For the nearly 5,800 Long Islanders living with HIV/AIDS, the COVID-19 pandemic remains a constant struggle.
Concerns about getting to doctor appointments when hospitals are overrun with virus patients.
Worries about paying rent or affording groceries when paychecks stopped coming in.
And a deep anxiety that they could be at higher risk of contracting COVID-19.
"There's almost a PTSD reaction with the pandemic similar to the earliest days of HIV," said Allison Covino, program director for Options for Community Living in Ronkonkoma, which provides services and housing to Long Islanders living with HIV/AIDS. "For clients with compromised immune systems, it's a scary time."
The 32nd annual World AIDS Day, set to be commemorated Tuesday, will be particularly resonant in 2020, with the country in the grips of its worst public health crisis since the HIV epidemic of the 1980s and early 1990s.
While more than 700,000 people with AIDS have died since cases were first reported in 1981, antiretroviral therapy and medication have both helped substantially lower the mortality rate and improve long-term outcomes for people living with HIV.
According to the Centers for Disease Control and Prevention, people with HIV and on effective treatment regimens are at no greater risk from COVID-19 than the overall population.
But older adults and individuals with serious underlying medical conditions, including those with weakened immune systems, can be at increased risk for severe illness, the CDC said.
Georgette Beal, senior vice president for planning and grants management and community impact at United Way of Long Island, said while a handful of HIV-positive clients have succumbed to the virus, the pandemic's greatest damage has been financial and emotional.
Many HIV positive residents, Beal said, struggle with food and housing insecurity and live alone with a limited support system. For most, doctors visits became telehealth appointments during the pandemic while support groups were canceled or limited to Zoom.
"Our population took a lot of extra precautions because they knew they were at higher risk," Beal said. "But that's very isolating for people dealing with multiple issues and who are taking lots of medications that have side effects related to depresssion."
With 5,734 residents living with HIV/AIDS, Long Island has one of the highest numbers of cases of any suburban area nationally and more than 26 states across the country, advocates said.
Traci Shelton, 60, of Hempstead, a peer navigator with Options for Community Living who has lived with HIV/AIDS for 20 years, said the pandemic did not drastically change her lifestyle.
But many of her clients, including those who are homeless and living below the poverty line, have not been as fortunate.
"If you are already in a struggle it definitely got worse," said Shelton, who will receive a service award during the United Way's annual World AIDS Day ceremony, which will be held remotely Nov. 4.
"If you are homeless it's a struggle out there," she said. "They shut everything down … Where are they going to go? Everything is closed."