How the coronavirus harkens back to another modern epidemic

This year was meant to mark the end of the HIV/AIDS epidemic in New York state, which has killed tens of thousands of residents since the 1980s. But this year has been overwhelmed with a new epidemic where – just like the HIV/AIDS crisis – New York again found itself at the center of the outbreak.

There are major differences between how AIDS initially emerged compared with the coronavirus. But to health experts and those who survived the worst of the HIV/AIDS crisis, a faltering government response, disparate health outcomes for people of color and heightened stigma during the coronavirus pandemic harken back to the HIV/AIDS crisis.  

The viruses themselves manifest quite differently. HIV transmits through certain bodily fluids, such as blood or semen, while the coronavirus spreads mainly through respiratory droplets from coughs or sneezes.

“This is like HIV fast forward,” said Dr. Demetre Daskalakis, deputy commissioner of the Division of Disease Control at the New York City Department of Health and Mental Hygiene. “It’s high speed because of the way this transmits. It feels like we’ve been through 10 years in four months.”

LGBTQ people, in particular gay and bisexual men, and people with substance abuse disorders were disproportionately affected by HIV/AIDS. AIDS also proved to be consistently deadly, unlike the coronavirus, and was even more poorly understood at the outset of the outbreak. Whereas the coronavirus was identified early on, it took two years after HIV/AIDS was declared an epidemic for scientists to discover the human immunodeficiency virus that caused acquired immune deficiency syndrome. Data and information on the spread of the coronavirus has also been significantly more accessible. 

Still, ongoing uncertainty about the coronavirus, the large numbers of deaths and no access to a cure reminded some of how the HIV/AIDS outbreak initially erupted.

“The early days of the COVID pandemic were really – I think I and others who have been doing HIV work for decades were really struck,” said Sharen Duke, founding executive director and CEO of the Alliance for Positive Change, a community-based organization created in response to the AIDS crisis. “A lot of us almost felt like PTSD – the early days of the AIDS epidemic where people were getting sick and dying and there was nothing we could do.”

Much of the failure to conduct sufficient research and support on HIV/AIDS back then came from stigma against the gay community and a weak government response. Then-President Ronald Reagan notoriously mostly ignored AIDS until his second term in office, four years after the first cases in America, and the media largely failed to press officials on their inaction. New York City’s mayor at the time, Ed Koch, also was widely lambasted by gay activists for also failing to promote risk reduction and education early on, which was especially distressing given that New York City became the epicenter of the outbreak. The failed government response to the coronavirus crisis evoked similar feelings, though their causes may be dissimilar. The federal government is mostly at fault for failing to boost the testing capacity needed to identify the disease and provide enough supplies to protect front-line workers. Though the response has been comparatively robust in New York on a state and local level, there has been plenty of criticism that delays in shelter-in-place policies and rules regarding nursing homes exacerbated the severity of the outbreak.

“The three months of neglect that we saw at all levels of government here in New York, where you have a much more virulent virus, had the same impact in terms of leaving folks woefully unprepared to address this, leaving a lot more death than needed to have happened,” said Charles King, CEO of the nonprofit Housing Works and a former member of ACT UP, an early AIDS activist group.

For Kelsey Louie, CEO of Gay Men’s Health Crisis, the current approach still represents a major difference between both epidemics. “Whether you like the government response or not with COVID, at least it’s happening and it is being paid attention to,” he said.

Many people familiar with the HIV/AIDS epidemic have suspected that the more robust response from government officials likely ties into the fact that the coronavirus can affect anyone, where HIV was largely seen as specific to the marginalized gay community.

“If this were a disease of Black, Latino, LGBTQ people and people who inject drugs only, would the federal response have been as robust?” Daskalakis said. “Absolutely not.”

Among the other major differences between both health crises has been the reaction from health care workers. Many attempted to eschew their responsibilities to treat HIV-positive patients throughout the 1980s because of fears that they would contract the disease, though research has since proven that there was minimal risk of transmission. Health care workers who did help people with HIV or AIDS were often shunned.

“It was a very hostile atmosphere towards the disease and towards the practitioners who worked with patients with the disease,” said Gerald Oppenheimer, a historian with expertise in the HIV/AIDS epidemic at the Columbia University Mailman School of Public Health. “The patients were very unpopular and greatly feared.”

Some discussion has occurred among doctors who fear treating coronavirus patients, given the high transmission risk and shortages of personal protective equipment that marked the worst of the pandemic. But for the most part, it hasn’t stopped health care workers from doing their jobs, and the public has celebrated them as heroes for continuing to work throughout the crisis.

What also made the HIV/AIDS outbreak particularly pernicious was the fact that it heightened already existing homophobia and stigma against people using illegal drugs. Physicians designated four groups stigmatized as high-risk at the time, condensed in the term “the 4-Hs,” which stood for “homosexuals, hemophiliacs, heroin addicts, and Haitians.” The U.S. Centers for Disease Control and Prevention erroneously included Haitians, who many at the time accused of carrying HIV to the United States, and as a result faced widespread discrimination not entirely dissimilar to that faced by Asians and Asian Americans during the coronavirus crisis. Also incorrectly targeted for bringing the coronavirus from China, Asian Americans have increasingly been the victims of hate crimes in New York City. Asian-owned businesses were also among the first to experience financial hardships in the coronavirus outbreak.

There are indications that people who have tested positive for the coronavirus, even if they have recovered, have been shunned by their peers and felt stigmatized.

Racism has also manifested in poor health outcomes for people suffering from either disease. Although Black people made up 13% of the country’s population in 2018, they represented 42% of new HIV diagnoses nationally, according to the CDC. The majority of transgender women who have tested positive for HIV are either Black or Latino as well. The coronavirus similarly disproportionately affects Black and Latino people, who have died at twice the rate of white people from the disease in New York City.

Some valuable lessons have transferred over to the recent pandemic. For example, New York City’s health department issued a guide for how to safely have sex during the coronavirus pandemic. “That is very directly from the HIV experience and looking at public health and government and how it failed in that era to be leading on giving people clear advice rather than waiting for community members to feel around in the dark to come up with a strategy,” Daskalakis said. These harm-reduction strategies also led to the agency producing another guide for how to safely gather in groups with the understanding that – while not gathering would be safer – many will still do so despite the risk.

Even with the great medical strides that have transformed HIV into a manageable chronic disease and slowed the virus’s spread, some of that progress may be at risk because of the coronavirus. As health care transitioned to tackling the coronavirus, regular treatment of chronic health conditions became deprioritized, Daskalakis said. And organizations on the front lines of helping people with HIV are also concerned that funding for their initiatives could dissipate amid the immense fiscal crisis facing New York City’s government. They are now expressing concerns that New York state may not reach its goal of ending the AIDS epidemic this year. “I’m only half kidding – I think we need an extension in terms of getting our 2020 target,” Daskalakis said.