groups to identify the underlying causes of this testing decline. Providers described both enabling and obstructive factors in delivering services during the pandemic. Telehealth, cross-training, service bundling and flexible engagement strategies helped sustain HIV testing programs. However, systemic challenges, including rigid safety protocols, staff furloughs and reassignments, top-down decision-making and resource constraints, hindered service provision. Community mistrust and barriers to access further exacerbated these issues, particularly among marginalized populations. Despite these challenges, some providers leveraged new partnerships and flexible funding to innovate and maintain services. Findings highlight the vulnerability of essential public health services during crises and underscore the importance of community-informed, adaptable and equitable approaches. Sustaining HIV testing access requires trust-building, inclusive planning and workforce policies that prioritize staff well-being and reduce burnout. The experiences of NYC-based providers demonstrate the value of culturally grounded, community-driven strategies in navigating and responding to public health emergencies.