The lies we tell ourselves are the hardest for us to see. Take, for instance, the comforting lie that we can—with absolute certainty—prevent a disease, whether HIV or COVID-19, if only we put together the right combination of preventative measures. It’s also true that if I never leave the house, I’ll never be in a car accident. The lie here is that achieving perfection is practical or even possible.
It’s in acknowledging the deceptive nature of this belief that we find effective public health strategies. We see with pre-exposure prophylaxis, or PrEP—at least with those who have the privilege of access to PrEP—that adding an option alongside the condom is even more effective at preventing HIV than offering mere condoms alone.
I do occasionally leave the house; during the rare times I drive, I wear a seatbelt. I open myself up to the risk of a car accident while taking steps to reduce harm if it happens. Activists, people with lived experience, and others who talk about these realities bridge the gap between government and everyday people. For legal or scientific reasons, the government and other authorities can’t say what is known by anecdote or practical experience.
It’s why Mark S. King, longtime HIV-positive writer and activist, came out swinging with his 2013 essay, “Your Mother Liked It Bareback,” reminding everyone that our mothers had condomless sex, so we should welcome PrEP, even while the Centers for Disease Control and Prevention (CDC) was still stuck saying that oral sex may transmit HIV. Yes, oral sex “may” transmit HIV, and the sun may blow up today. It’s scientifically possible. But I’ll bet anyone cash money the sun will rise again tomorrow, using my own experience and what knowledge I’ve gleaned from attending high school and watching “How the Universe Works.”
It’s why there’s sometimes a difference between what the CDC says and what HIV-competent doctors will say privately one-on-one. Advocating this practical approach isn’t always popular.
I remember when PrEP first emerged and many of us hailed it as a wonderful addition to the HIV prevention toolbox, only to find a not insignificant population of preachy prattlers pouncing on us with countless lies wrapped around facts: PrEP will cause super AIDS, PrEP will increase chlamydia and gonorrhea, or even that PrEP will increase licentiousness.
Heavens to Mergatroid, licentious gays!
The resistance to PrEP, the reflexive need some have to add moralism into an otherwise science-based discussion, is seemingly pathological—and it’s enduring. Even today, in the third decade of the 21st century, we have irrelevant hypocrites like Chadwick Moore popping off with more fearmongering and finger wagging.
Which brings me to your many posts about masks in the age of COVID-19. The insidiousness of ignorance coupled with a desire to do good finds a happy home in people claiming they want to prevent disease all the time.
Some say PrEP is bad because it will erode “personal responsibility.” Others take pictures of someone 30 yards away who’s unmasked, posting their picture online. Usually, there’s some sanctimonious caption about killing vulnerable people. In both cases, people warp a science-based fact that saves lives—PrEP prevents HIV, masks prevent COVID-19—and add moralism to empower themselves. Empower is the right word, too.
These self-appointed deputies of Anthony Fauci, M.D.—whom I love, don’t get me wrong—will imply that they behave perfectly. Just as people who once decried PrEP forgot the many times they had sex without condoms, people will likewise forget the morning they walked into a supermarket unmasked.
They’ll even ask for the maximum possible penalty in 2020 for the unmasked: online shaming.
Amusingly, these folks, often otherwise good Obama-coalition voters in their minds, will not realize they are the mirror image of gun-toting crazies who refuse to wear masks and think wearing one means you’re a communist.
The summary judgment of other human beings will always be exhilarating to the ego, which is probably a good signal that it’s wrong. Most appalling of all isn’t the effect judgment in this context has on one’s character, though. Rather, it’s the effect it has on others that makes it truly terrible.
This judgment is the fuel that drives the engine of stigma, initiating a tragic sequence: sanctimony turns to judgment, which then in others evokes shame and, eventually, avoidance of the issue altogether.
Recently, I tweeted that I don’t always wear a mask but do wear one entirely in line with what public health authorities at every level have suggested. I mean that when I am alone in a park and no one is nearby, I lower my mask. It’s nice, being able to breathe naturally. Likewise, I’ve increased activities that don’t require a mask; I’ve gotten better at home DIY projects.
I have assessed what public health authorities say and developed a practical approach that works for me and will prevent transmitting COVID-19 if I am asymptomatic or in the early stages of infection and don’t know it.
Under the surface, I was saying, “It’s OK if you are not capable of perfection; please try your best, and have you considered developing a masking strategy that works for you that will maximize your ability to prevent COVID-19?” This is a garden variety harm-reduction strategy.
Of course, some people on Twitter had opinions.
One person paternalistically informed me that people are so dumb and helpless that if anyone ever sees me walking 100 yards away with a mask around my neck instead of on my face it will prompt others to not wear a mask. Eventually, nobody will wear masks and, presumably, we all shall die.
I remember this argument back when it was, “If you stop saying, ‘Use a condom every time,’ because of PrEP, then everyone will become HIV-positive.” Shrill paternalism and the false notion that perfection is possible didn’t work for HIV prevention—and it will not work for COVID-19 prevention, either. People are much smarter than some of you seem to think.
Likewise, as the old saying goes, while people might not remember what you say, they will remember how you made them feel. If you couple two things together enough, let’s say disease prevention and shame, eventually people are going to avoid the former in order to not feel the latter.
This is the danger of the sanctimonious lies that fuel stigma.
I get it. A majority of people do, in fact, have noble intent. But there’s also a saying about the road to hell and good intentions.
People would do well to remember that. And they ought to think about the times they listened to people versus the times they didn’t.
If the goal is to prevent disease, let’s do the things that get us there most effectively and scrap the counterproductive nonsense.
Because right now, there’s a lot of hyperbole warping what public health authorities are actually saying. And there’s even more ego zooming across the digital world masquerading as public health advocacy.