As June approaches, we’re entering the fourth calendar month of a worldwide coronavirus pandemic that, for those of us living in the United States, has required a degree of discipline when it comes to physical distancing that we may have never before thought possible. Family members go unhugged, friends are hardly ever embraced. And, as part of the public health order of the day, many people have foregone sexual activity, as current public health messaging makes it clear that all efforts must be made to stay home—and stay away from each other. If and when a person does venture outside, mask-wearing and avoidance of skin-to-skin contact are sacrosanct.
In the absence of physical contact, many people have found creative ways to express their sexuality while still maintaining distance. There are Zoom sex parties. Phone sex has gone from retro analog pleasure to lifesaving release. So far, people have used technology to have sex in an epidemic in a way that was not available to people, especially queer people, during the AIDS epidemic.
While this is a worthwhile testament to human resilience and adaptive abilities, it’s also no substitute for the real thing. These methods are only palliative; people need to have sex. And it’s time that we have a plan in place on how that can happen safely during the time of COVID-19.
Of course, the first problem is that we must think of sex as essential. During the early part of the coronavirus lockdown, things like a trip to the grocery store or even a run in the park have been viewed as essential parts of human existence. But very few people seem to extend the same “essential” label to human sexuality—despite mounds of evidence, including the evidence of our minds and bodies, to the contrary.
“In the case of staying home to prevent coronavirus transmission, we need to support people in doing that, but we also need to make sure we’re not sacrificing other aspects of people’s health,” says Harvard Medical School assistant professor Julia Marcus, Ph.D., M.P.H.
Of course, Marcus isn’t advocating that we throw away everything we know about social distancing rules and go back to our pre-COVID lives. “We need to support people in having some pleasure in their lives, enough that they can live through this pandemic in a sustainable way.”
Americans not only devalue sex; they put sex on a hierarchy—straight and procreative sex tops the pyramid, with a steep downward slope ending in the kind of sex being denied to many queer people now: sex for pleasure, including condomless anal sex. It’s also true that many people have had to let go of sex at the very moment it might be most useful, both as a coping strategy and as a way to feel intimacy at a time when human contact is severely limited.
Going without pleasure can have psychological ramifications, so much so that the American Journal of Public Health dedicated its February issue to the idea of pleasure and the need to make room for it in public health discussions.
“When we talk about the history of public health, the first paradigm is often tied to the concept of sanitation,” one article in the February issue (written by Stewart Landers, J.D., M.C.P., and Farzana Kapadia, Ph.D., M.P.H.) reads. “From John Snow [the founder of epidemiology] to the formation of the U.S. Environmental Protection Agency, a seminal focus on clean water, air, and land permeated our field. The basis for this foundation was disease prevention—from cholera and typhoid to asthma and emphysema. Yet there was undeniably pleasure to be had in breathing clean air, drinking purified water, and seeing skies unblackened by smog.”
And, of course, this extends to sexuality. We cannot talk about public health and sexual health in the age of COVID-19 merely as the absence of disease, whether it be coronavirus or a sexually transmitted infection (STI). A healthy sexual life during COVID-19 includes physical touch between two consenting adults who understand the individual and public risk involved in their sexual escapade. Also paramount in this situation is that they have the required tools to keep risk of STI and coronavirus transmission to a minimum.
Until now, COVID-19 risk has been explained in public health messaging as an all-or-nothing binary, and that can prove dangerous for several reasons, according to Marcus, who also wrote about this “risk binary” and the idea of quarantine fatigue in a recent article for The Atlantic.
— Mark D. Levine (@MarkLevineNYC) May 19, 2020
Some politicians seem to be getting on board with this mentality, as well. In a recent Twitter thread, Mark D. Levine, chair of the New York City Council’s health committee, called for an end to the “all or nothing” mentality behind the city’s current approach to distancing.
“Let’s give people the tools to understand that the riskiness of social activities lies on a spectrum. We are staring quarantine fatigue in the face. We need new guidance—and policies—to meet this challenge,” he tweeted. “If we don’t give people the information to choose low-risk activities, they will choose high-risk ones—like house parties, large gatherings in front of bars, or swimming at beaches without lifeguards. (All of which is already happening in NYC.)”
It’s time to update the all-or-nothing messaging on Covid-19 risk.
Let’s give people the tools to understand that the riskiness of social activities lies on a spectrum.
We are staring quarantine fatigue in the face. We need new guidance–and policies–to meet this challenge. 1/
— Mark D. Levine (@MarkLevineNYC) May 19, 2020
If we don’t give people the information to choose low-risk activities, they will choose high-risk ones–like house parties, large gatherings in front of bars, or swimming at beaches without lifeguards. (All of which is already happening in NYC.) 5/
— Mark D. Levine (@MarkLevineNYC) May 19, 2020
Just as we must make provisions for people to see loved ones and enjoy their lives while minimizing risk, we must do the same for sex, an essential component of human experience that we should not expect people to live without.
“The message can’t be, ‘Don’t have sex,’” Marcus said in a phone interview. “We just know that doesn’t work. And it misses an opportunity to help people keep their risk low, because we’re not telling people anything beyond a zero-risk option. We know that won’t work, and it will encourage shaming.”
We’ve all been privy to tons of online behavior-shaming when it comes to the coronavirus pandemic. Marcus’s Atlantic article wrestles with the shaming, which, she writes, is a byproduct of an all-or-nothing message:
“The anger behind shaming is understandable. Photos of crowded beaches or videos of people at a large indoor party may make viewers feel as if they’re watching coronavirus transmission in action. Calling out seemingly dangerous behavior can also provide an illusion of control at a time when it’s particularly hard to come by. But, as years of research on HIV prevention have shown, shaming doesn’t eliminate risky behavior—it just drives it underground. Even today, many gay men hesitate to disclose their sexual history to health care providers because of the stigma that they anticipate. Shaming people for their behavior can backfire.”
A recent Washington Post op-ed did similar work, arguing that shaming is just as much about our own sense of control in this time of helplessness as it is about people who we view as breaking the rules.
“None of us can stop random strangers worldwide from throwing dinner parties, but it’s quite easy to photograph anything that could be however loosely defined as a crowd at a beach,” Phoebe Maltz Bovy wrote. “Those truly ignoring or oblivious to social distancing (having private gatherings) are often not in plain view, so the people who end up getting yelled at are roommates taking a walk together.”
That shaming has extended to people looking for sex, as well. A recent shame-heavy piece in Slate focused on hookup apps, the go-to bogeyman for a lot of people’s least-favorite parts of the gay community. The piece sets up a very “me versus them” milieu in which the author is looking out for his own physical health and must contend with a bunch of heathens who are prioritizing their sex lives over his own physical health. Many people on Gay Twitter also remember the day that a small group of men flouted social distancing rules and held a small circuit-party-esque rave in a private apartment.
As Marcus pointed out, so many of these behaviors have thrived in the times of all-or-nothing messaging because there hasn’t been any guidance on how people can keep safe while doing a variety of social activities. Now, as we enter the year’s most social season—and as quarantine fatigue sets in—it’s clearer that we need to give a green light once again to have casual sex without shame, and that we need guidance on how best to have sex.
Because #StayAtHome has had such a head start in terms of public health messaging—it has its own special sticker on Instagram—bucking it now for a new phase of social distancing may be difficult to present to the masses, but it is ultimately necessary for people’s mental health. In our phone interview, Marcus said that we not only need to reframe the conversation about risk, but that failing to do so could actually miss out on an opportunity to inform people on how to lower their risk if they do pursue casual sex.
“People who don’t have sex partners in their own household may still need to have physical intimacy,” she said. “We need to support people in finding ways to have sex that are safer than crowded sex parties, which could turn into 100 new cases.”
Marcus said that, rather than thinking about risk as a binary, it would be more helpful to present people with a sexuality risk spectrum. On one end is staying home and foregoing physical contact. On the other end is what most people might consider the riskiest sexual activity—for instance, a sex party with multiple people. Along the continuum are a series of options that include virtual sex, sex with one partner, sex with multiple partners, and so on. Then, she says, people should identify where on the spectrum they can find the activity that would meet their sexual needs while also keeping risk of transmission as low as possible. For most people, that would fall somewhere between abstaining at home and going to a circuit party. What’s important is that there is a way for someone to choose a form of sexual expression that keeps them healthy and keeps our current way of life sustainable.
Other countries have already offered their citizenry guidance on how to get off and stay safe. Earlier in May, the Dutch government issued guidance to its citizens to find a “sex buddy” to stay sexually satisfied while also minimizing transmission risk.
“It makes sense that as a single [person] you also want to have physical contact,” the guidance reads. The guidance says that potential sex buddies should engage in conversation about their risk and how best they can have fun and be safe. Marcus stressed a similar strategy, saying that we have to “promote communication about risk,” including asking partners what they’ve been doing over the past few weeks, if they think they may have been exposed.
“We’re going to have to bring back some of the risk communication that we needed earlier on in the HIV epidemic, when we had fewer strategies for prevention,” she said.
Ideally, Marcus says, this guidance would come from city or state health departments or the federal Centers for Disease Control and Prevention (CDC). Marcus also told TheBody that she has been in contact with several gay hookup apps about offering guidance to their users on how to hook up more safely, and that some may issue guidance in the future.
In a phone interview, assistant commissioner of the New York City Department of Health and Mental Hygiene’s HIV Bureau, Oni Blackstock, M.D., M.H.S., said that, while she cannot comment on guidance that’s currently in preparation, she emphasized that the city is keeping track of the rapidly evolving pandemic and updating the guidance as we move to a new phase of recovery.
“We recognize sexual health is an important part of overall health and well-being,” Blackstock said. “We want to be able to support people in engaging in pleasurable sexual activities that minimize the risk of passing COVID to one another.”
She added, “We all agree about moving from the risk binary to realizing there is a spectrum of activities that can minimize risk.”
Any plan that is rooted in harm reduction means that we must that understand that not everyone may act in a way that we find palatable, but that everyone at every level of the risk continuum deserves what protection they can be afforded.
“People need to have a clear sense of harm reduction strategies at every step of that spectrum, so if people look at that infographic and say, ‘I really need to have that sex party,’ we want to have tips even for that setting,” Marcus said. “There can be increased ventilation, or no-kissing rules. Those are some ideas to minimize risk. People deserve harm reduction strategies wherever they are on the spectrum.”
But, while hookup apps and health departments prepare to roll out their guidances on how to have sex, the first step is that we must shed the idea that a healthy sexuality is not part of life during the COVID pandemic.
“It’s essential,” Marcus said. “If we ignore it, we are denying people’s human needs. If we say ‘Stay home,’ or ‘You don’t need sexual pleasure,’ you’re denying reality for people, and it’s detrimental to our overall goals of public health.”