18 May 2020
In many ways, the HIV community is better prepared for COVID-19 than the rest of us. With already compromised immune systems, they’ve always known to wash their hands after using public transport and before eating, and not to touch their faces; they’re cautious about shaking hands with strangers. In addition, they know to stockpile some extra loo rolls, the odd extra can of beans, in case a bout of bad health or sudden vulnerability prevents their getting to the shops. The London HIV chaplain, Joseph Kyusho-Ford, has spent years nagging them to keep up to date with flu vaccinations, to stockpile 30 days worth of medication, to have a plan as to how to pursue their clinical care, should they ever be isolated or quarantined.
But in other ways, they are more vulnerable. For the chaplain’s 360-odd clients, “the notion of working from home means nothing. Many of the clients are in what you might term 'face to face' jobs. Among other things they work in retail, hospitality and human resources. Some struggle financially. But all are either living alone, or in situations where they have psychology isolation from unsupportive families. Let's be clear: these are inventive, brave and imaginative people. But all the usual means of coping with the specific isolations involved with being HIV positive are lost in the current situation..
"The personality of clients is neither stereotypical nor simplistic. Many clients are a unique combination of fiercely independent and sensitively introverted 'loners'. Frankly, given the conformist/pitying client profiles that are thrown at them you can't blame them. However in this case routine is very important. Clients often value being a crowd and watching the world go by without actually being part of the interaction. They are the 'watchers' among personality types. Routine is also very important for mental health. All this naturally is completely lost too. This, added to all the other pressures, can have a negative effect."
It’s too early to say for certain whether being HIV+ leaves you more vulnerable to contracting COVID-19. However it seems potentially true that compared with the general population, those with pre-existing conditions will tend to suffer more serious versions of the virus, a higher likelihood of suffering a severe illness, as well as higher death rates. In addition, the HIV population is ageing. Those on HIV medication often develop secondary conditions because of the medication. These can be cardiovascular, neurological, or psychological issues . They tend to deplete the system and in general leave clients fighting on more than one front which cannot be good during a viral outbreak. Older people are in general are more at risk of COVID-19, because of the way the immune system behaves as it ages. HIV positive people are more likely to develop cardiovascular disease, at a younger age than is usual….. Some HIV medications, particularly the older ones, cause depletion of the white blood cells that fight infection.
Clearly, therefore, it’s imperative that the HIV population do everything they can to shield themselves from this new virus. Stop non-essential contact, the experts advise, as this pandemic unfolds and the world unravels: but for humans, pretty well all contact is essential, and all the more so in times of fear. We need to be hugged and reassured, now more than ever. We need to hear other people’s stories to put our own into perspective; we need to squeeze a loved one’s hand, interlace our fingers with theirs, feel their pulse and breathing slow, watch their smile broaden.
One user of the HIV chaplaincy told me: “For years I was criticised for ‘drawing into myself’ to avoid cruelty and stupidity. Now we are all being told to withdraw on a grand scale to protect ourselves.” In the midst of a journey in faith communities this client’s defining experience has always been loneliness. “Why do Churches feel it’s acceptable to withdraw to protect life, but not to protect sanity, goodness and conscience? I’ve been lonely all my life: this crisis is nothing new to me.”
For him and for many others, isolation is already a real issue within the HIV community. During lockdown the chaplain is having to use all his imagination and every technical resource at his disposal to get them through this new crisis. Where formerly they would meet in community centres for book groups and therapy sessions, now these will be conducted by Skype; in addition, he plans to set up virtual flute and violin lessons, to bribe a pal to teach Japanese to anyone who fancies learning it.
“I’ve always been there to help them plot their pain. To re-imagine it. At first, when this disease struck and I was told to work from home, I felt as if I’d barely be earning my salary, forced to sit back, drinking coffee, waiting it out. I very quickly realised my imagination, energy and resources were to be stretched to greater limits than ever before. This pandemic will test us all.”
More than most of us, the HIV community are already in need of companionship, understanding and consolation, and this crisis has profoundly deepened that need. As Joseph says - “We are all going to get through this. And we’re not going to get through it miserably.”