No, Covid-19 Isn’t a Chance to ‘End HIV’

Much has been made of the similarities between viral outbreaks of HIV and Covid-19, and the many “lessons” the AIDS crisis might hold for tackling today’s pandemic: for instance, the need to consider health inequalities as structuring the spread of a pandemic, as well as access to prevention tools like vaccines. Less attention, however, has been paid to how Covid-19 has influenced HIV prevention and care, and in particular how the prevailing mode of Covid-19 prevention in the UK – the state of total lockdown and physical distancing – has helped foster the return of troubling approaches to prevention within the HIV sector not seen since the early years of AIDS crisis.

After the UK entered lockdown in March 2020, several organisations committed to the sexual health of the LGBTQ+ community announced that these measures offered a “once in a lifetime” opportunity to “end” the transmission of HIV. Capitalising on the assumption – fostered by a tacit and eventually explicit ban on sex outside of your household – that fewer people would be having casual sex under the strict conditions of lockdown, both Northern Ireland’s Rainbow Project and the London-based sexual health clinic 56 Dean Street launched campaigns towards the start of the first lockdown stressing to at-risk gay and bisexual men that now was the time to test for HIV. “We can now track down every single new infection that has possibly been contracted in the last three to four months and get those people onto a treatment pathway straight away,” said Gavin Boyd, policy and advocacy manager for The Rainbow Project, “so there’s no risk of the infection going any further.”

COVID lockdown has only shored up what a lot of public heath officials and advocates have long believed: that asceticism and abstinence are the best tools for enduring public health.

— ben (@benvyle) February 1, 2021

The message of these campaigns is consistent with ever-increasing efforts within the HIV sector to bring about the “end of HIV”, an aspiration reflected in the Joint United Nations Programme on HIV/AIDS (UNAIDS)’s target to “end the AIDS epidemic by 2030”. As the sociologist Tony Sandset argues, this turn to securing the “end of AIDS” was precipitated, in part, by the increasing recognition that a person living with HIV (PLWHIV) on effective antiretroviral treatment not only does not go on to develop AIDS, but cannot pass on the virus through sexual contact. Treatment, therefore, has been resignified as a form of prevention.

This prioritisation of eradication has been criticised by scholars of HIV and AIDS, who argue that it deprioritises care for PLWHIV, as well as the wellbeing of at-risk communities, including gay and bisexual men, in favour of prevention at all costs. Sociologist of health Liz Walker notes in a 2017 journal article that while access to effective antiretroviral treatment now renders HIV a chronic, manageable condition rather than a life-threatening one, fixation on a “post-AIDS” world neglects what it means to continue to live with HIV after the end of HIV transmission has been obtained. One facet of “the everyday life with HIV and AIDS” that Walker argues has been occluded by the dogged pursuit of a world after AIDS is the stigma of HIV, which remains rampant across the globe.

Similarly, early framings of Covid-19 measures as expedient for pursuing the long-awaited “end to HIV” neglected another issue, one especially important during lockdown: care for PLWHIV. Ignoring concerns that undiagnosed PLWHIV might have about testing positive during a pandemic – potentially cooped up in less-than-ideal living situations, having less easy access to healthcare – these campaigns insisted on HIV testing as a personal responsibility to stop new transmissions. Even antiretroviral treatment, once seen a life-saving form of care, was only signified within media about these campaigns as a means to bring “very infectious people” under control.

As well as being continuous with the eradicationism that has been gaining prominence within the HIV sector for some time, these campaigns are also the product of a trend inculcated by Covid-19 measures: the rise of hygienism. By hygienism, I mean the anxious and absolute isolation of bodies from one another for fear of contagion, a state where viral transmission is to be avoided no matter the cost. Framing lockdown as “an unprecedented opportunity to literally interrupt an epidemic (or two)”, campaigners have idealised quarantine and abstinence as methods of HIV prevention – methods deemed unethical at an earlier moment in HIV history. This notion – that a nation of queers abstaining from sex might represent an unparalleled chance to stop further transmissions of HIV – is ideologically linked to the UK government’s general (and disastrous) approach to managing the spread of Covid-19.

an excerpt (pp. 1-2) from @kanerace‘s “pleasure consuming medicine” that should provide some food for thought regarding the possibility of articulating “safer” covid-19 practice and exceeding the current regime of ascetism/sacrificing pleasure in the name of public health. pic.twitter.com/YX4Oz0eXAm

— ben (@benvyle) April 6, 2020

Since March last year, the UK government has heralded asceticism – the disavowal of frivolity – as the gold standard of public health. Moving unsustainably between binary states of total lockdown and complete reopening, the government has eschewed the grey area of risk management. The possibility of enabling citizens to safely engage in low-risk practices like outdoor gathering and indoor exercise by coupling them with precautions such as mask mandates and an efficient testing infrastructure was simply never entertained. Instead, attempts to flatten the curve have relied entirely on alienating people from one another and promoting paranoia about the risk of intermingling.

In this sense, public health officials have overlooked one of the most important practical implications of AIDS crisis for the management of Covid-19: what the American scholar and AIDS activist Douglas Crimp describes as “how to have promiscuity in an epidemic”. As Crimp notes, it was only by refusing to disavow pleasure – life-enhancing, community-building pleasure – and negotiating risk in the face of a viral outbreak that gay men were able to develop the techniques we now accept as safer sex.

Unfortunately, it was the government’s emphasis on asceticism rather than the promiscuous spirit of HIV history – the kind described by Crimp – that these early-stage pandemic HIV prevention campaigns chose to inherit. Choosing to believe, or perhaps even willing, that queer men had ceased hooking up during lockdown, 56 Dean Street and The Rainbow Project missed an early opportunity to educate people on how to have safer sex in the time of Covid-19. Other campaigners filled in the gaps, however: PrEPster, an HIV prevention and education advocacy group, swiftly released a series of tips to help people reduce Covid-19 risk while having sex. By promoting lockdown as a new form of HIV prophylaxis, a number of the UK’s most prominent LGBTQ+ sexual health organisations failed to meet significant numbers of people, particularly gay and bisexual men, where they were at – namely, having sex with each other – and instead fell prey to a wave pandemic-induced hygienism, the ripples of which we may feel for years to come.

Ben Weil is a writer and PhD student researching the protest of the so-called “gay blood ban” in the UK. This article is adapted from a peer-reviewed essay co-authored with Chase Ledin and first published in Culture, Health & Sexuality.