Background: Global efforts to combat HIV may be compromised by climate change since severe weather events disrupt livelihoods, food systems, and healthcare infrastructure. Few studies have examined the impact of climate change on HIV health outcomes. Using qualitative methods, we aimed to understand perceived impacts and mechanisms by which severe weather events affected HIV-related health, and gender-specific adaptation strategies.
Methods: We interviewed 40 HIV-infected-individuals from July to December 2018 enrolled within a larger cluster-randomized control trial of a multisectoral agricultural and financial intervention to improve HIV health outcomes among HIV-infected farmers in Kisumu, Homabay and Migori counties in Kenya (NCT02815579). We used purposive sampling to select an equal number of male and female participants from a diverse range of geographies among the 16-sites. In-depth interviews were conducted in participants'' native language, transcribed, translated into English and double coded. Thematic content analysis of transcripts followed an integrated inductive-deductive approach.
Results: Participants reported that severe weather including extreme flooding and droughts had negative impacts on HIV health through a number of interrelated mechanisms. Changes in food insecurity and diet quality, largely from decreased agricultural yields, negatively impacted nutritional status. Stress, insomnia, and symptoms of depression were important mental health impacts, attributed to loss of crops from flooding and drought, and hopelessness and despair related to not being able to feed one''s family. These mental health and nutritional impacts compromised adherence to antiretroviral therapy and clinic attendance, which were also affected by infrastructure challenges such as road blockages in the setting of flooding. Participants also noted increases in other infections including malaria, diarrhea and flu-like illnesses related to contaminated waters during floods, and cold and damp living conditions. Men and women reported different strategies to adapt to severe weather, with resources more readily available to men including time, money, and utilization of agricultural extension services.
Conclusions: Climate change is an under-recognized potential determinant of poor HIV health outcomes operating through multiple interrelated pathways and should be explored in future studies. Furthermore, women may find it more difficult to adapt to the effects of climate change on HIV health due to access to fewer resources than men.

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