Let’s get real right away. The novel coronavirus disease (COVID-19) is not a hoax. It’s not an overblown media story. It’s here amongst us and we have to take it very seriously. The threat to our own health and to that of the community we live in is real.
We have the ability to fight this virus
If there is good news for people living with HIV, it’s twofold. First, we have been here before. This is not our first epidemic. We, more than anyone, know what it’s like to fight a virus while dealing with a myriad of other pressures. And secondly, if we are doing well on treatment and our immune system is healthy (your CD4 count will tell you that), we are likely at no greater risk than our HIV-negative friends. True, there may be complicating factors, such as age or other health concerns we may be dealing with, but otherwise we likely have an ability to fight the virus, largely unhampered by our HIV status.
As Sean Hosein has said in the recently published CATIE News: “An HIV-positive person on effective treatment is not expected to be at higher risk of becoming seriously ill with COVID-19”. However “a person with untreated HIV or a low CD4+ cell count may be at higher risk of becoming seriously ill with COVID-19. People with HIV or hepatitis C are more likely to have other conditions that carry a greater risk of becoming seriously ill with COVID-19.”
Our response needs to go beyond disease control
By now, most people understand what you need to do to lessen the chances of being infected with this coronavirus. Frequent handwashing and/or hand sanitizing, not touching your face, social distancing have all become, or should become, the new normal. You have probably already experienced that it’s easy to keep washing your hands, but it’s less easy to do without social interaction. People with HIV who live alone, in particular, need social interaction. In fact, the most marginalized arguably face the toughest battles. But again, we are a caring community that has fought battles like this before. We help each other in times of need. We communicate with each other. We provide support. We look beyond the medical condition. We save lives. It’s our history.
Our response to this virus, once again, needs to go beyond the medical and beyond disease control. We need to recognize the impact of prolonged isolation, prolonged anxiety and, in some cases, prolonged despair. Our community has always stressed the importance of strong mental, spiritual and sexual health. Let’s also stress their importance in the age of COVID-19.
Marginalized people are the most in need
Our most marginalized are potentially the most in need right now. Imagine you are in prison, homeless or living in a crowded shelter. Imagine you are a sex worker, dependent on that income to survive, with no safety net. Imagine you use drugs, need them to survive, are used to sharing. How do you deal with the new reality?
We have turned to harm reduction before. We recognize how hard it can be to change behaviours, so we provide solutions that reduce risk. In the last few days, for example, we have seen brand new resources that offer harm reduction solutions to both drug users and sex workers. Their aim is to reduce the risk of acquiring and passing on this new coronavirus. They are excellent resources, but we need more information like this.
Harm reduction may be the approach
It’s been said before that the queer community is particularly vulnerable. It’s a community whose members tend to be social. It’s not uncommon for us to live alone, so social isolation hurts. Sex is a part of our culture. Abstinence is not. Our history tells us that calls for abstinence were a hugely ineffective means of controlling the HIV pandemic. I worry they won’t work in relation to COVID-19.
We need to do more to meet those challenges so that a mini-epidemic of COVID-19 within the queer community is not in our future. I think it’s time to recognize that, for some, harm reduction recommendations, rather than a call for abstinence, are what is needed. Let’s have a solution-oriented community conversation about that, starting now.
This is not the time for moralizing
We have seen infection control addressed. We have seen the economic implications addressed. But there remains a gap in how we address the impact on us as humans. We need to think about the impact of the epidemic on those with fragile mental health. We need to address the human needs of those under extraordinary pressures. This is not the time for moralizing about lifestyles, about drug use or about sex.
I’ve talked to people who are struggling, people who are afraid, people who see drugs as their way out, people craving human touch, people in denial. We need stepped-up supports for all of these that go beyond recommending handwashing and isolation. The marginalized will always need extra help – and they should get it.
If all this sounds bleak, it wasn’t my intention. I have a profound belief in the goodness of humankind. Already I’ve seen people helping each other, making efforts to communicate with each other, checking up on each other’s practical needs, making isolation more bearable, finding new ways to communicate. I’m seeing kinder times. More importantly, I’m certain this will be over one day. Don’t despair. Stay strong. Be there for the big party once all this is over.
Bob Leahy is from Warkworth, Ontario and has lived with HIV since 1993. Formerly the publisher of PositiveLite, he is a frequent commentator on issues affecting people living with HIV.