Lessons from another pandemic

September 16th, 2020

Similarities between pandemics 

When the COVID-19 pandemic first affected our daily routines, many people looked back to the Spanish flu pandemic of the late 1910s. However, many of us lived through another pandemic, perhaps without realizing it: the HIV/AIDS crisis. Though the effects of HIV/AIDS and the novel coronavirus (known as SARS-CoV-2) differ greatly, both viruses are caused by pathogens that jumped from animals to humans. In contrast to COVID-19, HIV/AIDS is chronic and transmitted via the exchange of bodily fluids. The trajectory from discovery to containment with HIV/AIDS may give us some insight into our experience and our future with COVID-19. 

Upon initial discovery, new viruses create a climate of fear and uncertainty, which is often directed toward minorities and other marginalized people. In the case of HIV/AIDS in the United States, the disease was primarily associated with homosexuality and led to stigmatization and discrimination. It was only in 2010 that the United States lifted a ban prohibiting those living with HIV/ AIDS from entering the country. Similarly, COVID-19’s Chinese origins have been the impetus behind expressions of anti-Asian sentiment and even violence against Asian Americans. Dr. David Ho sees the greatest similarity between these two pandemics in the way each disease’s initial victims died: mostly alone. For those who died of AIDS, they were frequently shunned by family because of discrimination and fear. While those suffering from COVID-19 may not have suffered from similar discrimination, the isolation required to quarantine the disease led to a distressingly similar result. 

For both pandemics, celebrities played a prominent role in bringing the virus into public view. In March, as the pandemic was gaining ground in the U.S., the news that beloved actor Tom Hanks and his wife Rita Wilson tested positive for COVID-19 brought home the reality of the situation. With the HIV/AIDS pandemic, public opinion shifted when Los Angeles Lakers star Earvin “Magic” Johnson announced his retirement due to the disease. Although HIV/AIDS had been around for more than a decade, Magic Johnson gave the virus a high-profile, black, heterosexual face. In the early 1990s, as the death toll rose, Johnson’s openness about his diagnosis communicated that anyone could be susceptible, and his celebrity allowed him to advocate for more resources for treatment and decreased stigma.

History of the HIV/AIDS pandemic 

Data suggests that the HIV/AIDS pandemic began in the mid- to late 1970s, though the disease itself is thought to have jumped from chimpanzees to humans in the 1920s. By the early 1980s, suspicious patterns of illness (usually associated with weakened immune systems) emerged among healthy young gay men in California and New York. Tracing the disease to a group of gay men in Los Angeles led people to believe that it was sexually-transmitted, and the syndrome was initially called gay-related immune deficiency or GRID. 

Soon the same disease appeared in intravenous drug users. By 1983, the CDC had dubbed it AIDS (acquired immunodeficiency syndrome), identified all major routes of transmission, and ruled out transmission via casual contact. While the disease ravaged the gay community in particular, it also spread via heterosexual sex, blood transfusions, sharing needles and from mother to child during birth or breastfeeding. 

In 1985, President Reagan mentioned AIDS publicly for the first time and Congress allocated $190 million to AIDS research two weeks later. By the end of 1987, approximately 47,000 people had been infected by HIV in the United States, and the disease became a full-blown epidemic. Many believe that the silence from political authorities and the press in the early years of the epidemic, coupled with inadequate public health funding, led to a wider spread and more deaths. 

Better testing worldwide and programs for global awareness by the World Health Organization (WHO) were launched in the second half of the 1980s. By the end of 1990s, the WHO announced that AIDS was the fourth biggest killer worldwide and the number one killer in Africa with 14 million deaths attributed since the beginning of the pandemic. During the 2000s, the United States continued to address the global pandemic, thanks to President George W. Bush’s creation of PEPFAR (The President’s Emergency Plan for AIDS Relief), which to date has provided more than $90 billion in funding to combat AIDS in countries with high infection numbers. Four decades into the HIV/AIDS pandemic, more than 700,000 Americans and 32 million worldwide have died from the disease. 

HIV/AIDS today 

Today, the World Health Organization refers to HIV/AIDS as a “global epidemic” and notes regional epidemics in Africa, the Americas and the Eastern Mediterranean regions. In the United States, it may seem like HIV/AIDS is under control and no longer a critical issue, but today more than 13,000 people in the U.S. are living with AIDS. Over the last few decades, advances in both treatment and prophylaxes have greatly reduced the transmission of the virus. As of 2017, more than half of the global population living with HIV/AIDS received antiretroviral treatment, a record 19.5 million people. New infections continue to fall around the world, thanks to targeted campaigns, services and economic initiatives. No longer a death sentence, many individuals are living long, full lives with HIV/AIDS. 

Despite this optimistic trajectory, HIV/AIDS has not disappeared, and this may provide us with a model for how to live with COVID-19. An effective HIV/AIDS vaccine has proven elusive, but scientists and researchers continue to work toward that goal. Instead, global initiatives are focused on viral suppression, which lessens the likelihood of transmission, rather than waiting for a cure. If COVID-19 is similarly resistant to a vaccine, the possibility of mitigation through a combination of behavioral changes, treatments and prophylaxes offers us hope. Meanwhile, those who lived through the worst years of the HIV/AIDS pandemic see the similarities: “‘Back in the early ’80s, the answer was condoms and fewer sexual partners,’ [Dr. Michael] Gottlieb said. ‘Today, the answer is masks and social distancing. Behavior change is essential in preventing the spread of both of these viruses.’” 

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