The past six years have been a real whirlwind, haven’t they? No matter your current feelings about the COVID-19 pandemic, it has changed all of our lives in big and small ways. However, the longer the pandemic goes on, the harder a lot of people find to talk about it, or their fears and needs for safety and precaution.
While talking with some friends recently, I realized that many of us had taken the experience we had managing our sexual health risks and used those same skills to manage and communicate about COVID risk. These conversations occurred as we saw COVID restrictions and precautions lessening and the number of people left chronically ill after an infection rising, and the realization that we had a responsibility to each other to prevent the transmission of COVID as much as an STI like HIV.
So that’s why we’re here today! At Scarleteen we love talking about managing risks when it comes to our sexual health, and we wondered what it might look like to explicitly apply the same approaches and ideas we use for safer sex to COVID, and if that could help to keep ourselves and our lovers safer while getting intimate and in the wider world. These recommendations will help reduce your risk of other respiratory infections, too.
Maybe you’re a COVID-conscious person, someone who wants to learn more, or you’re reading this because a partner or potential lover forwarded it to you: Welcome, and we hope you find something useful in this guide.
Applying a sexual health toolkit to COVID
First, to be clear: we’re not trying to re-label COVID as an STI. An STI is an infection that is only or most typically spread via sexual contact. For example, a cold is not an STI, even if you can give it to someone when you kiss them (because that’s not the main way colds are spread).
Instead, what we’re doing today is applying a different way of thinking than usual to how we think about the virus: one that many people already use every day to learn about, prevent, detect, and treat STIs and other sexual health concerns.
What tools or ideas are we referring to when we talk about a sexual health toolkit? It could look like:
- Prevention being possible and effective;
- Knowing our status and testing to find it out;
- Managing and fighting our shame and stigma;
- Understanding what to do when we or our lovers test positive; and
- Keeping ourselves and each other informed.
It might sound like a lot of steps, but I promise each of them is simple. So, let’s dive into each of these in more detail.
Prevention and protection
To prevent the transmission of any infection, we first need to know how transmission occurs. Many STIs require physical contact, e.g. of skin or bodily fluids like semen or blood. However, COVID transmission occurs when infectious droplets enter a person’s mouth, nose, or eyes. These can be directly from someone else’s mouth, such as when kissing, or transmitted through the air via breathing, coughing, or sneezing.
As these droplets can sometimes stay in the air for hours after being breathed out, there is also the possibility of infection from someone you aren’t kissing but are in the same room with, or even from someone who left the room before you entered it.
It can seem a bit scary to name all of the ways we could get an infection, but now we have an accurate picture of how transmission occurs, we can plan to prevent it! While one option is abstinence, just like when talking about sex, this option isn’t going to work for everyone: social and sexual contact, being around other people, and access to public spaces are important or necessary for many people, so we also need to look at what our options are for minimizing harm. For preventing transmission, I like to think about barriers and behaviors.
Like using a condom or dental dam reduces the risk of pregnancy or STI transmission, using a barrier such as a mask—and face shield if you want more protection—provides very effective protection from all sorts of respiratory infections. To protect against infectious droplets in the air, you’ll need to use a specifically-rated and well-fitting maskexternal link, opens in a new tab, such as an N95 or P2—cloth masks or surgical masks won’t do this, but are better than nothing. These obviously get in the way of acts like kissing or oral sex, but there are many other kinds of sex or intimacy that don’t use our mouths.
Tools such as high-quality air filters that remove virus particles from the air, or portable far-UV devices that kill virus particles while they’re still in the air are both very effective, but they don’t act the same way as a barrier: they won’t be able to protect you from mouth-on-mouth contact or breathing close to your lover. As a result, they may be less helpful during sex, but can still be an effective tool to make a hotel room safer, in spaces used for play, or for non-sexual socializing.
Our other tool for prevention is to change our behaviors. This could look like changing how and when we have sex (e.g. only with people who know their status, or only with all the windows open and a stiff breeze and/or air purifier), or wider behaviors (such as masking while in public for the fortnight before your date, or rescheduling if you’ve been around someone who was sick). Good general hygiene, like washing your hands and body before sex, are good to do, but may be less effective at preventing COVID during sex than they are out in public or shared spaces.
Prevention is such an important part of our toolkit because COVID can still cause a lot of damage.
Not every barrier or behavior change will be for everyone, and part of good sexual health navigation is finding the place where everyone involved is having fun and comfortable with their level of risk, which brings us to our next tool.
Knowing your status
When we know that we are either negative or positive for an infection, we call that knowing our status. This phrase originates in HIV care and prevention, as knowing our HIV status allows us to make informed decisions about sex and healthcare. Importantly, we can be positive for COVID and also be asymptomatic (not having any symptoms), so assuming that we are negative for an infection does not count as knowing our status—we need some way of testing or checking to know for sure.
There are several different kinds of COVID tests available, depending on what you have access to and your budget. Rapid Antigen Tests, or RAT tests, are the kind of test you can buy over the counter. They are portable and easy to do for yourself, and relatively inexpensive. However, they can also be quite inaccurate: they are more likely to give a false positive or false negative result.
One way of being more sure of your status is to do multiple rapid tests, because the likelihood of two, three, or even four tests to all have the same error or inaccuracy is much lower than just one. There are also higher and lower quality rapid tests on the market, and purchasing ones that come recommended by the COVID-safer communityexternal link, opens in a new tab can help here too. However, by the time we’re doing multiple rapid tests, the cost can add up, so let’s look at some other options.
PCR (Polymerase Chain Reactionexternal link, opens in a new tab) tests are a type of NAAT (Nucleic Acid Amplification Test) that are a lot more accurate because they can detect a much smaller amount of the virus in the sample. Because of this, they are also much more accurate, and a false negative or positive from a PCR test is far less likely, but your result can take up to a few days to get back to you, so it’s a less useful option for your hot date tonight. When you go and do a lab test for COVID that uses a nose and/or throat swab, this is likely for a PCR test. Many countries have services that you can book into for COVID testing, though there is often a fee involved.
In recent years, there have been an increase in the availability of portable PCR devices such as the Metrix Reader or Altruan Pluslife—these provide a higher accuracy of test result than a rapid test but can be done from home and more quickly than a lab PCR. However, they can be expensive to purchase. It can be worth joining or starting a local COVID safe group or organization, as people in your community may already have a device or be interested in pooling resources to purchase one, and can provide more information about how they work and how to use them to keep yourself and your lovers safe. If you have access to health insurance, you could also look to see if any forms of testing are covered by your insurance.
Whatever kind of testing you’re doing, it is important to know the window period for that test—that is, the time from infection to where the test is able to identify the virus. Even if you have COVID, doing a test on the day you got it will show a negative result, as it takes a few days for it to become detectable. If information about the window period of a test is not included when purchasing or booking, make sure to ask!
Unlike many STIs, there is one other way of knowing our COVID status: time. Because COVID has a limited contagious period (estimated between 2–4 weeks, depending on the study and the existing strength of your immune system), if you have not been in a situation where you were at risk of an infection in that time, that’s a good indication of a negative status. It’s important to note that this is not always the same amount of time as when you stop feeling symptoms, or when your local health body says it’s safe to stop isolating!
The final part of knowing our status is sharing it! Telling a potential lover your status, or that you’re not sure what it is, allows you to make informed decisions together about if you do or don’t want to have sex, and what other precautions you might take as a result. By having these conversations, we facilitate consent through our words, actions and intentions. However, it can feel hard to know where to start these conversations!
Fighting shame and stigma
You might be familiar with the feeling of stigma surrounding sexual health—even as someone who has worked in sexual health for years, those old feelings of judgment, embarrassment or shame can be hard to ignore!
Sadly, in the past half decade, we have seen COVID caution go from an openly discussed part of daily life to being a topic that carries and creates stigma for many people. This could look like a disinterest in newer scientific findings, an othering or pushing away of people who advocate for COVID precautions in their homes or out in the world, or physical and verbal attacks, such as on people who are masking in public spaces.
The good news is that we have really effective and proven tools for fighting stigma in so many areas of life: education, knowledge sharing, and working together. Like any other skills we have had to learn, talking openly and lovingly about our health, our desires, and our safety needs can be difficult at first, but gets easier with practice.
Having these conversations with our lovers can be a really good place to do that practice, as we’re often being intimate and vulnerable with them already! However, if that feels too difficult a place to start, you can practice with a friend, a person in your COVID-cautious community, or even just by yourself. We have a great guide on the site to talking about sex with a partner, and a lot of the advice in that article can apply to talking about other difficult or new desires and needs.
The other part of fighting stigma is to figure out what we want and to believe that we deserve it, rather than it being something difficult, shameful, or unfair to ask of others. It can be difficult to navigate any difference in desired risk with our lovers, whether that looks like using a condom or not, or whether we have sex with someone who doesn’t know their COVID status. Knowing and then advocating for our needs doesn’t always mean the other person will say yes, but a no doesn’t mean you’re asking for too much, or that you won’t find someone whose desires match more closely with your own. At the end of this article, you’ll find some prompts for thinking through your needs.
A final way that shame or stigma can come up is when someone makes a mistake, or doesn’t always do things perfectly. While it’s understandable to desire that things always go perfectly to plan, we all sometimes slip up, and we can make that easier and build trust together by knowing we can admit our mistakes, learn from them, and still care for each other afterward.
What to do when we have it
Even with our best laid plans, tests and precautions, sometimes we just get unlucky. This is why part of looking after our sexual health is knowing what to do if we develop symptoms or test positive.
Clean Air Club have a great resource, My Covid+ Planexternal link, opens in a new tab, which discusses what to do after a positive result. Even if you’ve not tested positive, or aren’t expecting to anytime soon, it’s a great read to help plan and prepare for if you or a loved one does in the future.
The plan covers isolating while contagious, using barriers when around others or in public spaces (and minimizing time spent there to prevent further spread), notifying anyone who you’ve been around while potentially infectious, the importance of rest for recovery, and a range of other helpful admin items like symptom tracking and scheduling medical appointments.
It’s worth saying that it can be hard to meet these responsibilities when much of the world acts as if COVID is no longer a problem: we may still have our responsibilities to family, school and work. It might help to think about how those responsibilities may shift when we are positive for a virus. For example, our responsibility to school might be to recover as best as possible so we can study well in the future, and our responsibility to work or family might be to prevent any further infections so our community is safer and healthier.
Sometimes the effects or symptoms of a COVID infection don’t go away, or go away entirely, even if we are no longer contagious or testing positive. If this occurs for longer than 12 weeks, this is then referred to as Long COVID, and it can look very different for different people. If you are not feeling better in the weeks and months after your initial (or acute) infection, we highly recommend doing some more readingexternal link, opens in a new tab about managing, treating, and living with long COVID, and connecting with long COVID communities.
Staying informed
All of the above steps aren’t difficult with practice, but they all rely on two things: us wanting to put in the effort to do them, and us knowing enough information to do them well! That’s why the final tool in our toolbox today is keeping ourselves and each other informed.
Informed doesn’t mean we need to know everything, or be up-to-date on all the latest research, but it does mean we have enough information to manage our risk in the ways we want. For me, this looks like knowing where and how I can test, the window periods for each of these tests so I know my status, and the barriers I can use to minimize my risk in crowded spaces like a classroom, the shops or a workplace. For you it might look different, and that’s okay.
Staying informed also looks like following some news sources or people who you trust to share accurate information or resources about COVID like The Sick Timesexternal link, opens in a new tab, Dr Lucky Tranexternal link, opens in a new tab, Covid Free Pressexternal link, opens in a new tab, and many others.
When we start learning, and talking, and sharing, it builds up our skill in trusting one another to be doing the best we can. This doesn’t promise we won’t sometimes disagree or make mistakes, but means we’re better prepared to fix ruptures and find solutions, and maybe even change the world one kiss at a time.
If you’ve been thinking about or practicing safer sex, I bet that none of the tools above are totally new, we’re just using them in a slightly different way to usual.
I know I can get overwhelmed with a lot of new information to process though, so let’s finish up today with a few questions to take away and think about in your own time.
- If you were to think about, manage, prevent, treat, and talk about COVID the same way you would an STI, are there things you would do differently about the way you date, have sex, or are intimate with people?
- Are you comfortable having sex with people who take different precautions to you?
- Do you know your status, or do you know where you can get tests or get tested so you can find out?
- Where can you find people who share your level of caution or your values?
Are there things you definitively want or need, or do you have any hard limits? For example, do you never want the possibility of getting COVID?
You don’t need to know all or any of these answers, but hopefully the process of asking yourself or your lover(s) will create the space to imagine what you want, practice your values and build healthy relationships and lives
When it comes to our sexual health, we benefit from the work and advocacy of so many people before us who’ve fought for sexual health visibility, testing, research, and education — this work happened out in the world, but also in homes and bedrooms, and I believe it’s our responsibility to keep working, keep talking, and keep each other safe.
