Exploring intersectional stigma and COVID-19 impact on human immunodeficiency virus service provision for African Americans in a Southern city.

Abstract

Aims/objectivesThrough interviews with clinical service providers, we explored stigma's impact on HIV service provision for African Americans during COVID‐19.BackgroundAfrican Americans experience disproportionate rates of HIV and COVID‐19. We explored COVID‐19's impact on HIV services for African American adults in a Southern city.DesignThe study was qualitative and observational.MethodsKey informant interviews were conducted (n = 11) across two healthcare centres and two community‐based organisations and thematically analysed using phenomenological approaches by two coders. Interviews explored pre‐ and post‐COVID‐19 service provision and parallels between COVID‐19 and HIV, particularly as related to stigma. The COREQ checklist was utilised to ensure research quality.ResultsAccording to the providers interviewed, all providers offered HIV prevention/treatment, but PrEP and preventive services diminished greatly early in the COVID‐19 pandemic. Successful transition to telehealth depended on existing telehealth use. Challenges exacerbated by COVID‐19 included food/housing insecurity and physical distancing constraints. Clients' COVID‐19 informational needs shifted from concerns to vaccine requests over time. Interviewees stated HIV and COVID‐19 both carry ‘risk taking’; however, HIV risk was more physically intimate than COVID‐19. Notably, some providers used stigmatising language referring to clients with HIV/COVID and omitted person‐centred language.ConclusionsFindings suggest need to address challenges in telehealth to improve client experiences now and for future pandemics. More research is needed to examine intersectional stigmatisation of COVID‐19 and HIV for African Americans to design person‐centred counselling interventions.Relevance to Clinical PracticeResults demonstrate need for provider training to reframe stigma discussions using client centeredness, educating African Americans on HIV and COVID‐19 prevention, and coordination with local organisations to address multiple care needs.Patient/Public ContributionThis research highlights needs of clients based on the views of healthcare providers caring for predominantly African American communities in a Southern city. However, no patients, service users, caregivers or members of the public were directly involved in this study.