Discussion – Key Debates, Viewpoints & Interviews
Health, Illness and Medicine – From AIDS to Coronavirus: Who has the Right to Care?
Jaime García-Iglesias, University of Manchester, UK
Maurice Nagington, University of Manchester, UK
Since the advent of Covid-19, or coronavirus, we live – once again – in times of contagion, of updating death tolls, daily headlines, of governments spurred into action to fight an ‘all-out war’ on the Covid-19 virus, as the New York Times put it. As gay men, in times like these, we cannot avoid remembering the AIDS crisis that swept the world in the late 1980s and 1990s. We experience a highly mediated sense of déjà vu, and we have a responsibility to speak truth to power to avoid the same prejudices and mistakes being repeated. This responsibility is even more pressing when we realise that much of our social commentators who say that ‘we’ve never anything like this’ are simply ignoring the deaths of countless people during the AIDS crisis. We have lived something like this before, some of us survived, and we know how bad it can get.
Of course, Covid-19 is not a simple re-enactment of AIDS: the death rate of covid-2019 is 3.4% (WHO), whereas AIDS, in 1995, had become the leading cause of death among adults aged 25 to 24. In 2019 alone, HIV- the virus causing AIDS - infected over 1.7 million new people, and killed over 700.000 (UNAIDS). In total, almost 38 million people were living with HIV. Even today, therefore, HIV is still a major cause of morbidity and mortality for people who cannot access treatment, a fact that is not just limited to countries in the Global South, and instead encompasses people (particularly in the United States of America) who experience systematic disadvantages because of their socio-economic status, or who fail to test because of reasons of nativity or stigma. Covid-19 brings these issues of equity of access to healthcare and capital back into sharp focus, with concerns being raised about whether people, such as gig economy workers, will self-isolate and/or get testing and treatment if they do not have the financial resources to do so.
Despite the rampantly spreading and efficient killing machine that HIV was, it took US president Ronald Reagan over three years to first pronounce ‘AIDS’ in public, a sign of structural and sustained disinterest and malice among the political and medical elites of the time. By 1985, when Reagan first mentioned AIDS, 5636 US citizens had died of it. Unlike then, governments and scientists today have wholeheartedly embraced the ‘urgency’ of Covid-19 and, in a few weeks, have managed to understand the source and reproduction of the virus, its epidemiology, and have started to developed treatments (Guardian). It took science two years to understand that HIV was the cause of AIDS, and more than ten years to find the first effective treatments.
These different responses are not simply products of their time, or of scientific advancement, or of the speed of mass media, but rather they are the direct effects of how people were made to understand and care about the two viruses. From early on, AIDS was the disease of the gays, the prostitutes, the intravenous drug users, and all those who belonged to the already stigmatised groups of society. It was only when HIV ‘spilled over’ onto the straight communities that ‘innocent victims’ started to appear: haemophiliac children, wives of husbands who had been up to no good, etc. Only then did it become a pressing issue for wider society. While HIV can and does affect people regardless of their sexual orientation or practices, in The Global North it has never been perceived as a generalised threat. From its early days, it was associated with the marginal, the promiscuous, the gay. Covid-19, on the other hand, is the virus of those who matter, ‘all’ of us. Every day, we are reminded of how everyone, even the young and healthy, can die from it. Few people know that the same was true of HIV, and still is true in many parts of the world.
Another of the key icons of this difference is the promising use of antiretrovirals, effective in controlling HIV and preventing it from developing into AIDS, to treat Covid-19 patients experimentally. A number of trials are currently under way that have taken this approach, leading the media to generate a sense that antiretrovirals such as Kaletra, a staple of HIV treatment for years, are suddenly ‘life saving’ in their capacity to treat Covid-19. From China, stories emerge of bulk buying among those at risk of Covid-19, and of people living with HIV who give or sell their stocks of the medication, so much so that the United Nations have urged people living with HIV not to abandon their treatments to sell or give them away. This is a fantasy, of course. No actual concrete evidence exists yet of antiretrovirals working against Covid-19, but it is a revealing fantasy nonetheless: in hailing them as ‘life saving’ now against a disease where the overwhelming majority survive with only a short period of illness, we are wilfully ignoring that antiretrovirals are and have been life-saving for millions of people worldwide against HIV, the death rate of which – if left untreated – is close to 100% after a protracted and painful series of illnesses. At the heart of this act of omission is not a lack of knowledge, but a deep-seated belief that there are some lives more worth saving than others, and that those who live with HIV are perhaps not as significant, not as central to our notion of society, not quite within the purview of ‘all’ of us. AIDS is held, firmly, on the ‘margins of our attention’.
If AIDS, for all its meaningless ongoing death and suffering, has taught us anything, it is to remain profoundly attentive to the ways in which perhaps the most vacuous of organisms, a virus, is used by those in power and in control of social narratives to exclude, stigmatise, and persecute populations. A racist attack against a Chinese student in London evidences this, as does the NHS’s attitude towards PrEP, where the cost of providing this ‘lifestyle drug’ was pitted against childhood cancer. Should effective treatments emerge for Covid-19 we must not forget to ensure that drugs are made available for all bodies, not just those bodies that matter to the prevailing moral climate of the time. As the example of the pharmaceutical company Gilead’s fight to sustain the patent of PrEP at all costs shows us, relying on the pharma industry’s good intentions rather than watching out for the moment in which their greediness and their willingness to use sick people as pawns, would be a folly we cannot afford to repeat.
Despite these differences, we cannot ignore a degree of resonance between AIDS and Covid-19. We can learn from comparing both epidemics. When Spanish newspaper, El País, published an article with the headline ‘Humans Eating Wild Animals Without Controls: A Minefield for Public Health’, it illustrated its text with images of a woman in Cameroon preparing a porcupine, and referred to the eating of dogs and bats. However, it forgot to mention that, for example, mad cow disease and its human equivalent Creutzfeldt–Jakob disease, originated in the UK, in the context of a highly industrialised beef industry. This article is just one example of the striking similarities between the racialised othering of Covid-19 and the ever-present and unscientific efforts to place the source of AIDS somewhere in ‘Africa’. In the same way, viral (literally and metaphorical) panics about people willingly infecting others by spitting in China, carry a striking resemblance to the urban legends of people living with HIV leaving infected needles around cinema seats to spread the virus, or the ‘reckless’ infectors. Just as AIDS mobilised pre-existing beliefs and narratives of racism and justified discrimination and violence, so apparently does Covid-19. Even the narratives of religiously motivated homophobia seen in the AIDS crisis are being replayed, with Covid-19 being a sign from God to cease celebrating LGBT history month or gay pride events.
The AIDS crisis acts as a reminder of how the decisions of governments, media and pharma industries are always and already contingent on existing narratives about whose lives matter. These narratives determine whose lives are valued, and who exactly is included and excluded from the ever present ‘all of us’. These beliefs and processes of exclusion delimit the boundaries of who has or does not have the right to healthcare and the continuance of life that it brings. We learned this the hard way with AIDS. Let it act as a reminder for Covid-19 before it is too late. As Larry Krammer, seminal figure of the AIDS crisis wrote, ‘show me the plague, and I will show you the world!’.
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