“Government approved intimacy is only possible within a bubble”COVID-19, HIV and isolation

The last six months have been an intense and frightening time for many people, none more so than those with health vulnerabilities and the people who care for them. Galway as a city and county has had low rates of COVID-19, something which for most of us has meant we have been watching the health crisis in other areas with a level of remoteness that has been a luxury in many parts of the world. The exception to this has been the people who have those health vulnerabilities who have been isolated from the world ‘cocooning’, and in some cases still are.

Since the start of the COVID-19 outbreak, HIV has been on and then off the list as a pre-existing condition increasing COVID risk. For the people living with HIV (PLHIV) in our communities, the absence of concrete knowledge has, for many, exacerbated their anxieties and magnified their isolation above that of the general population. Before COVID it was found that people who live with HIV are at greater risk of experiencing social isolation, with 64% experiencing at least a moderate amount, which can be due to both experienced and perceived stigma inhibiting the formation of social networks, fear of rejection, or the use of social isolation as a coping mechanism to avoid HIV disclosure or pre-emptive grief avoidance. Now with social isolation on the menu for all of us, many PLHIV have endured an even more extreme version of this.

Fergus, a 50 year old PLHIV in Galway, describes his experiences of the COVID lockdown:

“the impact Covid has had on me has largely been the isolation from the rest of Galway, the people, my kids’ friends that they had play-dates with; the work I used to get to do, which had me meeting and chatting to all manner of interesting characters, and the routine I got to have through my week, including even those mundane, but hugely important to me, encounters I would have with strangers who might give me a friendly nod”. Fergus goes on to say “(the COVID-19 pandemic) played havoc with my mental health. It still does; the endless news cycle warnings about spikes and second waves, and the possibility of tighter restrictions returning… It won’t last forever, for sure; but the longer it goes on, the deeper and more damaging will be the erosion into our collective peace of mind.”

Liz, another PLHIV in Galway, was grateful that she is “too young to be worried about being swept off in the first wave of Coronavirus”, however saying “I’m old enough to remember the first wave of the gay plague (as they called it, given (then) it only showed up in gay men)”. Liz’s perspective of this pandemic is shared by some other PLHIV, “COVID-19 is rampaging the world in 2020, same moral panic, same inept climbing casualties, the scary results.”

The HIV pandemic felt, in its early days, like it could affect anyone. Untrue rumours of catching HIV from toilet seats, kissing, touching, made us as a population become wary of interactions with strangers, afraid to give blood, use public toilets. The misinformation at the time damaged the lives of people who lived with HIV who were left untouched, ostracised, treated by double gloved medical professionals in isolation rooms, and left then to die alone because of others fear of catching HIV. And now, the Coronavirus pandemic is having the same outcomes. This experience we have now, that touching the people we love could make us sick, is not a novelty to the people who lived through the misinformation of the HIV pandemic. Again Sexual Health is part of the ‘moral panic’. Sexual Health is intrinsically linked to a person’s overall health and wellbeing, but if you’re single right now, meeting your sexual needs with a partner is against the rules. As Liz says, “Government approved intimacy is only possible with in a bubble”.

What of the people living with HIV while COVID is on the prowl? The most recent research is encouraging for those whose isolation has been and is more extreme than the population at large. The most current (October 2020) research conclusions tell us that PLHIV are no more susceptible to COVID that the general populations as a result of their HIV status, that PLHIV who contract HIV have a similar clinical disease course to those without HIV, and the majority of research states that PLHIV do NOT have a higher risk of mortality to others. The exception to this positivity is, in some studies, those who have a very low CD4 (immunity level measure) are impacted upon more than the general population by COVID; this is often those in the very early stages of diagnosis or treatment.

Whilst this is overall good news, there is a proviso. Although PLHIV are generally not further at risk as a direct result of their HIV, there are many people who live with HIV who have co-existing conditions that do definitely increase their vulnerability to COVID. Furthermore there are other health determinants that have a significant impact on who contracts COVID and the outcome if they do. Some examples are people living in crowded housing situations, people who can’t work remotely, people who can’t access testing or afford healthcare, people with language barriers, people who care for others, people whose medical care or medication provision is threatened by COVID practicalities, and people who choose riskier health behaviours. In many communities PLHIV are also impacted upon by these other determinants, and these factors increase their risk.

It’s a relief to know that the people in our communities and families who live with HIV are no more vulnerable than people who live without HIV in the same circumstances. They need not be more significantly impacted on by having to cocoon, or social isolation messages. But those social isolations messages do exist for us all, and being in the firing line of a potentially deadly virus is the reality for all of us. Fergus reminisces “with typical middle-aged foolish nostalgia for The Good Old Days I recall my 20’s during an equally dangerous pandemic, and at least having so much fun, surrounded by so many people.” Here we are in the 2020 pandemic of Coronavirus, which will end one day. It’s unlikely there will be much nostalgia for these lonely times.

Nicole McGuigan, Sexual Health West, Galway, Ireland

References available on request to nicole at sexualhealthwest.ie