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Zana's Health Corner

HPHR Fellow Elizana-Marie Joseph

By Elizana-Marie Joseph

PrEPare for Summer Lovin': Unmasking the Realities Behind Sexual Activity, STI and HIV Rates as We Emerge From Lockdown

Photo by cottonbro from Pexels

With the announcement of the CDC’s new guidelines for fully vaccinated individuals , some people wonder if the end of the COVID-19 pandemic is really in sight. While experts are confident in the vaccines’s safety, efficacy and durability, many members of the general public wonder if there is enough honor in the honor system. Similarly, there are many people who are not quite ready to unmask yet. Although persisting challenges like vaccine hesitancy and variants are still at play, COVID-19 vaccine eligibility and availability have never been higher in the United States. 

 

Encouraged by the news from the CDC, many states and retail stores have already started relaxing their pandemic-related safety measures. New York City, which was one of the places hit hardest by the pandemic, started making its grand entrance back to “normalcy” as soon as May 19th, with support from NY Governor Andrew Cuomo. Similarly, Mayor Bill de Blasio plans for New York City to “fully reopen” by July 1. Across the country, schools and universities are preparing to be in person as much as possible this fall. Students, teachers and parents alike are looking ahead to the next school year with renewed optimism. The easing of COVID-19 restrictions ushers in a return to in person dining, increased travel, the re-opening of Broadway, pools, beaches, and the many joys of summer. These activities are bound to put the CDC’s new guidelines to the test. Ready or not, summer 2021 is here. 

 

After a year full of restrictions, social distancing and limited physical touch, a lot of people crave human connection and the familiar comforts of a time before the pandemic. For over a year, high-fives, handshakes, hugs, kisses and other physical forms of intimacy have all felt dangerous or even forbidden as they posed a possible threat to our health. But now, reinstating some forms of physical connection could be incredibly important for rebuilding social trust, as well as our mental and emotional health. 

Enter sex.

Believe it or not, it is kind of impossible to practice social distancing protocols when you are lying on top of someone. Or underneath… or next to someone for that matter… take your pick. But instead of switching positions in bed, many Americans in 2020 were switching positions on their couches as they curled up with Netflix and their latest homemade sourdough.

 

Contrary to popular – and at times comedic – speculation, there was no “baby boom” inspired by widespread lockdowns. Despite an increase in activity on virtual dating apps, soaring sex toy sales, and more time at home with partners, the many stresses of the pandemic seemed to decrease libido – resulting in a “baby bust”. In fact, according to a study conducted by researchers at Indiana University nearly half (49.2%) of U.S. adults reported a decrease in their sexual behavior during the COVID-19 outbreak. 

Love photo created by freepick – www.freepik.com

This makes sense. Less people engaging in sexual behaviors resulted in less babies being born in 2020. Seems simple enough, right? 

 

While the previous logic statement is true, it remains to be seen whether or not the same can be said for STIs. Although most Americans were engaging in less sexual activity, that does not necessarily mean there were less STIs in 2020. Emerging evidence suggests it is unclear whether STI rates in the U.S. are falling or rising. Public health experts in this area are voicing their concerns. 

According to the CDC, 1 in 5 people in the U.S. have a sexually transmitted infection. In 2019, the number of reported STIs in the U.S. reached an all-time high when more than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported. For six consecutive years, STI rates in America have been steadily increasing and STI rates in early 2020 were on track to follow that trend. 

Then COVID happened.

According to a survey conducted by the National Coalition of STD Directors, 83% of STD programs in the United States were forced to pause or defer STD/STI related care services. As the pandemic continued, STD/STI clinics across the country were forced to close due to massive resource and personnel shortages. Personal protective equipment, including masks, face shields, gowns, and gloves were in high demand and short supply. At times it was even difficult to get swabs for routine STI screenings. Major condom-producing countries throughout Asia were forced to stop production due to high COVID-19 infection rates among their workforce and consequently, there was a global condom shortage

 

A follow up survey conducted by the National Coalition of STD Directors found that the majority of STD/STI program staff have been leading their local and state COVID-19 testing and contact tracing efforts, because of their extensive experience doing similar work for STIs. As of August 2020, “only two percent of STD programs have not been involved in their state’s COVID-19 contact tracing efforts”. In January 2021, 37% of state and local STD program staff were still working to combat COVID-19.

 

STD program operations were completely disrupted due to the demands of the pandemic. Unable to provide services at capacity, many patients delayed STD/STI screening services and are presenting with more complicated and advanced cases. This too raises alarms about what the future of STIs in America could look like as a result of the COVID-19 pandemic. Public health professionals are wary that drastic declines in STI rates for 2020 could be attributed to a combined lack of testing and reporting of STIs, not just stay-at-home orders. 

 

Similarly, wide-spread unemployment, financial hardship, stress, grief, and depression could be motivators for increased STI rates. Increased risk for contracting HIV could also be associated with increased substance use, increased intimate partner violence, decreased testing, and/or decreased PrEP utilization.   

 

One study found that the number of acute HIV cases doubled during the pandemic in 2020. This is especially concerning because the pandemic posed new challenges and diverted resources in ways that may have delayed efforts to End the HIV Epidemic. There are an estimated 1.2 million people living with HIV in the United States. 1 in 7 individuals living with HIV do not know it and need testing. 

 

It is also important to note that health disparities exist regarding this health topic too. Sex, substance use and HIV are highly stigmatized topics that can impact people’s willingness and ability to engage in care. People of color, people of sexual and gender minorities (LGBTQIA+ individuals), and youth are negatively impacted by STDs/STIs and HIV the most. 

 

As the world reopens and opportunities for meet-cutes, in person dating, summer flings and all things worthy of “hot girl summer” begin to flourish, it is important to keep in mind the realities of the sexual landscape we may be entering. 

 

There may be more cases of STIs and more cases of HIV than we are currently aware of.  That being said, there are also plenty of things you can do to make sure your summer is safe, sexy and full of lovin’. 

Here are some things to keep in mind as you prepare to share love this summer:

  • Get tested and know your status so you can make more informed decisions about your health. If you test positive, work with your provider to get the correct treatment. 
  • Talk to a provider and see if PrEP (pre-exposure prophylaxis) is right for you.
  • Utilize healthy sex tools like condoms, lube, dental dams, finger cots, etc.
  • Utilize safe injection practices and engage in substance use related support services.
  • Use a birth control method that suits your wants and needs. 
  • Have open and honest conversations with your sexual partners about consent, pleasure, boundaries, condom use, birth control use, STI status, COVID-19/vaccination status, etc.
  • Embrace technology (sex toys, video calls, etc.) as a way to explore your sexuality alone or with others – near or far. 
  • Be aware of your risk for contracting and/or transmitting COVID-19. Follow CDC guidelines. Wash hands, wear masks, get vaccinated
  • Check in with yourself and see if you are emotionally and or physically ready to engage in intimacy with others. It is okay to go slow and at your own pace. Engage in self care, utilize mental health resources, make a gradual transition, and lean on your support network. 
  •  Try this Sexual Exposure Calculator to get a more comprehensive understanding of your direct and indirect exposure to STIs/STDs.

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