Social and behavioral health responses to COVID-19: lessons learned from four decades of an HIV pandemic

Factors influencing CDC- recommended preventative behaviors through the COVID-19 pandemic in college students

Objective: To understand how student perceptions of physical health and generalized concern about infection influenced engagement in COVID-19 preventive behaviors. Participants: 418 full-time undergraduate and graduate students attending a public university in South Carolina, USA. Methods: A self-administered survey was distributed during the 2020-2021 academic year. The health belief model, structural equation modeling, and regression methods were used to evaluate associations between students' perceived physical health and the use of CDC-recommended mitigation strategies. Results: Our findings suggest that an individual's perception of their own physical health impacted engagement in preventive behaviors by influencing concerns about disease severity (p = 0.01) and susceptibility (p = 0.03). However, perceived physical health was not associated with perceived benefits (p = 0.21), barriers (p = 0.57), or self-efficacy (p = 0.62) of mitigation strategies. Conclusions: Intrapersonal factors may play a strong role in the way a student undertakes disease control and prevention.

Strengthening COVID-19 vaccine confidence & demand during the US COVID-19 emergency response

In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses.

Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders

Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.

UK media responses to HIV through the lens of COVID-19: a study of multidirectional memory

This article proposes correlations and parallels in UK newsprint media coverage of the COVID-19 and HIV/AIDS pandemics through engagement with Michael Rothberg's model of multidirectional memory. It achieves this via qualitative and quantitative analysis of newsprint media during selected timelines of the respective outbreaks. Although the COVID-19 outbreak, which originated in Wuhan, China in 2019 and spread globally, has prompted reference to a number of previous traumatic events, including 9/11 and the Holocaust, one might contend that it correlates most closely with HIV/AIDS given the latter's ongoing nature and worldwide reach. COVID-19, having infected 629 million people since December 2019 with 6.5 million deaths by November 2022, still presents a global threat through which we might read the trauma of HIV, a disease that has thus far seen 32.7 million deaths and has infected 75.7 million people worldwide. This relationship exists despite the fact that the two viruses and their effects differ markedly: HIV is a retrovirus, has a long incubation time, is transmitted via bodily fluids, has a low risk of infectivity via everyday contact and, to date, no fully effective vaccine has been developed. Contrastingly, COVID-19 is a coronavirus, has a short incubation time, is transmitted via contact and airborne respiratory aerosols, has a high risk of infectivity via everyday contact, and investment in vaccine development has been significant, with several vaccines now successfully developed. Nonetheless, while the two viruses and their prognoses are quite different and government strategies have followed highly divergent trajectories, certain parallels are apparent to the extent that one might read HIV/AIDS through the lens of COVID-19. It is therefore argued here that the connections between these two traumatic events constitute what Rothberg terms 'multidirectional memory' whereby we understand one traumatic event through another.

The design and psychometric evaluation of a COVID-19 social stigma questionnaire in nurses

BACKGROUND

The patient's fear of social reactions, the disease stigma, and being a transmission agent is a psychological and social consequence of contracting some diseases, especially infectious ones, in any society. The present study aimed to design and psychometrically evaluate a COVID-19 social stigma questionnaire in nurses.

METHODS

This mixed-method study was conducted using a sequential exploratory approach according to the Creswell method in Mazandaran Province (Iran) during 2021-22. The study was performed in three phases: (1) a qualitative phase to explain the key concept, (2) designing the scale items, and (3) an experimental phase with the scale psychometric evaluation. In the first phase, nurses' experiences regarding the concept of COVID-19 social stigma were evaluated using a qualitative method with an inductive qualitative content analysis approach. In this phase, the lived experiences of 12 nurses working at hospitals of Babol University of Medical Sciences were extracted through in-depth interviews with semi-structured questions and analyzed by conventional content analysis. The main classes are contradictory feelings, rejection, and adaptation strategies. In the second phase, the designed items were validated by determining face validity, content validity, and construct validity using exploratory factor analysis (EFA). In addition, the scale's reliability was determined through internal consistency and stability.

RESULTS

Following the study's first phase, a pool of questions with 64 initial items was formed. After evaluating face and content validity, the number of items was reduced to 24 cases. An excellent total content validity (S-CVI/Ave) of 0.93 was calculated for the scale. According to EFA outputs, three factors accounted for the most variance (52.82%), and four items were excluded in this phase. The Kaiser-Meyer-Olkin (KMO) statistic and Bartlett's test of sphericity were calculated at 0.776 and P < 0.001, respectively. The results of Cronbach's alpha (0.796) and intraclass correlation (0.793) indicated the correlation and internal consistency of the scale.

CONCLUSION

This scale can help healthcare managers and policymakers apply necessary protective measures by evaluating the social stigma of COVID-19 in nurses and emerging infectious diseases that may occur in the future.

The role of the social sciences and humanities in pandemic preparedness responses: insights gained from COVID-19, HIV and AIDS and related epidemics

The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations (e.g. adolescent girls and young women) who are the focus of these programmes and - as importantly but less well-documented - the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during "lockdowns"). The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic (e.g. wide-spread surveillance coupled with rapid updates on the epidemiology of infections, rapid development of vaccines and revisions of treatment). However, drawing upon the widespread criticisms of state responses to the socio-economic effects of the COVID-19 pandemic and of "lockdowns" themselves, this article elaborates a core argument within those criticisms, namely that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. Our critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses. At root, we re-assert a key value of 'integrated' interventions, namely the accommodation of context-sensitive considerations in the formulation of strategies, policies, plans and programme designs.

Is experience of the HIV/AIDS epidemic associated with responses to COVID-19? Evidence from the Rural Malawi

INTRODUCTION

Starting in late 2019, the coronavirus "SARS-CoV-2", which causes the disease Covid-19, spread rapidly and extensively. Although many have speculated that prior experience with infectious diseases like HIV/AIDS, Ebola, or SARS would better prepare populations in sub-Saharan Africa for COVID-19, this has not been formally tested, primarily due to data limitations.

METHODS

We use longitudinal panel data from the Malawi Longitudinal Study of Families and Health (MLSFH, waves 2006, 2008, and 2020) to examine the association between exposure to the HIV/AIDS epidemic and perceptions of, and behavioral response to, the COVID-19 pandemic. We measured exposure to HIV infection through perceived prevalence of HIV/AIDS in the community, worry about HIV infection, perceived likelihood of HIV infection, and actual HIV status; and the experience of HIV/AIDS-related mortality through self-reports of knowing members of the community and extended family who died from AIDS (measured in 2006 or 2008). Our outcome measures were perceptions of COVID-19 presence in the community, perceptions of individual vulnerability to COVID-19, and prevention strategies to avoid COVID-19 collected through phone-interviews in 2020.

RESULTS

Based on our data analysis using multivariable regression models, we found that the experience of HIV-related mortality was positively associated with perceptions of COVID-19 prevalence in the community and preventive behaviors for COVID-19. However, perceived vulnerability to HIV-AIDS infection and actual HIV positive status 10-years prior to the COVID-19 pandemic are generally not associated with COVID-19 perceptions and behaviors.

CONCLUSIONS

Our results suggest that COVID-19-related behaviors are impacted more by experience of AIDS mortality instead of HIV/AIDS risk perceptions, and that individuals may be correctly viewing HIV/AIDS and COVID-19 transmission as distinct disease processes.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

HIV policy legacies, pandemic preparedness and policy effort to address COVID-19

That the world was unprepared for a major infectious disease outbreak is now readily apparent to all credible observers. However, some countries were more prepared than others and we have seen a variety of responses to COVID-19 emerge across nations. While recognizing that the sources of variation in country responses to COVID-19 are many and varied, in this study we seek to examine how policy legacies from national responses to HIV have influenced countries' responses to COVID-19. The aim of this study was to examine whether countries with a more conducive HIV policy environment were better prepared for COVID-19 and have therefore had more preemptive and rights-based responses. Using data from the Oxford Covid-19 Government Response Tracker, we develop measures of country effort to respond to COVID-19 including early containment and closure policies, prevention policies, economic policies, and health system policies. We combine this with data from the HIV Policy Lab and correlate overall and disaggregated country HIV Policy scores with COVID-19 Policy scores. We find that the COVID-19 Containment and Closure Measures Index was negatively correlated with supportive social policies related to HIV in the early stages of the pandemic, but the association did not persist as time went on. The COVID-19 Economic Support Measures had prolonged positive associations with supportive social policies related to HIV and negative association with clinical and treatment policies. Countries with stronger structural responses to HIV have been less inclined towards involuntary measures and more prepared for the social and economic elements of COVID-19 pandemic response.

COVID-19-related stigma among infected people in Sweden; psychometric properties and levels of stigma in two cohorts as measured by a COVID-19 stigma scale

BACKGROUND

Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event.

METHODS

Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach's α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test.

RESULTS

The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19-80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26-79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3-12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma.

CONCLUSIONS

The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV.

Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

BACKGROUND

While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White).

METHOD

Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month.

RESULTS

The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3).

CONCLUSION

Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.

Measuring social resilience in cities: An exploratory spatio-temporal analysis of activity routines in urban spaces during Covid-19

Covid-19 has dramatically changed life in cities across the globe. What remains uncertain is how national policies and appeals to comply with suggested rules translate to changes in the behaviour of citizens in urban areas. This lack of local knowledge leaves urban policy makers and planners with few clues as to the determinants of social resilience in cities during protracted crises like a pandemic. Methods are required to measure the capacity of people to conduct routine activities without risking exposure to a prevalent disease, particularly for those most vulnerable during a health crisis. By spanning the fields of urban resilience, human geography, mobility studies and the behavioural sciences, this study explores how to measure social resilience in cities during a protracted crisis. Using a public participation GIS online platform, we observe changes in citizen behaviour within urban spaces during the Covid-19 pandemic. Inhabitants from three districts of a Dutch city mapped their activity routines during the lockdown period and during the year before the pandemic. Spatio-temporal analysis reveals changes in the clustering of activities into what we describe as 'activity bubbles'. We reflect on the influence of the urban space on these changes and assess the contribution of this exploratory research methodology for gaining insights into behavioural change. Implications for urban planning and resilience theory are discussed.

Learning from community-based HIV prevention to inform control and mitigation of the COVID-19 pandemic

The current COVID-19 pandemic and the likelihood of future viral pandemics demonstrate a need for strategic prevention campaigns that integrate biomedical, structural, and behavioral interventions within larger scale comprehensive public health initiatives. In Human Immunodeficiency Virus (HIV) prevention, community-based efforts have resulted in reductions in transmission rates, increases in testing, increases in biomedical prevention uptake, and increased engagement in secondary and tertiary prevention efforts. In this paper, we review three community-based strategies (health communication, accessible screening, and accessible prevention resources) that have demonstrated effectiveness in HIV prevention and offer recommendations for utilizing these strategies in the COVID-19 pandemic. For example, health communication strategies have positively influenced HIV testing behavior, sex communication, and condom use among HIV negative individuals and treatment initiation, treatment adherence, and retention in care among people living with HIV. In addition, studies have shown that improving accessibility of HIV screening and prevention resources in community venues such as schools, pharmacies, mobile-testing sites, churches, hair salons, and bars is useful for increasing the uptake of HIV testing, especially among disproportionately affected populations and those deemed hard to reach. Despite differences in modes of transmission, it is plausible that a synergistic multilevel response with emphasis on community-based efforts could lead to similar outcomes for the current COVID-19 pandemic and future viral pandemics. Community-based prevention strategies offer an opportunity to integrate, and bolster disconnected and siloed initiatives that achieve limited impacts independently.

Archiving the COVID-19 pandemic in Mass Observation and Middletown

The COVID-19 pandemic generated debates about how pandemics should be known. There was much discussion of what role the human sciences could play in knowing - and governing - the pandemic. In this article, we focus on attempts to know the pandemic through diaries, other biographical writing, and related forms like mass photography. In particular, we focus on the archiving of such forms by Mass Observation in the UK and the Everyday Life in Middletown (EDLM) project in the USA, and initial analyses of such material by scholars from across the human sciences. Our main argument is that archiving the pandemic was informed by, and needs viewing through, the history of the human sciences - including the distinctive histories and human sciences of Mass Observation and Middletown. The article finishes by introducing a Special Section that engages with archiving the pandemic in two senses: the archiving of diaries and related forms by Mass Observation and the EDLM project, and the archiving of initial encounters between researchers and this material by History of the Human Sciences. The Special Section seeks to know the pandemic from the human sciences in the present and to archive knowing the pandemic from the human sciences for the future.

Adaptation and Utilization of a Postmarket Evaluation Model for Digital Contact Tracing Mobile Health Tools in the United States: Observational Cross-sectional Study

BACKGROUND

Case investigation and contact tracing are core public health activities used to interrupt disease transmission. These activities are traditionally conducted manually. During periods of high COVID-19 incidence, US health departments were unable to scale up case management staff to deliver effective and timely contact-tracing services. In response, digital contact tracing (DCT) apps for mobile phones were introduced to automate these activities. DCT apps detect when other DCT users are close enough to transmit COVID-19 and enable alerts to notify users of potential disease exposure. These apps were deployed quickly during the pandemic without an opportunity to conduct experiments to determine effectiveness. However, it is unclear whether these apps can effectively supplement understaffed manual contact tracers.

OBJECTIVE

The aims of this study were to (1) evaluate the effectiveness of COVID-19 DCT apps deployed in the United States during the COVID-19 pandemic and (2) determine if there is sufficient DCT adoption and interest in adoption to meet a minimum population use rate to be effective (56%). To assess uptake, interest and safe use covariates were derived from evaluating DCTs using the American Psychological Association App Evaluation Model (AEM) framework.

METHODS

We analyzed data from a nationally representative survey of US adults about their COVID-19-related behaviors and experiences. Survey respondents were divided into three segments: those who adopted a DCT app, those who are interested but did not adopt, and those not interested. Descriptive statistics were used to characterize factors of the three groups. Multivariable logistic regression models were used to analyze the characteristics of segments adopting and interested in DCT apps against AEM framework covariates.

RESULTS

An insufficient percentage of the population adopted or was interested in DCTs to achieve our minimum national target effectiveness rate (56%). A total of 17.4% (n=490) of the study population reported adopting a DCT app, 24.7% (n=697) reported interest, and 58.0% (n=1637) were not interested. Younger, high-income, and uninsured individuals were more likely to adopt a DCT app. In contrast, people in fair to poor health were interested in DCT apps but did not adopt them. App adoption was positively associated with visiting friends and family outside the home (odds ratio [OR] 1.63, 95% CI 1.28-2.09), not wearing masks (OR 0.52, 95% CI 0.38-0.71), and adopters thinking they have or had COVID-19 (OR 1.60, 95% CI 1.21-2.12).

CONCLUSIONS

Overall, a small percentage of the population adopted DCT apps. These apps may not be effective in protecting adopters' friends and family from their maskless contacts outside the home given low adoption rates. The public health community should account for safe use behavioral factors in future public health contact-tracing app design. The AEM framework was useful in developing a study design to evaluate DCT effectiveness and safety.

Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population

Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

Love in the Time of COVID-19: The Social Dimensions of Intimate Life under Lockdown

Although popular media across the United States reported that the coronavirus disease 2019 COVID pandemic incited dramatic transformations in personal relationships, identities, and practices, little sociological research examines these developments. What exists elaborates the "how" and "how much" of sex, the frequency of sexual conduct, and changes in the patterning of sexual behavior. In this study of the intimate trajectories of 46 young adults, conducted during the height of U.S. quarantine restrictions in 2020 and early 2021, the authors explore the "whys" of sex. They find that the exogenous force of the pandemic profoundly altered individual relationship trajectories, prompted sexual introspection projects, shifted understandings of sexual risk, and promoted new modes of intimacy. These findings suggest that pandemic life reached deep into subjective self-understandings and ways of relating to others. They also reveal the benefits of foregrounding cultural meanings over behaviors, changes in thoughts over actions, and social processes over individual outcomes.

"Everything…Fell Apart Once COVID-19 Hit"-Leveraging the COVID-19 Response to Strengthen Public Health Activities toward Ending the HIV Epidemic: A Qualitative Study

COVID-19 caused widespread disruption of activities for Ending the HIV Epidemic (EHE). In this study we assessed public health perspectives on leveraging the COVID-19 response to advance the goals of EHE. We conducted a qualitative study with 33 public health partners in the Midwestern and Southern United States from October 2020 to February 2022. Participants were asked how the strategies developed for COVID-19 could be applied to the HIV epidemic. Interviews were recorded, transcribed, and examined using rapid qualitative analysis. Four themes emerged: (1) Rebuilding teams and adapting culture for success in EHE activities; (2) Recognizing and modernizing the role of disease intervention specialists (DIS); (3) Enhanced community awareness of the public health role in disease response and prevention; and (4) Leveraging COVID-19 data systems and infrastructure for EHE activities. The COVID-19 pandemic called attention to the dearth of public health funding and outdated information technology (IT) infrastructure used for HIV activities. It also led to greater public health knowledge, including increased familiarity with partner services and molecular epidemiology of HIV, and opportunities to develop new data systems for surveillance that can be applied to efforts for EHE.

Examining four types of anti-vaccination attitudes prior to and during the COVID-19 pandemic

People hold different anti-vaccination attitudes. Having an understanding of how these attitudes have changed prior to and during the COVID-19 pandemic is critical for combatting anti-vaccination attitudes and increasing vaccine intention and uptake. Data were collected from different samples in the United States at three time points prior to (n = 840) and four time points during (n = 1543) the pandemic. All participants completed a multi-dimensional measure of anti-vaccination attitudes (VAX Scale) through an online platform. Results showed that, when it comes to vaccines, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity were higher during the COVID-19 pandemic than they were prior to it. However, mistrust of vaccine benefit was lower during the COVID-19 pandemic than prior to it. These differences were found even after controlling for the potential effects of participant sex, education, socioeconomic status, age, and race/ethnicity. Additionally, worries about unforeseen side effects, concerns about commercial profiteering, and preference for natural immunity increased linearly alongside the persistence of COVID-19; whereas, mistrust of vaccine benefit showed no change. Although it might be intuitive to emphasize vaccines' effectiveness to increase uptake, the public's trust in vaccine effectiveness did not appear to be the major concern. Thus, public health efforts to increase uptake of vaccines should also focus on reducing concerns about potential side effects from the vaccine, tempering the attention on financial benefits to pharmaceutical companies, and rebuffing the overreliance on natural immunity.

Factors of COVID-19 Vaccination among Hong Kong Chinese Men Who Have Sex with Men during Months 5–8 since the Vaccine Rollout—General Factors and Factors Specific to This Population

This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.

Integrated primary care behavioural health in a regional network of FQHC agencies during COVID-19

Objectives

(1) Examine the ability to sustain integrated primary care behavioural health (eg, colocation, communication and coordination) in 40 community health centres, during the COVID-19 pandemic and (2) review adaptations and challenges to provide integrated behavioural health via telehealth.

Methods and analysis

This qualitative investigation assessed 55 behavioural health consultants (BHCs), via semistructured interviews, spanning 40 practice sites and 10 organisations, on their adjustment to telehealth delivery, modified practice workflows and challenges of maintaining integration while displaced by the pandemic. Assessment of the level of integrated care was also conducted with available semistructured tools

Results

The results highlight rapid service adjustment, positive patient and provider satisfaction, increased but lowered ratings of remote BHC integration and collaboration with the primary care teams and reduced behavioural health screening, compared with prepandemic levels. This investigation also highlights the co-occurring importance of racial disparities and injustice in patient care. In several settings, BHCs had a significant support role for staff self-care.

Conclusion

The COVID-19 pandemic, and its subsequent shelter-in-place mandates and telehealth care provision, has altered standard integrated behavioural health practice, yet harnessed the accessible, generalist and team-based spirit to meet the increasing behavioural health needs in this community.

Ethnolinguistic diversity and the spread of communicable diseases: a cross-country study on the COVID-19 pandemic

Motivated by the varying effectiveness of government intervention policies to contain the COVID-19 pandemic, and the potential positive relationship between ethnolinguistic diversity and social distance, this paper aims to provide empirical evidence on the relationship between ethnolinguistic diversity and the spread of COVID-19. In particular, using global data from 113 developed and developing countries during the early stages of the pandemic (from 31 December 2019 to 8 July 2020), we have found a significant negative effect of ethnolinguistic diversity on the spread of the virus. The result is robust to alternative measures of ethnolinguistic diversity and estimator that addresses endogeneity. Moreover, we also show that the impact of ethnolinguistic diversity on the spread of COVID-19 differs in economies characterized by different levels of democracy, policy stringency on addressing COVID-19 and health expenditure.

Spatial Analysis of Socio-Economic Vulnerability in COVID-19 Handling: Strategies for the Development of Smart Society and Smart Economy

Sleman Regency has always had an increasing and highest rate of COVID-19 cases in the Special Region of Yogyakarta, Indonesia. One of the implementations of a smart city in some cities and regencies is an appropriate strategy in handling the COVID-19 pandemic. This study aims to analyze the level of socio-economic vulnerability during the COVID-19 pandemic, compile a village typology based on the level of vulnerability, and explore the strategies of smart society and smart economy in handling COVID-19. This study used a mixed method with a sequential explanatory design. The results show that the high level of socio-economic vulnerability can be found in urban areas, while the low and moderate ones dominate in rural areas or the northern region of Sleman Regency. The pattern of socio-economic vulnerability levels is clustered, resulting in eight village typologies. The COVID-19 handling through a smart society and smart economy does not spatially consider aspects of socio-economic vulnerability, but implicitly adjusts the needs and problems of the community. Strategies for managing socio-economic vulnerabilities during the COVID-19 pandemic in the implementation of smart society and smart economy are bringing services closer to the community, shifting services to digital, increasing application features, and increasing community capacity through training.

Predicting preventive travel behaviors under the COVID-19 pandemic through an integration of Health Belief Model and Value-Belief-Norm

This study developed a conceptual framework for a preventive travel decision-making process amidst the COVID-19 pandemic, combining the Health Belief Model (HBM) and Value-Belief-Norm (VBN). Analyzing 409 responses collected from an online survey, this study verified the integrated model as a salient theory addressing the importance of social components and health belief factors in affecting behavior. The model revealed that altruistic value influences the HBM variables, whereas personal norms mediate preventive behaviors and beliefs in both VBN and HBM. These findings offer new theoretical insights into decision-making process and provide practitioners with effective crisis management strategies concerning pro-social and health beliefs.

Behavioral Medicine in the COVID-19 Era: Dawn of the Golden Age

(Reprinted from Ann Behav Med 2020; 54:541-543, with permission from Oxford University Press).

Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study

Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.

Ecological Model Explaining the Psychosocial Adaptation to COVID-19

The main objective of this study is to understand and characterize the adoption of an ecological perspective and the physical, psychological, social, and contextual health factors that may influence the adjustment to and mental health experiences during the COVID-19 pandemic. The study included 5479 participants, of which 3710 were female (67.7%), aged between 18 and 90 years old, with a mean age of 48.57 years (SD = 14.29), were considered three age groups: 21.5% up to 35 years old, 61.8% between 36 and 64 years old, and 16.7% 65 years old or more. The mental health and individual adjustment to the COVID-19 situation are explained by socio-demographic factors, health-related factors, lifestyles, attitudes and behaviors, lockdown experience, and place of residence. A better adaptation and mental health are observed among men, people with a higher educational level, people with lower sadness, nervousness, and burnout, and people whose health situation did not worsen with the pandemic. In terms of lifestyle, a better adaptation is related to a better quality of sleep, fewer nightmares, a higher practice of physical activity, and less consumption of processed foods and sweets. A better adaptation is also associated with lower levels of dependence on alcohol, TV, and SN (social networks) and a more positive experience of the lockdown imposed by the pandemic. Gender and age group differences in the described context were studied. Promoting a better adjustment and improved mental health when dealing with the COVID-19 requires an ecological understanding and multitarget interventions, targeting physical, mental, and social health together with the contextual environment.

SARS-CoV-2 Infection in Iranian People Living with Human Immunodeficiency Virus-1 Infection

Background: A novel Coronavirus first emerging in Wuhan, China, was named severe acute respiratory syndrome Coronavirus 2 (SARS‐CoV‐2). The disease caused by SARS‐CoV‐2 is known as Coronavirus disease 2019 (COVID‐19). HIV-1 infected individuals may be at risk of COVID-19. Objectives: This cross-sectional study evaluated the SARS-CoV-2 infection rate and COVID-19 prevalence among Iranian HIV-1-infected people. Methods: The study was conducted on 155 HIV-1-infected patients from June 2020 to October 2020. COVID-19 Ab (IgG) was detected using an enzyme immunoassay in serum specimens. Furthermore, nasopharyngeal and oropharyngeal specimens were collected. Then, the genomic RNA of SARS‐CoV‐2 was detected using a real-time polymerase chain reaction (RT-PCR). Clinical symptoms of the studied participants with and without COVID-19 were examined. Results: Of 155 HIV-1-infected individuals, 12 (7.7%) had positive real-time PCR results for SARS-CoV-2. Out of 12 (7.7%) patients with COVID‐19, four (33.3%) were males. Anti-COVID Ab (IgG) was detected in 10 (6.5%) participants, of whom eight (80.0%) were males. The most common COVID-19 clinical symptoms, including dry cough, fever, runny nose, anosmia, and hypogeusia, were observed in seven (58.3%), five (41.7%), five (41.7%), five (41.7%), and five (41.7%) patients with COVID-19, respectively. Conclusions: A recent study has shown that the risk of SARS‐CoV‐2 infection in HIV-infected individuals is similar to that in the general population.

Social Determinants of Disease: HIV and COVID-19 Experiences

PURPOSE OF REVIEW

The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis.

RECENT FINDINGS

With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.

Partners' Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners' agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners' consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B = 0.23; p = .001) and the number of other COVID-19 prevention behaviors engaged in (B = 0.17; p = .003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B = 0.40; p = .029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

Policing the pandemic: Estimating spatial and racialized inequities in New York City police enforcement of COVID-19 mandates

The use of policing to enforce public health guidelines has historically produced harmful consequences, and early evidence from the police enforcement of COVID-19 mandates suggested Black New Yorkers were disproportionately represented in arrests. The over-policing of Black and low-income neighborhoods during a pandemic risks increased transmission, potentially exacerbating existing health inequities. To assess racialized and class-based inequities in the enforcement of COVID-19 mandates at the ZIP-code-level, we conducted a retrospective spatial analysis of demographic factors and public health policing in New York City from March 12-May 24, 2020. Policing outcomes (COVID-19 criminal court summonses and public health and nuisance arrests) were measured using publicly available police administrative data. After controlling for two measures of social distancing compliance, a standard deviation increase in percentage of Black residents was associated with a 73% increase (95% CI: 35%, 123%) in the COVID-19-specific summons rate and a 34% increase (95% CI: 17%, 53%) in the public health and nuisance arrest rate. Percentage of Black residents and historical stop-and-frisk rates had stronger associations with COVID-19 summons rates than multiple measures of social distancing compliance. Findings demonstrate pronounced spatial and racialized inequities in pandemic policing of public health that mimic historical policing practices deemed racially discriminatory. If the field of public health supports criminalization and punishment as public health strategies, it risks reinscribing racialized health inequities.

Evaluation of Stigma Related to Perceived Risk for Coronavirus-19 Transmission Relative to the Other Stigmatized Conditions Opioid Use and Depression

BACKGROUND

The coronavirus-19 (COVID-19) pandemic was initially characterized by misinformation and fear related to transmission that has been previously shown to produce stigma toward persons perceived to be at risk for transmission. This study evaluated perceptions toward scenarios with variable levels of perceived risk for COVID-19 acquisition, and compared stigma to COVID-19 to depression and opioid use disorder.

METHODS

Respondents (N = 280) from the United States completed a web-based survey 6 months after pandemic declaration. Questions included demographics and COVID-19 misconceptions, expected response to hypothetical scenarios with variable risk for COVID-19, and the Attribution Questionnaire-9 for COVID-19, depression, and opioid use disorder.

RESULTS

Participants had several COVID-19 misconceptions, including that opioids increased immunity (63.6%), persons were more susceptible based upon racial/ethnic background (63.2%), and underlying health conditions did not influence risk (58.9%). Respondents were highly likely (64/100) to assume someone coughing had COVID-19 and the majority (93.5%) recommended quarantining persons with recent travel. However, the majority of respondents (>70% in all cases) also believed they would not change their COVID-19-related behavior when interacting with persons of different racial, ethnic, and age backgrounds. Finally, persons with COVID-19 engendered greater pity, less fear, less blame, less anger, and more willingness to help from respondents relative to persons with opioid use disorder.

CONCLUSION

Stigma ratings toward persons perceived at risk of transmitting COVID-19, collected soon after the onset of the pandemic, showed less evidence of stigma relative to persons with opioid use disorder despite pronounced misconceptions regarding COVID-19 risk. Data provide a foundation for additional research in this area.

An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts)

BACKGROUND

Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health-recommended protective measures.

OBJECTIVE

We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect.

METHODS

SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor-delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern.

RESULTS

The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022.

CONCLUSIONS

The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34381.

Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research

Purpose of the Review

The SARS-CoV-2 (COVID-19) pandemic brought unprecedented social change with the most severe impacts on the most vulnerable populations, including people living with HIV (PLWH). This review examined findings from empirical studies of social and behavioral impacts of COVID-19 on PLWH in the first year of the pandemic.

Recent Findings

Impacts of COVID-19 on PLWH fit within an HIV syndemics framework, with overlapping COVID-19 and HIV comorbid conditions concerning mental health and structural inequality. Early impacts of COVID-19 on social isolation, emotional distress, stigma, and substance use varied across studies with few consistent patterns. Structural inequalities, particularly impacts on food security and housing stability, were observed more consistently and globally.

Summary

COVID-19 intersects with HIV infection along with multiple interlocking comorbidities that are best characterized and understood within a syndemics framework.

Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies

(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.

The COVID-19 lessons learned for business and governance

Due to the vast number of countries that have been affected, the coronavirus (COVID-19) pandemic has brought about a devastating global financial crisis. This commentary considers the ongoing COVID-19 recession, its global economic impact, the responses from governments, future projections, business and governance lessons learned so far, as well as future research prospects. In doing so, two key questions are considered: what can we draw from this unprecedented ongoing crisis so as not to experience the same scale of pandemic and recession in the future? What did we do wrong and what can be changed for good to reshape our businesses and economies? The author aims to provide key takeaways for resilient and sustainable organizations, corporate governance, and compensation systems.

The grip of pandemic mononormativity in Austria and Germany

How distancing requirements in the COVID-19 pandemic transformed intimate relationships is under-researched. Against the backdrop of research on the HIV pandemic, the paper departs from the assumption that decreased legitimacy of intimate arrangements and subjective worry about the likeliness of infection may reduce the frequency of multiple sexual contact and intimate well-being during the pandemic. Based on findings from a quantitative study which included measures of risk perception, frequency of contact with sexual partners and communities, concealment, as well as relationship quality in Austria and Germany, this paper examines sexual behaviour in association with relationship status and sexual identity. Analysing data from a convenience sample of 4,709 respondents, of whom 24 per cent identified as LGBQA+, 2 per cent as non-binary, and 6 per cent as consensually non-monogamous, bivariate analysis found significant differences in social distancing, frequency of contact with sexual communities and satisfaction with current sex life. Text analysis of the survey's open-ended responses indicates monogamisation due to declined legitimacy of less conventional intimate arrangements during the pandemic. Findings point to the importance of the sexual morality that defined pandemic experiences in times of HIV for understanding normative pressure on intimate life during COVID-19.

"That same stigma...that same hatred and negativity:" a qualitative study to understand stigma and medical mistrust experienced by people living with HIV diagnosed with COVID-19

BACKGROUND

The COVID-19 and HIV epidemics have exacerbated existing inequities among vulnerable groups and severely impacted communities of color. People living with HIV (PLWH), who may already face stigma or discrimination, are at risk of experiencing further stigma as a result of COVID-19, which can result in medical mistrust.

METHODS

We performed qualitative interviews between June and August 2020 among 32 PLWH, including 10 individuals diagnosed with COVID-19. A majority of participants perceived themselves as having an increased risk of contracting COVID-19 due to their HIV status.

RESULTS

Of those who tested positive for COVID-19, the majority regarded their HIV diagnosis as having a more profound impact on their lives but found similarities between COVID-19 stigma and HIV-related stigma. Many participants also expressed mistrust.

CONCLUSIONS

These results can be used to better understand the perspectives of PLWH during the COVID-19 pandemic and have important implications for potential COVID-19 vaccine hesitancy and future health crises.

Perceived-stigma level of COVID-19 patients in China in the early stage of the epidemic: A cross-sectional research

Objective

To investigate the perceived-stigma level of COVID-19 patients in the early stage of the epidemic and analysed related factors and correlations that affected the stigma levels.

Methods

The COVID-19 patients were selected using the convenience sampling method. Perceived-stigma level was evaluated using the Social Impact Scale (SIS). Frequency was used to describe the general information and disease investigation status of COVID-19 patients; mean and standard deviation were used for describing stigma levels, Wilcoxon signed-ranks test (nonparametric test) was applied for pairwise comparison. Kruskal-Wallis non-parametric test for grade data, and Dwass-Steel-Critchlow-Fligner test for multiple comparative analysis. Multiple linear regression analysis was performed, and statistically significant indicators in single-factor analysis were included to investigate the independent factors of stigma. The p<0.05 was considered statistically significant.

Results

SIS score of the 122 COVID-19 patients averaged 57.37±9.99 points. There were statistically significant differences in perceived-stigma levels among patients of different ages (p = 0.008), occupation (p <0.001), marital status (p = 0.009), and disease severity (p = 0.020). Multivariate logistic regression analysis revealed that age was the main influencing factor of stigma (p<0.05).

Conclusions

The overall perceived-stigma level of COVID-19 patients in the early stage of the epidemic was moderate. Younger, unmarried, and severely ill patients had a higher level of perceived-stigma, with age being the main factor. More attention should be given to the young COVID-19 patients.

Stigmatisation associated with COVID-19 in the general Colombian population

BACKGROUND

As the COVID-19 pandemic progresses, the fear of infection increases and, with it, the stigma-discrimination, which makes it an additional problem of the epidemic. However, studies about stigma associated with coronavirus are scarce worldwide.

AIMS

To determine the association between stigmatisation and fear of COVID-19 in the general population of Colombia.

METHOD

A cross-sectional study was carried out. A total of 1,687 adults between 18 and 76 years old (M = 36.3; SD = 12.5), 41.1% health workers, filled out an online questionnaire on Stigma-Discrimination and the COVID-5 Fear Scale, adapted by the research team.

RESULTS

The proportion of high fear of COVID-19 was 34.1%; When comparing the affirmative answers to the questionnaire on stigma-discrimination towards COVID-19, it was found that the difference was significantly higher in the general population compared to health workers in most of the questions evaluated, which indicates a high level of stigmatisation in that group. An association between high fear of COVID-19 and stigma was evidenced in 63.6% of the questions in the questionnaire.

CONCLUSION

Stigma-discrimination towards COVID-19 is frequent in the Colombian population and is associated with high levels of fear towards said disease, mainly people who are not health workers.

Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China

This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, [Formula: see text]), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (- 0.8 days) and diagnosis (- 2.2 days, [Formula: see text]). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (- 1.6 days, [Formula: see text] and - 2.2 days, [Formula: see text]). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ([Formula: see text]) for diagnosis from the first doctor visit and 0.6 days ([Formula: see text]) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.

The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance

The social sciences are essential to include in the fight against both public health challenges of antimicrobial resistance (AMR) and COVID-19. In this scoping review, we document what social science knowledge has been published about the social relationship between COVID-19 and AMR and which social science interventions are suggested to address this social relationship. We analysed 23 peer-reviewed articles published between 2019 and 2021. Results emphasize that changes in antibiotic prescription behaviour, misinformation, over-burdened health systems, financial hardship, environmental impact and gaps in governance might increase the improper access and use of antibiotics during the COVID-19 pandemic, increasing AMR. The identified social sciences transformation strategies include social engagement and sensitisation, misinformation control, health systems strengthening, improved infection prevention and control measures, environmental protection, and better antimicrobial stewardship and infectious diseases governance. The review emphasizes the importance of interdisciplinary research in addressing both AMR and COVID-19.

Individual health behaviours to combat the COVID-19 pandemic: lessons from HIV socio-behavioural science

INTRODUCTION

COVID-19 parallels HIV in many ways. Socio-behavioural science has been critical in elucidating the context and factors surrounding individual levels of engagement with known effective prevention and treatment tools for HIV, thus offering important lessons for ongoing efforts to combat the COVID-19 pandemic.

DISCUSSION

Non-adherence to effective disease mitigation strategies (e.g. condoms for HIV and masks for COVID-19) can be attributed in part to prioritizing comfort, convenience and individual autonomy over public health. Importantly, misinformation can fuel denialism and conspiracies that discredit scientific knowledge and motivate nonadherence. These preferences and the extent to which individuals can act on their preferences may be constrained by the structures and culture in which they live. Both HIV and COVID-19 have been politicized and influenced by evolving recommendations from scientists, clinicians, policymakers and politically motivated organizations. While vaccines are vital for ending both pandemics, their impact will depend on availability and uptake. Four decades of experience with the HIV epidemic have shown that information alone is insufficient to overcome these challenges; interventions must address the underlying, often complex factors that influence human behaviour. This article builds from socio-behavioural science theory and describes practical and successful approaches to enable and support adherence to prevention and treatment strategies, including vaccine adoption. Key methods include reframing tools to enhance motivation, promoting centralized sources of trusted information, strategic development and messaging with and within key populations (e.g. through social media) and appealing to self-empowerment, altruism and informed decision making. Orchestrated evidence-based activism is needed to overcome manipulative politicization, while consistent transparent messaging around scientific discoveries and clinical recommendations are critical for public acceptance and support. Ultimately, the effectiveness of COVID-19 vaccines will depend on our ability to engender trust in the communities most affected.

CONCLUSIONS

Many lessons learned from socio-behavioural science in the HIV pandemic are applicable to the COVID-19 pandemic. Individual behaviour must be understood within its interpersonal and societal context to address the current barriers to adherence to disease-mitigating strategies and promote an effective response to the COVID-19 pandemic, which is likely to be endured for the foreseeable future.

The impact of narrative writing on empathy, perspective-taking, and attitude: Two randomized controlled experiments on violations of Covid-19 protection regulations

Objective

Two randomized controlled experiments investigated if writing a narrative text about a fictional person who shows disapproved of behavior in the Covid-19 pandemic influenced empathy, perspective-taking, attitude, and attribution of causes regarding that person’s behavior.

Methods

In both studies, a fictional scenario was described, and participants answered questions regarding empathy, perspective-taking, attitude, and attribution regarding a fictional person’s disapproved of behavior (pre-post-measurement). Participants were randomly assigned to one of two conditions. In the experimental condition, they wrote a narrative text about the fictional person. In the control condition, they wrote about an unrelated topic.

Results

We found that writing a narrative text increased empathy more strongly than writing about an unrelated topic; Study 1: p = 0.004, _part.η² = 0.06, Study 2: p < .001, _part.η² = 0.19. This did not apply to perspective-taking; Study 1: p = 0.415; Study 2: p = 0.074. We also found that writing a narrative text about a fictional person resulted in a more positive attitude toward this person; Study 1: p = 0.005, _part.η² = 0.06; Study 2: p<0.001, _part.η² = 0.10. Finally, in Study 2 we found that participants who wrote a narrative text attributed the person’s behavior to internal causes to a lesser degree; p = 0.007, _part.η² = 0.05.

Conclusion

Our findings indicate that empathy and attitude are positively modifiable through narrative writing tasks. Empathy training could potentially prevent discrimination related to Covid-19.

Trial registration

The studies presented in this article were pre-registered on the pre-registration platform AsPredicted (aspredicted.org) before we began data collection; registration numbers and URL: #44754 https://aspredicted.org/vx37t.pdf (Study 1), and #44753 https://aspredicted.org/ig7kq.pdf (Study 2).

Explicit and Intrinsic Intention to Receive COVID-19 Vaccination among Heterosexuals and Sexual Minorities in Taiwan

The present study compared the levels of explicit and intrinsic intention to receive COVID-19 vaccination among sexual minority and heterosexual individuals and examined the association of explicit and intrinsic intentions with sexual orientation. We enrolled 171 sexual minority and 876 heterosexual individuals through a Facebook advertisement. The participants' explicit and intrinsic intentions to receive COVID-19 vaccination and their risk perception of COVID-19 were measured. We discovered that sexual minority individuals had higher levels of explicit and intrinsic intention to receive vaccination relative to heterosexual individuals. Intrinsic intention was positively associated with explicit intention after the effects of demographic characteristics and risk perception of COVID-19 were controlled for. Sexual orientation did not moderate the association between explicit and intrinsic intentions. The present study determined the relationship between sexual orientation and intention to receive COVID-19 vaccination.

HIV and COVID-19: Lessons From HIV and STI Harm Reduction Strategies

PURPOSE OF REVIEW

This review highlights the intersection of the COVID-19, HIV, and STI pandemics and examines how harm reduction strategies can be applied broadly to controlling a pandemic.

RECENT FINDINGS

Since the onset of the COVID-19 pandemic, remarkable advances in the understanding of COVID-19 prevention, diagnosis, and treatment have been made at a much faster pace than prior pandemics, yet much more still remains to be discovered. Many of the strategies to control the COVID-19 pandemic mirror those employed to stem the HIV pandemic. Harm reduction principles used in the HIV pandemic can be applied to reduce the morbidity and mortality of the COVID-19 pandemic through effective prevention, detection, and treatment strategies.

COVID-19 Experiences and Social Distancing: Insights From the Theory of Planned Behavior

Purpose:

The objective of this study is to identify the relationship between COVID-19 experiences, perceived COVID-19 behavioral control, social norms and attitudes, and future intention to follow social distancing guidelines.

Design:

This is a cross-sectional study.

Setting:

Participants responded to an on-line survey in June 2020.

Subjects:

The study included 3,183 residents within Quebec, Canada aged 18 and over.

Measures:

Measures include perceived COVID-19 related discrimination, fear of COVID-19 infection, prior exposure to COVID-19, and prior social distancing behavior. Participants self-reported attitudes, perceived behavioral control, and perceived norms related to social distancing. Finally, we measured social distancing behavioral intention.

Analysis:

We evaluated a theory of planned behavior (TPB) measurement model of social distancing using confirmatory factor analysis (CFA). The association between COVID-19 perceived discrimination, fear of infection, previous social distancing behavior, exposure to COVID-19, TPB constructs and behavioral intentions to social distance were estimated using SEM path analysis.

Results:

TPB constructs were positively associated with intention to follow social distancing guidelines. Fear of COVID-19 infection and prior social distancing behavior were positively associated with behavioral intentions. In contrast, perceived discrimination was negatively associated with the outcome. Associations between fear of COVID-19, perceived COVID-19 discrimination and behavioral intentions were partially mediated by constructs of TPB.

Conclusions:

COVID-19 prevention efforts designed to emphasize positive attitudes, perceived control, and social norms around social distancing should carefully balance campaigns that heighten fear of infection along with anti- discrimination messaging.