Conceptualizing the impact of climate change on diarrheal diseases among people living with HIV/AIDS

Diarrhea remains a common symptom among people living with HIV (PLWHIV), even those who are virally suppressed on antiretroviral therapy (ART). Although climate change is projected to increase the global prevalence of diarrheal diseases over the coming decades, few studies have explored how this will impact PLWHIV. Here, we present a conceptual framework that identifies multiple pathways mediating the relationship between changing climatic conditions, diarrheal disease prevalence, and HIV health outcomes. This framework is based on an in-depth literature review in PubMed and Google Scholar between January 4, 2025 and April 23, 2025. Climate change was found to impact diarrheal disease outcomes through multiple pathways, including increased ambient and sea temperatures; changes in precipitation patterns; extreme weather events such as droughts, floods, and cyclones; and changes in water salinity. The impacts are regional- and pathogen-specific, with increased temperatures likely to increase diarrheal diseases from bacterial and protozoal pathogens, but not viruses. PLWHIV are particularly vulnerable to these effects due to a dangerous combination of dehydration and malnutrition that often accompanies gastrointestinal infections. Adaptation strategies that focus on sustainable agriculture interventions, improving the durability of water and sanitation infrastructure, and optimizing medical supply chains will be needed to lessen the negative health impacts of a changing climate on PLWHIV.