Written by: Kelly Fan
The HIV/AIDS and COVID-19 pandemics are at large today, affecting communities worldwide in similar and different ways. Both viruses originated from animals and, as humans continue to encroach on natural habitats, such animal-to-human transmissions will become much more common. Thus, it becomes pertinent to reflect on past (and ongoing) government and public responses in preparation for future infectious disease outbreaks.
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About HIV/AIDS and COVID-19
Still affecting 1.2 million people in the US and 38 million in the world, the Human Immunodeficiency Virus (HIV) weakens the immune system by attacking its cells. This causes the person to become vulnerable to other infections and diseases, which were diagnosed rather than the true origin and delayed scientists from identifying the virus until the 1980s (HIV.gov, 2020). Meanwhile, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was discovered soon after the first few clusters in Wuhan, China. Research on the connection between the virus mechanism and health effects is ongoing, as not even a year has passed since December of 2019.
HIV spreads through specific bodily fluids, which increases the risk of infection for people having unprotected sex and using contaminated injection equipment. Its symptoms will always progressively worsen without proper treatment. This is why getting tests and early diagnosis are important. Despite that, there are around 14% who remain unaware. Similarly, COVID-19 could have a “rate of asymptomatic infection [...] somewhere between 50% and 80% of cases;” many also only show mild symptoms. These negligible symptoms, however, do not negate that the “virus’s fatality rate seems to be roughly 10 times that of the flu” (Bleicher & Conrad, 2020). For these reasons and its high transmission rate, COVID-19 testing efficiency has become increasingly important for contact tracing and minimizing transmission.
It is not possible for people to naturally get rid of HIV, as the virus targets the immune system. Therefore, over the 40 years since its discovery, many effective treatments have been created and/or improved. Antiretroviral therapy (ART) in particular prevents further viral transmission and progression into AIDS, the late stage of HIV infection, allowing people to live long lives. In contrast, many people so far with COVID-19 are able to recover at home. For the population that must depend on hospital care, early treatment depended on the effects of the virus on their body and only alleviated symptoms. However, researchers are quickly discovering effective treatments, like monoclonal antibodies. Both viruses do not have a vaccine, and many wonder when they will be available and if they will be viable due to the numerous viral strains.
Interestingly, even with the 40-year difference in emergence, there are many similarities in the US government and public responses to the HIV/AIDS and COVID-19 pandemics. However, one major difference is the inaction of the US government during the early years of the HIV/AIDS pandemic.
Government and Public Responses
The US often reacts in a cycle of “panic–neglect–panic–neglect” during pandemics (Valdiserri & Holtgrave, 2020). In the beginning of HIV’s discovery, it was labeled the “gay-related immune deficiency” or “gay cancer” due to the high prevalence and diagnosis of the virus in urban gay communities. This certainly furthered their experiences of stigmatization and discrimination. Intertwined was the neglect from governmental officials, such as legislators and policy makers, to address the emerging HIV pandemic. They saw HIV/AIDS as solely the problem of gay people and drug users, not yet knowing its method of transmission. Soon after, the public and governmental spheres feared the unproven belief that HIV infection was easily spread, as there were reports of people not part of those communities with HIV. This fear— “fanned because we live in an era in which the authority of scientific expertise has eroded”—increased discimination against the aforementioned communities, especially as HIV transmission was associated with their “deviant behaviors.” Additionally, the American public was “relatively unsophisticated in our assessments of relative risk,” which escalated panic; people with HIV ended up increasingly ostracised from society and medical treatment (Brandt, 1988).
The cycle is seen with the COVID-19 pandemic as well. Many Americans unnecessarily emptied stores of all items, like toiletries and food, in a panicked shopping spree—once again proving a culture of lacking relative risk assessment. This left people of marginalized groups, who may live each week with only necessary resources or be otherwise restricted and in even more stressed living states. Furthermore, as a consequence of the Chinese origin and unceasing racism, particular Americans started to blame Chinese people for COVID-19. They (like certain political leaders) have taken up calling COVID-19 by the many variants of “Wuhan/China/Chinese virus” or the “Kung Flu.” The efforts of the World Health Organization (WHO) in creating the name “COVID-19” to detach the association of China and COVID-19 were in vain. Chinese (and Asian) people have been affected by undue discrimination and racism; I can still remember reading news articles reporting on attacks against Chinese people once COVID-19 cases started increasing steadily. We were no longer able to just worry about our relatives in China and the new virus, but also had to fear the possibilities of verbal and physical assault against ourselves and our community.
Throughout the ongoing pandemic, the government has continued to neglect their responsibility toward the people in numerous ways. One of the first was that the administration lacked urgency in containing COVID-19 and provided inadequate funding due to the initial low number of cases, which were low because of the few unreliable tests (Schwellenbach, 2020). This allowed for infected people to unknowingly spread the virus to others, creating a chain reaction of transmissions. Another problem was the neglect of addressing American anti-maskers. Rather, many government officials were anti-maskers and endorsed their position until COVID-19 personally impacted them negatively. Certain factors, but especially a disbelief in science, compounded to result in a pandemic that has taken at least 200,000 deaths in the US. There are many more ways that the US has failed in addressing this pandemic, however I believe that you can think of such examples yourself.
When the “panic–neglect–panic–neglect” cycle is finally broken, the results of scientific research can finally be implemented into the US healthcare system to provide tests, treatments, and prevention methods as well as be accepted by more US residents.
Nevertheless, the health of marginalized communities, especially African Americans, are disproportionately affected by the HIV/AIDS and COVID-19 pandemics because of an amalgamation of structural inequalities. African Americans make up around 13% of the US population, yet their HIV diagnosis was the highest of any population at 42% in 2018 (CDC, 2020). In addition, 1/7 African Americans with HIV are unaware of it and, therefore, unable to receive vital treatment and prevent further infection. These statistical findings are largely because of the high poverty rate, a product of historical and current inequalities. Such disproportionate trends are similar to those of the COVID-19 pandemic. While white Americans have a death rate of 40.4 per 100,000, the African American death rate is two times that at 88.4 per 100,000 (Godoy, 2020). A large systemic reason is the lack of access to quality health care in addition to their high representation as essential workers.
Ongoing battles against both COVID-19 and HIV/AIDS
Unlike how the US government initially ignored the HIV/AIDS pandemic, we have to acknowledge its impactful role in fighting the global spread of HIV—investing over $85 billion through the President's Emergency Plan For AIDS Relief (PEPFAR) since 2003. This battle is far from over despite all the efforts: more people need to be tested, treatments need to become widely available globally, an effective cure and vaccine do not exist, and social discrimination and inequalities persist. These large investments and problems are similarly shared with COVID-19 and, as infectious disease outbreaks continue to occur, public health initiatives will continue far into the future. Accordingly, it becomes important that we do not commit the same mistakes and prevent outbreaks from evolving into epidemics and pandemics with much greater consequences.
References
Bleicher, A., & Conrad, K. (2020, October 2). We Thought It Was Just a Respiratory Virus. https://www.ucsf.edu/magazine/covid-body.
Brandt, A. M. (1988). AIDS in historical perspective: Four lessons from the history of sexually transmitted diseases. American Journal of Public Health, 78(4), 367-371. doi:10.2105/ajph.78.4.367
Centers for Disease Control and Prevention. (2020, May 18). HIV and African Americans. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html.
Godoy, M. (2020, August 27). 'Racial Inequality May Be As Deadly As COVID-19,' Analysis Finds. NPR. https://www.npr.org/sections/health-shots/2020/08/27/906002043/racial-inequality-may-be-as-deadly-as-covid-19-analysis-finds.
HIV.gov. (2020, June 18). What Are HIV and AIDS? https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids.
Schwellenbach, N. (2020, May 6). The First 100 Days of the U.S. Government's COVID-19 Response. Project On Government Oversight. https://www.pogo.org/analysis/2020/05/the-first-100-days-of-the-u-s-governments-covid-19-response/.
Valdiserri, R. O., & Holtgrave, D. R. (2020). Responding to Pandemics: What We've Learned from HIV/AIDS. AIDS and behavior, 24(7), 1980–1982. https://doi.org/10.1007/s10461-020-02859-5
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