LAUSR

The pandemic of coronavirus disease 2019 (COVID-19) has led to unprecedented disruption in people’s lives and healthcare across the globe. In China, where the COVID-19 outbreak was first identified, people living with HIV (PLWH) have experienced critical challenges and barriers to optimal care outcomes. It may be important to note that prior to the COVID-19 outbreak, PLWH in China were already affected by high levels of HIV stigma [1], psychological distress (depression, anxiety) [2–4], and suboptimal adherence [5, 6]. For instance, in two most recent large sample survey studies (conducted in 2013–2015) among PLWH in China, 32.9–38.4% PLWH reported depressive symptoms and 27.4% experienced anxiety symptoms [7, 8]. Among patients who regularly attend clinical care, a meta-analysis found 77.6% PLWH had adequate adherence [9], though this is likely an overestimate of actual adherence in the population due to sample selection and report bias. In a recent report of a northeastern clinic in China that synthesized patients’ data in the past ten years, only 15% of PLWH achieved viral suppression [6]. The COVID-19 outbreak further intensifies existing challenges while highlighting structural barriers. This note is informed by authors’ observations and clinical experience in HIV care in China as well as preliminary findings from a recent survey we conducted among PLWH in China (in February and March 2020, full report in writing). Herein, we describe two significant challenges during the COVID-19 outbreak experienced by PLWH in the China context, including (1) linkage to care and access to medication, and (2) psychosocial consequences including stigma and mental health issues.