Intersecting Epidemics

The Impact of Coronavirus Disease 2019 on the HIV Prevention and Care Continua in the United States

Camille E. Spears; Barbara S. Taylor; Albert Y. Liu; Sera M. Levy; Ellen F. Eaton


AIDS. 2022;36(13):1749-1759. 

In This Article

Abstract and Introduction


Objective: To summarize the broad impact of the coronavirus disease 2019 (COVID-19) pandemic on HIV prevention and care in the United States with a focus on the status-neutral HIV care continuum.

Design: We conducted an editorial review of peer-reviewed literature on the topics of HIV-risk behaviors, sexually transmitted illness (STI) and HIV prevalence, HIV prevention and treatment trends, and evolving practices during the COVID-19 pandemic.

Methods: For relevant literature, we reviewed, summarized, and categorized into themes that span the HIV prevention and care continua, including sexual risk behaviors, mental health, and substance use.

Results: We identified important changes within each component of the HIV care continuum across the United States during the COVID-19 pandemic. Shifts in prevention practices, engagement with care, care provision, medication adherence, testing, and prevalence rates were observed during the pandemic.

Conclusion: Although heightened disparities for people at risk for, and living with, HIV were seen during the COVID-19 pandemic, many health systems and clinics have achieved and maintained engagement in HIV prevention and care. This review highlights barriers and innovative solutions that can support durable and accessible health systems through future public health crises.


With the emergence of the novel coronavirus, SARS-CoV-2 and its clinical syndrome, coronavirus disease 2019 (COVID-19), in the United States in 2020, people who are marginalized because of poverty and structural racism have been disproportionately impacted in terms of both COVID infections and exacerbations of chronic disease.[1,2] Marginalized populations, including those with chronic diseases and lack of insurance, were among the first group to be infected as many live in congregate settings and/or work in frontline jobs, such as food service. In addition, this group experienced delays in COVID diagnosis and treatment because of lack of resources and healthcare access. Beyond COVID infection, the pandemic led to disruptions in service delivery for routine healthcare that were more devastating to people who are chronically ill, sexual and gender minority populations, and racial/ethnic minority groups who face structural barriers to care.[3–5] People at risk for, and living with, HIV are at heightened risk for poor HIV outcomes at least in part because of underlying social determinants of health and barriers to care, including poverty, transportation issues, and stigma. The purpose of this review is to summarize the broad impact of the COVID-19 pandemic on HIV prevention and care in the United States with a focus on the status-neutral HIV care continuum.