Research from Spain has provided an initial snapshot into how people living with HIV, and specifically queer men, may be at heightened vulnerability for the coronavirus—although the researchers note that further study will be needed.
People with HIV were disproportionately represented among hundreds of Catalonians treated for COVID-19 in at least one Barcelona hospital during the first two weeks of the crisis there, according to an April 15 correspondence published in The Lancet by University of Barcelona researchers.
By the time schools were ordered to shut down in Spain on March 9, over 500 patients carrying the SARS-CoV-2 virus were admitted to Hospital Clínic Barcelona. Nearly one percent, or five of them, were HIV-positive. In contrast, the proportion of the Spanish population living with HIV is roughly 0.32 percent.
All five patients were men who have sex with men (MSM). Two were sex workers, one of whom identified as transgender; he disclosed that he seroconverted in 2020, has yet to get on antiretroviral therapy, and still has a high viral load. The other sex worker, who identified as cisgender, disclosed that he had participated in chemsex in the past week. The five patients’ other professions—noted because of their elevated risk for coronavirus transmission—included gym work and healthcare.
Although the overrepresentation of HIV should spark concern, the researchers noted that these patients’ “COVID-19 clinical pictures [were] resembling the general population[‘s].” That’s not to say they were not facing health crises: Two were moved to the intensive care unit, and one was still there as of the correspondence’s publication date.
Further inquiry into the experiences of “older MSM population, drug users, and heterosexual men and women in middle-income and lower-income settings” is needed, the researchers wrote, as well as into the efficacy of adjusted HIV treatment regimens. For the researchers, the coronavirus response requires “implementing health education programmes” that “explain that such activities as [chemsex and sex work] could cause clusters of SARS-CoV-2 transmission.”
Chemsexeurs in Barcelona have already faced police hostility. On March 20, eight men were charged with “crimes against public health” for gathering to party. Alternatives to in-person chemsex, like video chat and porn, work for some, but not for others. It’s unclear whether simply educating chemsex participants about their coronavirus risk would change behaviors that have come to be the basis of community, pleasure, and coping.
Even with risk awareness, many sex workers simply need to continue working, and often in-person. “We recognize that many sex workers will need to go about their business as usual,” stated Canadian sex worker activist organizations Butterfly Asian and Migrant Sex Workers Support Network and Maggie’s Toronto in a March 19 harm reduction guide. “That is the reality of surviving in a capitalist society while enduring criminalization and stigmatization. In-person sex work should be a last resort at this time, and those who can refrain from in-person sex working should do so immediately.”
The guide offers practical tips on reducing the harms that workers need to risk, such as having the client wash their face and hands thoroughly before the session, and offering alternative services like erotic massage and strip-tease.
“This pandemic is a challenge affecting everyone,” wrote the University of Barcelona researchers. “By generating information such as we present here, the management and prognosis of patients co-infected with HIV and SARS-CoV-2 might be improved.”