Paying the ultimate price
COVID-19 is teaching us lessons we should have learned from the HIV epidemic.
The video of Dr. Anthony Fauci, US President Donald Trump’s health advisor, snickering and covering his face in response to Trump’s remarks at a press conference addressing the COVID-19 pandemic has been a source of catharsis for many of the millions of Americans currently sheltering in their homes. It illustrates a juxtaposition: the posturing executive spills out a fluid mix of misinformation, bravado, and cagey defensiveness, to be followed by the calm medical professional who articulates critical guidance, warnings, and corrections.
Dr. Fauci, who has directed the National Institute of Allergy and Infectious Diseases since 1984, developed and honed these communications skills during the US response to the HIV epidemic. And the interplay between President Trump and Dr. Fauci, as well as the wide variety of public and national responses to the coronavirus, reveals that the majority of Americans, including politicians, failed to internalize the key lessons they should have learned in the AIDS response.
The HIV epidemic originated in Central Africa in the early 1900s when the Simian Immunodeficiency Virus (SIV), a disease native to chimpanzees, transferred over to a human, likely a hunter, and became Human Immunodeficiency Virus (HIV). It circulated slowly in its local area over several decades before reaching urban centers in the 1960s and early 1970s, at which point it began spreading across the continent via intercity travel routes. After this second stage of proliferation, HIV began to spread off the continent. The first cases of AIDS in North America began appearing in the late 1970s. The virus was first identified and named in 1981 by American clinicians from the CDC studying an outbreak among gay men living in San Francisco. Simultaneously, doctors in Central and Southern Africa began to notice a massive and unusual outbreak of deaths by illnesses that usually afflict individuals with highly compromised immune systems. Epidemiologists quickly connected these two dots, and by the late 1980s, the global public health community had organized an unprecedented disease response.
The parallels between HIV and coronavirus are legion. A highly infectious virus with a lengthy and asymptomatic incubation period spreads silently and quickly in its geographical region of origin. By the time medical and public health professionals understand it to be a problem of significance, it has already made its way to other regions. Pre-existing social and political structures and divisions set the mold for both the spread of the disease and the response. The disease proliferates rapidly among traditionally vulnerable populations least capable of taking precautionary steps to protect themselves. Knowledge of the epidemic’s region of origin, as well as entrenched attitudes toward the vulnerable classes affected, allow national governments to create scapegoats, which are used either to ignore or downplay the crisis or to promulgate nationalist sentiment.
We see these patterns emerging in response to the coronavirus, just as they did during the HIV epidemic decades before. The virus’s origin and rapid spread in the Wuhan region of China has led Trump and many of his followers to dub COVID-19 the “Chinese Virus.” Such xenophobic naming echoes the common characterization of HIV as an “African” disease, implying some biological or cultural predisposition to the viral pathogen. Conspiracy theories proliferate. In China, some citizens wonder why this virus seemed to target them in particular. For explanation, many dip into existing political wells. The Chinese government has blamed American service members who visited the Wuhan region in October 2019, playing on geopolitical tensions with the United States. Similarly, many Africans still suspect that HIV was deliberately introduced by westerners seeking to debilitate the continent after the end of formal colonialism.
Yet, in truth, the explanation is far simpler and far less satisfying: the coronavirus affected China’s population most severely in its early days because it is a virus that crossed over into humans in China, just as HIV infected more Africans than any other group for no other reason than it began in Africa. Both diseases possess lengthy asymptomatic incubation periods (though they differ by several orders of magnitude) during which they are highly contagious, and thus both spread with great speed in the places they originated before health or government officials noticed their presence. It is precisely this trait that made both difficult to contain.
Viral crises unearth and widen already extant social divisions. Around the world, nations and publics continue to recycle and repackage familiar scapegoats to explain coronavirus and its spread. In Italy, far-right politicians invoke the familiar bogeyman of migrancy, despite a total lack of supporting evidence. In the US, the state closed borders and issued travel bans long after the virus had taken root. But the true problem lies in the fact that many of these latent social problems (migration, poverty, racism) are built into the very structure of societies, and facilitate the spread of disease. These structures usually render vulnerable those already most likely to be targeted by scapegoating.
Take, for example, the first urban area ever hit by HIV, the city of Kinshasa (then Léopoldville), the capital of the Democratic Republic of the Congo. As Jacques Pepin has shown, Belgian colonial authorities imported men into the city during the colonial era in order to exploit their labor and extract profit for Belgium. They made it enormously difficult for women to migrate into the city to join their husbands. As a result, an illicit market for prostitution emerged. Once HIV reached the city, the dense sexual networks structured by colonial law spread the virus like wildfire among the African population of the city.
Homophobia in the US performed similar work. The illegality of sodomy in multiple states coupled with government-sanctioned discrimination against queer individuals and the growing ties between evangelicalism and the ruling Republican Party in the 1970s and 1980s led many to disconnect from their families and local networks and move to urban areas. Places like New York City and San Francisco played host to burgeoning queer communities, which performed critical social, cultural, and political work, and exploded into the queer rights movement. However, the sexual networks created as part of this reaction to structural oppression placed the gay communities in these cities at the epicenter of the American HIV epidemic.
What HIV teaches us is that social discrimination and the vectors by which disease spreads are inextricable. While slogans like “coronavirus doesn’t discriminate” serve an important awareness-raising function, coronavirus discriminates inasmuch as the society it operates within does. As a result, the largely black and brown corps of hourly service workers who, according to the Economic Policy Institute, are far more likely to be paid poverty-level wages than their white counterparts and therefore cannot afford to take time off, are disproportionately likely to come into contact with the virus. Additionally, that same class of individual is least likely to be able to afford the costs for treatment in the US for-profit healthcare system if and when they fall ill. And all the while, the risk of mass infection grows daily in the detention camps along the southern border that house the migrants Trump blames for the crisis.
As scapegoating proliferates, governments utilize these widening social divisions in one of two ways. First, some use discrimination as a tool for excusing and extending inaction, as was the case of the US in the 1980s and in South Africa in the early 2000s. Ronald Reagan’s administration famously refused to acknowledge AIDS until the late 1980s, resulting in, by some estimates, the deaths of more than 80,000 Americans. When questioned by reporter Lester Kinsolving about Reagan’s lack of response, then deputy press secretary Larry Speakes deflected by implying that Kinsolving’s ongoing interest in the disease must mean that he was homosexual. It would be another five years before the administration took any official action in response to the epidemic, under internal pressure from experts such as the young Dr. Fauci and, more importantly, external pressure from activist organizations like ACT UP. In South Africa, Thabo Mbeki engaged in official AIDS denialism starting in 2000, publicly questioning whether or not it was a coincidence that HIV had emerged immediately after the end of white rule in South Africa. By raising the specter of apartheid, Mbeki invoked the most fraught line of fragmentation in South African society, and thereby stalled government action until public campaigns from grassroots organizations like the Treatment Action Campaign forced his hand in 2003.
Second, some states employ the “othering” of scapegoating to turn the federal response to the virus into a nationalist propaganda tool. As scholars Ashley Currier and Robert Lorway have pointed out, during the explosion of HIV in Namibia several government officials posited that homosexuals were “responsible for spreading the epidemic,” theorizing that Americans had created the disease and introduced it to the homosexual population. Coupled with public assertions that “governors should see to it that there are no criminals, gays and lesbians in [their] villages and regions,” and exhortations to police to “eliminate” gay and lesbian Namibians, officials made it clear that the national response to HIV required that citizens come together to denounce and even forcibly expatriate non-heterosexual individuals. By framing homosexuality as “pervert[ed]” and “European,” and accusing Namibians who engage in same-sex practices of “appropriating foreign ideas in our society [and] destroying the local culture,” the Namibian government used the HIV epidemic to deny citizenship to an entire class of person and to rally Namibians around a heteronormative form of nationalism.
In his response to COVID-19, President Trump has employed both tactics. On January 22, in one of his first public statements on the burgeoning pandemic, he said “We have it totally under control. It’s one person coming in from China. And we have it under control.” Shortly afterward, his administration blocked travel from China alone, despite the fact that 100 cases had been reported in 21 countries, including the US. A month later, he referred to the virus as a “hoax” concocted by Democrats to damage his electability, tapping into yet another social division in the US in order to avoid action. In fact, during this time period the administration did virtually nothing to prepare for the imminent crisis, save to redirect blame to familiar targets, much as Larry Speakes had done in the 1980s.
Once the need for immediate action became unavoidably apparent in March, Trump pursued the second tactic. By scapegoating his usual targets, he attempted to consolidate his electoral base and promote his distinctive brand of American nationalism. He repeatedly criticized the way the media has reported the virus and the previous administration’s response to the swine flu in order to deflect criticisms of his own administration, and even blamed former president Barack Obama and former vice president Joe Biden for failures in the current crisis. He began insistently referring to COVID-19 as the “Chinese Virus,” going so far as to cross out “Corona” on his own speech transcript and replace it with “Chinese.” Additionally, he started blaming the Chinese government for the pandemic’s spread. And while publicly scapegoating his enemies, he promoted his own nationalist brand by wearing campaign hats to press conferences, adding campaign slogans to public statements about the virus, and advocating for his preferred xenophobic policies as solutions to the crisis. These three tweets from March illustrate this tactic: On March 10, he shared a Charlie Kirk tweet that reads, “Now, more than ever, we need the wall. With China Virus spreading across the globe, the US stands a chance if we can control our borders,” and added the note “Going up fast. We need the Wall more than ever!”; on March 18, he tweeted “I always treated the Chinese Virus very seriously, and have done a very good job from the beginning, including my early decision to close the ‘borders’ from China—against the wishes of almost all. Many lives were saved. The Fake News new narrative is disgraceful & false!”; and, on March 27, he tweeted “I love Michigan, one of the reasons we are doing such a GREAT job for them during this horrible Pandemic. Yet your Governor, Gretchen ‘Half’ Whitmer is way in over her head, she doesn’t have a clue. Likes blaming everyone for her own ineptitude! #MAGA.”
In between these tweets, Trump declared that immigrants would be barred from crossing into the US from Mexico, where he had already forced asylum seekers to wait in crudely erected, crowded, unofficial refugee camps for months on end. By the time of that statement, the number of diagnosed cases in the US had surpassed 8,000, including multiple infections in every state along the US border. On March 24, Trump stated that the federal government would be willing to hold back aid and supplies from states with Democratic governors unless they stopped criticizing him. And on April 1, The New York Times reported that the Trump administration had sped up construction of the wall along the Mexican border, contending, against the advice of the CDC, that it would slow the spread of COVID-19, days after the US received the dubious distinction of hosting the most diagnosed cases of any nation in world. Despite Dr. Fauci’s warnings, the familiar scapegoats set the mold for the virus response once again.
All of this is not to say that there are no differences between the two viruses. They are genetically dissimilar, operate on vastly different timescales, and spread in distinct ways. The hope for defeating HIV lies in ending its transmission, a future made possible by recent scientific breakthroughs that taking anti-retroviral medication correctly prevents transmission, while the end of COVID-19 hinges on the creation and dissemination of a successful vaccine. However, the most significant distinction between the two may prove to be that coronavirus has reached pandemic status, while HIV remains an epidemic confined predominantly to certain regions, like Southern Africa and Eastern Europe, and, depending on the location, certain vulnerable classes, such as black and queer individuals in the US. And if governments do not begin to take the lessons of the AIDS crisis seriously, lessons learned at the cruel expense of 32 million lives lost, untold millions more will be made to pay the ultimate price.