Pandemics have been a periodic staple of life throughout human history. No two pandemics are the same because no two societies are the same, and responses to pandemics differ accordingly. That does not mean, however, that lessons cannot be learned from actions taken in the past. We can learn a lot from past pandemics about how to deal with Covid-19. The 1918 Influenza pandemic, for example, teaches us about the benefits and potential pitfalls of various quarantine methods.
In the early 1980s a terrifying new virus erupted amongst the American gay community. This new disease was invariably fatal and, to this day, no cure has been found. By the end of 2019 the virus, which became known as human immunodeficiency virus (HIV) and the syndrome it too often progressed to, acquired immunodeficiency syndrome (AIDS), had killed approximately 33 million people worldwide.1 By remembering how the world handled the AIDS pandemic at its height, we can discover several lessons for coping with the current Covid-19 crisis.
Health Care Workers
In the early 1980s, when the AIDS crisis was in its early stages, frontline workers such as hospital staff and first responders found themselves at increased risk of contracting the virus.2 This was, in part, due to the lack of knowledge pertaining to the route of transmission, which meant that appropriate precautions, such as covering broken skin and limiting contact with infected blood, were not undertaken.3
It is a hard-learned lesson which we have since taken to heart: when it comes to unknown pathogens, it is always best to be overly cautious. For Covid-19, which is spread through respiratory droplets, this translates to the speedy testing of presenting patients, isolation of confirmed cases, regular sterilisation of hands and equipment, and the strict adoption of PPE (Personal Protective Equipment) such as gloves, masks, and disposable gowns.4
Treatments
Since 1982, the American government has invested over $76 billion in the AIDS virus.6 While a vaccine for HIV has yet to be discovered, the ongoing search for more effective treatments has resulted in the development of new technologies and approaches to vaccines and treatments for other viruses.7 It is a minor miracle that people are able to be vaccinated against Covid-19 less than a year after the virus was discovered, a miracle which can be largely attributed to the race to slow the spread of AIDS.8
““Everything we do with every other pathogen spins off of things we’ve learned with HIV.”
Anthony Fauci5
Because infection with coronaviruses doesn’t give long-term immunity, like Polio, or prevent re-infection by remaining in the system, like HIV, it is likely that Covid-19 will develop resistance to single drugs.9 This is an issue which has plagued the treatment of AIDS and, as is the case with AIDS, it is likely that the treatment of Covid-19 will require the application of a combination of medications.10
AIDS Treatment Timeline11
March 1987: FDA approves the first antiretroviral drug, zidovudine (AZT), as treatment for HIV
June 1995: FDA approves the first protease inhibitor beginning a new era of highly active antiretroviral treatment (HAART). Once incorporated into clinical practice HAART brings about an immediate decline of between 60% and 80% in rates of AIDS-related deaths and hospitalisation in those countries which can afford it.
September 1997: FDA approves Combivir, a combination of two antiretroviral drugs, taken as a single daily tablet, making it easier for people living with HIV to take their medication.
July 2010: the CAPRISA 004 microbicide trial is hailed a success after results show that the microbicide gel reduces the risk of HIV infection in women by 40%.
2010: Results from the iPrEx trial showed a reduction in HIV acquisition of 44% among men who have sex with men who took pre-exposure prophylaxis (PrEP).
2011: results from the HPTN 052 trial show that early initiation of antiretroviral treatment reduces the risk of HIV transmission by 96% among serodiscordant couples.12
August 2011: FDA approves Complera, the second all-in-one fixed dose combination tablet, expanding the treatment options available for people living with HIV.
September 2015: WHO launched new treatment guidelines recommending that all people living with HIV should receive antiretroviral treatment, regardless of their CD4 count, and as soon as possible after their diagnosis.13
2017: more than half of the global population living with HIV are receiving antiretroviral treatment, a record of 19.5 million people.
Over 25 million people are currently receiving combined drug antiretroviral therapies (ART), known colloquially as the AIDS-drug cocktail, suppressing the disease to the point where they are unlikely to pass it on.14 It can be theorised that another 25 million or more infections were prevented altogether due to the wide availability of these treatments.15
Harm Reduction (Not Elimination)
Attempting to eliminate risky behaviours is an exercise in futility. People didn’t stop having sex because of the risk of Syphilis in the 19th Century, nor did they give up sex to avoid AIDS in the 1980s.16 It stands to reason, therefore, that people won’t stop going to bars and clubs because of the threat of Covid-19.
Human nature is such that it is more prudent to pursue a path of risk minimisation rather than trying to eliminate risky behaviours altogether. Past experience with AIDS has shown that the more people understand the risks, the more willing they become to limit risky behaviours and adopt protective measures.17 AIDS campaigns attempting to educate the public about the dangers of AIDS proved highly effective. It would, perhaps, be beneficial to emulate their example with regards to Covid-19.
Even before ART became the go-to treatment for HIV, many carriers were asymptomatic.19 The same can be said of Covid-19. To reduce the harm caused by this pandemic, it is important that we carry out frequent widescale testing in order to identify infected individuals who do not display symptoms and implement protective measures.20
Funding
If the AIDS crisis has taught us anything, it is the importance of established avenues of research.21 Just as the rapid production of Covid-19 vaccines can be attributed to developments in the quest for a cure for HIV, many of the AIDS studies are built upon the foundations of Cancer research.22
Yet this is not the first time coronaviruses have threatened widespread destruction. Two previous epidemics — SARS and MERS — have caused serious concern amongst health officials.23 According to William A. Haseltine, as soon as the threat level reduced, and “[d]espite clear, persistent, highly vocal warnings from many of those who battled SARS and MERS up close, funding dried up. The development of promising anti-SARS and MERS drugs, which might have been active against SARS-CoV-2 as well, was left unfinished for lack of money.”24
This may be one of the most important lessons to be learned from the AIDS pandemic: It is vitally important to continue funding research when the threat level is low, so that we retain the ability to respond rapidly when new pandemics emerge.25
Collaboration
As with HIV, the battle against COVID-19 requires cooperation between government departments, affected communities, religious organizations, traditional leadership, and the business and private health sectors.26 During the AIDS crisis, these sectors, along with organisations such as the World Health Organisation (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), President’s Emergency Plan for AIDS Relief (PEPFAR) and the International AIDS Society shared information between healthcare providers and communities, distributed resources, and fought to increase access to lifesaving drugs through reductions in price.27 These same organisations may prove critical in the fight against Covid-19, particularly with regards to the rapid development and equitable distribution of effective vaccines.28
Response
The early days of the AIDS epidemic were marked, in the U.S. and the UK at least, by government inaction.29 Competing interests, erratic policy-making, and mixed messaging undermined the efforts of health professionals and cost lives.30 It is a scenario which, while the reasons may be different, has been eerily mirrored during the Covid-19 crisis.31
By formulating a coordinated and focused response, governments in countries like Australia and New Zealand have been able to mount an effective defence against the Covid-19 virus, resulting in fewer cases and far fewer deaths than many other countries have suffered.
In cooperation with governments, community-led organizations, faith-based groups and local leaders can lead the COVID-19 response by reaching vulnerable people, and combating stigma and discrimination, as they did during the HIV epidemic.32
The HIV response leveraged clear, simple, evidence-based messaging and popular culture such as music, film and television to change behaviour and educate the general public about the disease and how to minimise risk.33 Similar campaigns, with the additional use of social media platforms, could prove effective in combating today’s Covid-19 epidemic.
We’ve seen what governments, religious leaders, and community groups can do to aid in the Covid-19 response, but what about business? At the height of the AIDS epidemic, businesses were recruited to aid in the dissemination of vital products. In the 1980s, condoms were trucked into remote areas alongside soft drinks.35 The same can be done for COVID-19 by having masks, soap and medical supplies delivered alongside commercial products.
Discrimination
An unfortunate characteristic of the 1980s AIDS epidemic was a tendency towards prejudice and discrimination. This was based partly on fear, born of ignorance of the method of transmission, and partly on the misconception that the disease was some kind of punishment for risky behaviours.36 The prevalence of Covid-19 means that sufferers do not share the same stigma, but the fear is still there, and so is the prejudice.37
The unfortunate location of ground zero in Wuhan, and the anti-immigration rhetoric espoused by the Trump administration have led to growing discrimination against Asian communities, and a reluctance to access health care lest immigration status be revoked.38
Another unfortunate aspect of both HIV and Covid-19, is their disproportionate effect on African Americans. The AIDS disparity began to show itself in the 1990s when cases of HIV increased within the black community, despite a slight drop in cases amongst whites, and their death rate remained the same despite a drastic 18% reduction of deaths within the white community.39 African Americans continue to have the highest rates of HIV infection in the nation, accounting for nearly half of those living with HIV and AIDS.40
This disturbing trend has carried over into the Covid-19 pandemic. Black people are more likely to be hospitalised from Covid-19 than any other racial group, and African Americans and Hispanics account for more than half of the in-hospital Covid-19 deaths in the first half of 2020.41 Similarly, black Americans have received just 5% of the Covid-19 vaccinations nationwide, despite comprising nearly 15% of the population.42
Another alarming source of discrimination which has been highlighted by the Covid-19 epidemic is socio-economic status. While the disease itself does not discriminate along economic lines, responses to the epidemic have a harsher impact on low income workers and welfare recipients.43 Many of these workers cannot afford to stay at home from work, for example, and compulsory lockdowns may result in increased disadvantages up to, and including, loss of their place of residence. Strategies need to be developed for dealing with the financial impact of the epidemic on those who are economically vulnerable.
“A critical lesson from the HIV response is that an epidemic cannot be ended without prioritizing vulnerable and marginalized populations and without guaranteeing the human rights of everyone affected by the epidemic and the response.”
Global HIV Prevention Working Group44
Pandemics happen, and they happen quite regularly. They haunt our past and will populate our future. Previous pandemics, like the AIDS crisis of the 1980s and 1990s, can teach us many things about dealing with Covid-19 and help us mitigate the effects of pandemics to come. The lessons are there. We need only listen.
1 William A Haseltine, “Lessons from AIDS for the Covid-19 Pandemic,” Scientific American, October 1, 2020, https://www.scientificamerican.com/article/lessons-from-aids-for-the-covid-19-pandemic/.
2 Prerak V. Juthani and Dr. Howard P. Thorman, “Five lessons from the AIDS epidemic on how to cope with COVID-19,” USA Today, December 1, 2020, https://www.usatoday.com/story/opinion/2020/12/01/covid-lessons-from-hiv-epidemic-world-aids-day-column/6458569002/.
3 Juthani and Thorman, “Five lessons from the AIDS epidemic.”
4 Juthani and Thorman, “Five lessons from the AIDS epidemic.”
5 Anthony Fauci, quoted in Gregory Zuckerman and Betsy McKay, “How HIV Research Laid the Foundation for Covid Vaccines,” The Wall Street Journal, 24 December, 2020, https://www.wsj.com/articles/how-hiv-research-laid-the-foundation-for-covid-vaccines-11608821508?page=1.
6 Gregory Zuckerman and Betsy McKay, “How HIV Research Laid the Foundation for Covid Vaccines,” The Wall Street Journal, 24 December, 2020, https://www.wsj.com/articles/how-hiv-research-laid-the-foundation-for-covid-vaccines-11608821508?page=1.
7 Zuckerman and McKay, “How HIV Research Laid the Foundation.”
8 Zuckerman and McKay, “How HIV Research Laid the Foundation.”
9 Haseltine, “Lessons from AIDS.”
10 Haseltine, “Lessons from AIDS.”
11 “History of HIV and AIDS Overview,” Avert, last modified October 10, 2019, https://www.avert.org/professionals/history-hiv-aids/overview.
12 Lisa A. Eaton, Tessa V. West, David A. Kenny and Seth C. Kalichman, “HIV Transmission Risk among HIV Seroconcordant and Serodiscordant Couples: Dyadic Processes of Partner Selection,” AIDS and Behavior 13, no. 2 (2008): 5, doi:10.1007/s10461-008-9480-3.
Serodiscordant couples are couples where one partner is HIV positive and the other partner is not, while seroconcordant couples share the same HIV status.
13 Daniel Murrell, “CD4 vs. Viral Load: What’s in a Number?,” healthline, April 24, 2020, https://www.healthline.com/health/hiv-aids/cd4-viral-count.
CD4 cells are a type of white blood cell, a subset of T cells, which are important to the immunity process.
14 Haseltine, “Lessons from AIDS”; “AHF: Lessons from 40 Years of AIDS, ‘the Other Pandemic,’ Must Guide Global Response to COVID-19,” http://www.businesswire.com, June 4, 2021, https://www.businesswire.com/news/home/20210604005616/en/.
15 Haseltine, “Lessons from AIDS.”
16 Haseltine, “Lessons from AIDS.”
17 Haseltine, “Lessons from AIDS.”
18 J. Keeler, A forlorn looking child with arms outstretched among flowers, representing a child with AIDS ostracized for fear of transmitting the disease, 1987, lithograph, printed in colours, 37.8 x 27.8 cm. California, Centre for Attitudinal Healing, Wellcome Collection, no. 667425i, accessed June 9, 2021, https://wellcomecollection.org/works/jak3rf2a.; Victorian AIDS Council and Gay Men’s Health Centre, A bunch of keys and coloured packs of condoms on a key ring representing a reminder to practice safe sex, 1990 – 1999, lithograph, printed in colours, 42 x 59.2 cm. Victoria, Victorian AIDS Council and Gay Men’s Health Centre. Wellcome Collection, no. 669811i, accessed June 9, 2021, https://wellcomecollection.org/works/u5df9zew.; Department of Health, Housing and Community Services, Australia and Aboriginal Health Workers of Australia, Condoman, a cartoon figure, holds a packet of condoms on a beach; advertising safe sex among indigenous Australians, 1990 – 1999, lithograph, printed in colours, 41.4 x 28.2 cm. Queensland, Department of Health, Housing and Community Services, Australia and Aboriginal Health Workers of Australia, Wellcome Collection, no. 669751i, accessed June 9, 2021, https://wellcomecollection.org/works/vj3bap7x.; Terrence Higgins Trust, A face with large eyes and a condom as a halo; recommending use of condoms as good behaviour, 1992, lithograph printed on blue with pink, 50.6 x 33.8 cm. London, Terrence Higgins Trust UK, Wellcome Collection, no. 666545i, accessed June 9, 2021, https://wellcomecollection.org/works/m8s5bjqc.; Stichting soa-bestrijding, A gay couple, one wearing sailor attire and makeup, hold up condoms with the message: ‘Your condom or mine. I have safe sex or no sex”; an advertisement for safe sex, 1990 -1999, lithograph, printed in colours, 59.4 x 41.9 cm. Utrecht, Stichting soa-bestrijding, Wellcome Collection, no. 671416i, accessed June 9, 2021, https://wellcomecollection.org/works/arz7nnfs.; Torsten Schmidt and Detlev Pusch, A man’s hand holding a syringe poised to inject into his arm with five further smaller images showing the procedures for safe drug use, 1990 – 1999, lithograph, printed in blue, green and black, 59.3 x 41.9 cm. Berlin, Deutsche AIDS-Hilfe e.V., Wellcome Collection, no. 674206i, accessed June 9, 2021, https://wellcomecollection.org/works/ac6fspd3.; Dimitra Tselebidis, A hand with the index finger pointing up wearing a condom, 1990 – 1999, lithograph, printed in colours, 59.3 x 41.8 cm. Duisburg, GH-Uni Duisburg, Wellcome Collection, no. 673565i, accessed June 9, 2021, https://wellcomecollection.org/works/y5agxku6.; Texas Department of Health, Warning that you can get AIDS from your partners innumerable ex-partners, 1990, lithograph, printed in black on yellow, 27.7 x 37.7 cm. Texas, Texas AIDSLINE, Wellcome Collection, no. 668789i, accessed June 9, 2021, https://wellcomecollection.org/works/r4pejbm3.
19 Juthani and Thorman, “Five lessons from the AIDS epidemic.”
20 Juthani and Thorman, “Five lessons from the AIDS epidemic.”
21 Haseltine, “Lessons from AIDS.”
22 Haseltine, “Lessons from AIDS.”
23 Haseltine, “Lessons from AIDS.”
24 Haseltine, “Lessons from AIDS.”
25 Haseltine, “Lessons from AIDS.”
26 “Lessons from HIV prevention for preventing Covid-19 in low – and middle-income countries,” Global HIV Prevention Working Group, April 2020, https://www.unaids.org/sites/default/files/media_asset/lessons-hiv-prevention-covid19_en.pdf.
27 Linda-Gail Bekker, “Battles won – and lost – against AIDS hold valuable lessons for managing COVID-19,” The Conversation, November 29, 2020, https://theconversation.com/battles-won-and-lost-against-aids-hold-valuable-lessons-for-managing-covid-19-150786.
28 Bekker, “Battles won.”
29 Donald Nicolson, “After a year of COVID-19 we can still learn from the experience of AIDS,” LSE, April 14, 2021, https://blogs.lse.ac.uk/impactofsocialsciences/2021/04/14/after-a-year-of-covid-19-we-can-still-learn-from-the-experience-of-aids/.
30 Nicolson, “After a year of COVID-19.”
31 Nicolson, “After a year of COVID-19.”
32 Global HIV Prevention Working Group, “Lessons from HIV prevention.”
33 Global HIV Prevention Working Group, “Lessons from HIV prevention.”
34 “Grim Reaper Aids Advertisement,” YouTube video, 1:04, posted by “supercyborge,” January 4, 2009, https://youtu.be/OJ9f378T49E.
35 Global HIV Prevention Working Group, “Lessons from HIV prevention.”
36 Nicolson, “After a year of COVID-19.”
37 Nicolson, “After a year of COVID-19.”
38 Nicolson, “After a year of COVID-19.”; Anna Lucente Stirling, “COVID-19 Response Missed The Lessons Of AIDS Crisis, Experts Say,” Spectrum News, February 12, 2021, https://www.ny1.com/nyc/all-boroughs/news/2021/02/12/covid-19-response-missed-the-lessons-of-hiv-aids–experts-say.
39 Stirling, “COVID-19 Response.”
40 Stirling, “COVID-19 Response.”
41 Stirling, “COVID-19 Response.”
42 Stirling, “COVID-19 Response.”; U.S. Census Bureau, QuickFacts 2019 Population Estimate, Table V2019, 1 July 2019, https://www.census.gov/quickfacts/fact/table/US/PST045219.
43 Nicolson, “After a year of COVID-19.”
44 Global HIV Prevention Working Group, “Lessons from HIV prevention.”
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