Mary Glenn, 67, of Jacksonville, Florida, has been living with HIV since 1990. She was also among those first vaccinated against COVID in early February, because she was part of the Pfizer vaccine trial. In fact, Glenn was one of the nearly 10% of trial participants who were Black. (Black folks have historically been underrepresented in all sorts of clinical trials.)
Now, Glenn is enjoying the relative freedom that comes with being fully vaccinated. “I’m taking my mask off when I’m outdoors, and I’m venturing out to restaurants and stores as needed,” she said. “I miss being around others so much.”
Yet, said Glenn, she’s still masking up in stores and at restaurants during those moments she is not eating. “And I try to keep a distance from others,” she said. “I’m still frightened, aware of those that are refusing to vaccinate and the harm they can cause me. When will this end?”
Glenn’s sentiments reflect some of the confusion and anxiety that greeted the U.S. Centers for Disease Control and Prevention’s (CDC) surprise guidance last week—guidance declaring that Americans who are two weeks out from being fully vaccinated can abandon masks in most indoor and outdoor settings, with some exceptions, such as while riding on public transit or visiting hospitals or nursing homes. The CDC also said that people have to still abide by state, local, and workplace mask rules—for example, about two dozen states still require masking in public.
Let’s Not Forget the Unvaccinated
The new guidance, the CDC said, reflected a “coalescence” of data showing that vaccinated people are dramatically protected against both getting COVID and passing it on. It pointed to an almost one-third drop in COVID cases nationwide over the past two weeks due to widespread vaccination.
But the guidance was greeted with a host of questions by lower-level health officials and everyday people alike: What about the fact that there’s no way to make sure that the roughly 60% of Americans who have not been fully vaccinated—some of whom have no intention of getting vaccinated and also sometimes have been hostile to masking—would wear masks in public to help stop the spread? What about the long-cited fact that masks could not be widely abandoned until we reached vaccination rates of 70% to 85%, otherwise known as the herd immunity threshold? What about the many teens and children who have not yet been vaccinated? And what about the fact that, for reasons that commingle access and trust issues, there are lower rates of vaccination in Black and Brown communities, which have been hardest hit by COVID?
The new guidance has also created a special layer of confusion for us folks living with HIV. Different data sets have suggested both that we may be at higher risk for COVID infection and severe illness and that our COVID rates and outcomes don’t look significantly different from those of the overall population. There’s even been (unproven) thought that our HIV meds might protect us from COVID infection and/or severe COVID illness. (It’s true that HIV treatment in general may give your immune system a boost.)
What Say Folks in the HIV Community?
So with all that in mind, do HIV community folks—both experts and regular folk living with HIV—find the new CDC guidance too hasty? Overall, it doesn’t seem so. For example, back in early February, when we talked to Peter Meacher, M.D., chief medical officer of New York City’s HIV- and LGBTQ-specializing clinic Callen-Lorde, he cautioned against folks mulching their masks once vaccinated. To be precise, he said: “[We don’t know if] the vaccine makes [those who’ve received it] 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.”
But now, of course, we do know that both those things are largely true. So said Meacher on a call the morning of May 17. He now thinks the new CDC guidance is “pretty clear” that folks, including those living with HIV, who are two weeks out from being fully vaccinated can now take off their masks in most settings.
Meacher’s only caveat is that those who have a rough and long history with HIV—say, a long-ago single- or double-digit CD4 count and a current count of roughly 300 or below—and/or other chronic issues such as asthma, diabetes, and high blood pressure—all of which have been found to be key underlying conditions for higher COVID risk—check in with their doctors first before flinging aside the mask.
Plus, he noted, there’s nothing wrong with keeping a mask on indoors or in crowded outdoor settings if it gives you peace of mind, even if you are COVID-vaccinated. “I liken it to getting malaria shots before traveling but still sleeping under a mosquito net,” Meacher said. “Or being on PrEP but still wearing a condom to avoid STIs other than HIV.”
That’s about how Mary Glenn in Florida is going to play it. But other folks living with HIV out there feel a bit more confident. In Missouri, Devin Hursey, a graduate student in public health living with HIV who also does HIV advocacy in the state, has been vaccinated and said he’s no longer going to wear a mask in most settings.
“But I still bring a mask with me everywhere I go,” he said, adding that he’s happy to wear one in certain settings if it makes others feel more safe and comfortable. “Yesterday, I went into a restaurant and asked the staff if they were comfortable with my not wearing a mask,” Hursey said. “They said it was up to me—but they were still required to.”
A Sudden Shift in Mask Advice
As for unvaccinated people, Hursey said, “If they weren’t wearing a mask before, they’re certainly not going to wear one now.” He said he trusts the science behind the CDC’s latest guidance, although the federal response to COVID, with its (perhaps somewhat inevitable) ever-shifting advisories, has left him frustrated. “It’s been a very politicized conversation, and we’ve gotten a lot of mixed messages from the highest levels.”
He’s not alone among those, both living with and without HIV, who were surprised by the CDC’s dramatic reversal last week. Just a few weeks prior, the agency had said that vaccinated folks could remove their masks outdoors but not indoors.
“I think the CDC’s message is as confused as it has been since the start of COVID-19,” said Andrew Spieldenner, Ph.D., head of MPact Global Action for Gay Men’s Health and Rights and vice chair of the U.S. People Living with HIV Caucus. “But considering how long it took for them to recognize that oral sex does not have the same risk as anal sex for HIV transmission, I am not surprised.”
Spieldenner, who is living with HIV, said that he is vaccinated but will continue to wear his mask in all places required by the state of Jalisco in Mexico where he lives, such as on public transit.
Optimistic but Still Cautious
As for me, living with HIV the past 20 years, I was vaccinated in March and have gotten pretty used to the new mask gray area we now seem to live in. Recently, I’ve stopped wearing a mask on sidewalks and while outdoors, carrying it instead in my pocket like Hursey, whereas back during the winter months, I’d wear the mask under my chin and lift it up as I approached someone on the sidewalk or a narrow path. Living on the Brooklyn/Queens border in New York City, I am struck by how many people still wear their mask outside, even walking down an empty sidewalk. It seems like masks have become such an appendage of our public selves the past year, like wearing a top or a bottom, that people have almost forgotten they’re wearing one. I’d rather it be that way than the opposite!
Per the policy of most restaurants, I mask while walking in and out, and to and from the bathroom, but while at the table, it’s off. Per the policy of my gym, it’s on through my entire workout, as sweatily uncomfortable and acne-inducing as that is. And it’s on as I descend into the subway, per city policy, although now that I’m vaccinated and know that most New Yorkers have been given ample opportunities to be vaccinated—the city is even calling and texting people now to see what willing takers they might’ve missed—I no longer inwardly explode with ire over the rare fellow traveler who’s not wearing one. I certainly don’t miss occasionally politely asking someone to pull up their mask. Nobody wants to be a Karen, and being vaccinated certainly reduces the pressure to be one.
It also seems, among many people with HIV who struggled with isolation during COVID, to be reducing depression. “I’ve been fully vaxxed since mid-February and I feel protected,” said Tez Anderson in San Francisco, founder of the HIV long-term survivors group Let’s Kick ASS. “My depression has been reduced with the return of human contact and hugs.” As for Anderson, he doesn’t think the new CDC advisory is hasty. “The science backs it up,” he said. “If we’re vaccinated, we can’t spread COVID—including the variants.”
New York City activist Jay W. Walker shares that sentiment: “I got my second vaccine dose in late March,” said Walker. “It’s allowed me to venture back in—to the homes of dear friends, into restaurants, and back to my beloved live piano karaoke bar, Sid Gold’s.”
But old habits—even merely year-old habits—can die hard. Longtime survivor Mark Milano, also a professional HIV advocate, who is fully vaccinated, finally took his mask off a few days ago in the Village. “I have to admit that peer pressure played a part,” he said. “No one—literally no one—was wearing a mask, including my brunchmates. I’m still wearing a mask indoors. I think the science is sound for mask removal, but the psychological step of going mask-free is a different matter.”
In Jacksonville, Mary Glenn feels much the same. At a recent in-real-life event, she stayed six feet away from a friend who had not been vaccinated (“because she has faith in God”), even though the friend was wearing a mask, as the event required. Despite ample strong data from the CDC, Glenn just can’t shake the fear that “I could become infected even though I’m fully vaccinated,” she said. “I’ve lived 30 years with HIV/AIDS. And I’d like to live 30 more.”