HIV Testing & Treatment Access during COVID-19

The entire world is learning how to navigate daily life in response to the COVID-19 pandemic. Healthcare systems and resources are strained. Many people are facing financial hardships and fear. This is especially true for those living with a chronic condition like HIV. The COVID-19 pandemic has impacted so many aspects of health including HIV care.

HIV treatment adherence and access

HIV treatment has greatly improved over the last several years. With regular, long-term treatment, a person’s HIV viral load can be so low that it is considered undetectable. When a person’s viral load is undetectable, they have virtually no risk of transmitting the virus to someone else. This idea is called U=U (undetectable = untransmittable).

Achieving an undectable viral load

In order to get to an undetectable viral load, a person must take their medication as prescribed every day. This is called being adherent to treatment. Regularly taking HIV drugs also prevents the virus from mutating and becoming resistant to treatment.

Everyday barriers to HIV treatment

Although treatment can be so beneficial, many with HIV have issues accessing care. Some of the barriers to care include stigma, financial strain, transportation issues, lack of health insurance, and more. Fortunately, there are programs that exist to help alleviate some of these issues, like the Ryan White HIV/AIDS Program.

How the COVID-19 pandemic has impacted HIV care and prevention

Unfortunately, during a time of crisis like the COVID-19 pandemic, these barriers to care and treatment can be even harder to overcome. Even those who could normally receive care, testing, and prevention treatment like PrEP, may find they are unable to do so.

Healthcare systems are strained

Many clinics and healthcare systems are strained by COVID-19. Hospital beds may be filled and doctors may be reassigned to different areas as needed. Regular, outpatient care has taken a back seat. This includes wellness visits, minor sick visits, and some chronic condition follow-up appointments, like HIV.^1,2

Challenges with routine visits

It may be harder to get an appointment with your regular doctor, or you may be rescheduled to a later date. Even if your doctor is open, physical distancing and quarantine may prevent you from being able to go in, or from interacting with the people you normally rely on for transportation or support. This may make it challenging to have regular blood work done, find testing if you are at risk for HIV, visit your pharmacy, and make treatment plan changes.

Also, many people rely on the healthcare system for access to PrEP, and need regular testing and monitoring to ensure they are still HIV-negative if they are using this option. This may be difficult within the pandemic era.

HIV prevention and harm reduction services

There are also many organizations dedicated to providing testing, education, PrEP, harm reduction services (like clean needle distribution), and more that cannot operate due to rules on group gatherings. These (often free) services are essential for many and may lead to severe impacts on the HIV care landscape. Additionally, many jobs have been impacted by COVID-19. People who lose their job or have hours cut may also lose health insurance, preventing them from getting the care they need.^2,3

How are organizations meeting HIV-related needs?

Although some of these issues are unavoidable during a global crisis, there are some steps that many healthcare systems and HIV-related organizations are taking to help maintain treatment adherence and access during this time.

Telemedicine visits

Many clinics and hospital systems are offering telemedicine visits, where you can still “see” your doctor over video message or by phone. This may help with regular check-ups or prescription refills.

Extended prescription refills

Some doctors and pharmacies are offering extensions on refills as well. Instead of a 1-month supply of medication, you may be able to get a 2- or 3-month supply.^1-3 This can help ensure you have the medications you need to get by without leaving the house as frequently.

Relaxing certain requirements for PrEP

Other healthcare systems are relaxing the requirements needed to receive a PrEP prescription. PrEP may be available during telemedicine visits or may be extended without testing if not possible right now. This may help maintain HIV prevention plans and continue to reduce the spread of HIV during a vulnerable time.

Express HIV/STI testing

Some clinics are also offering express testing, where you can get tested for HIV or other STIs without needing to meet with a doctor. This can help reduce face-to-face interactions, while still providing you with the information you need to be safe. At-home HIV testing kits may also be used when other options are not feasible.^1-3

Support for HIV-related services

Many HIV organizations are still operating, and are finding ways to spread awareness and support through social media, online counseling or support groups, and more. However, for many of these groups, hours and staff have needed to be cut due to financial strain.³

Fortunately, several emergency fund sources have been created specifically for HIV-related organizations.

Coronavirus Aid, Relief, and Economic Security (CARES) Act

In the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act approved by the United States federal government, $155 million has been set aside for HIV organizations. This includes $90 million for the Ryan White HIV/AIDS Program (and the local operations they support) and another $65 million for the Housing for People with AIDS federal program, which helps those with HIV find secure housing.^3,4

Additionally, Gilead, a pharmaceutical company that makes several HIV drugs, has pledged $20 million to support nonprofit groups. This includes HIV-related groups. Even if an organization has already received funds from Gilead, they can apply for up to $100,000 in emergency aid to support the people they serve.⁵

Adapting to the COVID-19 pandemic

Although the HIV care landscape will look different during the COVID-19 pandemic, adaptations in the healthcare system and funding for HIV-supporting groups can help provide healthcare access, prevention strategies, testing, and more.