COVID-19 & the LGBTQ+ Community, VA CLCs & People w/ HIV

This past week, several studies and reports were released related to COVID-19 and its effects on the LGBTQ+ community, the nation’s VA Community Living Centers (CLCs), and people with HIV. Below is a rundown on the facts and findings of each study along with links for your review.

CDC Report: COVID-19 & Disparities Related to Sexual Orientation and Specific Racial/Ethnic Groups

On February 5, 2021, the CDC released “Sexual Orientation Disparities in Risk Factors for Adverse COVID-19-Related Outcomes, by Race/Ethnicity” that looked to introduce new information into existing pandemic surveillance systems because sexual orientation is an overlooked area of study. According to the report, the “CDC examined disparities between sexual minority and heterosexual adults in the prevalence of underlying conditions with strong or mixed evidence of association with severe COVID-19-related illness.”

In its review, the CDC outlined that sexual minority persons have higher prevalences of self-reported conditions such as cancer, kidney disease, chronic obstructive pulmonary disease (COPD), heart disease (including myocardial infarction, angina, or coronary heart disease), obesity, smoking, diabetes, asthma, hypertension, and stroke. These conditions were seen to have contributed to severe COVID-19 outcomes.

Below are points from the report’s discussion:

  • Non-Hispanic Black and Hispanic populations have been disproportionately affected by the COVID-19 pandemic in the United States, and the increased prevalence of certain risk factors among sexual minority members of these racial/ethnic minority populations is of particular concern.
  • Because of their sexual orientation, sexual minority persons experience stigmatization and discrimination that can increase vulnerabilities to illness and limit the means to achieving optimal health and well-being through meaningful work and economic security, routine and critical health care, and relationships in which sexual orientation and gender identity can be openly expressed.
  • Persons who are members of both sexual minority and racial/ethnic minority groups might therefore experience a convergence of distinct social, economic, and environmental disadvantages that increase chronic disease disparities and the risk for adverse COVID-19–related outcomes.

The report then states that because data on sexual orientation are not collected in COVID-19 data systems, the effect of COVID-19 on sexual minority populations is unknown. You can access and download the CDC’s report here.


GAO Report: COVID-19 Reveals Infection Control Deficiencies Existed Before the Pandemic

On February 6, 2021, the Government Accountability Office (GAO) released a report titled, “VA Health Care: Community Living Center Were Commonly City for Infection Control Deficiencies Prior to the COVID-19 Pandemic.”

The report showed that of the 135 Community Living Centers (CLCs) inspected between fiscal year 2015 and 2019, 128 (or 95%) had an infection and prevention control (IPC) deficiency in one or more years. During each fiscal year, CLCs with IPC deficiencies ranged from 46% to 70% respectively. IPC deficiencies were reported to be situations where CLC staff failed to use proper hand hygiene or wear personal protective equipment (PPE) to prevent spread of infections or failed to properly clean reusable medical items.

In total, there were approximately 365 IPC deficiencies reported though, according to the GAO’s analysis of the VA’s CLC data, inspectors classified all of them as “not severe” meaning CLC residents were not harmed. Additionally, inspectors found that 58% of IPC deficiencies were isolated, 40% were reported as a pattern of behavior, and 1% were reported as widespread.

Below is a snapshot of how VA CLC’s throughout Northern California fared according to the GAO report. VA Northern California currently has one CLC located in Martinez, CA; the other CLC’s are operated by VA Palo Alto and VA San Francisco respectively.

CLC LocationFY 2015
Inspections/
IPC Cited
FY 2016
Inspections/
IPC Cited
FY 2017
Inspections/
IPC Cited
FY 2018
Inspections/
IPC Cited
FY 2019
Inspections/
IPC Cited
Loma Linda, CA1 / None1 / 11 / None1 / 1 1 / 1
Martinez, CA 1 / None2 / 21 / 11 / 11 / 1
Menlo Park, CA1 / 11 / None1 / 11 / 12 / 2
Palo Alto, CA1 / 11 / None1 / 1None / None1 / None
San Francisco, CA1 / 1None / None2 / 11 / 11 / 1

You can access and download the GAO’s report here.


JAMA Network: Limited Study on COVID-19 Outcomes Among Persons Living With and Without HIV Diagnoses

On February 3, 2021, the Journal of the American Medical Association (JAMA) released a limited study (“COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State“) to determine if there is an association between a prior diagnosis of HIV infection and COVID-19 diagnosis, hospitalization, and in-hospital death among residents of New York State which has been an epicenter for both the U.S. COVID-19 and HIV/AIDS epidemics.

Though limited, the study provides more insight into an area of research related to COVID-19: the extent to which HIV-diagnosed people are acquiring COVID-19, the severity of the virus in HIV-diagnosed people, or how the virus distribution in HIV-diagnosed people compares to persons living without diagnosed HIV. Additionally, a growing body of literature indicates that persons living with diagnosed HIV experience similar or better COVID-19 clinical outcomes than compared to persons living without diagnosed HIV1.

Here are the outcomes of the study:

  • COVID-19 diagnoses, hospitalizations, and in-hospital deaths were elevated among persons living with diagnosed HIV than persons living without diagnosed HIV.
  • Persons living with diagnosed HIV were nearly 40% more likely to be diagnosed with COVID-19 than those living without diagnosed HIV.
  • COVID-19 diagnosis rates for non-Hispanic Black and Hispanic individuals were 1.6 and 2.1 times higher compared to non-Hispanic White individuals respectively.
  • Persons living with diagnosed HIV were more likely to be hospitalized with COVID-19 than those without; the rate increases among diagnosed persons without viral suppression and lower CD4 counts.
  • Case fatality among HIV-diagnosed persons was nearly twice that among persons living without diagnosed HIV.
  • In-hospital mortality among hospitalized persons living with diagnosed HIV was three to four times higher for persons aged 40 years or older, this reflects an elevated risk of COVID-19 severity-enhancing comorbidities including diabetes, hypertension, and chronic lung and cardiovascular disease.

You can access and download the study here.

  1. “Clinical Features and Outcomes of Patients With Human Immunodeficiency Virus With COVID-19”, Clinical Infectious Diseases, Volume 71, Issue 16, 15 October 2020, Pages 2276–2278, https://doi.org/10.1093/cid/ciaa579