The COVID-19 pandemic has put tremendous pressure on our nation’s public health and healthcare infrastructure, exposing and exacerbating existing vulnerabilities and inequities. The scale of the pandemic and the response are unprecedented, but the urgency of addressing COVID-19 has overshadowed existing health crises and opportunities.

The U.S. continues to battle record-high STI rates, outbreaks of hepatitis A, and an epidemic of drug overdoses. Decades of research and public health action have put within reach an end to the HIV epidemic and the elimination of hepatitis B and C. However, local health departments (LHDs) face an uphill battle—despite the availability of tools to prevent, detect, and treat HIV, STIs, and viral hepatitis—as the local public health workforce has decreased by 25% since 2008. Gaps in access to HIV, STI, viral hepatitis, and harm reduction services are getting worse during the pandemic, as LHDs and healthcare providers respond to COVID-19, millions of Americans lose their health insurance, and populations disproportionately impacted by HIV, STIs, and viral hepatitis face increased risk for COVID-19.

NACCHO has heard from LHDs across the country that HIV, STI, viral hepatitis, and harm reduction staff have been pulled to support the COVID-19 response, and that reduced staffing and the need to implement social distancing guidelines have forced them to suspend programs and reduce services. Maintaining HIV, STI, viral hepatitis, and harm reduction services during the pandemic and scaling up services after the pandemic is under control are both critical to prevent a surge in cases. Consequently, NACCHO will continue to monitor and report on the impact of the COVID-19 pandemic on HIV, STI, viral hepatitis, and harm reduction services.

This page will be updated as new research emerges. To share any relevant resources, please contact Kat Kelley, Senior Program Analyst, HIV, STI, & Viral Hepatitis at [email protected].

• LHD HIV, STI, and Hepatitis Programs Respond and Adapt to COVID-19. This article highlights the results of a recent survey distributed by NACCHO to LHDs on the impact of COVID-19 on their HIV, STIs, and viral hepatitis (HSH) programs. The findings reveal that HSH program staff have been pulled to support the COVID-19 response and that reduced staffing and the need to implement social distancing guidelines have forced many HSH programs to suspend outreach, education, and prevention efforts, and reduce testing and treatment.
  
  
• COVID-19 and the State of the STD Field. The National Coalition of STD Directors released a new report highlighting the findings of a survey conducted by STD program directors, DIS, and STD and sexual health clinic administrators regarding the impact of COVID-19 response on the STD field. The report reveals that many programs and clinics are deferring services or field visits, struggling to maintain caseloads, experiencing reduced capacity to treat, temporarily losing staff to COVID-19 deployment, and more. View the report for the full findings.

• The Impact of COVID-19 on Syringe Services Programs in the United States. A new article in AIDS and Behavior examines the impact of COVID-19 on syringe services programs (SSPs) in the U.S. The findings are based on the results of a survey distributed to SSPs by the North American Syringe Exchange Network and key informant interviews conducted with SSPs in COVID-19 hot spots. One-fourth reported closing at least one site and nearly half of SSPs report a decrease in the availability of services, including medication for opioid use disorder and HIV, hepatitis C, and STI testing. More than half are prepacking all supplies for clients, 20% are providing delivery services, and 6% are providing mail-based services.

• Impact of COVID-19 on CBOs and HIV Continuum of Care. A new article published in AIDS and Behavior highlights the impact of COVID-19 on community-based organizations (CBOs) and the HIV continuum of care. Many CBOs are closed, healthcare providers have reduced hours, and medical professionals are shifting from primary care to focus on COVID-19. CBOs are expecting declines in private donations and increases in clients who are unable to pay for services. As clients and staff are affected, morale has declined among providers working in CBOs.

• The Impact of COVID-19 on MSM. A new article in AIDs and Behavior characterizes the impact of COVID-19 on the sexual health of men who have sex with men (MSM) in the U.S. The findings are based on the results of an online survey completed by 1,051 MSM and reveal that half have had fewer sex partners and that some have faced challenges in accessing HIV testing and treatment.
  
  
• Impact of COVID-19 on STI Services in Indiana. The Indiana State Department of Health’s Division of HIV/STD/Viral Hepatitis recently examined how COVID-19 has impacted local chlamydia and gonorrhea testing efforts. The assessment found that 32% of providers had completely closed and only 16% were seeing asymptomatic patients.
  
• Podcast from Washington: Effects of COVID-19 on HIV, STI and Viral Hepatitis Programs. In last week’s episode, Ian Goldstein chatted with Leah Casanave, Supervisor of the STD Prevention and Control Program at Douglas County Health Department, NE and Kat Kelley, NACCHO’s Senior Program Analyst for HIV, STI and Viral Hepatitis. They discuss the impact that the COVID-19 pandemic has had on local health department’s HIV, STI and viral hepatitis programs and services.

• The Potential Impact and Availability of Sexual Health Services During the COVID-19 Pandemic. This article in the Journal of American Sexually Transmitted Diseases Association reviews a provider survey conducted to understand how the COVID-19 pandemic is affecting the availability of sexual health care services in New York City. The survey found that the majority of clinics providing sexual health services indicated a significant decrease in the regular services they were able to provide, including a 75% reduction in services surrounding pregnancy termination from March 1 to April 1 2020. Moreover, only 18% of sites previously offering STI testing for either symptomatic or asymptomatic patients were still able to offer testing to asymptomatic patients, and only ~25% of sites were able to offer HIV testing.
  
• Kaiser Family Foundation: Reduction in Sexual and Reproductive Health Services During the COVID-19 Pandemic. The Kaiser Family Foundation released a new issue brief highlighting the findings of several studies and polls which demonstrate reductions in sexual and reproductive heatlh services during the COVID-19 pandemic. During the COVID-19 pandemic, patient visits at hospitals and doctors’ offices for STIs reduced by 52% and more than half of U.S. women report that they or a family member have skipped or postponed medical care due to the pandemic.
  
• The Impact of COVID-19 on Hepatitis Elimination. The World Hepatitis Alliance published the findings of a global survey to assess the effects of the COVID-19 crisis on viral hepatitis services and on people living with viral hepatitis, conducted in April 2020. Only 47 (36%) of all 132 respondents reported that people were able to access viral hepatitis testing. 101 respondents gave reasons for lack of access to testing, with the main reason being closure of testing facilities and the prediction that public were avoiding going to testing facilities due to COVID-19. 23 (34%) of 68 respondents outside the USA reported that people on treatment for hepatitis were unable to access their medications at this time; and only 39 (30%) of 131 responses indicated adequate information on COVID-19 had been provided to people living with viral hepatitis in their country.
  
• NCSD Report: COVID-19 and the State of the STD Field: Phase II . The National Coalition of STD Directors released Phase II of its COVID-19 and the State of the STD Field Report this week, finding that almost 80% of the STD/HIV health department workforce is or has been redeployed to COVID-19 emergency response for any period of time. This report is a three-month follow up to the initial report in May 2020, highlighting the immediate response of the STD prevention field to the pandemic. This new report describes the field’s ongoing, longer term response to COVID-19 and what effect this response continues to have on our nation’s STD programs and the work of DIS staff.
  
• New Survey Shows Many Ceased PrEP During COVID-19 Pandemic Despite Provider Recommendations. In a new survey from the American Academy of HIV Medicine (AAHIVM), about one-third of respondents using pre-exposure prophylaxis to prevent HIV reported having stopped taking the medications when they were forced to stay home due to the coronavirus pandemic. Of those stopping PrEP, 85% cited that they were not engaging in risk behaviors – mirroring the risk taking behaviors of the overall group. AAHIVM presented the findings last week at the virtual International AIDS Conference.
  
• COVID-19 Could Lead to a Surge in Overdose Deaths. A recent article in Hep Magazine warns that the COVID-19 pandemic could worsen a rise in overdose deaths. Analysis by the Overdose Detection Mapping Application Program (ODMAP) found that 62% of participating counties reported a rise in suspected overdoses after March 19, when states began imposing stay-at-home orders; subsequent analysis by the Washington Post found that suspected overdoses nationwide rose by 18% in March, by 29% in April and by 42% in May compared with the respective months a year earlier.
• Infographic: COVID-19 Impact on Viral Hepatitis Care. The National Viral Hepatitis Roundtable and other leading viral hepatitis advocacy organizations launched a survey in June to assess the impact of COVID-19 on viral hepatitis care. The results are stark and show that public health departments and community organizations have had to limit hepatitis treatment as a result of the pandemic. In particular, nearly two-thirds of community-based organizations providing viral hepatitis services have received inadequate or no funding to adapt services during COVID-19. Furthermore, more than half of community-based organizations survey had to furlough or lay off staff or reduce operations due to COVID-19. The survey shows that vaccinations, testing, and treating viral hepatitis has decreased as a result of COVID-19. For additional information, access their new infographic here.