(PS6-A18) Difficulty Accessing General Healthcare During the COVID-19 Pandemic Among Hiv-positive Men

Introduction: The COVID-19 pandemic has affected healthcare access around the world, including barriers to care for people living with HIV (PWH). In South Africa, the COVID-19 lockdown heavily impacted both HIV testing and antiretroviral therapy (ART) initiations. A gender-based gap already existed in HIV care; only 56% of men in South Africa who know their HIV status have initiated ART, compared to 65% of women. Commonly cited barriers to care for men engaging in HIV care include transportation, interference with work, and perceiving clinics as women’s spaces. To examine HIV-positive men’s experiences accessing healthcare during the pandemic, we sought to investigate the extent to which men (1) endorsed various barriers to accessing general healthcare (not HIV specific) during the COVID-19 pandemic; and (2) whether poor mental health and alcohol use were associated with difficulty accessing healthcare during this time.

Methods: Data were taken from an ongoing cohort study of HIV-positive men, recruited from community clinics in Cape Town, South Africa. The sample (N=24) was 100% isiXhosa-speaking and Black African, average age was 36.3 (SD=9.2), with 96% self-identifying as heterosexual. Men responded to a question about access to healthcare during the COVID-19 pandemic, responses ranged from 1 (very easy) to 4 (very difficult); those who reported care was “difficult” or “very difficult” were combined. Men with difficulty accessing care were asked to select barriers to care from a list of six items (e.g., fear of COVID infection). Mental health and alcohol use were measured using the Alcohol, Smoking, and Substance use Involvement Screening Test (ASSIST), Center for Epidemiological Studies-Depression (CES-D-10), and the Primary Care-Post Traumatic Stress Disorder (PC-PTSD-5) scales. Total scores of all measures were used, with higher scores indicating worse mental health and more risky alcohol use. Logistic regression models were used to predict difficulty accessing healthcare from each individual predictor.

Results: Approximately 38% of the sample (n=9) reported difficulty accessing general care during COVID-19. On average men reported 1.1 (SD=0.3) barriers to care of those listed; long queues at the clinic (66%) and waiting outside in the rain (22%) were the most commonly cited barriers. Regression analysis results indicated that none of the mental health variables or alcohol use scores were significantly associated with difficulty engaging in care (βs ranged from .011 to .394, ps >.24).

Discussion: The most commonly cited barrier to general healthcare access during the COVID-19 pandemic related to long wait times. This is reminiscent of barriers to HIV care, particularly for men who may be employed and unable to take time off work and/or willing to lose income. However, waiting outside in the rain is likely a pandemic-specific barrier to care, as only a limited number of patients were allowed in the clinic at a time in order to enforce social distancing. A differentiated service delivery policy may be needed during a pandemic to efficiently and effectively provide care and not deter patients from healthcare services.