Risk has never been more in the headlines. The news about the new coronavirus, however you slice it, is all about risk—the risk of catching it, the risk of dying from it. But people with HIV are no strangers to the subject of risk.
Many, but not all of us contracted HIV from taking a risk, whether we regret it or not. And the annals of PrEP and U=U are full of discussion about risk, in particular the risk of catching a sexually transmitted infection (STI) despite the effectiveness of the HIV prevention method. (PrEP refers to pre-exposure prophylaxis, a daily prevention pill for those who are HIV negative, and U=U stands for Undetectable Equals Untransmittable, a way of stating the fact that HIV-positive people who take meds regularly and mainstain an undetectable viral load can’t transmit HIV through sex, even when condoms are not used.)
The way we process risk is a very individual thing. Not everybody will agree with your assessment. Go on any PrEP or U=U site and you will find people arguing about what constitutes “safe,” particularly when HIV prevention and barrier-free sex have been simplified. Barebacking (I hate the word, but it sounds less unfriendly than condomless sex) clearly remains frowned on by many. It’s irresponsible to indulge in it, they say. Others argue that condomless sex is a joy that PrEP and U-U have made not only possible but a godsend. It’s what our parents did, argues Mark S. King. Surely it can’t be wrong?
Even if the risk is quantified, it likely won’t help. We humans are either risk averse or risk friendly—or, like me, somewhere in between. I happen to live in the country. Many people around me won’t go to Toronto, our nearest big city, because they have heard it’s unsafe. It isn’t. But the very, very tiny chance of a stray bullet going in their direction or even less unlikely, a drug deal going wrong (when they don’t buy drugs) is enough to keep them away from the big city. That’s risk averse
So is using condoms if you are using PrEP or have an undetectable viral load, where the risk of HIV transmission is either very tiny or in the case of U=U, non-existent. The opportunity to enjoy sex unfettered or free of barriers is outweighed, in the minds of the risk averse, by the danger of STIs. That those infections are mostly easily treated, at least in 2020, makes no difference. If you don’t take risks you don’t take risks. (Although how many of those insisting on condoms for oral sex, potentially a transmission route for STIs, is another story.)
The risk averse can be very unkind to those who see risk as part of everyday life. But even the risk averse take risks. Every day. You cross the road. That’s risky. You fly in planes. That’s risky too. You go on dates with folks you don’t know. All these you do because you weigh the risk against the rewards. That’s why people have condomless sex (and plain lust feeds heavily on the rewards side) or ride the subway in the middle of a coronavirus epidemic or go sky-diving if they are brave enough. Risk taking can clearly be exciting.
It doesn’t always help that “both sides” can be incredibly judgmental. This article is inevitably a bit judgmental too (that’s the nature of opinion pieces), and I will be judged for not mentioning risks like superinfection through condomless sex (although I find the argument unconvincing) or untreatable STIs (because I choose to see them as a future threat rather than a present one). I tend to think, though, that the anger we see on social media directed at the less risk averse than us is often misplaced. Because everyone sees risk differently, value judgments are often more about us than them.
When it comes to gay men, Mark S. King got it right. “Gay men have always barebacked, of course (along with every other human being and their parents), certainly before HIV ever showed up and yes, even immediately after,” he says. “If we all had stopped fucking without barriers we would have halted the HIV epidemic in its tracks. Instead, we kept behaving like human beings, making mistakes or getting horny or saying yes when we should have said no or getting drunk or falling in love or being young and stupid.” In other words, there can be consequences to taking risks when the dice don’t fall the right way. We are human for sometimes ignoring them.
As for the new coronavirus situation, whose fast-moving narrative will make this article old as soon as it is published, we see similarities. Some folks, people living with HIV included, are downright scared, will wear masks (even though they offer no protection), will wash their hands repeatedly (good idea) and won’t go places that seem dangerous. Others see the restrictions on their routine as unwarranted, an imposition, and they’ll ignore preventative measures. It may not make sense, but it’s an entirely human reaction also.
(For an informative article on “What People With HIV Need to Know About the New Coronavirus” go here. I found it reassuring that if your CD4 number is good, your HIV status likely won’t be much of a factor in whether your poz body can fight off infections like this one. Others will differ.)
In any event, taking risks is as human as not taking risks. So let’s not beat up each other for being human.