Lessons of two epidemics: Our response to COVID-19 and HIV/AIDS

The urgency to develop a COVID-19 vaccine has led to the mobilization of the largest public health intervention in recent history; this is an immense effort in the wake of a virus that has spread rapidly with immeasurable destruction. 

At the same time, we must recognize that we have yet to fully address the simultaneous viral epidemic that has been ravaging communities and causing devastation since it was first reported 40 years ago — HIV/AIDS. The disparity between the rapidity of government responses and availability of care is rooted in discrimination, and how marginalized populations, including the LGBTQ community, are often overlooked. 

This marks the 40-year commemoration of the first official report of HIV/AIDS by the Centers for Disease Control and Prevention (CDC). In the lead up to HIV Long-term Survivors Awareness Day, on June 5 we honor the resilience of long-term survivors of HIV/AIDS, who have overcome the odds and thrived despite the challenges of being diagnosed before effective treatment was available.

The parallels to HIV/AIDS and the COVID-19 pandemic are alarmingly similar as those at the forefront of the crisis are Black and Brown people. Black people in the U.S. account for 43 percent of new HIV diagnoses and 30 percent of all COVID-19 cases, despite representing 13 percent of the population. Additionally, 50 percent of Black gay and bisexual cisgender men are projected to be diagnosed with HIV in their lifetime. The detrimental effects of HIV are also profoundly felt in the transgender community, with almost half of all transgender women living with HIV/AIDS.

Despite significant strides in biomedical advancements in HIV/AIDS prevention, treatment and care, the deep-seated barriers present at the height of the epidemic continue to further exacerbate disparities seen today. The health inequities in communities of color are fueled by social determinants such as socioeconomic status, housing, transportation, employment and institutionalized racism in the health care system.

In the early 1980s, fearmongering and misinformation shaped the narrative that gave rise to HIV/AIDS stigma, discrimination and the marginalization of LGBTQ communities. As HIV-related mortality rates rose steadily through the 1980s and early 1990s, LGBTQ activists and people living with HIV became influential in accelerating the development of effective treatments through acts of civil disobedience to amplify HIV’s impacts. This powerful work led to the funding of community based organizations, development of federal programs, like the Housing Opportunities for People with AIDS Act, and the more than two dozen agents and combination therapies we have to treat HIV today.

It was not until 2012 that the Food and Drug Administration (FDA) approved the use of pre-exposure prophylaxis (PrEP) to significantly reduce the chances of contracting HIV, 30 years after its emergence. The waning urgency of addressing the epidemic is indicative of our overdue response to prioritize the historically excluded Black and Brown voices that continue to be at the frontlines of the epidemic. At its heart, it underscores a shameful truth: When the transmission rates and death rates dropped for white people, so too did the amount of investment by institutions.

Vaccine development is a long and arduous process, often taking 10 to 15 years, but building on the HIV Vaccine Trials Network, the medical and scientific community went into overdrive to develop not one, but three FDA-approved vaccines within a year to fight COVID-19. Science has come a long way, yet we find that inequity perseveres in the rates at which people are being vaccinated. While COVID-19, like HIV/AIDS, does not discriminate against race, gender identity or sexual orientation, our health care system does — and studies have found that Black Americans are being vaccinated at rates two to three times below white Americans. 

Over the past year, we have seen how an unwavering commitment to ending an epidemic has accelerated scientific innovation; but we also see, 40 years later, how the fight to end HIV/AIDS is being denied those same resources. And we must acknowledge how the continued struggle to end this epidemic is entrenched in systemic racism, homophobia and transphobia, all of which have minimized response efforts in the communities that need them the most. 

Our inability to finish the job when it comes to ending these dual epidemics is a glaring moral failure as a society. When the threat against white people is mitigated or eliminated, so is our effort to advance the wellbeing of all Americans, including the survivors we leave behind. But by recognizing this failure for what it is, and with the resources now available, we have the ability to course correct.

The disproportionate weight of death, due to these two viruses, most heavily falls on those lives that are not valued nor supported in employment, housing or health care. We owe it to the survivors and activists who continue to grapple with the consequences of racism and homophobia to provide high-quality health care to all people and reform these systems of power so that we may build a world free from HIV/AIDS. 

Alphonso David is the president of the Human Rights Campaign, the largest U.S. LGBTQ civil rights organization, he is the first civil rights lawyer and person of color to serve as its president.     

A. Cornelius Baker is a lecturer in the Hubert Department of Global Health at the Emory University Rollins School of Public Health and special advisor to the NIH Office of AIDS Research and liaison to the U.S. President’s Emergency Plan for AIDS Relief.