Julia Marcus writes:

In the earliest years of the HIV epidemic, confusion and fear reigned. AIDS was still known as the “gay plague.” To the extent that gay men received any health advice at all, it was to avoid sex. In 1983, the activists Richard Berkowitz and Michael Callen, with guidance from the virologist Joseph Sonnabend, published a foundational document for their community, called “How to Have Sex in an Epidemic.” Recognizing the need for pleasure in people’s lives, the pamphlet rejected abstinence as the sole approach and provided some of the earliest guidance on safer sex for gay men, including recommendations about condoms and which sex acts had a lower or higher risk for disease transmission.

Public-health experts have known for decades that an abstinence-only message doesn’t work for sex. It doesn’t work for substance use, either. Likewise, asking Americans to abstain from nearly all in-person social contact will not hold the coronavirus at bay—at least not forever.

#StayHome had its moment. The United States urgently needed to flatten the curve and buy time to scale up health-care capacity, testing, and contact tracing. But quarantine fatigue is real. I’m not talking about the people who are staging militaristic protests against the supposed coronavirus hoax. I’m talking about those who are experiencing the profound burden of extreme physical and social distancing. In addition to the economic hardship it causes, isolation can severely damage psychological well-being, especially for people who were already depressed or anxious before the crisis started. In a recent poll by the Kaiser Family Foundation, nearly half of Americans said that the coronavirus pandemic has harmed their mental health.

Meanwhile, most public-health experts agree that a premature return to the old version of normalcy would be disastrous. States continue to lack the capacity for widespread coronavirus testing or contact tracing. Serologic testing to date suggests that the majority of the population is still susceptible to infection. A vaccine is months or even years away. New cases continue to rise, with thousands of people dying each day, and those numbers will inevitably increase if communities go back to business as usual.

But the choice between staying home indefinitely and returning to business as usual now is a false one. Risk is not binary. And an all-or-nothing approach to disease prevention can have unintended consequences. Individuals may fixate on unlikely sources of contagion—the package in the mail, the runner or cyclist on the street—while undervaluing precautions, such as cloth masks, that are imperfect but helpful.

Public-health campaigns that promote the total elimination of risk, such as abstinence-only sex education, are a missed opportunity to support lower-risk behaviors that are more sustainable in the long term. [Continue reading…]