In the early years of the HIV/AIDS pandemic confusion and fear reigned. The “gay plague” was initially misunderstood by science, medicine and religion all of whom admonished the world to steer clear of anyone even suspected of being gay.
In response to the emergence of Covid-19 in the United States, we’ve been either at home or in place and social distancing for nearly 8 months. The United States is now the global epicenter of the novel coronavirus and has invoked the use of masks > handwashing > social distancing as a precaution. However, the profound burden of extreme physical distancing has created a dynamic the medical community refers to as “quarantine fatigue.” Physical isolation, confinement and loss result in depression, loneliness and despair. According to the Pew Research Center, nearly half of all Americans have lost or gained 20-25 pounds in the last year. The body's physical manifestation of a crisis.
Moderation: The Defense to Excess
Neither community nor risk are binary. An all-or-nothing approach to disease prevention can have unintended consequences. Individuals may fixate on unlikely sources of contagion (the package in the mail, an unmasked runner on the street) in the same way we avoided our hairdresser, waiter, and flight attendant during the AIDS pandemic.
In 1983, the virologist Joseph Sonnabend published a foundational document for the community called “How to Have Sex in an Epidemic.” Recognizing our fundamental need for human contact, the pamphlet rejected abstinence as the sole approach and coined the phrase “safe sex.”
Those that promote the total elimination of risk miss out on the hidden value of lower-risk behaviors. Studies show that abstinence education, for example, deprive young people of understanding how to reduce risk when they do have sex. Moreover, extremist philosophies often promote a discontent within our communities. For example, cities who’ve locked down during the pandemic can incite riots toward their state. Closing restaurants, bars and gyms produce lawsuits. When others violate our personal canons of freedom—such as sexual orientation or social distancing guidelines—some people feel their liberties have been called into question.
Don't Shoot the Messenger?
Instagram stories of spring break and parties at crowded beaches made headlines this year due to the bifurcation of news and information. Google, for example, ensures we see information that will engage us. Through surveillance capitalism and data mining, tech and social media companies know how we search, browse and shop. Seemingly free of charge, they’re the proverbial drug dealer who offer their products and services for free—in exchange for a lifetime of addiction. Advertisers on Madison Avenue in the 1970's coined the phrase "If you’re not paying for the product—you are the product," and its never been more true than now.
Sonnabend knew that abstinence wasn’t realistic for everyone and offered practical alternatives to mitigate HIV transmission. The harm-reduction model, which recognizes that some people are going to take risks, offered strategies to reduce the consequences. Acknowledging that individual-level decisions happen in a broader context—that include factors that are often of our control— his approach met people where they are.
What does harm reduction look like for the coronavirus? First, rather than hiding behind the shield of Section 230—which legally absolves all tech/social media companies from user liability—Silicon Valley might be better poised in society as a public trust. They could assist their users’ access to information, regarding low and high-risk activities, and point them toward a measured response. Sadly, information and data without context is destructive.
Mitigating Risk Means Understanding Cost
Scientists are still learning about this virus, but the science suggests that not all activities or settings confer an equal risk for transmission. Enclosed and crowded settings, especially with prolonged and close contact, have the highest risk of transmission. Casual interactions outdoors present a much lower risk. A sustainable anti-coronavirus strategy from tech companies might drive information about house parties; suggest redesigning outdoor and indoor spaces to reduce crowding, direct us to products and services that increase our home’s ventilation, and ultimately promote physical distancing thereby allowing people to live their lives while mitigating risk. While these alternatives would speak only to America’s white middle class, tech companies would have the prerogative of filtering the information culturally.
The health community acknowledges that some people can’t comply with public-health guidelines due to structural factors; including systemic racism that render physical distancing a privilege. Front line workers, essential services, and public transport are administered primarily by minority communities for whom these sage advices are irrelevant. As the collective we ignore the broader context of our communities, people of color will continue to bear the brunt of misinformation within contextual factors and will continue to bear the brunt of the risk of the coronavirus.
Moreover, many people across the spectrum are seeking human contact outside of their households due to intense loneliness, anxiety, and/or a desire for sexual intimacy. The decision to go for a run with a friend, gather in an outdoor setting, or attend the funeral of a family member may be in conflict with current public-health guidance in some communities, but the low risk of transmission in these settings may be outweighed by the mental health benefit.
Certainly clinicians, science, and state health departments can lead the way. Physicians at Harvard Medical School, for example, have created guidance on sexual health during the coronavirus pandemic that could provide a road map for a harm-reduction approach to socialization and other settings. They implicitly acknowledge that some people may choose to have sex outside of their households and offer practical advice to reduce harm and mitigate risk.
The HIV/AIDS epidemic has claimed 32 million lives since 1983, and continues to claim the lives of 1 million each and every year. Covid-19 has currently taken the lives of more 1.2 million around the world in just the past 8 months, and is on track to becoming among the most virulent viruses the world has ever known. What Americans, in particular, need now is a constructive national narrative on life and living in a pandemic. As discrepancies between various health organizations and the White House attest, we’d be wise to shift our focus to big tech and social media companies; who’re no longer the mere messengers of data, but visceral drivers of information in human society. Looking back to the Gay Community, who took on the last pandemic by asking a fair and simple question of one another—are you positive or negative—is a solid and respectable place to start.