Experts say our history with past health crises can offer valuable insight in dealing with the current pandemic, but we aren’t applying what we learned as well as we could.
Two infectious diseases. Two global health crises. Two examples where slow government response and the spread of stigmatizing misinformation made matters worse.
Though marked by very different viral outbreaks, the AIDS crisis — at its height from the 1980s through the 1990s — and the current COVID-19 pandemic, present striking similarities.
Have we been taking lessons from the AIDS crisis and applying them to combating the coronavirus pandemic? Experts say “yes and no.”
Today, AIDS still continues to disproportionately impact many vulnerable groups, including communities of color, those who engage in injectable drug use, and stigmatized members of the transgender community.
But public health officials clearly look to the recent past of the AIDS crisis to handle COVID-19.
While this is important, a gulf exists between federal and local response to this current pandemic, with experts saying that, worryingly, history seems to be repeating itself.
Dr. Hyman Scott, MPH, the clinical research medical director at Bridge HIV and an assistant clinical professor of medicine at the University of California San Francisco (UCSF), told Healthline that there are a “lot of similarities” between the AIDS crisis and the COVID-19 pandemic.
He noted the “disjointed” government response to HIV and AIDS when it first emerged and the often confusing government attention paid to COVID-19.
There was no cohesiveness in messaging — the response to COVID-19 varied greatly from jurisdiction to jurisdiction, and directives over whether people should physically distance or even wear protective masks were confusing.
“One of the biggest parallels is that we see how Ryan White really helped to coalesce some of the best practices in care for HIV, how there was that system put in place to improve outcomes, to have consistency across the United States,” Scott explained.
“There hasn’t been the same type of cohesive programming with COVID,” he added.
Scott said given how the pandemic evolved so quickly — first identified less than 12 months ago — the message around prevention got muddied due to very public governmental disputes over how it would be implemented.
“There was a lot of fear and stigma associated with COVID as it first emerged initially and still to this day, especially directed toward people perceived as having Asian descent regardless of what their background was,” Scott added.
“You still see this in political rhetoric about how the virus is referred to in some spaces,” he said.
Scott said that this racist “othering” stigma and unfounded fear placed on people’s identities during COVID-19 is similar to what happened during the early days of the AIDS crisis.
“It’s so similar to HIV, where it has been very stigmatizing toward gay men, Haitian immigrants, heroin users,” Scott said.
“In fact, you still have this identification toward people seen as potential vectors of an infectious agent and all the stigmas associated with that. The same mentality has been very prominent with COVID-19 as well,” he added.
Scott also sees a parallel between this stigmatizing dialogue and confusion over how the two viruses are transmitted.
He cited fears of HIV being transmitted through kissing, which is obviously based on no scientific fact.
With COVID-19, mixed messaging and what at times feels like intentionally confusing information from political figures resulted in the public’s chaotic understanding of how the virus is transmitted and how to protect oneself.
Dr. Robert Gross, MSCE, co-director of the Penn Center for AIDS Research at the Perelman School of Medicine at the University of Pennsylvania, said many of the figures who were at the helm of national infectious disease response in the 1980s are still around now, including Dr. Anthony Fauci.
He stressed there are people with expertise at the highest levels of government who have learned from mistakes made during the AIDS epidemic.
That being said, Gross said the “parallels are obviously striking,” with another disease being spread asymptomatically and the shaming over whether one does or doesn’t wear a mask — not unlike shaming over condom use and other barrier methods when it comes to HIV.
“I think those kinds of parallels are really important because you have the issue of how stigmas are imparted to people when they are shamed, how does that change people psychologically, to make them then go and engage in ‘underground behavior’ that will further lead to undesirable health outcomes,” Gross told Healthline.
He said that during the early days of the AIDS crisis, it was harder to reach some people who might have been shamed or stigmatized by the messaging of the time.
The emphasis was on shame rather than on “harm reduction,” an emphasis on crafting behavioral strategies to lessen harmful impacts on people’s health, Gross said.
“The same thing is happening now with masks,” he said, noting how shame is directed at people’s personal choices rather than helping them adopt behaviors that may best help themselves and those around them.
“I think taking that approach and recognizing that it’s virtually impossible to keep behavior perfectly in line with protection — that means with safe sex, that means with injection drug use with HIV, that means with mask wearing, and always avoiding the breath of other people — well, that’s essentially impossible,” he added.
“If we recognize that, maybe we can decrease the stigma for someone infected and encourage them to behave in ways that are going to protect them and others,” Gross said.