“‘Corona’ was bigger than AIDS”: exploring how female sex workers with HIV navigated HIV care and treatment during the onset of COVID-19 in the Dominican Republic and Tanzania

Initial efforts to control COVID-19 included restricting human movement, which caused heightened economic insecurity and challenges to the management of chronic health conditions such as HIV. The aims of this study were to: (1) explore how female sex workers living with HIV in the Dominican Republic and Tanzania, two different cultural and epidemic contexts, reacted to the onset of the COVID-19 pandemic, and (2) assess how lockdown measures impacted HIV care and treatment experiences. We analysed data from interviews (20 in each country) conducted during the onset of the COVID-19 pandemic as part of a longitudinal study of the social determinants of HIV outcomes. Using narrative and thematic analytic techniques, we identified fear and financial insecurity as the two main impacts of the initial COVID-19 lockdown on female sex workers in both settings. While participants experienced challenges accessing HIV-related care and treatment and received limited to no state-level social protection, they adapted to these changes by drawing on individual resilience and family and community support to sustain adherence to medication and overall wellbeing. Findings highlight the need for systems-level social protection to reduce economic insecurity prior to shocks and bolster individual resilience, family, and community-level supports during crises such as COVID-19.