Testing for sexually transmitted infections, including HIV, is still necessary despite the ongoing COVID-19 pandemic. People on PrEP, or pre-exposure prophylaxis to prevent HIV infection, are in fact supposed to be tested every three months to make sure they’re still negative. But when your state is on lockdown, the process of interacting with the outside world might seem overwhelming on its own.
“In my office practice we are still advising people to continue their regular three-month testing,” said Anuradha Seshadri, MD, a physician in internal medicine at UCLA and the medical correspondent for +Life, an HIV-advocacy publication. This recommendation is ultimately still case-by-case, as physicians weigh patient health risk, including sexual behavior. “Even though we are advising that people practice social distancing or isolation, there is still unsafe sex being practiced,” Seshadri said.
Seshadri believes it is necessary to keep testing for HIV during the COVID-19 pandemic, but access to HIV testing isn’t always accessible.. Medical professionals have expressed concern that sexually transmitted infections could increase during the COVID-19 pandemic due to a decrease in accessible testing, even as at-home testing is made available in lieu of clinical care. “We are seeing a complete disruption to STD prevention here in the United States,” David Harvey, the executive director of the National Coalition of STD Directors, told The Hill. “We expect to experience even higher STD rates as a result.”
Medical providers are deciding whether or not to continue advising patients to get tested for STIs regularly in an individualized way. “Every hospital or clinic system [in the U.S.] has been given their own set of guidelines and practice methods,” Seshadri said. “Most clinic practices and hospital settings understand that ‘healthy’ patients still need to be seen for non-COVID related issues.”
“There are still many individuals who are meeting up and having sex regardless of the social distance order,” said Jacob Rostovsky, a Los Angeles-area mental health provider. Survival sex work, he said, is one example of why there is an ongoing need for HIV testing despite the COVID-19 pandemic.
Rostovsky is a gay transgender man, and an advocate for the trans community, a population disproportionately impacted by HIV. In the long run, he is more concerned about HIV- and AIDS-related complications impacting the lives of his community members and patients than the symptoms of COVID-19. “The least we can do is provide safe ways for HIV testing and treatment.”
Any risk of exposing yourself to COVID-19 by leaving home and going to a medical facility to an HIV test may be outweighed by the risk of foregoing available testing during this time. Ultimately, “risk is risk,” Rostovsky said. If you may have been exposed to an STI, Rostovsky says to take it seriously and, “contact your doctor, and ask for their advice.”
The risk of exposing oneself to COVID-19 by entering a medical facility can be mitigated with the appropriate protocol, for practitioners and patients alike. For instance, separating patients who are exhibiting COVID-19 symptoms apart from patients who are not. Individuals can protect themselves in a medical setting, too, Seshadri said: “Donning a face mask, gloves, [and] practicing safe hygienic practices, would greatly help protect people, even if they have to go to a medical facility.”
It remains especially important to monitor HIV status, “regardless of a pandemic or not,” Seshadri said, in part “because of the short and long term side effects that HIV poses.” The Centers for Disease Control doesn’t yet have the data to say how greatly HIV status impacts COVID-19 symptoms, however, the organization presently advises that the risk of extreme illness from the novel coronavirus is greater for HIV-positive people who aren’t on anti-retroviral medication.
“HIV is a viral illness that affects the immune system, potentially rendering a person immunocompromised, and therefore placing them in the high risk category of COVID-19 effects,” Seshadri said. “We are blessed to have testing measures, treatments, preventative medications at this time and age–and thus should take advantage of these resources.”
“If we are having sex we need to know the risks, symptoms, and treatments for HIV,” Rostovsky said. “Many clinics and doctor’s offices are still open and are still testing.”