Graduation Date

Fall 12-16-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Promotion and Disease Prevention Research

First Advisor

Keyonna King, DrPH, MA

Second Advisor

Nada Fadul, MD

Third Advisor

Jason Coleman, PhD, MSPH

Fourth Advisor

Anthony Podany PhD, PharmD

MeSH Headings



The COVID-19 pandemic disrupted HIV care and prevention services. COVID-19 guidelines required physical and social distancing, resulting in movement restrictions and limited healthcare services. People living with HIV (PLWH) may be more vulnerable to the pandemic’s impact due to immune suppression and socioeconomic status than people without HIV. Consistent use of pre-exposure prophylaxis (PrEP), condoms, and regular sexually transmitted infection tests are critical strategies for HIV prevention. The pandemic’s impact on PLWH have not been thoroughly studied, and whether PLWH may be more impacted than PrEP users is inconclusive.

This research aimed to use an explanatory sequential mixed methods design to assess and understand the perceived risk of COVID-19, biopsychosocial impacts, and lived experiences of the pandemic among PLWH and PrEP users in Nebraska.

The biopsychosocial model guided this research. Quantitative and qualitative data were collected in two phases. In the quantitative phase, eligible participants (N=150, PLWH= 100, PrEP users= 50) completed an electronic survey. Quantitative data analyses included descriptive statistics, Chi-square test, simple logistic regression, and negative binomial. Selected participants (N=28, PLWH= 19, PrEP users= 9) from the quantitative phase participated in semi-structured one-on-one interviews. Thematic analysis was applied for qualitative data.

Quantitatively, the perceived risk of COVID-19 was moderate in both groups. Age (19-30 years) predicted lower perceived risk and higher risk of COVID-19 infection among PLWH. Psychological impacts were low, but assessment scores were higher among PLWH. Food insecurity, age and marital status predicted biopsychosocial impacts among PLWH. There were no significant predictors among PrEP users. Qualitative data revealed that experiences with food, finances, COVID-19 exposure, COVID-19 vaccines, and movement restrictions were the main drivers of the pandemic’s impact.

Overall, PLWH experienced more biopsychosocial impact than PrEP users. Food insecurity, financial constraints, COVID-19 exposure, COVID-19 vaccines, and movement restrictions contributed to these impacts. Future research is needed to understand the long-term impact of the pandemic on this population.


2022 Copyright, the authors

Available for download on Thursday, October 31, 2024