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The Winter issue of Poslink takes a look at how people living with HIV and grassroots community initiatives are responding to Covid-19. As face masks become mandatory in Melbourne and Mitchell Shire, we enter a new phase of living with Covid-19. Ross Duffin is a long-term consumer advocate and PLHIV. He shares his top three insights from living across two global pandemics, including how we can incorporate emerging evidence into our lives and what we can do to make it through the long term as a community. This article has been updated to reflect the fast-changing nature of the Covid-19 response.

Taking new information into account
Across both pandemics initial important messages persist but new knowledge is often not sufficiently taken into account. For instance, it’s still the case that people get an HIV positive test result and think it is a death sentence.

With Covid-19 the two initial guidelines – physically distancing and hand washing – are well known and remain important. However, there is more knowledge that needs to be utilised.

We now know that most infections happen inside. And in these environments, it is not just physical distancing that is important – it is how often the air is refreshed and how the air circulates that plays a role in transmission. The longer you stay within an inside environment, the more the risk.
The second area where knowledge has increased is in mask wearing. Initial advice was not for mask wearing. Now the evidence is that if you have Covid-19 (and may not know) it can prevent onwards transmission. Additionally, the evidence is now more solid that mask wearing provides some protection from infection to the wearer. This is especially important in environments where the risk is greater and you cannot effectively social distance, such as in indoors. Avoid touching your face while wearing a mask and with cloth masks remember to change and wash them often.

We rely on each other
In a lot of ways, HIV brought us together to respond. In Covid-19 it’s go home and get on Zoom. As a social life, Zoom really doesn’t cut it. But it’s still important to recognise that we rely on each other. If you are younger and healthy, your individual risk of serious illness from Covid-19 is not great. However, there is much greater risk of serious illness to your much older friends should you pass on the virus. One would hope given how well younger people have responded to this health crisis, that the responses to the incoming recession recognises them appropriately.

HIV was also responded to using modern public health strategies based on the Ottawa charter where communities most at risk were heavily involved in the response. In Covid-19, we have gone back to the old public health approach led by public health doctors. A response where everyone is at risk like Covid-19 is probably better suited to a traditional public health model. But as the impact sets in and keeps persisting, it would be useful involving younger people and older people most at risk in helping with responses to the economic impact and longer-term adjustment to living in a world with Covid-19.

With this shared responsibility it is still important not to heap blame onto some segments of the community. I was on a tram while restrictions lifted. Four nurses got on. They got abused loudly by someone on the tram telling them that people like them should not travel on trams. Early on there were a number of reports of racist abuse blaming Asian people for Covid-19. For someone with HIV, like me, who has lived through decades of HIV stigma, it felt sadly familiar and equally ridiculous.

We are in this for the longer term
On the way to effective HIV treatments, there were thousands of ‘breakthroughs’ and a lot of bad science. Once upon a time there was optimism about a HIV vaccine. Now that we know how HIV evades the immune system pessimism has become the norm.

Each virus is different. There is more reason to be optimistic about an effective vaccine for Covid-19 – but the oft quoted statistic of 6% success rate for any vaccine is quite dependent on what virus you are talking about. Covid-19 has some tricks that may create difficulties in vaccine development. It is also often much harder to get effective vaccines for older people – who are those most at risk of serious illness. And even if an effective vaccine is developed by early next year, rollout and manufacture will take 12 months or longer. There has been a lot of news about some treatments having some benefit. Perhaps combinations of these given at the right time could show extra benefit. However, the costs involved in scaling up manufacture are huge. If a vaccine proves difficult this will be necessary, but I’m not sure any treatment strategy yet shows enough benefit for mass roll out.

So it seems to me, like HIV, we have to adjust to Covid-19 being with us for the medium term at least. This will change how we live our lives – and I’ve already been talking with some of my close friends about the sort of strategies we will use for living in a Covid-19 world – to replace the things we can no longer do. And as this goes on, I hope my life gets bookended by an effective Covid-19 vaccine (I’m hopeful) and an effective HIV vaccine (less hopeful) and we learn that science works and use it to apply where appropriate – such as a better response to global warming. Probably the biggest lesson from HIV is that pandemics have consequences on mental health. Be aware – look after each other and value your friends.

What can we do to protect each other?
· In addition to hand-washing and physical distancing, wearing masks is an effective means of prevention for Covid-19. Avoid touching your face and wash and replace cloth masks regularly.
· Most Covid-19 transmissions occur indoors. If possible, socialise or dine outside to reduce your risk when we return to restaurants, bars and events and wear a mask indoors.
· We are in this together. Protecting the vulnerable among us from health and economic impacts is reliant on the collective action of everyone. Piling blame and stigma onto others won’t help.
· This is for the longer term. Covid-19 will change our lives. Look after each other and value your friends.