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Ending the HIV Epidemic in the U.S. (EHE) was a program launched by the U.S. Department of Health and Human Services to reduce the number of new diagnoses and scale up prevention and treatment services. However, the COVID-19 pandemic in 2020 has halted its progress due to extensive government mitigating efforts. We aimed to assess the relationship between the state-level COVID-19 policy stringency and interruptions to HIV prevention and treatment services in the United States in 2020 to monitor our effort better to end the HIV epidemic. In this observational study, we collected five leading indicators for government to track the EHE progress, including diagnoses rate, HIV testing and positive rate, PrEP-to-Need ratio, and viral suppression. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index for each state. Multiple linear and logistic regressions were used to explore the association between COVID-19 policy stringency and HIV prevention outcomes. Geographically weighted regression was then used to examine the spatial distributions of the associations. We found that the more stringent COVID-19 government response was significantly correlated with decreased diagnoses rate but insignificantly with reduced HIV tests, increased HIV positive rate, and increased odds of falling viral suppression. PrEP-to-Need ratio was positively correlated with the COVID-19 government response but negatively correlated with COVID cases. Such correlation was stronger in the Northeast and weaker in the middle part of the United States. Our finding implied that a more stringent COVID-19 government response resulted in new HIV infections that were undetected and not yet linked with clinics and health departments. PrEP use was improved by the stringent COVID-19 government response mainly because of concurrent expansions on PrEP delivery services, but it still was negatively affected by the COVID-19 pandemic. We also found a concerning trend in HIV target groups of decreasing viral suppression rate and prevention use, which needed more attention.
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