HIV and COVID-19: Intersecting Epidemics With Many Unknowns

Catherine R. Lesko; Angela M. Bengtson


Am J Epidemiol. 2021;190(1):10-16. 

In This Article

Structural Vulnerabilities

The HIV epidemic has disproportionately affected marginalized communities: people belonging to minority racial or ethnic groups, and in particular women of color, young men of color who have sex with men, people who inject drugs, transgender individuals, and people with a history of incarceration. The same structures that placed these groups at higher risk for HIV—including racism, stigmatization, limited economic opportunities, and oppression—also place them at higher risk for SARS-CoV-2, such that the term syndemic has been used to describe these overlapping epidemics and vulnerabilities.[47,48] Less than 6 months into the COVID-19 pandemic, we are already seeing staggering disparities in the proportion of confirmed SARS-CoV-2 infections and COVID-19 deaths among Black Americans and persons in homeless shelters and prisons.[49–52] Persons with limited income are less likely to be able to take some precautions that require financial resources, such as driving in lieu of taking public transportation,[53] stockpiling groceries, or paying for grocery delivery. Indeed, even in the first 2 weeks of implementation of physical distancing regulations in Alabama, there was increased need for wrap-around social services such as provision of nutritional and personal care items.[54] There is likely to be increased need for services among PLWH who were already receiving such services, as well as an increasing number of people in need of services.