Opinion | The Coronavirus And HIV: Different Pandemics With The Same Lessons

San Francisco's world-leading public health department is a byproduct of our multidecade fight against AIDS. The lessons we learned then are just as vital today.

For many of us who’ve been on the front lines of the HIV pandemic for decades, the emergence and explosion of the novel coronavirus has been scary in a very particular kind of way.

As a gay man who started having sex as a 17-year-old in 1987 — when huge numbers were dying of AIDS and there was no effective treatment — and who began my HIV advocacy in 1990 as an AIDS hotline volunteer in North Carolina, the spread of the coronavirus brought back dark memories.

We’ve been through this before with a virus that killed millions and made so many sick, right?

Yes and no. HIV and the novel coronavirus are both highly destructive, with massive and tragic human consequences. But they’re obviously also quite different in the way they spread, the options for treatment and recovery, and the way they kill. But despite their differences, each virus reminds us of some strikingly similar truths.

First among them: The government’s early response to a pandemic — or its lack of response — helps determine the pandemic’s trajectory.

As HIV appeared in the early 1980s, the federal government was MIA. Because the virus only appeared to impact gay men and intravenous drug users, the federal response was borderline non-existent. President Ronald Reagan didn’t even say the words “HIV” or “AIDS” until the late 1980s, after the virus had spread out of control. Had the federal government decisively intervened with widespread public health strategies and improved care, lives would have been saved. We would have had a fighting chance to stop HIV from becoming a worldwide pandemic that, to date, has infected 75 million people and killed 32 million.

While the national response to the coronavirus in the United States has been far from ideal — particularly the lack of testing and President Donald Trump’s ignorant statements denying the pandemic — we’ve seen aggressive steps in a number of states to enforce social distancing, and actions to quickly invest huge resources in creating treatments and a vaccine. Unlike the slow response to HIV, it didn’t take years and years for our federal government to take the pandemic seriously

We’ve also learned that governments are much more likely to respond aggressively to a pandemic that infects “mainstream” society and not just marginalized groups.

So, why the fast — albeit not fast enough — government response to the coronavirus instead of the slow and destructive response to HIV? That’s a simple one: COVID-19 threatens everyone, including rich people, white people, powerful people, and straight people. HIV overwhelmingly has impacted gay and bisexual men, trans people, low-income people of color, people who inject drugs, and people from impoverished countries.

Indeed, it wasn’t until Ryan White, a child who became HIV-positive after a blood transfusion, heroically publicized his infection, that Congress stepped up with serious funding for the pandemic.

When pandemics overwhelmingly impact marginalized communities, they get ignored. And that can mean 32 million people dying. When problems impact the rich and the powerful, we spring into action, even if it means shutting down much of the economy and spending more than a trillion dollars in federal funds.

The same wasn’t true for people living with HIV. So many died quiet deaths, with little or no government or medical support.

Yet, despite all of this, there are also wonderful things to learn from the way our communities have responded to pandemics, whether HIV or the coronavirus. In each case, we’ve seen the absolute best that people have to offer.

People become more pro-science. This was true when the HIV pandemic was at its peak. And it should be true today. In an era when vaccine-denialism is on the rise, when public health infrastructure has been gutted, and when our federal government has essentially abandoned serious efforts to plan for pandemics, we’re at serious risk. The coronavirus with all the pain it is causing, is helping build support for improved public health infrastructure.

We’re already seeing a broad community response. People are checking in on their elderly neighbors. People are collecting masks and other protective equipment, given the shortage. Businesses are voluntarily manufacturing masks and ventilators. We’re seeing major organizing to help our most vulnerable community members. And, of course, the heroes in our health care system — nurses, physicians, other health care workers, nursing home workers — are putting themselves at significant risk, often without proper protective gear, out of a sense of duty. Similarly, our grocery and pharmacy workers, as well as delivery drivers, are putting themselves at risk to ensure that people have access to food and medicine.

The HIV pandemic saw a similarly inspiring community response. As the federal government ignored the pandemic through much of the 1980s, some cities sprung into action. San Francisco devoted untold resources to fight the virus. Our city built a massive public health infrastructure to prevent infections and improve care. San Francisco has the best Department of Public Health in the nation — perhaps the world — and part of the reason is our incredible response to the HIV pandemic.

“My hyper-vigilance is built in, particularly having been trained during the HIV crisis,” Dr. Grant Colfax, San Francisco’s current director of public health, told the San Francisco Chronicle. “The early action is required, and many places retroactively are asking why they didn’t take aggressive action earlier.”

Similarly, San Francisco built a highly effective network of community-based organizations to combat HIV. These nonprofits formed a powerful safety net to take care of our neighbors. For decades, these nonprofits have played an essential role in San Francisco’s successful effort to collapse new infections (which it has done, by more than 95%), to connect people living with HIV to care (our city has one of the most virally suppressed HIV-positive populations in the world), and to enact cutting edge, progressive, forward-looking public health strategies that are models worldwide.

Pandemics can bring out the best and the worst in humanity. They show the fault lines and inequities, while also showcasing community resilience.

Let’s get through this pandemic together and then build a better future.

Scott Wiener represents San Francisco and northern San Mateo County in the California State Senate. He previously served on the San Francisco Board of Supervisors, representing the district previously represented by Harvey Milk. He has worked on HIV and STI prevention and care for 30 years.

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