Sex, Mental Health & COVID-19

When asked to write about sex and COVID-19, I wasn’t exactly sure where to start. Even though I’m part of multiple COVID-19 taskforces, there are still so many unknowns, with many PLHIV affected in wide a range of ways. The reintroduction of restrictions in Victoria has been particularly difficult for many members of community.

I chose to interview two sexual health professionals, Dr. Wendell Rosevear and Associate Professor Darren Russell, to get their take on sex and mental health at the current time. This interview was conducted on the 19/6/2020.

Dr Wendell Rosevear is the director of Stonewall Medical Centre in Brisbane, a recipient of the Order of Australia, and lobbies nationally to generate understanding about drugs, addiction, recovery, prisons, male sexual assault, sexuality, relationships, suicide and prevention. He believes passionately in the value of each person and in nurturing honesty to deal with life’s issues and has the life motto and aim, “to make Love infectious”.

Dr Darren Russell is a sexual health physician and the Director of Sexual Health at Cairns Hospital. He holds the positions of Clinical Associate Professor in the Department of Population Health at The University of Melbourne and Adjunct Professor in the School of Medicine and Dentistry at James Cook University in Cairns. He was also the Principal Investigator for the Queensland HIV prevention study – ‘QPrEPd’, with interests including Indigenous sexual health, transgender health, and the elimination of Hepatitis C infection and HIV transmissions in Australia.

How has coronavirus affected the sex lives of your patients that are living with HIV?

Wendell: “Gay people are pretty good at connecting with each other. The whole pandemic has actually produced a lot of isolation, where people actually have less access to connect, through venues and internet hook ups. I find that people are having a lot less sexual connections. Interestingly, in preparation for this talk, I contacted both Gladstone Road Medical Centre and Holdsworth House and doctors at Stonewall and surprisingly I found that there were no local transmissions of coronavirus in the Brisbane community via clinics accessed popularly by gay community.”

Darren: “I think initially there was a lot of concern by people living with HIV about the effect that COVID could have on them, given the immune system issues that many people have, especially long-term survivors with HIV. I think there was real fear, which did lead to quite a drop in sex seeking behaviour amongst many of the folk. Many guys who are very sexual reigned it in quite a lot or totally for a bit of time. That may be starting to change a bit now. Clearly some people didn’t, they continued to have a very full ‘social’ life, but there’s certainly a lot of people who toned things down because of fear, and also wanting to help others, not wanting to pass COVID on. So, there was fear for themselves, but also wanting to protect other people, wanting to protect their sex partners.”

Over 40% of people living with HIV that recently responded to a NAPWHA survey about the impacts of COVID-19 on people living with HIV indicated that physical distancing significantly impacted their mental health, and 47% of respondents indicated that their most pressing needs relate to mental health support. Do these percentages surprise you?

Darren: “I think a lot of this is personality driven. Many people in the world are extroverts, love company, love going out, love socialising, love hugging, and being around others. For those individuals, it’s been an extremely difficult time. That lack of physical touch, intimacy, that lack of closeness, not being able to kiss a friend, or hug a friend or family has been very difficult and mentally challenging for people. There are other individuals out there who are more introverted, and were never particularly social butterflies, and for them it’s been less challenging.”

Wendell: “The biggest problem I’ve seen is the angst that’s come in parallel with COVID; people losing their jobs, losing their security, having their rent or their mortgage in jeopardy, and also the loneliness. Some of my patients say ‘ah this is normal for me, I’m pretty alone anyway’, but people really are starved for connection, starved for that opportunity to have social contact. Some people will see going out to a venue like a weekly charging the batteries or keeping the motivation up. Interestingly I run GLADS, the Gay and Lesbian Alcohol and Drug Support Group. I’ve kept it going right through the pandemic. We’ve offered social distancing, masks, and hand sanitisers as options for people coming to the meeting, and our numbers have gone up.”

What should people be doing to look after their mental health at the current time?

Darren: “Trying to maintain social contact in some way or another is vital; with family, with friends, with other people. I found it challenging. I’m a member of some sporting clubs and I enjoy that, and we haven’t been able to do that sport. Part of my life that was quite important, my socialising disappeared. I think we have to be a bit creative. We have to find other ways that we can meaningfully engage, even if we can’t be as close to each other physically as we would like to be. Keeping in touch by email, text, phone call, having Zoom meetings. It gives a real sense of community and keeps people in touch. As we are coming out of isolation and out of restrictions now, hopefully some of the difficulties people have had will reduce, but the issues of employment are huge. A lot of people gain satisfaction from their job, or money of course, but there is a ‘family’ or a social group at work. That’s been missing also and may not start up again. So, these are very uncertain times.”

Wendell: “The analogy that I find helpful is … if you can see big waves, and you’re out at sea, and you’re just on your own, and all the things seem to pile up on you, of course you think that you will sink. You can’t stop the waves, but what you can do is build a life raft and connect with people in whatever way is possible; either by phone, by texting, or by internet communication – to build the life raft so that even though you can’t see over the waves, you can stay afloat and float through the crises. Closer to the beach, the smaller the waves. Otherwise you get a sense of loneliness or overwhelming, the tidal waves swamped feeling. I say to people ‘if you’re in a rip, float, don’t try to swim against it, otherwise you’ll drown, because you’ll get exhausted or you’ll feel no hope or you’ll panic’. I like the life raft analogy as a coping strategy.”

Darren: “I think something that’s already been alluded to is taking solace in alcohol and substances, which we’ve probably all done to a certain extent during this time but it’s not a good long-term coping strategy. We’ve certainly seen a lot of people have increased drug and alcohol usage, sometimes at quite a harmful level, when they’ve managed not to do that for a long time. There are good ways of coping, and there are perhaps not such good ways of coping.”

Wendell: “That’s very valid Darren because one of the alcohol and drug research institutes found that alcohol use has gone up 70%, and people’s concern about it has gone up 40% through the pandemic. I’m on the state domestic violence council, and certainly domestic violence has been raised through this time due to isolation and increased substance use.”

As restrictions are lifted across the country, many individuals will be wondering how they navigate casual sex off hook up apps. What are your thoughts?

Wendell: “I think that the ASHM and New York Guidelines are very helpful and also George Forgan-Smith with his thehealthybear.com.au, translating them into local, user- friendly language. They’re really helpful resources for people. I’ve been through HIV pandemic and now COVID pandemic, and I’ve got two basic guidelines; i) I treat everyone as valuable, and ii) I treat everyone as potentially infectious. I don’t get safety out of prejudice, out of assumption, out of guessing, any form of labelling people. I get safety out of safe practice and promoting safe practices as the strategy. It’s pretty hard to use distance when it comes to sex. I think the leather scene is quite clever, that they wear doggy masks and things like that. Even in ASHM, they talk about maybe looking at sexual interaction that doesn’t involve too much direct face-to-face breath exchange. The other thing is that hygiene is important, like washing before and after sex, and limiting the number of partners, and considering old fashioned ways like condoms, and there is flavoured lube and flavoured condoms. It doesn’t mean we have to think that sex is impossible. We need to be quite creative and innovative. Most people actually like the body and the intimacy of sex more than just the turn on or cumming, so we need to look at maybe concepts like massage or sex that doesn’t involve too much breath exchange. If you’re symptomatic, with fever or current respiratory symptoms, look after yourself and look after the people you care about, because that’s the highest risk for transmission.”

Darren: “Any sexual contact, any contact between two humans, is going to involve a risk for COVID-19. We can’t get rid of that totally. We can reduce the number of sexual partners, we can reduce the amount of time we spend with a person, with a casual contact, we can have sex that doesn’t involve face-to-face contact. There have been two studies in semen; one found that they could find COVID-19 in the semen of some people with COVID (Li, Meiling & Pengtao, 2020), the other study found that they could not find any (Song et al., 2020). One study of vaginal secretions also found no COVID in the vaginas of 10 women with COVID-19 infection (Lin et al., 2020). Rectal swabs are a good way of finding COVID-19, but we don’t know if the virus is actually capable of transmitting or whether it’s just remnants of the virus. There have been no cases of sexual or faecal transmission, as far as we’re aware. So, if it does happen it’s much less common than breath, exhaled air, or what’s called fomites, which is virus being on surfaces. Attention to hygiene, not being face-to-face, and reducing the number of sexual contacts and the time you spend with them are going to be the best ways to reduce risk if you’re wanting to continue to have sex of some sort.”

Do you anticipate many changes to sexual health services across Australia post-pandemic?

Wendell: “I think we’ve got a renewed awareness of the need for accessibility. People have got a renewed sense in the value of their health and that our life is actually quite precarious, that the whole world can shut down and our life could be at risk. I would really welcome people reclaiming ‘my life is valuable’, ‘my health is valuable’. Who could ever believe there would be such awareness of social distancing or hygiene? I was at the Black Lives Matter rally and most of the people actually had masks on. I’ve never seen such radical social awareness and public awareness about health and prevention before.”

Darren: “I don’t think we know yet. It’s only been three months when you think about it. We normally see around 300 people a week through our service, and that dropped to about 150 in the middle of this. It’s now climbing up again so things can change very quickly, for better or for worse. I hope we keep a bit of a reliance on Telehealth, if that suits the patient or the client. It’s not always easy for people to get to a doctor, take time off work, wait in that waiting room for forever. Being able to do it from your mobile phone on your lunch break would be much better. There’re many consultations that can be had that way. Not all of them, clearly, but I’d like to see that continue if it’s what the patient wants.”
Wendell: “I’ve got a personal life motto ‘to make love infectious’ and if love could spread as quickly as COVID, I think we’d have a new world. If we each love within our reach then we are part of a revolution, so I think we need to use love to prevent COVID.”

Please refer to local information within your state regarding restrictions currently in place. This will continue to be an extremely challenging time for many members of HIV community. Please look after yourselves and those that you love and care for, stay connected to others, maintain routine appointments, and seek support if you require it.

Additional Resources:

Sex & COVID-19

Harm Reduction Approaches to Casual Sex During the COVID-19 Pandemic (Michaels, Riley & The ASHM Taskforce on BBVS, Sexual Health & COVID-19, 22/6/2020)

COVID-19 UPDATE: Easing of Restrictions, Physical Distancing and Casual Sex (Joint Statement from ACON, Kirby Institute and ASHM, 12/6/2020)

Safer Sex & COVID-19 (New York City Health Department, 8/6/2020)

Sexual Health in the SARTS-CoV-2 Era (Turban, Keuroghlian & Mayer, 8/5/2020)

Mental Health

HIV: Impact on Mental Health & Quality of Life in Time of COVID-19 (UNICEF, 29/5/2020)

Supporting Mental Health & Wellbeing Through COVID-19 (The ASHM Taskforce on BBVS, Sexual Health & COVID-19, 23/4/2020)

Supporting Mental Health and Wellbeing Through COVID-19: Support for the Health Workforce (Hennessy, Coote, Bulsara and members of The ASHM Taskforce on BBVS, Sexual Health & COVID-19, 6/5/2020)

Wendell recently contributed to a book about substance use in the music industry, titled ‘Musicians and Addiction: Research and Recovery Stories’, which examines the full spectrum of substance use, dependency, alcoholism, addiction and recovery in the music industry.

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