Key points overview
• Increasing extreme weather events due to climate change are disrupting HIV care, especially in vulnerable regions like the South, which accounts for 52% of new HIV diagnoses.
• HIV care requires consistent access to antiretroviral therapies (ART) to prevent disease progression and transmission.
• Climate disasters, like hurricanes and wildfires, disrupt healthcare access, pharmacy operations, and medication availability for people with HIV.
• Stigma complicates care during emergencies, as many patients hide their medications when staying with others.
• Missing ART doses can lead to viral rebound, increased transmission risk, and drug resistance.
• Programs like the Ryan White HIV/AIDS Program need better climate adaptation, including flexible funding and support for displaced patients.
• Federal tools like the CDC’s take-home HIV tests and FEMA preparedness grants can help maintain care continuity during disasters.
• Addressing basic needs such as housing and food security is critical for ensuring medication adherence during emergencies.
Extreme weather events, such as hurricanes Helene and Milton, are becoming more frequent and severe, with devastating consequences for already vulnerable populations. These disasters not only wreak havoc on infrastructure and displace communities, but also disrupt access to critical healthcare services. For the 1.2 million people living with HIV in the United States, consistent access to medications and care is essential for survival. Climate change, however, is increasingly undermining these lifelines.
The Centers for Disease Control and Prevention (CDC) estimates that HIV-positive individuals rely on daily antiretroviral therapies (ART) to maintain undetectable viral loads and prevent the progression of the virus to AIDS. This daily regimen is critical to their health and prevents further transmission of the disease. Climate-related disruptions, such as hurricanes, flooding, and wildfires, are complicating access to these medications and services, jeopardizing the lives of some of the most vulnerable Americans.
The South remains the epicenter of HIV in the U.S., accounting for 52% of new diagnoses in 2022. This same region is highly susceptible to extreme weather events. Data from the Federal Emergency Management Agency’s (FEMA) National Risk Index shows that 50 high-priority jurisdictions under the federal Ending the HIV Epidemic (EHE) program are among the most climate-vulnerable areas in the country, with an average risk score of 96.8 out of 100. These jurisdictions, which include counties in states like Alabama, Mississippi, and South Carolina, are home to nearly half of all people living with HIV in the United States.
The risks posed by climate change extend beyond physical health. HIV-positive individuals are often members of marginalized communities already facing systemic inequities. Black Americans account for 38% of new HIV infections, Latino Americans 32%, and LGBTQI+ individuals are disproportionately affected. These same groups are more likely to live in areas vulnerable to flooding, extreme heat, and pollution, compounding their health risks.
Hurricane Ida in 2021 demonstrated the fragility of HIV care systems during disasters. In New Orleans, a city with one of the highest HIV rates in the country, the Ryan White HIV/AIDS Program surveyed patients after the storm. Of those who evacuated, 30% reported difficulties accessing care. For those who stayed, the number was even higher at 32%. Pharmacies closed due to damage, and widespread power outages prevented patients from refilling prescriptions. Many evacuees were unaware they could use their insurance to cover medications out of state, leading to skipped doses and potential viral rebound.
Wildfires on the West Coast pose additional challenges. Smoke exacerbates respiratory conditions, which HIV-positive individuals are more susceptible to due to weakened immune systems. Flooding in the South further disrupts healthcare access, with roads, clinics, and pharmacies often inaccessible for weeks.
HIV stigma adds another layer of complexity. Many HIV-positive individuals who evacuate to stay with friends or family feel compelled to hide their status, making it difficult to take medications openly. As Vatsana Chanthala, director of the Ryan White Program in New Orleans, explained, “There’s still a lot of fear with HIV, and so many clients don’t disclose their status. And so they find ways to hide their medications, and if they’re around people, they’re less likely to take those medications out.”
When HIV-positive individuals miss doses of ART, the consequences can be dire. Viral loads begin to rise, increasing the risk of disease progression and transmission. In some cases, skipping doses can lead to medication resistance, rendering previously effective treatments useless. Dr. Paula Seal of the University Medical Center New Orleans stressed, “When you have trouble is when patients are running out of medications. If they don’t have enough medicine and start skipping doses to make it last longer, that’s when we run into problems, and then the virus can become resistant to those medications.”
Structural problems require structural solutions. The Ryan White HIV/AIDS Program, which provides comprehensive care and support to low-income individuals with HIV, must integrate climate resilience into its framework. Policymakers can allocate disaster-specific funding to ensure that services, such as transportation and housing assistance, follow patients when they evacuate. This flexibility is essential, as housing instability often takes precedence over medication adherence during crises.
The CDC’s take-home HIV test program can be mobilized during disasters to reduce post-disaster transmission rates, particularly given that infectious viral secretions peak in the first 10 to 12 weeks of infection. Meanwhile, FEMA shelters should include staff trained in HIV care to ensure stigma-free environments and consistent access to treatment.
Federal agencies like the Department of Health and Human Services (HHS) can leverage data tools such as the Environmental Justice Index and the Climate Explorer to identify and prioritize resources for the most vulnerable populations. This October, the Biden administration updated its clinical guidelines for displaced HIV populations, a crucial step in addressing these intersecting crises. “Providing ART is very complex,” said Haley Norris, a policy analyst at the Center for American Progress, “It’s really, really good that they were able to get that out when they did.”
“Medications are important, and adherence is important. But if a person needs food, needs a place to stay, that’s going to be first on their minds,” said Chanthala.
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