The Centers for Disease Control and Prevention (CDC) have highlighted that people living with HIV (PLWH) may be at heightened risk for severe physical health illness from COVID-19. A report in AIDS and Behavior highlights that HIV and medical comorbidities may function synergistically to fuel COVID-19 disease in a syndemic. The drivers of which are economic inequalities, psychosocial conditions, and healthcare access.
The known risk factors such as diabetes, hypertension, and chronic lung disease, for COVID-19 complications, are common in PLWH. Other factors such as high rates of social burdens of violence, stigma, discrimination, isolation, and hate all potentially interfere with care.
PLWH have an increased likelihood of mental health burden, drug use, and other sexually transmitted diseases, which are all catalysed by elevated psychosocial burdens of marginalised populations including sexual and gender minorities, racial and ethnic minorities, and the poor. These burdens, along with medical mistrust, loneliness, stigma, and hopelessness are implicated in propagating disease.
Recent COVID-19 data shows the vulnerability of the 18-49-year old population, which may pose a heightened risk to PLWH under the age of 50 as they are less likely to be diagnosed, less likely to access care, and therefore to be immunocompromised.
Economic disparities associated with worse and underlying health conditions likely explain higher death rates due to COVID-19 in communities of colour. The COVID-19 pandemic has created more heightened food insecure states for all populations, including PLWH, therefore exacerbating these burdens. Addressing the vulnerability of these populations effectively, ART implementation, and consistent adherence have improved the long-term health outcomes among PLWH, but they are vulnerable if interruptions in treatment occur due to the COVID-19 pandemic.
Healthcare providers attend to the biological, behavioural, and occasionally psychological drivers of health. Public health focuses on the structural drivers of disease and disease surveillance. Neither fully brings together the concept of a syndemic.