Interruptions in Mental Health Care,Cannabis Use,Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles,California

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY — a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0–2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00607-9.     

Willingness to Attend Sex Venues in the Context of the COVID-19 Pandemic in New York City: Results from an Online Survey with Sexual and Gender Minority Individuals

Collective sex venues (places where people have sex in groups or in the presence of others, such as bathhouses or sex clubs) are locations where SARS-CoV-2 transmission is likely to occur. We conducted an online survey to examine the impact of the COVID-19 pandemic among 342 sexual and gender minority (SGM) individuals who had attended collective sex venues (CSV) in New York City (NYC) in the prior year. Almost 1 in 10 (9.9%) participants reported having received a positive test for SARS-CoV-2 infection or antibodies. Although a minority (27.5%) of participants reported being comfortable attending a CSV during the COVID-19 pandemic, multivariable ordinal logistic regression found that willingness was higher among participants who had taken the survey later in the pandemic (aOR = 2.90, CI_95% 1.90 to 4.43), who attended CSV at higher frequencies (aOR = 1.94, CI_95% 1.26 to 2.99), who used substances at CSV (aOR = 1.98, CI_95% 1.22 to 3.23), and who had tested positive for SARS-CoV-2 infection or antibodies (aOR = 2.27, CI_95% 1.17 to 4.39). In open survey answers, participants described reasons for or against attending CSV during the pandemic, as well as risk reduction strategies that would make them more comfortable attending (e.g., screening for test results, doing temperature checks, holding outdoor events, or restricting events to lower risk sexual practices). SGM individuals who attend CSV might be at increased risk for COVID-19. Public health officials should provide CSV organizers and attendees with guidelines on how to prevent or minimize transmission risk in the context of pandemics such as COVID-19.     

Evidence of Social and Structural COVID-19 Disparities by Sexual Orientation,Gender Identity,and Race/Ethnicity in an Urban Environment

The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago’s initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00497-9.     

Response to the COVID-19 Outbreak in Urban Settings in China

The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2–11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00498-8.     

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic.MethodsA sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income).ResultsAbout 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18–29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 (‘very worried’ AOR = 8.00, p < 0.001).ConclusionPandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.     

Delay in childhood vaccinations during the COVID-19 pandemic

ObjectivesIn many jurisdictions, routine medical care was reduced in response to the COVID-19 pandemic. The objective of this study was to determine whether the frequency of on-time routine childhood vaccinations among children age 0–2 years was lower following the COVID-19 declaration of emergency in Ontario, Canada, on March 17, 2020, compared to prior to the pandemic.MethodsWe conducted a longitudinal cohort study of healthy children aged 0–2 years participating in the TARGet Kids! primary care research network in Toronto, Canada. A logistic mixed effects regression model was used to determine odds ratios (ORs) for delayed vaccination (> 30 days vs. ≤ 30 days from the recommended date) before and after the COVID-19 declaration of emergency, adjusted for confounding variables. A Cox proportional hazards model was used to explore the relationship between the declaration of emergency and time to vaccination.ResultsAmong 1277 children, the proportion of on-time vaccinations was 81.8% prior to the COVID-19 declaration of emergency and 62.1% after (p < 0.001). The odds of delayed vaccination increased (odds ratio = 3.77, 95% CI: 2.86–4.96), and the hazard of administration of recommended vaccinations decreased after the declaration of emergency (hazard ratio = 0.75, 95% CI: 0.60–0.92). The median vaccination delay time was 5 days (95% CI: 4–5 days) prior to the declaration of emergency and 17 days (95% CI: 12–22 days) after.ConclusionThe frequency of on-time routine childhood vaccinations was lower during the first wave of the COVID-19 pandemic. Sustained delays in routine vaccinations may lead to an increase in rates of vaccine-preventable diseases.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00601-9.     

The COVID-19 Pandemic as a Threat Multiplier for Childhood Health Disparities: Evidence from St. Louis,MO

The COVID-19 pandemic has highlighted socioeconomic and racial health disparities in the USA. In this study, we examined the COVID-19 pandemic as a threat multiplier for childhood health disparities by evaluating health behavior changes among urban St. Louis, MO, children (ages 6–14) during the COVID-19 pandemic. From 27 October to 10 December 2020, 122 parents/guardians reported on their children’s health behaviors (Eating, Sleeping, Physical activity, Time outside, Time with friends in-person, Time with friends remotely, Time using media for educational proposes, Time using media for non-educational proposes, and Social connectedness) prior to and during the COVID-19 pandemic. We ran K-means cluster analyses to identify distinct health behavior cluster profiles. Relative risks were determined to evaluate behavioral differences between the two clusters. Two distinct cluster profiles were identified: a High Impact profile (n = 49) and a Moderate Impact profile (n = 73). Children in the High Impact cluster had a greater risk of being diagnosed with COVID-19, developed worsened eating habits (RR = 2.10; 95% CI = 1.50–2.93), spent less time sleeping, and spent less time outdoors (RR = 1.55; 95% CI = 1.03–2.43) than the Moderate Impact cluster. The High Impact cluster was more likely to include Black children and children from single-adult households than the Moderate Impact cluster (both p < 0.05). Our findings suggest that the COVID-19 pandemic may be a threat multiplier for childhood health disparities. Further research is needed to better understand the long-term effects of the COVID-19 pandemic on children’s health.     

The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey

BackgroundThe COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM).ObjectiveThis study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated.MethodsParticipants were MSM aged ≥18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted.ResultsHIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0% vs 61.0%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6% vs 44.0%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95% CI 0.48-0.98) were negatively associated with the dependent variable.ConclusionsHIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic.     

The impact of the COVID-19 pandemic on hepatitis B virus vaccination and transmission among men who have sex with men: A mathematical modelling study

BackgroundDuring the COVID-19 pandemic, the number of hepatitis B virus (HBV) vaccinations among men who have sex with men (MSM) has been considerably lower than before the pandemic. Moreover, less frequent HBV testing and a reduction in numbers of sex partners have been reported. We assessed the impact of these COVID-19-related changes on HBV transmission among MSM in the Netherlands.MethodsWe estimated the changes in sexual activity, HBV testing, and HBV vaccination among MSM during the pandemic from Dutch data. We used a deterministic compartmental model and investigated scenarios with small or large declines in sexual activity, testing, and vaccination for the current phase of the pandemic (without available data). We examined the increase in HBV vaccinations needed to prevent further increase in HBV incidence.ResultsWith a decrease in numbers of sex partners of 15–25% during the first lockdown and 5% during the second lockdown, we found a decline of 6.6% in HBV incidence in 2020, despite a >70% reduction in HBV testing and vaccination during the first lockdown. With numbers of sex partners rebounding close to pre-pandemic level in 2021, and a reduction of 15% in testing and 30% in vaccination in 2021, we found an increase of 1.4% in incidence in 2021 and 3.1% in 2026. With these changes, an increase of ≥60% in HBV vaccinations in 2022 would be needed to bring the HBV incidence in 2023 back to the level that it would have had if the COVID-19-related changes had not occurred.ConclusionsDespite reductions in sexual activity during the COVID-19 pandemic, the decrease in HBV vaccinations may result in a small increase in HBV incidence after 2021, which may persist for years. It is important to restore the vaccination level and limit further increase in HBV transmission among MSM.     

Downstream health impacts of employment losses during the COVID-19 pandemic

Objectives The Canadian workforce has experienced significant employment losses during the COVID-19 pandemic, in part as a result of non-pharmaceutical interventions to slow COVID-19 transmission. Health consequences are likely to result from these job losses, but without historical precedent for the current economic shutdown they are challenging to plan for. Our study aimed to use population risk models to quantify potential downstream health impacts of the COVID-19 pandemic and inform public health planning to minimize future health burden.MethodsThe impact of COVID-19 job losses on future premature mortality and high-resource health care utilization (HRU) was estimated using an economic model of Canadian COVID-19 lockdowns and validated population risk models. Five-year excess premature mortality and HRU were estimated by age and sex to describe employment-related health consequences of COVID-19 lockdowns in the Canadian population.ResultsWith federal income supplementation like the Canadian Emergency Response Benefit, we estimate that each month of economic lockdown will result in 5.6 new high-resource health care system users (HRUs), and 4.1 excess premature deaths, per 100,000, over the next 5 years. These effects were concentrated in ages 45–64, and among males 18–34. Without income supplementation, the health consequences were approximately twice as great in terms of both HRUs and premature deaths.ConclusionEmployment losses associated with COVID-19 countermeasures may have downstream implications for health. Public health responses should consider financially vulnerable populations at high risk of downstream health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00588-3.     

COVID-19 impact and vaccine effectiveness among healthcare workers of a large University Hospital in Lombardy,Italy

Background:Healthcare Workers (HCWs) are a key element in managing the COVID-19 pandemic, but they are also at high risk of infection.Objective:The aim of this study was to describe, in a large university hospital which provided healthcare services to patients with SARS-CoV-2 infection, the course of the epidemic among HCWs and effectiveness of COVID-19 vaccination in reducing SARS-CoV-2 infection and disease.Methods:Our case series included all “Fatebenefratelli Sacco” University Hospital workers. Data were collected until the 15th of May 2021 and analysed as part of the health surveillance program carried out by the Occupational Health Unit.Results:From March 2020 until May 2021, 14.4% of workers contracted COVID-19, with the highest incidence peak recorded during the second wave of the pandemic. The prevalence of infection was slightly higher in males than in females, and a greater number of cases was found in job categories characterized by direct patient care activities. We reported a higher prevalence of “serious/critical illness” in elder workers. A clear reduction of COVID-19 incidence was found in our population during the third pandemic wave, that coincided with the start of vaccination campaign.Discussion:HCWs have been at high risk of COVID-19 infection. Male sex and advanced age appear to be predisposing factor and negative prognostic factor respectively. An out-of-hospital setting appears to be the main source of COVID-19 confirming that the correct use of protective devices during work counters the risk of infection. Vaccination seems to reduce both documented cases of infection and severe illness.     

Appropriateness of COVID-19 public health guidelines for an Alberta First Nations community

ObjectivesThe First Nations people experience significant challenges that may influence the ability to follow COVID-19 public health directives on-reserve. This study aimed to describe experiences, perceptions and circumstances of an Alberta First Nations community, related to COVID-19 public health advice. We hypothesized that many challenges ensued when following and implementing advice from public health experts.MethodsWith First Nations leadership and staff, an online cross-sectional survey was deployed between April 24 and June 25, 2020. It assessed the appropriateness of public health advice to curb COVID-19 within this large First Nations community. Both quantitative and qualitative data were captured and described.ResultsA total of 106 adults living on-reserve responded; over 80% were female. Difficulty accessing food was significant by employment status (p = 0.0004). Those people with lower income found accessing food (p = 0.0190) and getting essential medical care (p = 0.0060), clothing (p = 0.0280) and transportation (p = 0.0027) more difficult. Some respondents described lost income associated with COVID-19 experiences, as well as difficulties accessing essential supplies. Respondents found “proper handwashing” most easy (98%) and “keeping a distance of 2 m from others” most difficult (23%). Many respondents found following public health advice within their personal domain easy and put “family safety” first but experienced some difficulties when navigating social aspects and obligations, particularly when unable to control the actions of others. People stated wanting clear information, but were sometimes critical of the COVID-19 response.ConclusionFirst Nations people face many additional challenges within the COVID-19 response, driven in part by ongoing issues related to significant societal, economic, and systemic factors.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00579-4.     

A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study

BackgroundThe COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders.ObjectiveIn this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status.MethodsA nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition.ResultsOur results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=–1.5; t=–2.5; P=.01) and anxiety (β=–1.1; t=–2.4; P=.02).ConclusionsIt is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.     

Infection fatality rate of COVID-19 inferred from seroprevalence data

ObjectiveTo estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from seroprevalence data.MethodsI searched PubMed and preprint servers for COVID-19 seroprevalence studies with a sample size ≥ 500 as of 9 September 2020. I also retrieved additional results of national studies from preliminary press releases and reports. I assessed the studies for design features and seroprevalence estimates. I estimated the infection fatality rate for each study by dividing the cumulative number of COVID-19 deaths by the number of people estimated to be infected in each region. I corrected for the number of immunoglobin (Ig) types tested (IgG, IgM, IgA).FindingsI included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people younger than 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%.ConclusionThe infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients and other factors. The inferred infection fatality rates tended to be much lower than estimates made earlier in the pandemic.     

Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men,Transgender Women,and Transgender Men Who Have Sex with Men: April–May 2020

Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n?=?3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β?=?0.90, 95% CI 0.40–1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR?=?1.21), being Black (AOR?=?1.79) or Latinx (AOR?=?1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR?=?1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.

     

To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study

BackgroundResponsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease.ObjectivesWe aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load.MethodsIn a mixed-method design, Fava’s clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner’s symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO.ResultsData of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3–4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5–7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility.ConclusionUnder changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.     

COVID-19, Stigma,and the Ongoing Marginalization of Sex Workers and their Support Organizations

Primary or first-hand stigma, associated with sex work, sometimes disparagingly referred to as "prostitution" or "whore" stigma, was a fundamental cause of social inequities for sex workers before the COVID-19 pandemic. In addition, courtesy stigma, or stigma by association linked with involvement with a stigmatized group, has long limited the ability of sex worker organizations to secure adequate funds to meet the needs of sex workers in their communities. In reaction to the pandemic, sex worker organizations quickly responded and in a variety of ways have been helping to ease the impact of the pandemic on sex workers in their communities. In November 2020, we interviewed 10 members of sex worker organizations from seven different communities across Canada about how they have been dealing with the immediate and longer-term impacts of the COVID-19 pandemic in their communities. Three strategic actions stood out in the interviews: (1) challenging stigma to help sex workers access government emergency funding; (2) reorganizing and adapting services to provide outreach to sex workers in their communities; and (3) advocating for continuous organizational funding. The findings show that primary stigma and courtesy stigma have further marginalized sex worker organizations and their clients during the pandemic. We conclude with participants’ recommendations to address avoidable harms of COVID-19 among sex workers and to better support sex worker organizations in Canada.

     

Soutien au réseau des services de garde montréalais dans la prévention et la gestion de la COVID-19 : un service à 3 pôles

SettingFrom April 2020, in sight of child care reopening, the Direction régionale de santé publique de Montréal (DRSPM) conducted a situational analysis with its child care (CC) partners in order to learn about the challenges they envisioned in their role in preventing and managing COVID-19. The CC partners requested access to preferred public health support.InterventionThe DRSPM established a service consisting of three components: (1) telephone support available 6 to 7 days/week for CC managers facing a COVID-19 situation; (2) a regional committee combining four Montreal representatives of CC associations and one from the Ministère de la Famille; (3) prevention brigades formed by front-line health workers from the Centres intégrés universitaires de santé et de services sociaux (CIUSSS).OutcomesThis health promotion intervention (1) enabled CC services to handle the pandemic with better capability and confidence through facilitating access to accurate and positive information; (2) supported the commitment and collaboration of CC services by acting as a mediator between them and decision-makers; and (3) responded to the psychosocial needs of community members.ImplicationsThis service helped to adjust public policy and promote community resilience by raising awareness of the importance of balancing COVID-19 prevention and the collateral impacts of the pandemic.     

Nursing staff fatigue and burnout during the COVID-19 pandemic in Greece

IntroductionThe coronavirus pandemic (COVID-19) is an unprecedented global health crisis with emotional and physical impact on health care workers.ObjectiveThe purpose of this study was to investigate the levels of fatigue and burnout in nursing staff during the pandemic.MethodsThe present study involved nursing staff from hospitals in Greece in February 2021, who completed the Fatigue (FAS) and Burnout (CBI) questionnaires. Gender, age, years of work experience, workplace (COVID-19 or non-COVID-19 wards) and SARS-CoV-2 infection status were recorded.ResultsThe sample included 593 women and 108 men, with a mean age ± SD: 42.9 ± 9.9 years and 18.14 ± 10.8 years work experience. Slightly more than half, (367, 52.4%) worked in COVID-19 departments. Fifty-six (8%) tested positive for SARS-CoV-2 and 14 of them needed to be treated. The mean ± SD FAS and CBI scores were 25.6 ± 7.4 and 46.9 ± 18.8, respectively (67.9% and 42.9% had scores suggestive of fatigue and burnout, respectively). Women showed higher values in both scales (p < 0.01). Subjects working in COVID-19 wards scored significantly higher on both the FAS and CBI scales; they were also younger and with less work experience (p < 0.01). Staff treated for COVID-19 scored higher on the burnout scale (p < 0.01) than the uninfected staff. Fatigue showed a strong positive correlation with burnout (p < 0.01, r = 0.70). Stepwise multiple regression showed that the variation of fatigue was explained by 47.0% and 6.1% by the scores on the subscales of personal and work-related burnout, respectively.ConclusionIn conclusion, high rates of fatigue and burnout were found in the studied population. Nurses working with COVID-19 patients had higher rates of fatigue and burnout compared to those working elsewhere. There was a strong positive correlation (r = 0.70) between burnout and fatigue. Particular attention should be paid to staff who became ill and need to be treated.