Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;18(8):e0289007.
doi: 10.1371/journal.pone.0289007. eCollection 2023.

Impacts of COVID-19 on sexual risk behaviors, safe injection practices, and access to HIV services among key populations in Zambia: Findings from a rapid qualitative formative assessment

Lauren E Parmley  1 , Tepa Nkumbula  2 , Lophina Chilukutu  2 , Lazarus Chelu  2 , Chipili Mulemfwe  2 , Brave Hanunka  3 , John Mwale  4 , Joyce Neal  5 , Ray Handema  6 , Prisca Kasonde  2 , Kennedy Mutale  7 , Henry M Sakala  7 , Maria Lahuerta  1   8
Affiliations

Impacts of COVID-19 on sexual risk behaviors, safe injection practices, and access to HIV services among key populations in Zambia: Findings from a rapid qualitative formative assessment

Lauren E Parmley et al. PLoS One. .

Abstract

Background: Despite achievements in the HIV response, social and structural barriers impede access to HIV services for key populations (KP) including men who have sex with men (MSM), transgender women (TGW), and people who inject drugs (PWID). This may be worsened by the COVID-19 pandemic or future pandemic threats. We explored the impact of COVID-19 on HIV services and sexual and substance use behaviors among MSM/TGW and PWID in Zambia as part of a formative assessment for two biobehavioral surveys.

Methods: From November-December 2020, 3 focus groups and 15 in-depth interviews (IDIs) with KP were conducted in Lusaka, Livingstone, Ndola, Solwezi, and Kitwe, Zambia. Overall, 45 PWID and 60 MSM/TGW participated in IDIs and 70 PWID and 89 MSM/TGW participated in focus groups. Qualitative data were analyzed using framework matrices according to deductive themes outlined in interview guides.

Results: KP reported barriers to HIV testing and HIV treatment due to COVID-19-related disruptions and fear of SARS-CoV-2 exposure at the health facility. MSM/TGW participants reported limited supply of condoms and lubricants at health facilities; limited access to condoms led to increased engagements in condomless sex. Restrictions in movement and closure of meet-up spots due to COVID-19 impeded opportunities to meet sex partners for MSM/TGW and clients for those who sold sex. COVID-19 restrictions led to unemployment and loss of income as well as to shortages and increased price of drugs, needles, and syringes for PWID. Due to COVID-19 economic effects, PWID reported increased needle-sharing and re-use of needles.

Conclusions: Participants experienced barriers accessing HIV services due to COVID-19 and PWID attributed unsafe needle use and sharing to loss of income and lack of affordable needles during pandemic-related restrictions. To maintain gains in the HIV response in this context, strengthening harm reduction strategies and improvements in access to HIV services are necessary.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al.. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77. doi: 10.1016/S0140-6736(12)60821-6 - DOI - PMC - PubMed
    1. Poteat T, Scheim A, Xavier J, Reisner S, Baral S. Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People. J Acquir Immune Defic Syndr. 2016;72 Suppl 3:S210–9. doi: 10.1097/QAI.0000000000001087 - DOI - PMC - PubMed
    1. Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 2010;376(9737):285–301. doi: 10.1016/S0140-6736(10)60742-8 - DOI - PubMed
    1. Global HIV statistics: Fact Sheet 2022 Geneva, Switzerland: UNAIDS; 2021 [Available from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_....
    1. The impact of COVID-19 on HIV, TB and malaria services and systems for health: A Snapshort from 502 Health Facilities across Africa and Asia. Geneva, Switzerland: The Global Fund to Fight AIDS, Tuberculosis, and Malaria; 2021.

Publication types