Comparing COVID-19 to HIV is, in many ways, like comparing apples to oranges: HIV is transmitted
primarily through sexual contact or intravenous drug use, while COVID-19 appears to be airborne,
transmissible through coughing and sneezing.
Yet, they both expose the underlying, often unspoken, issues afflicting the social worlds
in which we live.
For example, HIV and COVID-19 have both laid bare that stark racial disparities exist in
population health and in access to quality medical care in the United States.
According to the CDC, Black men who have sex with men are the population most affected
by HIV by race, gender, and sexuality.
In 2018, 42% of new infections in the United States were among Black adults and adolescents.
COVID-19 has revealed similar disparities: Black and Latinx residents of the United States
have been three times as likely as white people to become infected.
Nationwide, Black people are dying at a rate 2.5 times higher than white people.
And in Ohio specifically, where only 13% of the population is Black, the Ohio Department
of Health reports that 26% of COVID-19 cases, 32% of hospitalizations, and 19% of deaths
are among Black residents.
These racial disparities point to the clear need for a social-justice based approach to
public health that focuses on removing structural, particularly economic barriers, to accessing
quality health care.
We have much to learn from the development of anti-retroviral therapy (ART), now used
to prevent and treat HIV.
Once a death sentence, HIV can now be managed as a chronic illness in most parts of the
world.
Yet it took decades of treatment activism in the United States and in Sub-Saharan Africa
to make ART affordable, and it is still not widely available in many poorer countries.
While HIV has a long and complicated history, experts consider the global HIV pandemic as
having flared from roughly 1981-2005.
HIV, or the Human Immunodeficiency Virus, was first detected in 1980 in California among
a group of otherwise healthy young men who developed immune diseases like pneumonia.
In June of 1981, the U.S. Centers for Disease Control reported on the virus in five young
men at three different Los Angeles hospitals.
By the end of the summer, more than 108 cases had been reported, mostly from California
and New York.
All but one of those cases were men, and over 90 percent of those infected stated that they
were gay and sexually active.
In the United States, HIV quickly became understood as a “lifestyle disease,” associated primarily
with men who have sex with men.
The association was drawn by national public health data, by activists from the AIDS Coalition
to Unleash Power, or ACT-UP, an LGBTQ organization that advocates for the rights of those with
HIV, and by cultural productions, such as Tony Kushner’s Angels in America, which
won the Pulitzer Prize for Drama.
By 1992, HIV/AIDS was the leading cause of death for men in the United States.
Since the beginning of the pandemic, more than 700,000 Americans have died.
HIV/AIDS has also had devastating, and longer-reaching, impacts in Sub-Saharan Africa, so much so
that AIDS has become almost indelibly associated with the African continent in the western
public imagination.
Africa’s first case of HIV was documented in southwestern Uganda in 1982, where it was
known locally as “slim disease” because it causes extreme weight loss.
Uganda, a landlocked country in East Africa the size of Oregon, had one the world’s
worst outbreaks: by the early-1990s, HIV was killing one adult per every three households
in the hardest-hit regions.
A decade later, most people living with HIV and more than 75% of deaths from AIDS around
the world were in Sub-Saharan Africa.
The vast majority of those infections were among young women, and they remain so today:
in Sub-Saharan Africa, three in five new infections among young people ages 15-19 are in girls.
Despite its devastating impacts, the HIV pandemic has receded: according to the World Health
Organization, fewer than half as many die from HIV now than fifteen years ago.
The availability of anti-retroviral therapy has led to a steep decline in the number of
adults and children dying from the virus, yet access to ART was and remains unequally
distributed both within the United States and globally.
In the US, researchers had developed effective ART by the late 1980s.
However, the high cost of the medication, originally as much fifteen thousand dollars
a year, prevented many who needed it from accessing it.
To demand affordable ART, ACT UP organizers targeted Wall Street and the government, which
eventually established a federal funding mechanism called the AIDS Drug Assistance Program that
made ART affordable and widely available.
By 1996, the death rate from HIV/AIDS in the U.S. began to decline.
Researchers have estimated that ART saved over 3 million years of human life in the
U.S. between 1989 and 2003.
In Sub-Saharan Africa, however, the high costs of ART prevented access to treatment for more
than a decade.
ART only became widely available on the continent in 2005, and only after activists from South
Africa’s Treatment Action Campaign pressured the South African government and the World
Trade Organization to block pharmaceutical companies’ patents on the life-saving medications.
In other words, Africans had access to life-saving HIV treatment only ten years after Americans
did.
While more and more people in the United States and globally are managing HIV with treatment,
UNAIDS estimates that only 62% of all people who need treatment can access it.
What are the lessons of HIV for COVID-19?
Taking a global view of HIV/AIDS shows us that the populations most affected by the
virus varied by geography and that nationality, gender, race, and socioeconomic status have
shaped HIV vulnerability and access to treatment.
The lessons we have learned from HIV treatment activists also show us the need to regulate
the global pharmaceutical industry so that profit-seeking cannot inhibit life-saving
medications from reaching those who need them.
As “vaccine nationalism” for COVID-19 vaccines has already generated significant
global concerns—and as a record 5.4 million Americans have lost health insurance coverage
amid the pandemic—the need for affordable, quality health care has never been more urgent.
Comparing COVID-19 and HIV must attune us to the importance of demanding that both the
U.S. government and world health agencies ensure equitable access to life-saving testing,
treatment, and vaccines.