Thoughts on the STI analogy and changing behaviors re covid. Harm reduction only works for those who have bought into the concept of harm. For example people who get tested before a trip have accepted covid exists just like the person getting tested for chlamydia 1/n

So people who have bought into the risk who have pandemic fatigue or have underestimated risk may well benefit from harm reduction. Education about masks/distancing just like condoms/PrEP etc 2/n

But what about the group who laughs at lockdowns, who thinks it only affects people over 80 (they count by the way), or who deny that ICUs are full? Here too we can turn to STIs - AIDS denialists. 3/n

There are people who deny HIV is an illness or they accept the virus exists but believe the illness AIDS is caused by Big Pharma/Government and HIV meds 4/n

Now we can’t reach many of those people. If you don’t care about harm reduction because you don’t believe covid is dangerous then you have no need to engage in behaviors that reduce harm 5/n

And yet some people who take PrEP to prevent HIV have a degree of denialism about HIV. Why do they take the medications? It seems peer pressure — they see everyone in their community doing it and they either feel the need to conform or it impacts the conspiracy theory 6/n

There is some data from vaccines that scaring people about the risk of not vaccinating doesn’t work, in fact stoking fear may even lead people to more infection and they revert to the position of inaction (no vaccine) 7/n

So while we are dealing with two pandemics covid and disinformation we need to think about the different reasons people may not engage in safer behaviors/decline the vaccine 8/n

We could target the first group I mentioned, those who believe in harm just under estimate risk/pandemic fatigue by providing counseling with every result. Financial relief so they can stay from work if sick/survive lockdowns etc 9/n

Until we find out ways to tackle conspiracy theorists and those dedicated to misinformation the best option is likely being proud and vocal about masks and vaccines in hopes that it reassures those who are afraid and has a peer pressure impact on others 10/n