How to Have Sex in an Epidemic Redux: Reinforcing HIV Prevention in the COVID-19 Pandemic

Abstract

Sexual health is a fundamental determinant of health and wellbeing [1]. All persons-including gay, bisexual, and other men who have sex with men (GBMSM)-have the right to enjoy a safe and pleasurable sexual life with access to comprehensive information, affirmative care, and an enabling legal and sociopolitical environment [1]. The COVID-19 pandemic threatens to disrupt HIV programs and global progress toward UNAIDS 90-90-90 targets [2,3]. The unprecedented repurposing of health services and resources to address COVID-19, along with necessary restrictive public health measures [4], present a spectrum of psychological, sociocultural, structural, and biomedical concerns for sexual health and HIV prevention [5]. In this Note, we draw on lessons learned from four decades of the HIV response with GBMSM communities, and our respective programs of research, to advocate carefully recalibrated, communityengaged approaches to reinforcing HIV prevention in the COVID-19 pandemic. Sex and Risk in a PandemicSex in a pandemic is complicated. Key considerations for "safer sex" must address the immediate risks of new coronavirus (SARS-CoV-2) transmission and potential exacerbation of risks for HIV transmission. Sexual transmission of HIV, especially among GBMSM, remains the leading driver of the AIDS epidemic [6]. The integral role of sexual health in many people's lives, and its sociocultural and political ramifications for GBMSM and people living with HIV (PLHIV), suggests it is implausible to expect sexual contacts to cease for months or years in response to social distancing and stay-at-home guidelines [7] while awaiting new vaccines and therapeutics [4].Among the core lessons to emerge from the HIV response is the failure of sex-negative, stigmatizing, and ideologically driven approaches that defy science (e.g., abstinence-based interventions) [8,9]. SARS-CoV-2 presents very different transmission and infection risks than HIV; nevertheless, unilateral proscriptions around sex fail to capture the complexity of many GBMSM's sexual lives. They also reflect a concerning disconnection from the sociocultural meanings of sex for a community that has successfully struggled against more than a century of criminalization and repression. The burden of recommendations not to have sex with anyone outside of one's household, and unilateral advice to avoid new partners, are not equally distributed in the context of statesanctioned heterosexuality and the rights it confers in many parts of the world. In many countries, GBMSM are fighting for their very right to exist. Calls to shut down sexual network apps used by GBMSM in the context of the COVID-19 pandemic fail to account for their role in promoting health and social support [10].

Low Psychological Well-Being in Men Who Have Sex With Men (Msm) During the Shelter-in-Place Orders to Prevent the Covid-19 Spread: Results From a Nationwide Study

“…The prevalence of low psychological well-being was approximately six times greater among MSM who did not comply or could not comply with the social isolation measures, reinforcing the hypothesis that even though the individuals may not comply with social distancing measures to seek interactions, exposure still may cause concerns (Sousa, Oliveira et al, 2020;Newman & Guta, 2020;Sanchez et al, 2020. Nonetheless, having a small number of partners also affected these individuals' psychological well-being negatively. If, on the one hand, the individuals want to decrease exposure to protect .…”

“…The prevalence of low psychological well-being was approximately six times greater among MSM who did not comply or could not comply with the social isolation measures, reinforcing the hypothesis that even though the individuals may not comply with social distancing measures to seek interactions, exposure still may cause concerns (Sousa & Oliveira et al, 2020; Newman & Guta, 2020; This finding should be interpreted with caution because this study did not assess the context in which people violated social isolation measures, socialized with roommates, family, and co-workers, or yet how people interpreted the questions. Additionally, we should consider that seeking social interactions might not be a matter of choice but rather a compulsive behavior, even though it implies decreased psychological well-being afterward (Sanchez et al, 2020).…”

“…CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint The copyright holder for this this version posted September 23, 2020. ; https://doi.org/10.1101/2020.09.21.20198929 doi: medRxiv preprint themselves, on the other hand, not having the social support provided by relationships and partners, which would decrease the pandemic's harmful effects, could negatively affect these individuals' mental health (Sanchez et al, 2020;Carrico, et al, 2020;Newman & Guta, 2020). This variation in the number of affective and sexual partners has compromised MSM's psychological well-being.…”

“…Exposure to often unknown partners, or familiar partners who do not effectively adopt preventive measures, including those against COVID-19, increases the fear of being contaminated or anxiety with the possibility of presenting signs and symptoms of the disease, leading to low psychological well-being (Newman & Guta, 2020; Suen, Chan & Wong, 2020; Brennan, Card, Collict, Jolimore & Lachowsky, 2020).…”

“…Nonetheless, having a small number of partners also affected these individuals’ psychological well-being negatively. If, on the one hand, the individuals want to decrease exposure to protect themselves, on the other hand, not having the social support provided by relationships and partners, which would decrease the pandemic’s harmful effects, could negatively affect these individuals’ mental health (Sanchez et al, 2020; Carrico, et al, 2020; Newman & Guta, 2020).…”