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The Covid-19 vaccine and PrEP both require talking about our health without shame

Vaccines lets us relax some and let down our masks. What's wrong with that?
Image: Open bottle of prescription PrEP Pills for Pre-Exposure Prophylaxis to help protect people from HIV.
YakubovAlim / Getty Images

After over a year of living in fear, the Centers for Disease Control and Prevention on Thursday said the words we have been waiting to hear: It's finally time to begin taking off our masks.

That news comes as confirmation that with enough vaccinations, we as a country can begin to let people go back to some semblance of normalcy — at least in small groups.

You’d think many people would immediately leap to joy knowing that it’s safe to let people see your face in public, but I am still seeing so many people online and off — especially progressives — openly pushing back on the CDCs decision and the science behind it with distrust.

The debate that’s currently playing out among liberals is a version of one that’s been going on in the queer community for years: The battle to get people to begin taking the HIV prevention drug PrEP is a prime case of how stigma and shame only allow viruses to continue.

Since the first shutdowns began in March 2020, the pandemic has been extremely politicized, with masks becoming the symbol of our polarization in this country. Former President Donald Trump openly mocked mask use before eventually adopting it himself once getting sick. According to a 2020 Pew study, the divide on masks and political parties stood at 63 percent of Democrats believing people should wear masks outside compared to 29 percent of Republicans.

I remember talking to queer men older than me at the time about the new pill. Many of them resented me for having this level of protection available. (Some still do to this day.)

At the time, Democrats were entirely correct. The virus was raging and masks were our first line of defense. But “those who are vaccinated on the left seem to think overcaution now is the way to go, which is making people on the right question the effectiveness of the vaccines,” Dr. Monica Gandhi, a professor of medicine at University of California at San Francisco, recently told The Atlantic.

Which brings me back to PrEP. In 2012, the FDA approved PrEP after it was scientifically shown to be up to 99 percent effective in preventing acquisition of the HIV virus. I remember talking to queer men older than me at the time about the new pill. Many of them resented me for having this level of protection available. (Some still do to this day.)

It’s not hard to understand why. They had survived the height of the HIV epidemic in America during the 1980s and ’90s, burying more people than they’d like to count. They had been the ones who popularized condoms as the No. 1 prevention tool in fighting HIV/AIDS.

But this new drug was not only going to be just as powerful as a condom, it allowed for men to consider not wearing condoms at all. Since then, even as more and more ads roll out explaining how safe it is and its upsides, we still see queer men hesitating to use the pill that could stop the epidemic in its tracks.

Like the viruses and thevaccine, there’s no way to tell by looking at someone if they’re taking PrEP. It’s a pill I take myself, but still to this day find THAT people will make snide remarks about why folks are taking it and not just wearing condoms. Those remarks are never because they actually care about ending HIV/AIDS — they’re coming from people obsessed with slut shaming those taking measures to protect themselves.

Their rationale — a belief that only “sluts” need a pill like this — is rhetoric that folks taking birth control have also historically faced. It’s the logical outgrowth of the prevailing rhetoric of the early epidemic, which came from both inside and outside the community, that we as gay men just need to have less sex, or just one partner, or no sex at all.

In 2019, Pennsylvania state Rep. Brian Sims, a Democrat, came out as a politician who takes PrEP, at least in part to push back on a stigma that he saw as blocking a future where HIV/AIDS was eradicated.

“Think this is an invite to talk about my sex life? It's not. Think it's an invite to shame me or anyone else? Grow up.” he wrote in his Instagram post. “'Stigma' is the thing our enemies want us to be stunted by. It literally kills us. It's stupid and we control our own fate. No shame in this game. Just Pride."

He’s 100 percent correct that stigma is what's killing us at this point — not just HIV itself. For years, people have been opting out of getting tested or telling their doctor their full sexual health behaviors for fear of being shamed about it. And instead of that shame pushing folks to maybe wear more condoms, it instead had them performing riskier behaviors, which they then decided to not talk about with anyone, downplaying the need for their partners to get tested. That cycle is partially why HIV/AIDS will turn 40 years old this June, and why community health organizations are doing everything they can to get people to trust PrEP.

If this sounds similar to the underground parties we’ve seen reported all around the country that were superspreader events, it should. Shaming people about partying only made them go deeper underground and made the pandemic worse.

And while I do plan to take off my mask as someone who is vaccinated, I do understand some hesitancy from people who have experienced the darkest points of this pandemic. We cannot forget that we as a country are still traumatized. These changes, coming so quickly after more than a year of oppressive sameness, are happening in the midst of an “epidemic of grief,” as the founder of Modern Loss, Rebecca Soffer, wrote in an NBC THINK essay.

These two things don't have to contradict each other. Doctors and medical professionals now heavily rely on more harm reduction practices that have them engaging with people in ways that don’t perpetuate shame. Instead, the focus is on making people feel good in all their decisions by knowing their risks in whatever they do. We should apply similar practices to a world where, like PrEP, we are needing more and more people to adopt a life-saving medicine so we can control this disease forever and end the pandemic.

We have to learn how to talk about our health status, clearly and without shame

Vaccines, masks in crowded spaces, and having intentional conversations with friends and family are all practices we need to be more people to support. But not listening to science when it tells you to relax more in favor of telling people to keep masks on if they don’t want to is not the way to a more normal society for all of us.

We have to learn how to talk about our health status, clearly and without shame. If we don’t, similar to HIV/AIDS, we will be talking about finally eradicating Covid-19 for decades.