Skip to main content
Top
Published in: AIDS and Behavior 8/2020

01-08-2020 | Human Immunodeficiency Virus | Notes From The Field

The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective

Authors: Stephanie Shiau, Kristen D. Krause, Pamela Valera, Shobha Swaminathan, Perry N. Halkitis

Published in: AIDS and Behavior | Issue 8/2020

Login to get access

Abstract

The emergence of the novel coronavirus disease known as COVID-19 creates another health burden for people living with HIV (PLWH) who face multiple morbidities and may be at heightened risk for severe physical health illness from COVID-19. Our abilities to address these morbidities in PLWH must be considered alongside the socially-produced burdens that both place this population at risk for COVID-19 and heighten the likelihood of adverse outcomes. These burdens can affect the physical, emotional, and social well-being of PLWH and interfere with the delivery of effective healthcare and access to HIV treatment. We posit that a syndemic framework can be used to conceptualize the potential impact of COVID-19 among PLWH to inform the development of health programming services.
Literature
2.
go back to reference Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.PubMedPubMedCentral Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.PubMedPubMedCentral
3.
go back to reference Singer M. Pathogen-pathogen interaction: a syndemic model of complex biosocial processes in disease. Virulence. 2010;1(1):10–8.PubMedPubMedCentral Singer M. Pathogen-pathogen interaction: a syndemic model of complex biosocial processes in disease. Virulence. 2010;1(1):10–8.PubMedPubMedCentral
4.
go back to reference Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17(2):662–73.PubMedPubMedCentral Halkitis PN, Moeller RW, Siconolfi DE, Storholm ED, Solomon TM, Bub KL. Measurement model exploring a syndemic in emerging adult gay and bisexual men. AIDS Behav. 2013;17(2):662–73.PubMedPubMedCentral
5.
go back to reference Halkitis PN, Kupprat SA, Hampton MB, Perez-Figueroa R, Kingdon M, Eddy JA, et al. Evidence for a syndemic in aging HIV-positive gay, bisexual, and other MSM: implications for a holistic approach to prevention and healthcare. Nat Resour Model. 2012;36(2):365–86. Halkitis PN, Kupprat SA, Hampton MB, Perez-Figueroa R, Kingdon M, Eddy JA, et al. Evidence for a syndemic in aging HIV-positive gay, bisexual, and other MSM: implications for a holistic approach to prevention and healthcare. Nat Resour Model. 2012;36(2):365–86.
6.
go back to reference Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, et al. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDs. 2013;27(1):5–16.PubMedPubMedCentral Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, et al. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDs. 2013;27(1):5–16.PubMedPubMedCentral
7.
go back to reference Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi Zhonghua Liuxingbingxue Zazhi. 2020;41(2):145–51. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi Zhonghua Liuxingbingxue Zazhi. 2020;41(2):145–51.
8.
go back to reference Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl. 2020;395(10229):1054–62. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl. 2020;395(10229):1054–62.
9.
go back to reference González-Guarda RM, Florom-Smith AL, Thomas T. A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public Health Nurs Boston Mass. 2011;28(4):366–78. González-Guarda RM, Florom-Smith AL, Thomas T. A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public Health Nurs Boston Mass. 2011;28(4):366–78.
11.
go back to reference Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A Longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 Cohort Study. AIDS Behav. 2015;19(6):970–80.PubMedPubMedCentral Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A Longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: The P18 Cohort Study. AIDS Behav. 2015;19(6):970–80.PubMedPubMedCentral
12.
go back to reference Halkitis PN. Reframing HIV prevention for gay men in the United States. Am Psychol. 2010;65(8):752–63.PubMed Halkitis PN. Reframing HIV prevention for gay men in the United States. Am Psychol. 2010;65(8):752–63.PubMed
13.
go back to reference Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet Lond Engl. 2017;389(10072):941–50. Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet Lond Engl. 2017;389(10072):941–50.
14.
go back to reference National Minority AIDS Council. Continuing the Advance Against HIV/AIDS. 2014. National Minority AIDS Council. Continuing the Advance Against HIV/AIDS. 2014.
16.
go back to reference Singer M, Bulled N, Ostrach B. Syndemics and human health: implications for prevention and intervention. Ann Anthropol Pract. 2012;36(2):205–11. Singer M, Bulled N, Ostrach B. Syndemics and human health: implications for prevention and intervention. Ann Anthropol Pract. 2012;36(2):205–11.
17.
go back to reference Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423–41.PubMed Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423–41.PubMed
18.
go back to reference Sundermann EE, Erlandson KM, Pope CN, Rubtsova A, Montoya J, Moore AA, et al. Current Challenges And Solutions In Research And Clinical Care Of Older Persons Living With HIV: Findings Presented at the 9th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses. 2019;35(11–12):985–98.PubMed Sundermann EE, Erlandson KM, Pope CN, Rubtsova A, Montoya J, Moore AA, et al. Current Challenges And Solutions In Research And Clinical Care Of Older Persons Living With HIV: Findings Presented at the 9th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses. 2019;35(11–12):985–98.PubMed
19.
go back to reference Erlandson KM, Karris MY. HIV and aging: reconsidering the approach to management of comorbidities. Infect Dis Clin N Am. 2019;33(3):769–86. Erlandson KM, Karris MY. HIV and aging: reconsidering the approach to management of comorbidities. Infect Dis Clin N Am. 2019;33(3):769–86.
20.
go back to reference Collaboration ATC. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):e349–e356356. Collaboration ATC. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):e349–e356356.
21.
go back to reference Brooks JT, Buchacz K, Gebo KA, Mermin J. HIV infection and older Americans: the public health perspective. Am J Public Health. 2012;102(8):1516–26.PubMedPubMedCentral Brooks JT, Buchacz K, Gebo KA, Mermin J. HIV infection and older Americans: the public health perspective. Am J Public Health. 2012;102(8):1516–26.PubMedPubMedCentral
23.
go back to reference Duffau P, Ozanne A, Bonnet F, Lazaro E, Cazanave C, Blanco P, et al. Multimorbidity, age-related comorbidities and mortality: association of activation, senescence and inflammation markers in HIV adults. AIDS Lond Engl. 2018;32(12):1651–60. Duffau P, Ozanne A, Bonnet F, Lazaro E, Cazanave C, Blanco P, et al. Multimorbidity, age-related comorbidities and mortality: association of activation, senescence and inflammation markers in HIV adults. AIDS Lond Engl. 2018;32(12):1651–60.
24.
go back to reference Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Circulation. 2018;138(11):1100–12.PubMedPubMedCentral Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Clifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Circulation. 2018;138(11):1100–12.PubMedPubMedCentral
25.
go back to reference Shiau S, Broun EC, Arpadi SM, Yin MT. Incident fractures in HIV-infected individuals: a systematic review and meta-analysis. AIDS Lond Engl. 2013;27(12):1949–57. Shiau S, Broun EC, Arpadi SM, Yin MT. Incident fractures in HIV-infected individuals: a systematic review and meta-analysis. AIDS Lond Engl. 2013;27(12):1949–57.
26.
go back to reference Heckman TG, Halkitis PN. Biopsychosocial aspects of HIV and aging. Behav Med Wash DC. 2014;40(3):81–4. Heckman TG, Halkitis PN. Biopsychosocial aspects of HIV and aging. Behav Med Wash DC. 2014;40(3):81–4.
29.
go back to reference Guo W, Weng HL, Bai H, Liu J, Wei XN, Zhou K, et al. Quick community survey on the impact of COVID-19 outbreak for the healthcare of people living with HIV. Zhonghua Liu Xing Bing Xue Za Zhi Zhonghua Liuxingbingxue Zazhi. 2020;41(5):663–7. Guo W, Weng HL, Bai H, Liu J, Wei XN, Zhou K, et al. Quick community survey on the impact of COVID-19 outbreak for the healthcare of people living with HIV. Zhonghua Liu Xing Bing Xue Za Zhi Zhonghua Liuxingbingxue Zazhi. 2020;41(5):663–7.
30.
go back to reference Joob B, Wiwanitkit V. SARS-CoV-2 and HIV. J Med Virol. 2020 Mar 27; Joob B, Wiwanitkit V. SARS-CoV-2 and HIV. J Med Virol. 2020 Mar 27;
31.
go back to reference Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet Lond Engl. 2017;389(10072):951–63. Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet Lond Engl. 2017;389(10072):951–63.
32.
go back to reference Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.PubMedPubMedCentral Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.PubMedPubMedCentral
33.
go back to reference CDCMMWR. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2019;69:343–6. CDCMMWR. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19)—United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep. 2019;69:343–6.
35.
go back to reference Mimiaga MJ, O’Cleirigh C, Biello KB, Robertson AM, Safren SA, Coates TJ, et al. The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr. 1999;68(3):329–36. Mimiaga MJ, O’Cleirigh C, Biello KB, Robertson AM, Safren SA, Coates TJ, et al. The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr. 1999;68(3):329–36.
36.
go back to reference Dolder CR, Patterson TL, Jeste DV. HIV, psychosis and aging: past, present and future. AIDS Lond Engl. 2004;18(Suppl 1):S35–42. Dolder CR, Patterson TL, Jeste DV. HIV, psychosis and aging: past, present and future. AIDS Lond Engl. 2004;18(Suppl 1):S35–42.
37.
go back to reference Do AN, Rosenberg ES, Sullivan PS, Beer L, Strine TW, Schulden JD, et al. Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system. PLoS ONE. 2014;9(3):e92842.PubMedPubMedCentral Do AN, Rosenberg ES, Sullivan PS, Beer L, Strine TW, Schulden JD, et al. Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system. PLoS ONE. 2014;9(3):e92842.PubMedPubMedCentral
38.
go back to reference Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.PubMed Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.PubMed
39.
go back to reference Halkitis PN. Bridging the gap: public health psychology mends the chasm between clinical/medical care and public/population health. (In Press). Am Psychol. 2020; Halkitis PN. Bridging the gap: public health psychology mends the chasm between clinical/medical care and public/population health. (In Press). Am Psychol. 2020;
40.
go back to reference Wang Y, Wang Z, Jia M, Liang A, Yuan D, Sun Z, et al. Association between a syndemic of psychosocial problems and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis. 2017;17(1):46.PubMedPubMedCentral Wang Y, Wang Z, Jia M, Liang A, Yuan D, Sun Z, et al. Association between a syndemic of psychosocial problems and unprotected anal intercourse among men who have sex with men in Shanghai, China. BMC Infect Dis. 2017;17(1):46.PubMedPubMedCentral
41.
go back to reference Operario D, Yang M-F, Reisner SL, Iwamoto M, Nemoto T. Stigma and the Syndemic of Hiv-Related Health Risk Behaviors in a Diverse Sample of Transgender Women. J Community Psychol. 2014;42(5):544–57. Operario D, Yang M-F, Reisner SL, Iwamoto M, Nemoto T. Stigma and the Syndemic of Hiv-Related Health Risk Behaviors in a Diverse Sample of Transgender Women. J Community Psychol. 2014;42(5):544–57.
42.
go back to reference Singer MC, Erickson PI, Badiane L, Diaz R, Ortiz D, Abraham T, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med 1982. 2006;63(8):2010–21. Singer MC, Erickson PI, Badiane L, Diaz R, Ortiz D, Abraham T, et al. Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Soc Sci Med 1982. 2006;63(8):2010–21.
43.
go back to reference Halkitis PN, Krause KD, Vieira DL. Mental health, psychosocial challenges and resilience in older adults living with HIV. Interdiscip Top Gerontol Geriatr. 2017;42:187–203.PubMed Halkitis PN, Krause KD, Vieira DL. Mental health, psychosocial challenges and resilience in older adults living with HIV. Interdiscip Top Gerontol Geriatr. 2017;42:187–203.PubMed
44.
go back to reference Shippy RA, Karpiak SE. The aging HIV/AIDS population: fragile social networks. Aging Ment Health. 2005;9(3):246–54.PubMed Shippy RA, Karpiak SE. The aging HIV/AIDS population: fragile social networks. Aging Ment Health. 2005;9(3):246–54.PubMed
45.
go back to reference Perissinotto C, Holt-Lunstad J, Periyakoil VS, Covinsky K. A Practical approach to assessing and mitigating loneliness and isolation in older adults. J Am Geriatr Soc. 2019;67(4):657–62.PubMed Perissinotto C, Holt-Lunstad J, Periyakoil VS, Covinsky K. A Practical approach to assessing and mitigating loneliness and isolation in older adults. J Am Geriatr Soc. 2019;67(4):657–62.PubMed
46.
go back to reference Halkitis P, D’Avanzo P, Stults C, Levy M, Krause K, Kupprat S, et al. Neurocognitive functioning in an urban clinic-based sample of adults ages 50 and older living with HIV. J HIVAIDS Soc Serv. 2016;15:1–22. Halkitis P, D’Avanzo P, Stults C, Levy M, Krause K, Kupprat S, et al. Neurocognitive functioning in an urban clinic-based sample of adults ages 50 and older living with HIV. J HIVAIDS Soc Serv. 2016;15:1–22.
47.
go back to reference Cao J, Tu W-J, Cheng W, Yu L, Liu Y-K, Hu X, et al. Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clin Infect Dis Off Publ Infect Dis Soc Am. 2020 Cao J, Tu W-J, Cheng W, Yu L, Liu Y-K, Hu X, et al. Clinical Features and Short-term Outcomes of 102 Patients with Corona Virus Disease 2019 in Wuhan, China. Clin Infect Dis Off Publ Infect Dis Soc Am. 2020
49.
go back to reference Willen SS, Knipper M, Abadía-Barrero CE, Davidovitch N. Syndemic vulnerability and the right to health. Lancet Lond Engl. 2017;389(10072):964–77. Willen SS, Knipper M, Abadía-Barrero CE, Davidovitch N. Syndemic vulnerability and the right to health. Lancet Lond Engl. 2017;389(10072):964–77.
50.
go back to reference The Lancet Hiv null. The syndemic threat of food insecurity and HIV. Lancet HIV. 2020;7(2):e75. The Lancet Hiv null. The syndemic threat of food insecurity and HIV. Lancet HIV. 2020;7(2):e75.
51.
go back to reference Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2018;320(4):379–96.PubMedPubMedCentral Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2018;320(4):379–96.PubMedPubMedCentral
52.
go back to reference Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57(8):1164–71. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57(8):1164–71.
53.
go back to reference Halkitis PN, Kutnick AH, Rosof E, Slater S, Parsons JT. Adherence to HIV medications in a cohort of men who have sex with men: impact of September 11th. J Urban Health Bull N Y Acad Med. 2003;80(1):161–6. Halkitis PN, Kutnick AH, Rosof E, Slater S, Parsons JT. Adherence to HIV medications in a cohort of men who have sex with men: impact of September 11th. J Urban Health Bull N Y Acad Med. 2003;80(1):161–6.
56.
go back to reference Elvstam O, Medstrand P, Yilmaz A, Isberg P-E, Gisslén M, Björkman P. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment. PLoS ONE. 2017;12(7):e0180761.PubMedPubMedCentral Elvstam O, Medstrand P, Yilmaz A, Isberg P-E, Gisslén M, Björkman P. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment. PLoS ONE. 2017;12(7):e0180761.PubMedPubMedCentral
57.
go back to reference Gray ES, Madiga MC, Hermanus T, Moore PL, Wibmer CK, Tumba NL, et al. The neutralization breadth of HIV-1 develops incrementally over four years and is associated with CD4+ T cell decline and high viral load during acute infection. J Virol. 2011;85(10):4828–40.PubMedPubMedCentral Gray ES, Madiga MC, Hermanus T, Moore PL, Wibmer CK, Tumba NL, et al. The neutralization breadth of HIV-1 develops incrementally over four years and is associated with CD4+ T cell decline and high viral load during acute infection. J Virol. 2011;85(10):4828–40.PubMedPubMedCentral
58.
go back to reference Jones LE, Perelson AS. Transient viremia, plasma viral load, and reservoir replenishment in HIV-infected patients on antiretroviral therapy. J Acquir Immune Defic Syndr 1999. 2007;45(5):483–93. Jones LE, Perelson AS. Transient viremia, plasma viral load, and reservoir replenishment in HIV-infected patients on antiretroviral therapy. J Acquir Immune Defic Syndr 1999. 2007;45(5):483–93.
60.
go back to reference Marhefka S, Lockhart E, Turner D. Achieve research continuity during social distancing by rapidly implementing individual and group videoconferencing with participants: key considerations, best practices, and protocols. AIDS Behav. 2020 Marhefka S, Lockhart E, Turner D. Achieve research continuity during social distancing by rapidly implementing individual and group videoconferencing with participants: key considerations, best practices, and protocols. AIDS Behav. 2020
61.
go back to reference Gogia SB, Maeder A, Mars M, Hartvigsen G, Basu A, Abbott P. Unintended consequences of tele health and their possible solutions. Contribution of the IMIA Working Group on Telehealth. Yearb Med Inform. 2016;25(1):41–6. Gogia SB, Maeder A, Mars M, Hartvigsen G, Basu A, Abbott P. Unintended consequences of tele health and their possible solutions. Contribution of the IMIA Working Group on Telehealth. Yearb Med Inform. 2016;25(1):41–6.
64.
go back to reference Martinez MA. Compounds with therapeutic potential against novel respiratory 2019 coronavirus. Antimicrob Agents Chemother. 2020 Martinez MA. Compounds with therapeutic potential against novel respiratory 2019 coronavirus. Antimicrob Agents Chemother. 2020
Metadata
Title
The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective
Authors
Stephanie Shiau
Kristen D. Krause
Pamela Valera
Shobha Swaminathan
Perry N. Halkitis
Publication date
01-08-2020
Publisher
Springer US
Published in
AIDS and Behavior / Issue 8/2020
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-020-02871-9

Other articles of this Issue 8/2020

AIDS and Behavior 8/2020 Go to the issue