Study: HIV patients in Washington, D.C. reported intense distress during pandemic

The COVID-19 pandemic had substantial psychological impacts on the nation and around the world. New research shows patients with HIV were particularly susceptible to psychosocial challenges like depression, anxiety, substance abuse, loneliness and more. The study was co-authored by HIV/AIDS expert Michael Horberg, MD, and published in AIDS Research and Therapy.

Researchers analyzed the results from a 2020 survey of nearly 900 Washington, D.C.-based participants diagnosed with HIV. The survey asked patients to rate the degree to which they experienced challenges with financial stability, mental health, social connections and substance use during the peak of the pandemic. Researchers then evaluated how different demographics experienced psychosocial challenges and which groups were the most vulnerable.

"D.C. was an important place to conduct this research, as it is both an HIV hotspot and was a COVID-19 hotspot during various points of the pandemic," said Dr. Horberg, associate medical director and head of the of the Mid-Atlantic Permanente Research Institute.

Mental health

Seventy-seven percent of respondents reported struggling with their mental health during the peak of the pandemic. Nearly 50% reported feeling anxious, and 46% reported a decreased quality of life. Over a third of participants reported at least one of the hallmark symptoms of depression, and half of respondents reported decreased social connections.

Substance use

Researchers found more participants reported an increase in alcohol consumption compared to illicit drug use. Participants whose HIV was well managed were less likely to report an increase of alcohol or drug use. Males were more likely to report increase substance abuse compared to females.

Financial strain

Fifty-five percent of respondents reported experiencing financial strain during the pandemic, with 34% reporting a decrease in household income. A large number of respondents (27%) reported difficulty getting food, and even more (29%) reported difficulty paying their rent or mortgage. Participants with more education were less likely to report financial impacts but were more likely to report mental health impacts.

Older age and resiliency

Interestingly, older patients were less likely to experience negative psychosocial challenges. Researchers noted older age is likely protective against these challenges due to having more life experience, being better able to connect with necessary resources, having stronger social connections and being less likely to abuse drugs and alcohol.

"We found older patients were far more resilient compared to younger patients," Dr. Horberg said. "I think this demonstrates the importance of being socially secure when trying to weather intense stressors like the pandemic."

Addressing health equity

As the pandemic wanes and emergency intervention programs are removed, vulnerable individuals who are already at risk for worse HIV outcomes may suffer more, the authors said.

"People with HIV were already at an increased risk of psychosocial challenges, the pandemic only exacerbated these problems," Dr. Horberg said. "When we remove emergency pandemic relief efforts, we are taking away potential lifelines. It shows we need to do a better job ensuring our vulnerable populations have access to the care they need, regardless of the pandemic."