OFFICIAL GUIDELINES ON sexual activity and Covid-19 were prompted by a radio interview in which the HSE’s Chief Clinical Officer said there was no expectation on the public to stop being “intimate” while travel restrictions remained in place.

Documents released to TheJournal.ie under the Freedom of Information Act reveal how the health service’s sexual health unit drafted the advice alongside the Gay Health Network and HIV Ireland.

The guidelines on sex during the outbreak, which can be read here, were published in March on Sexualwellbeing.ie, the HSE’s official portal for advice about sex.

They include information on safe sex practices and how to minimise the risk of contracting Covid-19 while sexually active.

Although there is no evidence that coronavirus can be sexually transmitted, officials issued the advice because Covid-19 can be passed on through close contact with someone who has the virus.

The HSE warns that being sexually active with another person involves some risk of getting the virus, particularly if a sexual partner is asymptomatic.

Internal HSE emails show that officials took the decision to draft the guidance after Dr Colm Henry told the Brendan O’Connor show on RTÉ Radio 1 that partners were not expected to stop all aspects of their lives while living under Covid-19 restrictions.

In an interview on 21 March, Henry said:

People must continue to live their lives with the people they love in whatever format that takes We expect people, most of the time, for over 80% of the time to keep their social distancing.

We don’t expect people to stop all aspects of their lives, be it intimate, or not. This could be a marathon not a sprint and we have to bring people along with us.

Two days after the interview, an email sent by Maeve O’Brien of the HSE’s Sexual Health and Crisis Pregnancy Programme (SHCPP) suggested the creation of the guidelines and specifically referenced Henry’s comments.  

“I know you probably haven’t got a spare second to think, but there has been a bit of interest in this guidance published by New York City Health Department, and some comments made by Colm Henry at the weekend re intimacy,” she wrote on 23 March.

“I wonder, if we were to draft something similar and reference the sources of the evidence, would this be something you would be able to approve?”

Subsequent correspondence reveals that the HSE also felt it necessary to draft the advice after sex workers contacted the SHCPP requesting guidance about sexual activity during the pandemic.

New York guidelines

The first draft of the guidelines was largely based on information contained in previous advice issued by New York City’s health department, according to the correspondence.

The American advice was largely unchanged in that draft, and included information about how Covid-19 spreads, engaging in sexual activity alone, in living units and online, as well as specific advice about sexual activities.

One piece of advice, some of which was retained by the HSE in its final publication, reads:

You are your safest sex partner. Masturbation will not spread COVID-19, especially if you wash your hands (and any sex toys) with soap and water for at least 20 seconds before and after sex.

It also advised that having close contact, including sex, with only a small circle of people helped prevent the virus from spreading.

Another piece of the US advice used by the HSE in a draft provided guidance on the number of partners someone could have sex with outside their living unit.

“If you do have sex with people outside your household, limit to as few partners as possible,” an early draft of the HSE advice reads. This line was subsequently deleted before final publication.

The advice from the New York City health department also contained guidance on kissing (“avoid kissing anyone who is not part of your small circle of close contacts”), rimming (“virus in feces may enter your mouth”) and the use of condoms or dental dams during oral sex, all of which were subsequently used in the HSE’s advice.

Changes to drafts

Meanwhile, concerns were raised by officials that the HSE’s initial drafts contained no reference to consent or the inability of HIV treatment PrEP to protect against Covid-19.

“I think the consent message should be very visible in all our messaging, especially at a time like this when people are more secluded, when emotions are heightened and vulnerabilities more exposed,” Moira Germaine, Education and Training Manager at the SHCPP wrote on 24 March.

Later drafts subsequently added reference to consent, with the HSE’s website stating that sexual activity should only ever be between consenting adults who have a legal capacity to make the decision.

Information that PrEP or HIV treatment did not protect against coronavirus was also added to the second draft of the guidelines, after the idea was raised by a member of the Gay Health Network.

“There is some anecdotal evidence that men in PrEP or HIV treatment may think that it gives them some protection. Perhaps including some clarification on this too,” the group’s secretary Bill Foley said.

Further external correspondence also reveals how the HSE sought reviews of the guidance from the Irish College of General Practitioners (ICGP) and the Health Surveillance Protection Centre (HSPC).

In an identical email to both groups, the HSE said it had concerns that all public STI clinics were closed, that NGOs had been seeking advice from the health service and the GPs were likely to be inundated so providing sex advice may not be possible.

“We are of the view that guidance for the public on do’s and don’ts around sex and Covid-19 plus information on the public clinic closures… will help to inform public decision-making around sexual activity and reduce health risks in the current climate,” it read.

The guidelines later went live on 30 March, and are available to read on the HSE’s website.