Abstract: Extreme Weather As a Disruption to HIV Prevention and Care: “We Wound up [...] Using Dirty Needles and Picking Them up Off the Ground” (Society for Social Work and Research 31st Annual Conference)

Schedule:

Thursday, January 21, 2027

Golden Gate 5 (Hilton San Francisco Union Square)

* noted as presenting author

L Lauren Brown, PhD, LCSW, Assistsant Professor, Vanderbilt University, Nashville, TN

Aihua Bian, MPH, Principal Biostatistician, Vanderbilt University, Nashville, TN

Amber J Hackstadt, PhD, Assistant professor, Vanderbilt University, Nashville, TN

David Closs, MPH, Researcher, Friends for All, Memphis, TN

Kneeshe Parkinson, MHA, Program Coordinator, Washington University in Saint Louis, St. Louis, MO

Edda Rodriguez, PhD, Research Assistant Professor, University of Miami, Miami, FL

Taylor Ladson, MPH, Research Coordinator, Nashville CARES, Nashville, TN

Brieanna Boyd, MPH, Research Director, Five Horizons, Montgomery, AL

Samantha Hill, MD, MPH, Associate Professor, Emory University, Atlanta, GA

Emma Kay, PhD, Researcher V, University of Alabama at Birmingham

Brooke Lampe, MUSC HIV Community Liaison, The Medical University of South Carolina, Charleston, SC

Tyrell Manning, HIV Prevention Program Manager, City of St. Louis Department of Health, MO

Ginger McKay, PhD, Assistant Professor, Washington University in Saint Louis, St. Louis, MO

Eric Meissner, MD, PhD, Infectious Disease Physician, Medical University of South Carolina, Charleston, SC

Amanda Mitchell, PhD, Associate Professor and Licensed Psychologist, University of Louisville, Louisivlle, KY

Latrice Pichon, PhD, Professor of Social and Behavioral Sciences, University of Memphis, Memphis, TN

Emma Sterrett-Hong, PhD, Associate Dean of Equity and Inclusion, University of Louisville, Louisville, KY

Jamie Stewart, MSW, Program Manager, Meharry Medical College, Nashville, TN

LaTeshia Seaton, RN, Infectious Disease Advance Practitioner, Emory University, Atlanta, GA

Capric Walker, MPH, Director, University of Louisville, Louisville, KY

Amna Osman, CEO, Nashville CARES, Nashville, TN

Robert KD McLean, PhD, Senior Research Specialist, International Development Research Centre, Ottawa, ON, Canada

Background: Limited research addresses how extreme weather events (tornadoes, hurricanes, flooding, heat waves, droughts, winter storms) affect HIV prevention and treatment services and effective strategies to mitigate disruptions. Extreme weather events (EWE) disproportionately impact vulnerable communities facing housing instability, food insecurity, rural isolation, and transportation barriers. This study explores these issues across the Southern United States, a region heavily affected by both EWEs and the HIV epidemic.

Methods: Between September 2025- January 2026, we conducted a convergent mixed methods study using surveys and focus groups with clients and personnel from eight different HIV care organizations across Southern U.S. Surveys assessed exposure to EWE in the last three years and their impact on HIV services. Focus groups (1-9 participants/per group) explored lived experiences and practices to contextualize findings and were analyzed using content analysis. Logistic regression was used to evaluate the association between poverty and patient care.

Results: Study participants spanned the HIV Prevention and Care Continuum, including individuals from a mobile syringe exchange, HIV home testing, pre-exposure prophylaxis (PrEP) services, standard HIV care, and behavioral health care. Twenty-four focus groups were conducted, including 71 clients and 70 personnel (groups ranging between 1-9 participants). The quantitative surveys suggested self-identified exposure to EWE was pervasive amongst both clients (160/284, 56%) and personnel (165/205, 80%). Personnel reported significant perceived disruptions to clients’ ability to access needed medical care in general (71%) and 60% to clients’ access to HIV care or prevention services. Of the clients experiencing EWE, 41% reported disruptions to needed medical care in general and 23% to their HIV-related services. Also, 16% reported missing doses of PrEP or Antiretroviral Therapy. Among clients experiencing EWE, after adjustment for age, sex, education, and race, clients with greater difficulty paying for basic needs were more likely to report disruptions in needed medical care overall (Odds Ratio (OR): 2.86, 95% confidence interval (CI): 1.39-5.86, p-value = 0.004) and HIV care/ prevention services (OR=3.69, 95% CI: 1.57-8.67, p-value = 0.003). Qualitative findings identified key drivers of disruption, including clinic closures, canceled services, power and internet outages, staffing shortages, and transportation barriers, particularly in rural areas. A key theme was a gap between staff safety/emergency protocols during inclement weather and client access to essential services. Interruptions in syringe exchange services led some individuals to reuse unsafe needles. Some organizations already employ mitigation tactics (e.g., multi-month supplies of PrEP and ART, mail-order pharmacy options, provision of continuous care or crisis response options during and after events, and flexible scheduling). However, these mitigation approaches were unevenly available, underscoring that those with the least resources may be most vulnerable to disruptions.

Conclusions: Both clients and personnel reported perceiving there were care disruptions related to EWEs. Personnel reported higher awareness of disruptions, possibly reflecting efforts to shield clients from impacts. The study identifies practical mitigation strategies that could be standardized into shared guidelines to strengthen climate-resilient HIV prevention and care. Social work research is well positioned to support these efforts by addressing the structural and social drivers of health disparities.