By Katie Willingham
Members of The Well Project's Community Advisory Board attended, presented, and reported their perspectives on the virtual US Conference on HIV/AIDS, December 2 - 3, 2021. We've compiled their takeaways from the gathering into several multi-author topical articles. Read on for summaries of presentations dealing with COVID-19 pandemic-related changes to HIV care and service delivery – and check out all The Well Project's coverage of the US's largest HIV community convening.
Table of Contents
Responding to Increased Mental Health Needs
People living with HIV and their health care providers, as well as US adults and health care workers more broadly, have been affected by increasing rates of mental health symptoms and disorders since the COVID-19 pandemic began. These concerns inspired the work behind the poster "Using Virtual Platforms to Promote Mental Health Among People With HIV."
For example, a survey of health workers found high rates of conditions like:
- alcohol use disorder (nearly 43 percent)
- post-traumatic stress disorder, or PTSD (more than 23 percent)
- generalized anxiety disorder (almost 16 percent)
- major depression (14 percent)
And finally, in a 2020 CDC survey of 5,412 US adults, close to 41 percent of respondents reported at least one adverse mental or behavioral health issue – at rates three to four times those of the year before. More than 10 percent of these individuals reported having seriously considered suicide in the past month.
To begin to address these concerns in the community of providers that they serve, the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) conducted 168 virtual trainings reaching nearly 7,000 people. A third of the sessions were focused on behavioral health interventions, self-care, PTSD, and dealing with grief and loss. They addressed the well-being of providers struggling to work during the pandemic, and also focused on meeting the behavioral health needs of people living with HIV whether their conditions were present before COVID or emerged or got worse during COVID.
NECA AETC also conducted a study of behavioral health integration into HIV care in seven counties in their area that got funding through the federal Ending the HIV Epidemic in the US (EHE) initiative. These data included key informant interviews with 22 professionals from the jurisdictions discussing how they had shifted their behavioral health work from in-person to virtual – and how that shift had hindered or helped care for people living with HIV.
What they found by polling approximately 150 HIV care team members anonymously during a webinar was that 73 percent of participants reported experiences on a range from "moderate stress" to "a great deal of distress" as a result of the COVID pandemic. Leading sources of that distress included:
- 56 percent of participants felt traumatized by the upheaval the pandemic had caused
- 19 percent struggled with grief, loss, and/or loneliness
- 14 percent felt a loss of personal safety, including worrying about housing and other basic needs
- 8 percent reported pre-existing or new substance use and other mental health disorders worsened
As part of their response to these challenges, NECA AETC has delivered 49 virtual programs on COVID and mental health in the HIV community, with topics such as compassion fatigue, self-care, COVID and behavioral health in communities of color, and distinguishing distress from disorder.
In conclusion, according to the poster, the seven key lessons learned through this work were:
- Preparedness planning was needed before a crisis occurs and people may have to continue with their HIV and/or behavioral health care in new and/or altered ways
- Support will be needed when new crises trigger emotions and behaviors experienced in previous crises
- Care teams can be supported through virtual trainings
- With a skilled behavioral health workforce already part of an AETC, virtual support can be quickly scaled up
- Unless portals to virtual care can be made that are cost-free, secure, and user friendly, the digital divide will continue to be a barrier to needed care
- Behavioral health care is feasible and acceptable through virtual platforms for most people living with HIV
- Relaxation of rules by federal, state, and clinical entities during the COVID pandemic has created a new appreciation for the idea that care happens between people rather than buildings, and many organizations, care teams, and people living with HIV are advocating not to return to the old ways of exclusive in-person care
I can see myself in this study, though I'm not a health care provider of any kind – I am an advocate who has worked through and been affected by the COVID pandemic. During this pandemic I have also experienced increased depression and anxiety and have felt triggered by memories of my pandemic (HIV).
Reporting on NECA AETC's work led me to consider how I myself feel about using virtual platforms in my own care, and I have mixed feelings about it. Without a doubt, virtual platforms are convenient, particularly in the South where transportation is an obstacle for many. Personally, though, I miss the intimate connection that only truly happens face to face. I agree that the world is changing and virtual platforms are a great tool that are going to become more prevalent as time passes – but may we find ways to never lose touch with our human platforms. Convenience is not an adequate trade for intimate human connections.
Adapting to Virtual HIV Care in the South
In a session entitled "The COVID-19 Pandemic: Impact on Southern HIV Service Organizations, Staff and Clients," providers talked about challenges that arose during the pandemic, including safety and the need to shift to virtual platforms where possible. This was an adjustment made with growing pains, but it has been largely successful. They spoke about their own well-being as well as their clients' being affected by the pandemic, and the need for self-care.
During the pandemic, many health care organizations endured significant loss of staff and volunteers. This of course makes the work harder and more stressful for remaining staff, thus wearing even harder on their resolve to continue with the work themselves. Resources, training, and technology are needed to continue to do this work alongside COVID – because honestly, not many people really see our world going back to the state we once knew. The measures taken to adapt to the pandemic will likely not be changing very quickly, and vaccinations and PPE (personal protective equipment, such as face masks) will be with us for a while.
In this environment, it'll be important to address the mental health needs of both clients and staff going forward, because mental health care affects our physical, emotional, and psychological health as well. Further, the mental health of our providers is growing more and more precarious as the pandemic continues. Health care providers need to know that stepping back is OK and even necessary at times and should be done guilt free. Even soldiers take a leave of absence from time to time – and for the same reasons.
