The AIDS Pandemic
A moment of pause & lessons learned on the 40th anniversary of the AIDS pandemic
June 5, 2021 (tomorrow) marks 40 years since the first five cases of (what would later be named) acquired immune deficiency syndrome (AIDS) were officially reported in the Morbidity and Mortality Weekly Report (MMWR).
You may be wondering… why does this matter?
Personally, the work of epidemiologists during the early years of the AIDS pandemic (chronicled in one of my all-time favorite books And the Band Played On) led me to study epidemiology. I was inspired by the investigative nature of epidemiology as a science and the importance of applying that science to improve human health.
Professionally, the MMWR article that was published 40 years ago is a wonderful teaching tool for students interested in public/global health and epidemiology. This article focuses on five patients (just five). It summarizes the clinical manifestation of their disease and highlights the shared characteristics of those who were ill. Knowing that the first cases of AIDS were all young, male, and gay allowed epidemiologists to form hypotheses and to design studies to look for what was causing the disease. This report demonstrates the power of observation, the need for collaboration between clinical medicine and public health, and the importance of clear communication.
I strongly believe that as a community we need to mark the 40th anniversary of this report - to remember the more than 32 million individuals who have died from AIDS and 38 million who are living with it today. Additionally, there are lessons to be learned from the AIDS pandemic that can be applied to the current pandemic, and we need to think about the next 40 years. What impact will the COVID pandemic have on our legacy (both individually and as a community)? And what will we remember 40 years from now when the 40th anniversary of COVID-19 is marked?
Failure to learn from our past can only ensure repeated failure in our future.
The impacts of a pandemic - whether it is HIV, Ebola, H1N1, Zika, or something else - are not limited to only those who are infected with the disease. The negative effects of a pandemic impact social systems and structures, including the economy, schools/education, transportation, and access to basic necessities (clinical care, food, social support), among others. In order to recover from or end a pandemic, community-level responses and interventions are needed.
The goal of public health (particularly in the midst of a pandemic) is to protect the health of the entire population. We cannot just treat those who are sick (or ignore them, as was the case in the early 1980s when AIDS was spreading rapidly among gay men); we must act (through policy, programs, education, interventions, medical care) to ensure health for all peoples.
Both the HIV and COVID-19 pandemics have shown us that long-term funding and commitment for public health surveillance to monitor disease spread needs to be prioritized. As do systems for testing, education, treatment, and comprehensive medical care for all. We also need centers of innovation - to develop and test new treatments and vaccines - as well as clear communications. We need to invest in a strong public health system. This system needs to be in place NOW to protect communities from future disease pandemics.
Conversations around public health and pandemic preparedness must include conversations about discrimination, racism, and stigma. The initial response to the HIV pandemic (early-1980s) was denial. Politicians and the news media ignored the outbreak for years; convinced the disease was limited to the “unhealthy behaviors” of gay men and IV drug users. There was a failure to see and respond to the data, which clearly showed that this disease was able to infect (and kill) anyone who was exposed to it. Years of research, discovery, and action were lost because of denial. We need to address health concerns in all of our communities as priorities because viruses, bacteria, and fungus do not discriminate and will infect anyone who is susceptible.
“… as if viruses had the intelligence to choose between different inclinations of human behavior.” ~ Randy Shilts, author of And the Band Played On, commenting on the fact that a virus spread through bodily fluids (like AIDS) does not know how to discriminate against who it infects; it merely passes from one person to another to stay alive.
As we remember the start of the AIDS pandemic — 40 years ago — today, the public health community (including me) asks you to reflect on those who have died; recommit to global health programs that work toward health for all peoples; be reenergized to fight for/work toward equitable access to prevention, care, and treatment services for all (without stigma); and reengage in the work that we all need to be committed to in order to create healthy communities throughout the world. This isn’t the work of just the public health workforce. This is work that we all need to do — as family, friends, advocates, researchers, residents, caretakers, teachers, neighbors, writers, photographers, and decision-makers — to prioritize health for all and health in all policies.
As we look to the future, it is my hope that our experiences during the past 18 months (the good and the bad) will help us to prioritize the health of our communities. As we take steps toward a world that does not revolve around COVID prevention, testing, diagnosis, mitigation, and conversations – returning to “normal” cannot be our goal. We need to rethink how we care for one another and our communities, how we support our teachers and our community leaders, how we encourage our children, and how we get everyone access to food and health care (among other things). We need to think about those who are lonely and care for them. And we must rethink nursing homes/long-term care facilities. I believe we have the opportunity of a lifetime RIGHT NOW… We have learned so much about viruses, community-spread of disease, community health, and the amount of havoc caused by a pandemic (that impacts everyone - those who become sick and those who do not). Let’s work to create a healthier world together post-COVID. Let’s NOT return to normal.
Who’s in?
How can we change the world TODAY so that in 40 years the narrative about the COVID pandemic is a story of compassion, kindness, and healthy communities for all?
Having spent time in Kenya, I was curious about how COVID was affecting their population. I looked it up, to find that their rates were, in general, somewhat lower than other popuations. I wondered why, and its because their senior population is only 17% of that total population. And then I remembered that back in the 90s, HIV was running rampant in Kenya, killing middle aged men and women, so that the older population was today, much smaller than normal. The Nairobi newspaper would have pages and pages of obits for people under 50. Epi does indeed matter.