'Doing what I need to do': sustaining mental health, medication adherence, and engagement in care among Black women living with HIV during the COVID-19 onset of 2020.

Abstract

Background: The HIV epidemic and COVID-19 are disproportionately impacting Black communities. For Black women living with HIV (BWLWH), 2020 COVID-19 mandates (e.g. stay-at-home orders) may have had implications for HIV medication adherence, engagement in care, and mental health.

Method: In April 2020 during COVID-19 spikes in the US, thirty Black women living with HIV in Miami, FL participated in qualitative semi-structured interviews that asked about COVID-related concerns, HIV medication adherence, engagement in care, and mental health. Interviews were audio recorded, transcribed, and coded using thematic content analysis.

Results: Qualitative analyses highlighted themes around concerns (e.g. whether HIV placed them at increased risk for COVID-19, feeling confined and restricted); mental health (e.g. feeling anxious, depressed); medication adherence (adhering to HIV medication despite COVID-19); engagement in care (e.g. providers canceling appointments, being persistent in contacting providers); adaptive coping (e.g. cleaning/chores, watching series/videos, seeking/receiving social support, praying/watching virtual church services, limiting news consumption, social distancing and wearing masks); minimal use of unhelpful coping strategies (e.g. substance use, eating more unhealthy food); losses/deaths; and the need for financial, food, mental health, and community level (e.g. testing sites) resources. Additionally, survey responses to quantitative measures indicated that a significant portion of women (between 20% and 47%) had difficulties such as getting food, paying bills, getting hand sanitizer and cleaning supplies, communicating with loved ones, reduced wages/work hours, and transportation barriers.

Conclusion: Our findings indicate that in the context of COVID-19 stay-at-home orders BWLWH were moderately impacted, shared concerns and mental health symptoms, and voiced the shortfalls of medical providers. Further, BWLWH exhibited resilience with regard to medication adherence and the use of adaptive coping strategies while echoing the need for additional resources and structural interventions.