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August 04, 2021

Is Political Correctness Putting Gay Americans at Risk?

The Provincetown outbreak may be a warning about Covid vaccine effectiveness in immunocompromised people.

According to the NYTimes, 965 recent cases of Covid have been traced to gatherings in Provincetown  and 75% of those cases were among vaccinated individuals. Does this mean the vaccine was ineffective? Not at all.  If 100% of individuals were vaccinated (I wish), there would still be breakthrough cases and 100% of them would be among vaccinated individuals.

But it is a surprisingly high number of cases none the less. What does it tell us? The Times dances around one possibility. The article points out that Provincetown is “a mecca for gay men”. It then says:

“So many gay men poured in for Circuit Party week, the first week of July, that people on social media started sharing photos of the lines outside clubs, snaking for blocks….

“By the end of the week, Mr. Katsurinis [Chair of the town Board of Health] was taking reports of positive coronavirus cases — all gay men, with an average age of 30 to 35, many of whom had seen a doctor for other reasons, like flu symptoms or sexually transmitted infections, not suspecting the coronavirus.”

Later the article points out that one of the people it interviewed is a HIV positive.

But the article never raises the obvious question. Is it possible that the vaccine is less effective – perhaps much less effective – in a community which has a high percentage of HIV positive individuals? The question must have occurred to the reporters since the story is full of references to the gay population and HIV. Why else is the sexual orientation of the infected relevant? Did the question get edited out of the story because it may have been taken as homophobic? Has political correctness brought us to the point that we’d put a population at risk rather than ask a question which could be misinterpreted?

Here’s a possible line of reasoning which may be completely wrong but needs investigation – and hopefully is being investigated by the CDC. But please do NOT take my speculation as an assertion; I do not have enough information to claim that vaccination is not as effective in a predominantly gay population as it is in the general population.

  1. As the Times points out Provincetown visitors are predominantly gay men for the historic reason that Provincetown was tolerant long before the rest of the country.
  2. In the US HIV rates are higher among gay men than the general population so it’s reasonable to assume (but needs verification) that a higher proportion of HIV-positive men were in the partying crowds than would be the case in other party towns.
  3. “People living with HIV should be prioritised for COVID-19 vaccination, the World Health Organization (WHO) said last week, following the release of research at the 11th International AIDS Society Conference on HIV Science (IAS 2021) showing that people with HIV have an increased risk of being admitted to hospital with severe COVID-19 and of dying from COVID-19.”(link). Note that even if the vaccine has the same effectiveness in gay and non-gay populations, if WHO is right, the actual risk would remain higher in the gay population since vaccine only reduces risk proportionally from whatever the baseline is.
  4. A study by Dr. Dorry Segev, a John Hopkins transplant surgeon, shows that response to the Covid vaccine is greatly reduced in immunosuppressed people which indicates but doesn’t prove that the vaccine will be much less effective for them. Note that the people in Dr. Segev’s study were immunocompromised because they had transplant surgery, not because of HIV. However, the CDC says: “Examples of persons with weakened immune systems include those with HIV/AIDS; cancer and transplant patients who are taking certain immunosuppressive drugs; and those with inherited diseases that affect the immune system….”; and so the study results may well apply to those with HIV.
  5. It makes sense that some vaccines are less effective in immune-compromised people since vaccines stimulate the immune system to do the work of fighting the pathogen. If the immune system is weak, then it is liable to be less effective against infection even after vaccination than a fully functioning immune system.

So where does all this lead?

First it is urgent that the effectiveness of the vaccine in HIV-positive populations be studied. There should now be plenty of data to do that. If, as Provincetown may indicate, the vaccine is less effective for HIV-positive people, they need to know that their risk is higher, and it may be important to schedule them for a third shot. France is already urging boosters for the immunocompromised.

Second, the CDC should not over-react to the Provincetown cluster by appearing to downplay the effectiveness of vaccination against the Delta variant. As the Times keeps hinting at but never quite saying, this was not just any beach town.

It is bad for HIV-positive people (or any other cohort) not to tell them honestly what dangers they face. The CDC is not helping convince people to get vaccinated when it cites a cluster in an well-vaccinated but atypical reference population to get everyone to mask up again regardless of vaccination status.

Political correctness and government propagandizing are both hampering the fight against Covid.

See also:

Walk the Vaccination Walk!

Should Vaccination be Required for Medical Professionals?

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