Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
Department of Health Behavior, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC.
J Acquir Immune Defic Syndr. 2022 Apr 15;89(5):481-488. doi: 10.1097/QAI.0000000000002901.
The COVID-19 pandemic and its associated socioeconomic disruptions have disproportionally affected marginalized populations, including people living with HIV. Little is known about how the pandemic has affected populations experiencing multiple forms of stigma, discrimination, and violence, such as female sex workers (FSW) living with HIV.
We conducted a cross-sectional survey between August and December 2020 among 187 FSW living with HIV in the Dominican Republic to examine the impact of COVID-19. Using multivariable logistic regression, we examined associations between COVID-19-related financial concerns, mental health, substance use, and partner abuse on engagement in HIV care and antiretroviral therapy adherence. We conducted mediation analysis to assess whether mental health challenges mediated the impact of partner abuse or substance use on HIV outcomes.
Most participants reported no income (72%) or a substantial decline in income (25%) since the COVID-19 pandemic. Approximately one-third of the participants (34%) reported COVID-19 had an impact on their HIV care and treatment. Greater COVID-19 financial concerns (adjusted odds ratio [aOR] = 1.14, 95% CI: 1.02 to 1.27), mental health challenges (aOR = 1.38, 95% CI: 1.06 to 1.79), and partner emotional abuse (aOR = 2.62, 95% CI: 1.01 to 6.79) were associated with higher odds of negatively affected HIV care, respectively. The relationship between increased emotional partner abuse and negatively affected HIV care was mediated by greater COVID-19-related mental health challenges.
FSW living with HIV in the Dominican Republic have been significantly affected by the COVID-19 pandemic. Targeted interventions that address structural (financial security and partner abuse) and psychosocial (mental health) factors are needed to sustain HIV outcomes and well-being.
COVID-19 大流行及其相关的社会经济混乱对边缘化人群产生了不成比例的影响，包括艾滋病毒感染者。对于大流行如何影响那些经历多种形式的耻辱、歧视和暴力的人群，例如感染艾滋病毒的性工作者（FSW），知之甚少。
我们在 2020 年 8 月至 12 月期间在多米尼加共和国对 187 名感染艾滋病毒的性工作者进行了横断面调查，以研究 COVID-19 的影响。使用多变量逻辑回归，我们研究了与 COVID-19 相关的财务问题、心理健康、物质使用和伴侣虐待与 HIV 护理和抗逆转录病毒治疗依从性之间的关联。我们进行了中介分析，以评估心理健康问题是否介导了伴侣虐待或物质使用对 HIV 结果的影响。
大多数参与者报告自 COVID-19 大流行以来没有收入（72%）或收入大幅下降（25%）。大约三分之一的参与者（34%）报告 COVID-19 对他们的 HIV 护理和治疗产生了影响。更大的 COVID-19 财务问题（调整后的优势比 [aOR] = 1.14，95%置信区间：1.02 至 1.27）、心理健康问题（aOR = 1.38，95%置信区间：1.06 至 1.79）和伴侣情感虐待（aOR = 2.62，95%置信区间：1.01 至 6.79）分别与 HIV 护理受到负面影响的几率增加相关。情绪上的伴侣虐待增加与 HIV 护理受到负面影响之间的关系是通过与 COVID-19 相关的更大的心理健康问题来介导的。
多米尼加共和国感染艾滋病毒的性工作者受到 COVID-19 大流行的严重影响。需要针对结构性（经济安全和伴侣虐待）和心理社会（心理健康）因素的干预措施，以维持 HIV 结果和幸福感。
