It has been four months since we were first told to stay in our houses unless we absolutely have to leave. Since then, the US rates of Coronavirus have risen, and, mired in uncertainty and unrest, this surreal period drags on, sometimes feeling as though it will pull us under.
For some of us, it has been 4 months without a hug or a hang-out. We ration trips to the grocery store. We flirt online but don’t date. We ponder how to safely but evenly cut off our split ends. We cannot imagine how to live our old lives safely, and so some of us feel we are simply living less.
And some of us don’t sweat these details. We may be still be going to parties, restaurants, bars. Maybe because it is too immense to fathom that this is real, or to imagine how much it demands us to change.
Four months in, we are perhaps divided by the limits of our imaginations, unsure of how to meet the need for sterile safety as well as the need for connection.
Humans are social creatures. Isolating completely until a vaccine is found is not sustainable emotionally even for those privileged to make it work financially. Trans survivors, in particular, may already be isolated by both their identities and experiences of sexual violence, and may be unable to work from home because of economic marginalization. Lack of connection harms our minds and bodies further, even weakening our immune system.
We all need connection to survive.
At the same time, with coronavirus so ubiquitous in the environment, I posit that we may need to give up the myth of creating spaces completely and permanently free of those sticky microscopic particles. What if it is healthier for us to recognize that just as there are no fully emotionally safe spaces—hermetically sealed from a violent world—there are no fully decontaminated lives? Just as trans survivors have worked to create safer spaces, recognizing that fully “safe spaces” can be a dangerous myth, so too can we create spaces that are safer for our immunological responses.
Research is finding that this non-binary framework may bear out in reality: the fewer coronavirus particles we are exposed to, the fewer that infect our bodies, the milder the illness we experience, and the more likely we are to be asymptomatic (and therefore to spread milder, less deadly forms of the virus to others, if we spread it at all.) This research supports wearing a mask because “the volume [of virus] you breathe in may directly equate to the severity of the infection.”
In other words, being safer rather than perfectly safe can be enough to prevent many deaths.
So knowing this, how do we move forward? How do we embrace imperfection amidst calls for scientific purity, and also embrace the act of trying, of moving towards safety (knowing we may never fully arrive) in a dangerous world?
As others have pointed out, the principles of harm reduction offer us a middle path that we can each carve through our own lives, responsive to our own needs. Harm reduction has guided very successful interventions around other public health crises, most notably HIV and the opioid epidemic, so there is reason to believe this lens could help us safely bridge a weaponized divide in how to approach this virus.
Harm reduction is a framework that can be defined as “an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Most frequently associated with substance use, harm reduction also applies to any decisions that have negative consequences associated with them… At its core, harm reduction supports any steps in the right direction.”
Harm Reduction offers particular gifts to trans survivors.
One way some trauma survivors learn to cope with the pain of trauma is with “black and white thinking” or splitting. Abusers and others often vacillate between telling survivors they are all good and all bad, and so survivors internalize this polarized thinking. These black and white views of people and the world are damaging because they make it hard for trans survivors to accept their wholeness and complexity. Binary thinking also leaves little room for non-binary experiences of gender. So it can cloud and complicate the processes of healing and transitioning for trans survivors.
When it comes to Covid-19, gay physicians Eric Kutcher and Richard Greene “A harm-reduction approach to COVID-19 reflects going places with substantial space and air circulation, staying 6 feet apart, wearing facemasks when closer than 6 feet, and performing frequent hand hygiene. All decisions in a harm-reduction approach must be thoughtful, intentional, and negotiated.”
Here are some guidelines on how we can thoughtfully negotiate these decisions:
- First, don’t give up on taking measures to be safe just because you can’t get everything perfectly right. Accept complexity and imperfection and commit to taking steps towards safety.
- Recognize that, just like gender and abusive or healthy relationships, levels of risk occur on a spectrum. For example, different kinds of masks have varying levels of effectiveness and different levels of exposure lead to greater levels of risk. Do research, remain open to learning, and carve the path through risk that feels right for you or your household or pod.
- Begin to see anything you can do as reducing harm rather than see anything you don’t do as creating harm. This positive reframe can greatly reduce anxiety, self-blame, and stigma. We are still seeing the fallout from the blame we have placed on gay men and trans women in the HIV epidemic. A lesson of that epidemic is that stigma does not make us healthier as individuals or a society.
- Consider consent. Now that social behavior put us at risk in a similar way to sexual behavior, we can use what we know about sexual consent as survivors to build safe and healthy social relationships. If you’re hot and sweaty on a hike with a friend, ask if it’s okay before you take your mask off the way you might have once asked to kiss someone. Ask how far away you can stand. In your invitation to your small clear, be transparent about what kinds of restrictions will be in place. Recognize that risk-taking with those who have consented (a lover who opts in to a night over at your house knowing your exposure level) is more ethical than risk-taking with those who can’t consent (a stranger you reach over to grab something at a grocery store). If we keep risk-taking to smaller circles following principles of consent, the virus cannot spread as widely.
- Weigh physical safety and mental health creatively. In response to the pandemic, sex workers and their clients have moved online, flooding online platforms, and Major League Baseball is putting cardboard cutouts in the stands to simulate the experience of playing for a crowd. In our search for touch and in-person connection, we can surely muster this kind of radical creativity. Can we meet loved ones outside? Can we hug with masks on? The New York Times offers armfuls of tips for safer hugging. In more surprising examples of problem-solving, the Canadian CDC recently recommended glory holes for sex during the pandemic and the New York City Department of Health suggested sex with masks on. These activities are not without risk, but they are lower risk than touch with no barriers between you, and public health officials recognize that “abstinence for the duration of the pandemic is not going to work” for everyone.
- Consider your own social location and be understanding of that of others: As Kutcher and Greene point out, “Individuals who must continue to work in service jobs often have limited choices regarding what risk they will tolerate to maintain a livelihood. Individuals living alone or with depression may need to leave their home and socialize for their own mental health. Black and Latinx communities have already experienced disparities in enforcement of social distancing guidelines.” Trans survivors may find themselves needing more connection than others because we heal through connection. And we can find ways to heal more safely.
In a polarized and dangerous world, harm reduction can help us find empathy for ourselves and others. And just as it sustained our queer and trans ancestors, it can sustain us through this crisis and the next.