Impact of the COVID-19 Pandemic on Persons Living with HIV in Western Washington: Examining Lived Experiences of Social Distancing Stress, Personal Buffers, and Mental Health

Abstract

Background: People with pre-existing mental health conditions may be more susceptible to stressors associated with COVID-19. Understanding the psychosocial impacts of the pandemic for people living with HIV (PLWH) is critical, as they are already disproportionately at risk for common mental disorders such as depression and anxiety, and poor mental health is a predictor of negative HIV-related outcomes. We explored how PLWH in Western Washington State are coping with the COVID-19 pandemic.Methods: Stratified, purposive sampling was used to recruit 24 patients from the University of Washington HIV patient registry, who had participated in a quantitative survey on COVID-19 experiences, to participate in semi-structured individual interviews (IDIs). IDIs were conducted by Zoom, were audio recorded and transcribed. Thematic analysis, including a combination of inductive and deductive coding approaches, was used to develop an adapted stress-coping model to holistically capture participants’ experiences during the first year of the pandemic. Results: Although fear of acquiring COVID-19 was not a major stressor in their lives, participants felt acute stress following exposure events and symptoms compatible with COVID-19. Participants described experiencing longer term stress as a result of social distancing guidelines, which increased isolation and feelings of loneliness. Participants employed adaptive coping strategies, including cognitive coping techniques and physical exercise, to combat prolonged stressors and promote mental health. Participants who experienced multiple stressors simultaneously were less likely to be able to adopt positive coping behaviors, and increasingly engaged in maladaptive coping strategies. Healthcare providers were an important avenue of social support for PLWH, providing consistency in care, and referral and provision of mental health and social services. Conclusion: Our qualitative evaluation of lived experiences of PLWH in Western Washington suggests that social isolation and job loss are linked to higher levels of stress during the COVID-19 pandemic. PLWH should be encouraged to practice cognitive coping techniques and physical exercise while following social distancing guidelines. Likewise, maintaining social ties by providing and receiving social support is recommended. Healthcare providers and social workers ought to continue making concerted efforts to connect with their patients to address both HIV and non-HIV related needs, as the pandemic influenced numerous facets of daily life.