People, we’re finally getting there! As we trudge into 2021, COVID-19 vaccines are finally rolling out nationwide—albeit at an incredibly slow rate, which many say reflects the Trump administration’s failure to plan and scale up preparation last year. And of course now we have the worry of that new, highly transmissible COVID variant first found in South Africa showing up in the U.S., and the possibility that existing vaccines may be less effective against it. Gulp.
Yet nonetheless, people in the most COVID-vulnerable categories, particularly frontline health and other essential workers, and seniors, are starting to get the shot in the arm. As of the end of January, more than 23 million Americans had received their first dose of a COVID vaccine, with about 5 million people having received their follow-up shot and becoming fully vaccinated. Again, that’s only about 1.5% of the U.S. population—but it’s a start.
As for folks living with HIV, it’s unclear yet whether well-managed HIV (or even an AIDS diagnosis) will qualify state-to-state as a “high-risk condition” to put one in the Centers for Disease Control and Prevention’s third-tier category of prioritization for a vaccine. That’s according to Jennifer Kates, Ph.D., senior VP and director of global health and HIV policy at the Kaiser Family Foundation, which is tracking that matter. In 2020, existing data suggested it was unclear that HIV alone—independent of age or other risk factors like diabetes—put one at greater risk for severe COVID illness or death.
Be that as it may, it’s very likely that, whether you’re living with HIV or not, you may be vaccinated for COVID sometime in 2021. In which case, you’re probably thinking: Can my life go back to normal then? Sadly, the answer is no, at least not right away.
Waaaaaanh! Why Not?
The main reason is that we just don’t know yet if the current vaccines prevent transmission of COVID. They were studied and approved by the Food and Drug Administration based on their ability to prevent serious illness or death in people infected with COVID, but we’ll need months of vaccinations out there in the population to start getting a read on whether they stop the spread as well as the sickness.
“We know that after getting the second shot, after about two weeks, someone is very reliably protected from getting sick,” says Peter Meacher, M.D., chief medical officer at New York City’s large, LGBTQ-serving Callen-Lorde clinics. “But [we don’t know if] the vaccine makes them immune from becoming infected and transmitting COVID to others. And until we do, we can’t advise that people can go back to living how they did prior to COVID.”
So when will we know? That depends, in part, on how fast the United States can get up to 80% of its population vaccinated, which could take a while given the aforementioned slow vaccine rollout.
Of course, that might change now that the new Biden administration has taken aggressive steps to accelerate the process. Says longtime HIV activist Gregg Gonsalves, Ph.D., a professor of public health at Yale, “These distribution problems have to be solved, because private health centers plus CVS and Walgreens is not enough. We need a military-style distribution program.”
And that means not just commandeering huge parking lots, he says, but “mobile units, so that people who can’t drive can be gotten to.” He points to a recent New York Times op-ed by fellow HIV activists Peter Staley and James Krellenstein, as well as Dr. Wafaa El-Sadr, urging that Biden start a COVID program modeled after PEPFAR, the global HIV treatment distribution program started by President George W. Bush.
Take Callen-Lorde’s challenges alone, for instance. According to Meacher, for the clinics to vaccinate in the next six months a majority of their patients who want it—roughly 70,000 people—“We’ll have to have 200 people a day coming in five days a week, just to get vaccinated. We’re excited about that, but it’s a huge undertaking.”
The answer to how fast we’ll know if vaccines stop the spread, he says, “really lies in how much resources are put into this effort by the federal government, city and state departments of health, and everyone else.”
Says Gonsalves, “If we continue to see cases climb but deaths go down, especially among the elderly,” that would suggest that vaccines fail to prevent transmission.
So What Does All That Mean in the Meantime?
As tough as it is to hear, it means that people have to keep wearing masks, socializing outdoors, and, when not doing those things, maintaining their COVID social “bubbles” (be that your household or social group) for the time being, even if they’ve been vaccinated.
But how on earth do leaders put that message across to a public desperate to believe that vaccines are a silver bullet? “If I knew that ...” begins Meacher, adding, “It’s not going to be a welcome message.”
Yet it must be put forth, says Gonsalves. “We have to keep the community norms around masking and social distancing, because many of us are not getting vaccinated until this summer. Meanwhile, COVID is spreading so fast right now, burning at white-hot heat, and there are new viral variants [meaning strains that appear to transmit more easily]. The idea that ‘normal’ is around the corner is premature.”
So what does that mean for two things that all of us—gay or straight, living with HIV or not—are hungry for again: the ability to have sex and to socialize freely, be it in bars and clubs or in homes?
As for sex, says Gonsalves, “If two people have received both vaccine doses, yes, it’s fine, but that’s not how it’s always going to play out. With HIV, people did not always use condoms or ask about each other’s status. With COVID, are people going to ask to see each other’s vaccine cards?”
Says Joe Osmundson, Ph.D., a gay scientist and member of New York City’s COVID-19 Working Group, who has been writing often about COVID and sexual and social risk levels, “I can’t tell you how many people have reached out to me about whether they should get vaccinated and the larger questions about what it means. They ask if we’re going back to normal at a societal level. But ‘back to normal’ means no COVID, and a world with no COVID is not on the horizon.”
He continues: “It’s very difficult to eradicate an infectious disease, even with an effective vaccine. It’s only happened once, with smallpox. Even polio and measles are well-controlled but not eradicated. I anticipate at least 10 years in the U.S. of seeing COVID diagnosed among those who can’t or won’t get vaccinated.”
He says he expects that certain protections, such as wearing masks on subways and in other crowded public spaces—which had become a part of normal life in much of Asia even before COVID—may never go away completely.
But on a more intimate level, he says, such as with sex, he expects to see many couples who’ve closed their previously open relationships since COVID continue to keep them closed. “As for my single friends, most have chosen a few trusted partners,” he adds, often after they’ve had a conversation about recent COVID testing.
“There’s been thoughtful risk management about hookups, and the anonymous sex scene of Grindr, inviting people over while you’re waiting for them, blindfolded” has tapered off, he says.
Then there’s the lack of bars, clubs, and parties. “It’s been a challenge,” Osmundson says. “Nightlife is a way we commune with other people, and it’s hard to be without it. It’s going to be an incredibly complex year.”
He then muses aloud: “What if everyone at a circuit party [a gay rave] is vaccinated against COVID but still spreads it and takes it home? Will there be circuit parties where you have to have a vaccination certificate, a so-called immunity passport, to get inside? How is that done ethically? Only if, I would argue, vaccines are widely available across race and class.”
In the meantime, he says, he hopes that people will continue to socialize within their so-called COVID pods, which means everyone in a certain group of friends agreeing to not circulate widely outside the pod and to get COVID tested regularly, with anybody’s results temporarily shutting down the pod.
For months now, he says, he’s been living in a pod consisting of him and his partner, two single friends, and—between them all—three dogs. “We’re living together in Georgia right now, and we all tested for COVID twice before we left. We don’t wear masks and have normal social interaction within the pod, and we manage our risk outside of it.” When the single people have sex outside the pod, they communicate with their sex partners before and after to make sure nobody is COVID-positive.
“A gift of this time has been strengthening our relationships,” he says. “We cook and make cocktails for one another and we dance together. It’s deep and quality social interaction that’s easy to lose in the usual din of New York social life. Mutual care and being constantly appreciative have been huge in this time.”
For those who are really sinking into severe depression due to COVID isolation, Osmundson urges them to seek out mental health care (most likely via Zoom, these days). But for lesser cases, such as the many of us who are not clinically depressed but merely tiring of living by COVID’s rules, he urges some perspective. “No one is asking you to be home alone 100% of the time. There are ways to be social and to still limit risk.”
And he suggests that people try to frame our current moment as being not solely about one’s own gratification but about community well-being. “By managing your risk carefully,” he says, “you’re saving other people’s lives—and it feels good to do that.”