Yesterday, I heard Dr. Sanjay Gupta from CNN say something that everyone needs to hear in the coronavirus response here in the US. Encouraging people to do more about social distancing and self-isolating as precautionary measures he said:
“Act as if you might be carrying the virus.”
When I heard these words, they struck a chord in me. I remember very clearly in the late 80’s when a medical advocate for HIV/AIDS said the smartest thing I ever heard: “Act as if you and everyone else has HIV”. The rationale was that one would own responsibility for transmitting the virus to others more than if one was simply trying to dodge a bullet. This became a mantra for me. Not only did it make safer sex easy and fun, it lowered my anxiety because it put me in control of my choices. This same medical professional helped me understand that even without being HIV+, if I was sick in other ways, that I could be endangering someone with a compromised immune system. This posture gave me skin in the game and helped me make better more informed choices.
The other thing it did was it helped me see the world through the lens of ownership. Through the lens of ownership, it was impossible to see partners with HIV as something to avoid. I recognized that we were first and foremost human beings and that we were not defined by the viruses we carry. We all have agency and more importantly, we all hold responsibility for public health.
This is the reason that I believe Dr. Gupta’s words are crucial, particularly in the United States. Our country was founded on marginalization and otherization. “Haves and have nots” are built into our government, our economy, our religion and most definitely into our healthcare. As we move forward with strategies to face the reality of what this virus may do in our society, we also must be prudent not to fall into this most American of traps. How are people without access to healthcare getting tested and cared for? What about the unhoused? What about people who are undocumented? The Trump administration is already working to end asylum based on the coronavirus, an utterly heartless Steven Miller motivated move.
I’m not actually sure I agree with the language [of social distancing] …. But I agree and will comply with the strategy, particularly when I think of it as an act of mutual generosity.
And this is not just about the most vulnerable. Once we solve the inexcusable failing of providing easy and free access to tests, what about people who just don’t believe or don’t want to believe it will be them? What about the suburban parent who is afraid to get tested for coronavirus because of what that will mean for their family? What about the workaholic spouse under financial pressure to keep his family fed through this who refuses to get tested and self-isolate because he’s been taught that he needs to “man up” and “tough it out”? What about the stalwart elder who insists, “I know my body, it’s just a cold…it can’t be coronavirus”? These are the same kinds of denials I heard people offer in the early 90’s when HIV testing was a mark of shame in the gay community. Through denial and a lack of access to testing, HIV has killed more people than was ever necessary.
The idea of “social distancing” is very troubling and difficult for some. I’m not actually sure I agree with the language myself. But I agree and will comply with the strategy, particularly when I think of it as an act of mutual generosity. While having knowledge and a degree of ownership empowers me to be closer to people with HIV, similarly having knowledge and ownership can enable us to be physically separated with coronavirus. In both instances, I believe knowledge, ownership and responsibility are sacred acts of love.
Let me be absolutely clear, coronavirus is not in any way at all HIV. I am not attempting to equate the two and my decades long experience with and losses from the latter would never let me write something like this casually. We are still afraid of frank talk about sex and intimacy and we still haven’t figured out how to navigate what it means to live in an HIV+ world, although things have definitely gotten better. We have a long, long way to go to equity with HIV/AIDS. On the other hand, we are just learning how to live in a world with coronavirus. In this emergent time, what we must be most wary of is how our reaction to illness of any kind tends to be very similar and some of our worst impulses become activated. We must not make mistakes that are even vaguely similar to those we made/ make with HIV that are driven by fear and misinformation class snobbery, economic opportunism and shame.
Act as if you might be carrying the virus. We all must take responsibility, even if our leadership does not.
-ALD
Your analogy sparks so many thoughts for me. HIV changed the world in so many ways, as will this virus. You use the phrase “this emergent time” — in medical contexts, “emergent” is used to mean something that is life-threatening or otherwise an emergency. But in non-medical contexts, it means something that is just coming out into the light. It feels like both apply here — we’re in the middle of a painful, dangerous emergency, (like being in labor) but something new and unknown is about to emerge (be born).