The Beat Goes On: Stimulant Use and HIV in the Era of COVID-19 (Preprint)

Evidence suggests that economic, social and psychological circumstances brought about by the coronavirus pandemic may have serious impact on behavioral health. Men who have sex with men (MSM) are disproportionally impacted by HIV and stimulant use, the co-occurrence of which heightens HIV transmission risk and undermines the national treatment as prevention efforts for ending the HIV epidemic. There is a paucity of information regarding the potential impact of the COVID-19 pandemic on the substance use and HIV medication adherence of this key vulnerable population - MSM who use stimulants and are living with HIV.The aim of this qualitative study was to identify ways in which the coronavirus pandemic has affected the stimulant use and antiretroviral therapy (ART) adherence among a sample of MSM living with HIV.Two focus groups were conducted in August 2020 via HIPAA-compliant video-conferencing technology. Potential participants from a suitable research participant registry at SUNY Downstate Health Sciences University were invited and screened for study participation based on inclusion criteria. A semi-structured interview guide was followed. A general inductive approach was used to analyze the data. Findings in two general areas of interest, the impact of COVID-19 on stimulant use and ART adherence, emerged directly from the raw data.A total of 12 ethnically diverse participants over the age of 25 took part in the study. Results were heterogeneous in terms of the effects of the pandemic on both stimulant use and ART adherence among MSM living with HIV. Some men indicated increased or sustained stimulant use and ART adherence and others reported decreased stimulant use and ART adherence. Reasons for these behavioral changes ranged from concerns about their own health and that of their loved ones to challenges brought about by the lack of daily structure during the lockdown phase of the pandemic and emotion regulation difficulties.The COVID-19 pandemic has had differential impact on stimulant use and ART medication adherence among MSM living with HIV. The reasons for behavioral change identified by this study may be salient intervention targets to support ART medication adherence and lower stimulant use among MSM in the aftermath of the coronavirus pandemic, as well as beyond.