Extreme weather impacts HIV prevention and treatment access

New challenges in HIV prevention and care are emerging due to climate change, according to a review published earlier this month in Current Opinions in Infectious Disease.

Researchers from the University of Toronto analyzed 22 recent studies exploring HIV-related outcomes in the context of climate change and identified several links between extreme weather events and HIV prevention and care.

Climate change-related extreme weather events, such as drought and flooding, were associated with poorer HIV prevention outcomes, including reduced HIV testing. Extreme weather events were also linked to increased practices that elevate HIV risk, such as transactional sex and condomless sex, as well as increases in new HIV infection.

Climate change impacts HIV prevention through several mechanistic pathways. Extreme weather events cause structural damage to health care infrastructure and increase migration and displacement, both of which disrupt access to HIV clinics for prevention and testing. We also see increases in practices that increase HIV risk due to climate change-related resource scarcity."

Carmen Logie, Lead Author, Professor at the Factor-Inwentash Faculty of Social Work (FIFSW) at the University of Toronto and the United Nations University Institute for Water, Environment, and Health

The study also uncovered important implications for HIV care among those already living with HIV, such as reduced viral suppression, poorer treatment adherence, and worse physical and mental wellbeing.

"Extreme weather events present new challenges with access to HIV care and treatment adherence," said co-author Andie MacNeil, PhD student at the FIFSW at the University of Toronto. "Multilevel strategies are needed to mitigate the effects of climate change on HIV care, such as long-lasting antiretroviral therapy, increased medication dispensing supplies, and community-based medication delivery and outreach programs."

The authors highlighted several important gaps in the existing literature, including the lack of research on specific extreme weather events (e.g., extreme heat, wildfires, hurricanes) and in geographic areas with high climate change vulnerability and increasing HIV rates (e.g., the Middle East and Northern Africa).

They also described a persisting lack of knowledge on extreme weather events and HIV among key marginalized populations, including sex workers, people who use drugs, and gender diverse persons, as well as how extreme weather events interact with intersecting forms of stigma.

The researchers are hopeful that these findings can help offer ways forward for research, policy, and practice.

"Innovative HIV interventions, such as long-acting PrEP, mobile pharmacies and health clinics, and interventions that reduce food and water insecurity may all contribute to improving HIV care during extreme weather events. More research and evaluation is needed to test climate-change informed HIV prevention and intervention strategies," said Logie. "The integration of disaster preparedness and HIV care provides new opportunities to optimize HIV care in our changing climate."

Funding:

Carmen Logie was supported by Canadian Institutes of Health Research (CIHR) (Project Grants), Social Sciences and Humanities Research Council of Canada (Partnership Development Grant, Insight Grant), and the Canada Research Chairs Program. Funders played no role in the study design, analysis or interpretations.