Syndemic perspective of how people living with HIV faced the COVID-19 crisis in North Africa

The 2020-2023 COVID-19 pandemic impacted societies and healthcare access worldwide, including HIV services. Changes in access exacerbated social inequalities in health among socially underserved groups including people living with HIV (PLHIV). This study aimed to explore PLHIV's psychosocial experience of the COVID-19 pandemic in the MENA region using a syndemic approach. Sixty-three interviews were conducted with PLHIV between October 2020 and December 2021 in Tunisia, Morocco and Algeria. We conducted a thematic content analysis of the full corpus. Results from the syndemic framework showed that living with HIV in a pandemic context intersected with PLHIV's socioeconomic conditions, exacerbating their overall disease burden. Interviewees' experiences of the pandemic were closely associated with their HIV seropositive status and related socioeconomic constraints. To improve prevention, preparedness, and response for future pandemics, a global approach to health that incorporates syndemic and intersectional perspectives is needed. Such an approach would help to address the health, social and economic constraints that vulnerable groups face, and would ensure more effective and equitable public health responses.