“Am I going to have to run to get out of this place?” A qualitative study exploring HIV clinical and service provider experiences from California regions heavily impacted by climate disaster

Abstract

Maintaining continuity of HIV care and prevention resources is critical to the health, wellbeing, and at times survival of individuals who rely on those services. In California, disaster events and extreme conditions caused by climate change are becoming more frequent and intense, impacting many regions in what have become cycles of destruction and disruption. The HIV workforce, already under strain, must now contend with delivering services to clients during and in the wake of repeated climate-related events. From October 2021 to April 2022, using purposive and snowball sampling, we interviewed 18 HIV, sexual health, and harm reduction clinical and service providers in California counties heavily impacted by climate-related events. Participants were asked about their experiences providing services amid climate disasters, including reflections on client needs and strategies for maintaining continuity of care. Data were analyzed following the tenets of thematic analysis. We found that HIV, STI, and harm reduction service providers and their agencies play an integral role within their communities, both in maintaining continuity of essential services to clients during catastrophic events, as well as in disaster response as trusted community resources. We further found that individuals in these roles drive the innovations and adaptive strategies that allow their agencies to endure the shock and disruption of disaster events. Finally, we highlight the extent to which clinical and service providers experience harms due to cyclical climate disasters. We discuss existing research on health system resilience in the face of climate change, and identify a critical research gap: consideration of workforce needs is often limited to professional skills and capacity specific to caring for climate disaster survivors, rather than as support needed by workforce personnel who are survivors of disasters themselves. We propose recommendations for next steps and encourage further research on HIV workforce resilience in a new climate era.