Fifteen racially/ethnically diverse cisgender men participated; no participants refused to participate. Participant mean age was 28. Six participants were Black/African American, five were Latinx, and four were White; all Latinx participants completed their interviews in Spanish. One participant self-identified as bisexual; all others self-identified as gay. Eleven participants self-reported being virally suppressed while four reported not knowing whether they were virally suppressed.
Seventeen themes emerged from the interviews, categorized into six domains: (1) knowledge and perceptions of COVID-19; (2) COVID-19 information sources and perceptions of trustworthiness; (3) impact of COVID-19 on behaviors; (4) impact of COVID-19 on health; (5) impact of COVID-19 on social determinants of health; and (6) general COVID-19-related concerns. Domains and themes are outlined in Table II.
1. Knowledge and Perceptions of COVID-19
Knowledge of Transmission and Prevention of COVID-19 Is High
Participants knew a great deal about COVID-19 and its transmission. They were aware of recommended precautions to prevent infection, including wearing a face covering, social distancing, and handwashing. Many were aware of the NC stay-at-home order that was in effect at the time of the interview and reported adhering to the order. For example, a participant reported,
It’s contagious. It affects the respiratory system. It can be fatal in some cases, but some people get through. It’s important to take precautions and stay at home like the governor says. (Participant [P]13, Black/African American, 26 years old)
Another participant noted, “Es un virus muy contagioso, que se transmite de una persona enferma si está muy cerca cuando tose. También, si la persona enferma toca algo, y la persona sana toca la misma superficie, se puede contagiar.” [“It is a very contagious virus that is transmitted from a sick person if they are very close when they cough. Also, if the sick person touches something, and the healthy person touches the same surface, it can be contagious.”] (P4, Latinx, 35 years old)
COVID-19 Is Perceived as Serious, and Participants Perceive Themselves to be Susceptible
Participants reported that COVID-19 was serious and that those with compromised immune systems were especially at risk. They were worried about their own increased risks as PLWH and noted that hearing about others who had similar characteristics to them being seriously affected also increased their concerns. A participant stated,
Creo que es muy serio porque nunca en mi vida había visto algo así. Afecta a las personas que tienen el sistema inmunológico comprometido como personas con diabetes o con problemas respiratorios, así que es muy serio. Uno piensa que porque uno es joven no le va a pasar, pero estamos viendo casos de jóvenes que han muerto por este virus y eso lo hace más grave para mí. [I think it is very serious because I have never seen anything like this in my life. It affects people who have compromised immune systems like people with diabetes or respiratory problems, so it's very serious. You think that because you are young it will not happen to you, but we are seeing cases of young people who have died from this virus and that makes it more serious for me.] (P3, Latinx, 28 years old)
Another participant said, “The coronavirus is making me super cautious. I am just afraid to contract it so I think about it a lot, but I try to stay optimistic about the entire situation.” (P14, Black/African American, 27 years old)
Participants also reported worrying about the well-being of friends and family members, particularly those who were older, had comorbidities, or had other risk factors for developing serious illness from COVID-19. A participant noted, “Pues, estoy muy preocupado por toda mi familia y mi círculo porque no solo me puede afectar a mí, sino a toda mi familia también.” ["Well, I am very concerned about my whole family and my circle because it can affect not only me, but my entire family as well."] (P5, Latinx, 25 years old)
Confusion Exists from Conflicting Information about COVID-19
Participants found available and prevailing information regarding the transmission and prevention of COVID-19 to be conflicting. However, some reported verifying information by referring to several different sources. A participant shared,
Everyone is saying different things. They give different timeframes about symptoms. It gets very confusing. So I look for similarities across different [sources of] information that I receive. But it is hard to know what is true, what are assumptions, and what are lies. (P7, Black/African American, 23 years old)
2. COVID-19 Information Sources and Perceptions of Trustworthiness
Information About COVID-19 Is Obtained From Social Media, the Internet, Television, the Workplace, and Word-of-Mouth
Social media (e.g., Facebook), the internet (e.g., CDC website), and television (e.g., English- and Spanish-language national and local news) were noted as places that participants obtained information about COVID-19. Participants also reported that they received information from their workplaces, as guidelines and regulations changed and thus required changes to how work was performed. For example, participants who worked in restaurants noted that they learned about transmission, prevention, and the current state of disease burden from restaurant owners and managers. In addition, participants described friends and family as sources of information about COVID-19. A participant reported, “I get info on TV, and I did some research on the internet, read some articles, and heard some through word-of-mouth, like during a meeting at work when we go over protocols and changes that are going into effect because of the coronavirus.” (P10, White, 28 years old)
The President of the United States Is Not a Trusted Source of COVID-19 Information
Participants reported having little trust in what U.S. President Donald Trump communicated about the pandemic. They did not trust his assessment of the potential impact of the pandemic, his advice regarding how to prevent COVID-19 transmission, or his assertions regarding its treatment. A participant noted,
I don’t trust what the president of the United States says, especially because we have people like Dr. Fauci who immediately say ‘that's actually not the case.’ Also there is the World Health Organization that is saying that what the president is recommending is not okay. Other doctors working on this are saying that the president is just making things up as he goes. I don’t trust him. (P7, Black/African American, 23 years old)
Another participant agreed saying, “I honestly do not trust anything that the president says.” (P14, Black/African American, 27 years old)
A third participant stated, “No confío mucho porque creo que no le tomaron mucha importancia cuando empezó y por eso estamos con estos números tan altos.” ["I do not trust much, because I think they did not take it seriously when it started and that is why we have these high numbers."] (P4, Latinx, 35 years old)
Providers Are a Highly Trusted Source of COVID-19 Information
Healthcare providers, including HIV providers, were identified in particular as providing timely and trustworthy information about COVID-19. A participant stated, “I trust my doctor, especially because I believe they have the best interest at heart and they are the people on the frontline. They are telling us what they understand and what they are seeing from their patients.” (P7, Black/African American, 23 years old)
3. Impact of COVID-19 on Behaviors
Participants are Taking Action to Reduce Their Risks
Participants reported staying home, maintaining social distancing, and cleaning with disinfectants and sanitizers to prevent contracting COVID-19. A participant commented, “I have not been out. Today is actually the first time I went out to go to the store. No hugging anyone; I try to stay away from people as much possible or at least six feet.” (P6, Black/African American, 21 years old) This commitment to prevention was noted by other participants. For instance, a participant stated, “I have been extremely social distancing. I, in fact, haven't left my house; some of my friends do the grocery shopping for me and leave my groceries by the door. I bring them inside, sanitize them, and throw the bags out.” (P7, Black/African American, 23 years old)
Further, another participant noted, “Guardo mi distancia entre las personas cuando salgo a la tienda, uso desinfectante de alcohol en mis manos, mascarilla cuando salgo afuera, y limpio con desinfectante las áreas que más toco como el refrigerador, las llaves, mi tarjeta de débito, y las mancillas de la puerta.” [“I keep my distance from people when I go out to the store, use alcohol disinfectant on my hands, a mask when I go outside, and clean the areas I touch the most with disinfectant, such as the refrigerator, keys, my debit card, and the door handles.”] (P3, Latinx, 28 years old)
COVID-19 is Having a Mixed Impact on Health Behaviors
Participants noted that worries and fears related to COVID-19 and behavioral changes that they are making to stay safe are affecting them in both negative and positive ways. A participant noted that he is sleeping less because he is worried about his health, the health and well-being of his friends and family, and the long-term impact of the pandemic locally and globally, reporting, “My sleeping schedule has been changing a lot. It is hard to sleep 8 hours as I used to.” (P8, Black/African American, 21 years old). Another participant commented, “I am working out less to avoid public settings.” (P9, White, 23 years old)
However, some participants reported positive changes they had made in their health behaviors as a result of staying home and other adaptations related to COVID-19 prevention. A participant noted, “I stopped drinking alcohol because I figure that I have bad habits when I am at home alone; because in the first week or so of the stay home order for the coronavirus, I was drinking a lot and that kind of hurt me.” (P11, White, 25 years old). Further, another participant shared, “I actually started meditating in the mornings so I can have a good set of mind about all this. And I have been spending more time in the backyard and gardening more than I did before.” (P15, White, 27 year old)
Use of Social Media for Socialization and Support Has Increased
Before the initiation of the COVID-19 pandemic, participants were already communicating frequently through social media platforms such as Facebook, texting, and GPS-based mobile apps. After the pandemic began, however, participants reported increased use of these types of social media platforms. A participant noted, “I use Facebook much more now because it is the only way we have to communicate with other people.” (P12, Black/African American, 21 years old)
Use of other technology for communication, such as video calls, also increased, as another participant added,
“I don’t see my friends and family much now, and if I do, we try to FaceTime on the iPhone or call each other on Facebook to see them on video. We talk on the phone to catch up. That is the only way we do it to be safe and cautious.” (P10, White, 23 years old)
4. Impact of COVID-19 on Health
Feelings of Isolation, Hopelessness, and Worry Are Common
Participants reported that their mental health was profoundly affected by COVID-19 and the necessary precautions required to reduce risks of exposure. A participant noted, “The changes make me feel hopeless and sad. I am just realizing that everyone wants things to go back to normal, but I think a lot of things will change, and lots of polices that are in place will change, like in restaurants and bars. It will never be normal.” (P7, Black/African American, 23 years old) Another participant reported, “I do feel alone, and it kind of reminds me of when I learned that I had HIV.” (P15, White, 27 years old)
Accessing Medical Care is More Difficult
Participants reported that accessing medical care had become more difficult in the context of COVID-19. Though as of the time of data collection participants had not experienced interruptions in their HIV care, some had not been able to get other needed care. As a participant reported, “It [COVID-19] just makes things harder. I was not able to go to the dentist to take out my wisdom teeth because they do not do anything that is not a priority.” (P6, Black/African American, 21 years old). Participants had also had challenges with virtual appointments (e.g., telemedicine). For example, a participant shared, “For the follow-up appointment I had to see the doctor through Zoom, but he couldn’t really see me and that made things more challenging, especially because the technology wasn't really working. Things are more complicated now.” (P14, Black/African American, 27 years old)
Medication Adherence Is Difficult Due to the Interruption of Routines
Overall, participants reported obtaining HIV medications as needed since the initiation of the pandemic. However, they did report that adhering to medication regimens had become more difficult. A participant shared, “It’s been easy to get the medications because the pharmacy sends them, but it has been challenging to take them as I should because I had a routine before. I used to take my medication every day at work, but since I am working from home, I can’t follow the same routine.” (P15, White, 27 years old)
5. Impact of COVID-19 on Social Determinants of Health
Educational Opportunities and Jobs Were Lost
Participants reported multiple ways in which COVID-19 affected them through social determinants of health. First, some participants noted that they had lost educational opportunities. A participant reported, “I was supposed to have an internship this summer and make money. It’s been very stressful, and I am not having a good summer.” (P6, Black/African American, 21 year old). Another participant described losing his job, “I have been laid off from work till further notice, so I have not been working. So it is affecting me that way.” (P10, White, 28 years old)
Participants felt the financial impact of job losses on other social determinants, such as housing stability. A participant shared, “Ya empiezo a tener dificultad; no sé cómo voy a hacer este mes para pagar mi renta.” ["I am already having difficulty; I don't know what I am going to do this month to pay my rent."] (P5, Latinx, 25 years old)
Workplace Exposure Is a Worry
Participants who had jobs and were able to continue working during the stay-at-home order felt fortunate to be able to maintain an income. However, they also worried about exposure to COVID-19 when fulfilling roles as essential workers. A participant noted, “I think what makes it challenging is that I work in the public and interact with people every day, and I am not sure where they have been and if they have COVID-19 or not. I just think that interacting with people who might have it on a daily basis makes it hard.” (P14, Black/African American, 27 years old)
In-Person Social Support Has Been Sacrificed
Participants reported a reduction in in-person social support. A participant noted, “It is affecting my interactions with other people; I do not see my family and friends anymore.” (P9, White, 23 years old). Another remarked on his loneliness saying, “There are times when I think, if I had a boyfriend or a roommate, someone that at least can stay in quarantine with me, that will be better. I mean, I have a cat, but it is just hard sometimes.” (P10, White, 28 years old)
6. General COVID-19-Related Concerns
The Economy and its Impact on Self, Families, and Friends Are Concerns
Participants also reported worrying about the long-term implications of the pandemic for local, regional, and global economies. As a participant shared,
My biggest concern is [that] the way that it is happening here will have a devastating impact on the economy, just because it’s been so bad. I have such a big fear that this will reach areas of underdeveloped counties where the health system is even weaker than ours, and they will not be able to handle that. In addition, I think that when the economy is not doing well in America, the whole world economy falls after that. (P7, Black/African American, 23 years old)
States May Be “Opening Up” Too Quickly
Participants also worried that states may be re-opening businesses and institutions before the COVID-19 pandemic was under control, which could lead to more transmission. As a participant noted, “They are leaving it to the states to reopen or not, so I am worried about its [COVID-19] being spread." (P9, White, 23 years old)