COVID and AIDS: The Past Is Present

COVID and AIDS: The Past Is Present

As our nation faces one of the greatest public health and economic challenges of the century, many of us are reminded of similar events in our country’s history. Before COVID-19, another condition emerged that changed the way we view science, medicine, and the role of government during a national health crisis: the HIV/AIDS epidemic.

What have we learned from AIDS that is relevant to the COVID-19 pandemic, and how can we apply these lessons to address the health of our nation now? To do so, it is important to consider the early days of these pandemics and understand how each has changed our society’s approach to public health interventions.
Both COVID-19 and AIDS Were Initially Underestimated and Misunderstood
Nearly 4 decades ago, an issue of CDC’s Morbidity and Mortality Weekly Report describing five gay men in Los Angeles who contracted a rare lung infection was the first description of the condition we now call AIDS. Soon this syndrome was named Gay-Related Immune Deficiency in news outlets such as the New York Times, leading to the false perception that the condition was an illness predominantly of homosexual men. Later, AIDS was thought to be restricted to the “4 H’s”: homosexual men, heroin addicts (IV drug users), Haitian immigrants, and hemophiliacs.
Even when these misperceptions were dispelled — transmission was recognized from mother to child, through heterosexual contact, and from transfused blood products — the stigmatization of these risk groups delayed interventions and impeded public awareness of a universal threat.
Fast forward 38 years, to New Year’s Eve 2019. The World Health Organization China Country Office was informed of cases of pneumonia of unknown cause in China’s Wuhan City. This illness was named COVID-19 (Coronavirus Disease, 2019) by WHO in an astute effort to avoid stigmatization of this new disease. Despite early assumptions that this was limited in spread, the virus was reported in nearly every country within a matter of months.
Though severe COVID-19 was first seen in the elderly, we now know the disease can occur in all ages, ranging from asymptomatic to pneumonia with respiratory failure and death.
Due to COVID’s asymptomatic and mild presentations, there has been an emerging “optimism bias” in which individuals do not appreciate their own role in sustaining the pandemic or transmitting infection to more susceptible populations — similar to the start of the AIDS epidemic. This demonstrates the harm that premature conclusions based on limited and incomplete data cause during a new infectious disease outbreak.
There is inherent danger in failing to recognize false reporting, bias, and prejudices that lead to misdirected public health responses. Emerging initiatives such as multinational patient health record databases will undoubtedly be invaluable to enable coordinated and rapid monitoring of emerging illnesses moving forward.
Leadership and Legislation
Both the HIV/AIDS and COVID-19 pandemics have catalyzed changes in the role of government in public health. In response to HIV/AIDS, several government entities and affiliates worked in parallel to create national plans.
Yet, while major legislative strides were being made, the stigma of illness and rigidity of regulatory agencies increased tensions. For example, in 1993, the U.S. Congress enacted the National Institutes of Health Revitalization Act, codifying U.S. immigration exclusion on the basis of HIV status, a discriminatory practice that was not overturned until 2010.
In the era of COVID-19, the current administration’s response reflects some lessons learned from HIV/AIDS, yet maintains several shortcomings. The Families First Coronavirus Response Act and the COVID-19 stimulus bill were important first steps towards mitigating the pandemic’s toll.
However, government leadership largely underappreciated the threat of COVID-19. With failed COVID-19 test kits from the CDC, no centralized government acquisition of personal protective equipment, and recent public reopening efforts, the U.S. has subsequently achieved the highest COVID-19 case count of any country.
The many parallels between the AIDS and COVID-19 pandemics serve to remind us that past events must inform our approach to current public health crises. For both HIV/AIDS and COVID-19, adequate testing is essential for public health control. However, ensuring widely available testing and implementation of protective measures like social distancing is challenging in the absence of a centralized government response.
The ability to overcome a public health crisis is rooted in science, economics, race, policy, and ultimately the government. Without an appreciation of the interconnectedness of these entities, we are destined to repeat the mistakes of the past, making COVID-19 another déjà vu moment in history.

Prateek Sharma is a second-year medical student at the Perelman School of Medicine in Philadelphia; he thanks James A. Hoxie, MD, founding director of the Penn Center for AIDS Research, for his guidance in writing this article. The opinions expressed do not necessarily represent those of the University of Pennsylvania Health System.

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