The Impact of the COVID-19 Pandemic on People with HIV in Victoria,Australia: 1 Year Later

Since its first description in Wuhan, China in 2019, ¹ SARS-CoV-2 has had a major global impact on billions of people. As of March 6, 2022, there has been an estimated 440 million infections and almost 6 million deaths. ¹ From early on there has been concern about the effects of this pandemic upon vulnerable populations, including people with HIV (PWHIV), both directly due to SARS-CoV-2 infection, and indirectly through disruptions to health systems and economies. ²

In 2021, we presented in this journal our original study, which analyzed the impact of the COVID-19 pandemic on PWHIV in Victoria, Australia. ³ The original study was conducted between August 26 and November 26, 2020, at which time there had been <30,000 COVID-19 cases in Australia. ⁴ At the time, stringent public health measures such as curfews, state and international border closures, a 5 km travel restriction, and closure of nonessential services were implemented in the state of Victoria to limit disease transmission.

Furthermore, COVID-19 vaccinations were not yet available. Since then the treatment and public health landscape for COVID-19 has significantly changed and many of the public health measures are no longer in place. We wanted to repeat the survey to determine what the effects of these changes were on PWHIV. This follow-up survey was conducted between October 30, 2021 and January 31, 2022. At the later date, Australia had ∼1.8 million cases of COVID-19. ⁴ Our goal was to identify if there was change in how the COVID-19 pandemic was affecting PWHIV and to also examine COVID-19 vaccination uptake and attitudes among PWHIV.

To have a robust comparison between the two time points we made minimal changes between the two surveys, which were constructed in conjunction with key HIV stakeholder groups. Both surveys contained the same questions about demographics (age, gender, country of birth, and postcode), causes of concern, and impacts (positive, negative, or none) of the pandemic in the following domains: income, employment, accommodation, personal relationships, access to food, and access to health care. However, additional questions about COVID-19 vaccination, mental health, and quality of life sourced from the validated PozQol tool ⁵ were included in the second survey. Both surveys were advertised on social media and in the Infectious Diseases clinics of Monash Health and Alfred Health. Participants did not have to answer all the questions. The second survey had 95 respondents, the majority of which identified as male (59/71, 83%), were Australian-born (46/69, 67%), and were aged between 30 and 60 years (53/70, 76%).

Most (45/66, 68%) reported that their mental health had been negatively impacted by the COVID-19 pandemic. Furthermore, of the 38 out of 67 (56%) respondents who required mental health services in the past 6 months, more than a third (15, 39%) were unable to access them. The most common reason for this was not wanting a telehealth mental health appointment (5, 39%). In addition, a higher proportion of respondents in the second survey reported that they sometimes, or often worried about the impact of the COVID-19 pandemic on their mental health compared with the original survey (46/63, 73% vs. 86/130, 66%).

Regarding quality of life, many respondents answered “not at all” or “slightly” when asked how in control of their life they felt (18/62, 29%), whether they were enjoying life (18/62, 29%), or felt optimistic about the future (14/62, 23%). An Australian survey of PWHIV that utilized PozQol questions conducted before the pandemic demonstrated lower rates of PWHIV feeling a lack of control or enjoyment in life but higher rates of optimism about the future. ⁶ Overall these results indicate the ongoing negative impacts of the pandemic on markers of mental health in PWHIV in Victoria Australia in the periods of the first and second surveys.

The second survey had a higher proportion of respondents answering they worried often or sometimes about their financial situation (36/63, 57% vs. 65/129, 50%) and accommodation (16/63, 25% vs. 30/128, 23%) compared with the original. Whereas there was a slight reduction in the proportion reporting worrying sometimes or often about their physical health (39/62, 63% vs. 88/130, 68%). The reduced reports of worry for physical health may relate to the availability of effective COVID-19 vaccinations or emerging evidence that the Omicron variant was less life-threatening. ⁷

Ninety percent (60/67) of the study population stated that they had received two doses of a COVID-19 vaccination and one participant had received a single dose. This was slightly less than the general Victorian population two dose vaccination rate at the time of 93%. ⁸ Nine percent said that they had not been vaccinated and did not intend to get vaccinated against COVID-19. Another recent survey of PWHIV showed that 11% of Australian PWHIV were unlikely or very unlikely to get a COVID-19 vaccination. ⁹ The most common reasons selected for not getting vaccinated (more than one could be chosen) were concern about vaccine safety and not agreeing with the vaccination being mandated, which was reported by three participants each. Other studies have demonstrated much higher rates of vaccine hesitancy or refusal among PWHIV. ¹⁰

Reassuringly, our second survey demonstrated that provision of HIV and non-HIV-related care continued uninterrupted during the pandemic. The vast majority of respondents said they were able to access their HIV provider (61/65, 94%), antiretroviral therapy (ART) (64/64, 100%), and HIV-related monitoring tests (60/63, 95%) when required. Most were also able to access their non-HIV provider (34/40, 85%), non-HIV-related medications (49/53, 92%), and non-HIV-related monitoring tests (48/49, 98%) when required. The high rate of telehealth consultations continued with 61 of 67 (91%) respondents reporting use of telehealth services and 74% (43/58) were satisfied or very satisfied with telehealth. Allied health and dental services were more accessible with 72% (26/36) being able to access allied health and 64% (30/47) able to access dental services when required compared with 59% (35/59)and 42% (30/71), respectively, during the original survey.

Our follow-up survey demonstrates that access to HIV care such as ART, their ART prescriber, and routine blood tests remained excellent, yet the detrimental impacts upon mental health and quality of life experienced by PWHIV due to the COVID-19 pandemic continued. This, combined with the high levels of worry felt by PWHIV and a difficulty in accessing mental health services is cause for concern. As the pandemic enters its third year, the shortfall in this aspect of clinical care must urgently be addressed. A key to better health outcomes will be improved control of the COVID-19 pandemic, but in addition, there will need to be ongoing adaptions in health service delivery particularly around access to mental health services.