What does coronavirus (COVID-19) mean in regard to chemsex?
What should our messages be for our patients, clients, friends and communities who engage in chemsex?
The great majority of us human beings here on planet Earth will contract coronavirus (COVID-19) this year.
People who engage in chemsex are even more likely to, because in many cases (not all) chemsex includes lots of transmission possibilities within those chemsex scenarios; it also often (not always) involves higher numbers of new partners over two to three day periods,
For the great majority of us, the symptoms will pass and we’ll be fine.
So despite the fear and alarm associated with this pandemic, we really shouldn’t be frightened of that inevitability.
there is a minority of people among our chemsex communities who will develop more complicated symptoms when they contract COVID-19; and for a certain number of those, the symptoms will be fatal.
We all have a responsibility to protect that minority - vigilantly - from catching COVID-19; from us, from our communities.
That means doing our best to avoid that minority of people when we are potentially infectious.
Given the amount of COVID-19 peaking within our communities this year, it would be unwise and very unkind to hook up with/have chemsex with a COVID-19-vulnerable person;
- especially if we have had other partners in the previous days/weeks
- especially if we have not been vigilant about hand-washing, face touching in the previous days/weeks
- especially if we have been close to anyone with symptoms of cough or high temperature in the previous days/weeks
- especially if we have been around any confirmed cases of COVID-19 in the previous days/weeks
- especially if we have a new persistent cough, shortness of breath or a high temperature (self-isolate for 7 days in this case)
Who are the people most likely to develop the more dangerous complications from COVID-19?
- elderly people, over 70
- people with cancer
- people with high blood pressure
- people with problematic diabetes
- people with chronic kidney disease
- people with chronic heart disease
- people with chronic lung disease
- people with respiratory problems
- people with compromised immune systems.
During peak periods
Cities around the world are all experiencing coronavirus differently... but most are following the same model. The difference is that the "peak" periods are coming at different times. (The peak period is the time during which very very large numbers of people are infected all at the same time.) During the peak period, the risk is that there are SO many (unknowingly) infectious people in a city, that our health services just can't cope. Not enough hospital beds, not enough ventilators, lots of panic, people die in larger numbers.
So to protect against this, most cities are respecting physical distancing policies. Very urgently. Not so we can avoid catching coronavirus; that's pretty much inevitable. (And remember; most of us will be fine). It's to try and slow down (urgently) the number of people who catch it during the peak period. So there are enough hospital beds and care workers. So less people die.
To be blunt about it; If we hook up for sex with people who don't live with us in the same house during a peak period; more people will die.
Not necessarily you; not necessarily your hook-up this isn't about that.
It's about the six degrees of separation and saving the lives of people more vulnerable than us.
On the day this is written (April 5th 2020), thousands of people are dying every day.
Every time we hook up with a new person, every time we disrespect the physical distancing policies... the virus spreads. Every person we hook up with has a dad, or has a grandma, or has a cousin with heart disease. If they don't, then their grocer will. Or the person behind the till in the pharmacy will. Or the Amazon delivery person will.
We are responsible; we have the power to limit the deaths of the grandmas, the grocers, the cousins with heart disease.
Simply by not hooking up during the peak periods. During the urgent physical distancing periods.
Some people don't care.
Some people aren't able to do this; because of mental health, addiction, learning difficulties.
A lot of people really do struggle with compulsive behaviour.
Some people struggle with complex decision-making processes.
Some people don't have agency over their own choices.
Some people don't have control.
Some people have periods of powerful depression when they don't care about themselves or others.
Some people resist on principle, being told what to do, or not to hook up, or not to do drugs.
And some people just aren't getting the urgency of the message.
These are new, confusing and frightening times.
We do not shame these people.
We support them. We are kind to them. We point them toward support services that can help improve their agency over their compulsions and choices.
We support them (not lecture, but support them) to better understand the life-saving urgency of these times. Of the consequences of hooking up.
We deliver this message in our webinars, on our websites, on our social media.
As best we can. No shaming, but compassion and kindness.
And we make information available as plainly and as kindly and as easily as we can.
That's community, and that's our civic duty.
And for those of us who DO have agency over our own choices; those of us with good mental health, and the ability to choose cognitively; those of us capable of understanding the life-saving potential of our choices...
We respect the physical distancing policies. We avoid hooking up, we ease the burden on our healthcare workers and hospital beds.
And we save the lives of the more vulnerable people in our cities and communities.
A lot of us are schooled in the harm reduction of HIV.
A lot of us are schooled in the harm reduction of drug use.
Coronavirus doesn't leave room for a lot of harm reduction. We can't practice corona-safe sex with (real life) hook-ups. When we hook up, people die. Not us, not our lover, but by six (or less) degrees of separation, others will become infected, others will get very sick, hospitals will struggle, people will die.
And that's why the world is taking this so seriously.
It's not forever; it's just during these peak periods.
Remember; compassion (no shame) for those among us who can't or won't distance.
And no hooking up (with people we don't already share a house with) for those of us capable of choice and care.
COVID-19 is very new, so there is not a lot of evidence to give absolute reassurances on the following.
COVID-19 affects our respiratory tract mostly; the stronger our immune systems are, the better we can fight it. The HIV virus weakens the immune system if left untreated for too long. This time can vary person to person.
(For the information below, I consulted an HIV specialist, who I thank dearly.)
- Nearly all people living with HIV and on treatment with undetectable viral loads have strong immune systems, so COVID-19 would not necessarily pose a higher risk to them than anyone else. Take comfort in this; be reassured. (The British HIV Association recommends that HIV positive patients make sure they’re up to date with their annual flu vaccination and the pneumonia vaccination; both are common at this time of year, both are preventable; avoiding those illnesses will reduce the burden on our health services and hospitals during this COVID-19 pandemic.)
- It's possible that people living with diagnosed HIV, but who are not taking any HIV medicines, or people who have only recently started treatment might be at greater risk of developing the more complicated symptoms of COVID-19; but this isn't known for sure. Talk to your doctor or HIV healthcare team as soon as possible about this. They'll be able to answer this more exactly.
- If a person has HIV but doesn't know it, their immune system might have been damaged, putting them at risk of developing infections and other illnesses. It's possible that they might not be able to fight off infections like COVID-19 as well as people who don't have HIV, or people with HIV who are taking treatment. Therefore, if you haven't tested recently (or ever), it is a good idea to have a test so that if it's positive, you can start treatment as soon as possible.
- For some people, going for an HIV test is a scary thing; but it really shouldn't be. HIV medicines work brilliantly and the protection they give to your immune system should make it easier to fight infections like COVID-19. Now is a very good time to get tested for HIV. While you are there; ask about condoms, ask about PEP; ask what "undetectable" means, and ask about availability of PrEP. These are all HIV prevention tools, and now is a really good time to avoid a new HIV infection. A new HIV infection is quickly followed by some HIV seroconversion symptoms; these symptoms vary person to person, but they could complicate a COVID-19 infection if they happened simultaneously. HIV prevention is especially important during this COVID-19 outbreak.
Updated; Coronavirus advice from the British HIV Association (BHIVA) for people living with HIV:
➡️CD4 under 50: follow the *shielding* advice for extremely vulnerable people
➡️CD4 under 200/detectable viral load/not on ART: follow *social distancing* advice stringently
➡️CD4 over 200 and undetectable viral load: follow *social distancing* advice as for the general population
This isn't forever
At the moment we, as a global population, are coping with a new virus that we have no history with, and so no resistance to. We also have no vaccine at the moment (though people are working on it urgently). So these very first few months as it spreads around the planet are the most urgent. There'll be a 'peak' period where a whole lot of people in a city have it at the same time. It puts a strain on our health services and our lifestyles. But as the peak passes, our health services will return more to normal; hopefully, we'll develop some natural resistances to it, and in time, a vaccine will be developed... so this isn't forever. Let's all do what we can to get past the 'peak'; do what we can to not pass COVID-19 on to the more vulnerable people; do what we can to reduce the strain on our health services... and re-assess after the peak has passed. Experts say that 'peak' period is a few months.
Everyone has different and varying relationships to chems; they affect us all differently.
Some of us can stop chems, take a break during a dangerous period, practice excellent hygiene, wear condoms consistently, adhere to our HIV medicines perfectly, take our PrEP perfectly.
For many of us others, those things can be difficult.
Drug cravings can be overpowering
Mental health can fluctuate
The desire to self-care can be out of our reach sometimes, during some seasons of poor wellbeing.
Sometimes when things are bad, the lost ability to self care can be accompanied by an apathy in regard to caring for others
Choosing to take a break, or to practise meticulously safe chemsex during this COVID-19 pandemic is not something we can all accomplish.
And as a community, we need to be kind, understanding and intelligently aware of this.
And patient and flexible and generous.
Cruelty, lack of empathy, and unkindness make epidemics worse.
Many people participating in chemsex may be run down, depressed, off their HIV medicines for a period of time.
Many people participating in chemsex may be living with undiagnosed HIV; whether that’s a month or a year.
Many of our older brothers and lovers may be participating in chemsex despite the risks, because they may have less control over triggers, cravings and compulsions to use chems.
Many older COVID-19-vulnerable people may be lonely and isolated, and taking greater risks in regard to COVID-19 prevention.
For some of our older gay brothers, this is the second epidemic within their lifetime that affects their sex lives and their ability to seek connection, intimacy, pleasure; epidemic fatigue is a real thing.
This is life, this is gay life. This is addiction, this is mental health; this is fatigue, this is fluctuating seasons of wellbeing, and this is sex and horniness. This is the need for intimacy, this is the ‘Human’ in human nature. This is our primal desire for connection. This is the nature of gorgeous and sometimes vulnerable human beings.
This is chemsex too.