Changing the Narrative About Positivity
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“A lot of people are using this safety net of saying, ‘Oh, I got it at the winter party, I got the antibodies,’” he said. “It’s the first time gay men have been happy to say they’re positive since 1980.”
“Daniel Nardicio, an event producer who hosts a Friday underwear party at the Ice Palace in Cherry Grove, was dubious about the ability of people to restrain themselves over time. “They’re already starting to have parties here, whether people like it or not,” he said. “We’re trying to figure out how we can do it and be responsible, but I’m not going to check people’s Covid status at the door. This isn’t Nazi Germany.”
Both fromThe New York Times, Sunday June 7, 2020: “Is the Party Over on Fire Island?”
Above the corner of 51st and 9th Avenue in Manhattan’s Hell’s Kitchen on Sunday, June 7th after the gay bars re-opened. Read more here.
Changing the Narrative about Positivity
As someone who lived through the AIDS crisis of the 1980s, I could have never imagined that testing ‘positive’ for a viral pathogen that’s responsible for a catastrophic 21st century pandemic would be desirable or even a point of pride. This helps to create a different reality for the 1.2 million Americans living with HIV.
HIV, the virus that causes AIDS, has caused terror, havoc, and death around the world in the last two decades of the twentieth century. In the United States, 650,000 have died due to of AIDS-related complications. However, since the advent of effective antiviral therapies in 1996 and the science of treatment as prevention with the accompanying Undetectable=Untransmittable (U=U) campaign in 2012, we have begun to view an HIV-positive serostatus in a somewhat different light—significantly different from the rejection, stigma, and almost certain death that accompanied an HIV-positive diagnosis prior to 1996.
SARS-CoV-2 (the novel coronavirus) which causes COVID-19, has taken a brutal toll on our country—nearly100,000 deaths to date, with close to two million infected. This viral pathogen is more widespread and fast acting than HIV, but like HIV it has unfairly affected marginalized populations revealing the festering soars of our society including racism and health inequity.
At the same time, the current COVID-19 pandemic further shifts the HIV narrative in two substantive ways—first, with regard to the power of words and second with regard to the significance of HIV antiretroviral treatment.
In the last few weeks and since the widespread roll out of COVID-19 antibody testing, users of dating and sex apps have begun to include information about their ‘positive’ COVID-19 antibody status on their profiles—a label of pride, suggesting a highlighted level of desirability on the part of the bearer of antibodies. This is despite the fact that COVID-19 antibody testing is far from trustworthy and it is unclear if being antibody ‘positive’ confers any protection or immunity from the disease. Given the relatively low prevalence of the virus in our population, the mathematics surrounding antibody testing indicate that they have low predictive power, with only 1 in 3 of those testing positive, being truly positive. Yet, despite these circumstances, a positive COVID-19 antibody result is exalted by some, with proud pronouncement of status. (I, myself, have tested positive and all my friends and family have reacted with envy at my status.) This is far cry from the too often negative reactions associated with an HIV-positive status, despite the advance of science over the last decades and with no regard to U=U. SARS-CoV-2 makes being positive desirable, perhaps even for those who are HIV-positive.
A powerful shift within the HIV-positive narrative is informed by the impact of SARS-CoV-2 infection in people living with HIV. Of course, HIV-positive people have died due to this infection, including my own colleague Deloris Dockrey, a fearless public health leader and advocate, who graduated from the Rutgers School of Public Health some years prior. . But most doctors treating people living with HIV tell me that overwhelmingly, among those who are in care and virally suppressed with no other major underlying conditions, symptoms have been mild to moderate. My team and I had reported this weeks ago, and recently Jeffrey Laurence suggested that this level of protection may be due to either the use of the widely utilized HIV antiviral, tenofovir, which is akin to remdesivir a drug which is used to treat COVID symptoms, and /or the immune dysregulation experienced by people living with HIV due to the HIV status, may suppress the pathology associated with COVID-19infection.
COVID-19 and HIV have taken their tolls on our nation due to past and present missteps by our leadership, , as I have previously noted. The AIDS crisis catapulted public health forward, demeaned that medical providers attend to LGBTQ health, and redirected the manner in which treatments are advanced. No loss of life is ever worth a consequential good, but if the COVID-19 pandemic shifts how we think about HIV and healthcare as a whole, it is a positive result that I can embrace.
Perry N. Halkitis is Dean, Director of the Center for Health, Identity Behavior & Prevention Studies (CHIBPS), and Professor of Biostatistics and Urban-Global Public Health, at the Rutgers School of Public Health. Dr. Halkitis’ research examines the transmission of HIV, HPV, and other infectious diseases and he was a member of both the New Jersey and New York Ending the HIV Epidemic planning groups. He’s also co-author of the NIH Study: The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective
Follow him on Twitter: @DeanPNHalkitis
