Population-Level Risks for HIV Mortality During the COVID-19 Pandemic in the United States by Demographic Characteristics and Medicaid Access, 2020‒2021

<b>Objectives.</b> To evaluate the impact of the COVID-19 pandemic on HIV mortality rates with a focus on demographic predictors and Medicaid access. <b>Methods.</b> Using Wide-Ranging Online Data for Epidemiologic Research, we conducted a descriptive study comparing HIV mortality in the United States 2 years before the COVID-19 pandemic (2018-2019) and the initial 2 years of the pandemic (2020-2021), and identifying HIV mortality factors during the pandemic. <b>Results.</b> During the first 2 years of the pandemic, crude HIV death rates increased and then decreased marginally. COVID-19 and HIV together contributed to 11% of the HIV death rate. While African Americans had a higher HIV mortality rate, there was a slight decrease during the pandemic. Nonelderly adults in Medicaid expansion states had lower HIV mortality than those in nonexpansion states. <b>Conclusions.</b> Contrary to initial concerns, we found no substantial increase in HIV mortality. A slight decrease was observed with persisting racial disparities in mortality and lower mortality in states that expanded Medicaid. <b>Public Health Implications.</b> The study findings can inform the development of policies to address demographic disparities in HIV mortality through targeted system-level interventions for vulnerable populations, such as Medicaid expansion and Ryan White Program services. (<i>Am J Public Health</i>. 2025;115(4):579-587. https://doi.org/10.2105/AJPH.2024.307916).