Pathways Linking Climate Change to Advanced HIV Disease: A Narrative Review

Dicky Endrian Kurniawan; Ahmad Rifai; Alfid Tri Afandi; M. Nur Khamid

doi:10.31290/haj.v3i2.6540

Authors

Dicky Endrian Kurniawan Faculty of Nursing, Universitas Jember
Ahmad Rifai Faculty of Nursing, Universitas Jember, East Java, Indonesia
Alfid Tri Afandi Faculty of Nursing, Universitas Jember, East Java, Indonesia
M. Nur Khamid Universitas Duta Bangsa (UDB), Surakarta, Indonesia

DOI:

https://doi.org/10.31290/haj.v3i2.6540

Keywords:

Advanced HIV disease, ART adherence, climate change, food insecurity , HIV progression

Abstract

Climate change has emerged as a major global health challenge that may worsen HIV-related outcomes through biological, psychosocial, socioeconomic, and healthcare-related mechanisms. This narrative review aimed to synthesize current evidence on the pathways linking climate change to advanced HIV disease (AHD) and to develop a conceptual framework explaining these interactions. A literature search was conducted in the Scopus database for articles published between 2010 and 2025. Studies addressing the relationship between climate change and HIV-related outcomes, including disease progression, ART adherence, food insecurity, migration, psychosocial stress, and healthcare access, were included and synthesized narratively. Relevant studies were screened and synthesized thematically into major pathways, including biological effects, healthcare disruption, food insecurity, psychosocial stress, migration, and social determinants of health. The findings indicate that climate change contributes to HIV progression through direct biological mechanisms, including oxidative stress, NF-κB activation, immune dysregulation, and HPA axis dysfunction. In addition, indirect socioecological pathways, including disrupted ART access, malnutrition, poverty, migration, and psychosocial stress, further accelerate immune suppression and increase morbidity and mortality among people living with HIV. Climate-adaptive HIV care, resilient healthcare systems, nutrition-sensitive interventions, and interdisciplinary public health strategies are urgently needed to reduce climate-related HIV vulnerabilities

References

S. Zhong and C. Huang, “Climate change and human health: Risks and responses,” Chinese Science Bulletin, vol. 64, no. 19, pp. 2002–2010, Jul. 2019, doi: 10.1360/N972018-00898.

V. Gkouliaveras, S. Kalogiannidis, D. Kalfas, and S. Kontsas, “Effects of Climate Change on Health and Health Systems: A Systematic Review of Preparedness, Resilience, and Challenges,” Int. J. Environ. Res. Public Health, vol. 22, no. 2, p. 232, Feb. 2025, doi: 10.3390/ijerph22020232.

M. Lieber, P. Chin-Hong, H. J. Whittle, R. Hogg, and S. D. Weiser, “The Synergistic Relationship Between Climate Change and the HIV/AIDS Epidemic: A Conceptual Framework,” AIDS Behav., vol. 25, no. 7, pp. 2266–2277, Jul. 2021, doi: 10.1007/s10461-020-03155-y.

K. S. Orievulu, M. Buczkowska, and C. C. Iwuji, “Does climate change threaten delivery of HIV care in resource-limited settings?,” Curr. Opin. Infect. Dis., vol. 38, no. 1, pp. 18–25, Feb. 2025, doi: 10.1097/QCO.0000000000001079.

E. I. Obeagu, I. Isiko, and G. U. Obeagu, “Climate change and HIV prevention: Towards sustainable solutions – a narrative review,” Medicine, vol. 104, no. 16, p. e42198, Apr. 2025, doi: 10.1097/MD.0000000000042198.

J. Burgos, E. Ribera, and V. Falcó, “Antiretroviral Therapy in Advanced HIV Disease: Which is the Best Regimen?,” AIDS Rev., vol. 20, no. 1, Apr. 2018, doi: 10.24875/AIDSRev.M17000010.

D. Stelzle et al., “Prevalence of advanced HIV disease in sub-Saharan Africa: a multi-country analysis of nationally representative household surveys,” Lancet Glob. Health, vol. 13, no. 3, pp. e437–e446, Mar. 2025, doi: 10.1016/S2214-109X(24)00538-2.