Gone viral: Reading about HIV during a coronavirus outbreak

It’s hard to miss the headlines these days about the new coronavirus that’s sweeping around the world. Along with respiratory symptoms, this new disease has been accompanied by uncertainty, fear, and even misinformation. Who will be infected, and how? Who will suffer, and potentially die? How widespread and severe will the virus be, and when might the epidemic end? It seems too soon to tell on most fronts.

Last week, this new virus was bestowed with an official name: COVID-19. Spartan and clinical, the name easily rolls off the tongue and avoids pinning “blame” for the virus on particular populations of people or animal hosts. Meanwhile, whatever we choose to call it, the coronavirus continues its journey through human lungs around the world. Its reach is dutifully tallied in frequent reports of the numbers of newly diagnosed patients, deaths, and quarantine participants.

As the COVID-19 outbreak began, I quickly started saving articles about it. I occasionally teach a class for college students about connections between biology and human society, and I like to start the course with a look at notable epidemics in recent history. Ebola, MERS, SARS, seasonal influenza, measles, and others have each appeared in the starring role of a recent epidemic. The massive influenza pandemic (global outbreak) of 1918 serves as a notable historical point of comparison: millions of people died after infection with a particularly nasty influenza strain. In 2018, many researchers and science journalists noted the centennial of the 1918 flu with a look back over what we’ve learned about the spread of disease through human populations, and how these lessons might impact our current level of disease preparedness.

To include an ongoing disease concern, I also make a point to discuss HIV and AIDS with my students. We’re decades into this particular pandemic without any particular end in sight. The story of HIV also carries important lessons that are worth considering (and reconsidering) as we think about health and disease around the world.

I actually had HIV on my mind as the coronavirus outbreak began. Over the past few weeks, I was immersed in reading a really long book, And the Band Played On, by Randy Shilts. Published in 1987, And the Band Played On chronicles in sometimes graphic detail a narrative constructed from Shilts’s years working as a journalist in San Francisco during the early stages of the HIV/AIDS epidemic in the United States. I was working my way through the book to participate in a local community science book club discussion and learn more from a guest speaker, a physician who treats people with HIV. I had hoped add to my collective understanding of the perspectives I draw on when discussing HIV history with my students.

Shilts’s chronicling of HIV was at the same time broad, deep, and personal: the author himself died from complications of AIDS in 1994. My own awareness surrounding HIV has always been from a point of relative emotional distance and presumed biological “safety” on the sidelines. In my middle grades of childhood, for example, I remember teachers posting newspaper clippings on our classroom current events bulletin board about this “mysterious new disease” that no one seemed to understand. We didn’t really talk much about these articles in class, since the first waves of people infected in the United States included gay men and intravenous drug users, which I suspect were deemed too “adult” for us. Only when Ryan White—a young teenager with hemophilia who lived near my Midwestern hometown—contracted HIV in 1984 through blood products used in the treatment of hemophilia did it seem like we really started to pay attention to the epidemic. The marginalization of people infected with HIV is a theme Shilts returns to over and over again in his book.

As I grew to adulthood, the specter of AIDS was everywhere. Lessons about safe sex, testing availability, and precautions to avoid blood contact slowly permeated throughout our society. For those people in the early waves of infection, however, gruesome infections and near-certain death were not distant hypothetical scenarios. This fate became the norm for first thousands of patients, then millions of people around the world. I appreciated reading Shilts’s no-holds-barred perspective on the ravages of disease, and about his analysis of what may have gone wrong behind the scenes in the early weeks and months of diagnoses, research, prevention, and their respective attention and funding.

Some recent statistics:

According to the World Health Organization, as of this week (Feb. 17, 2020), 71,429 cases of COVID-19 were reported globally, with 2162 new cases in the past 24 hours. Most of these cases are in China, where the viral outbreak originated; over 1770 people have died. Much about the trajectory of the spread of the disease is unknown.

According to the World Health Organization, more than 32 million people have died from HIV/AIDS; almost 38 million people were living with HIV at the end of 2018; 770,000 people died of HIV/AIDS in 2018; 1.7 new people became infected in 2018; 62% of people living with HIV are receiving treatment. In many cases, treatment extends lifespan dramatically and eliminates the risk of passing on the virus to other people.

The new coronavirus is concerning because of its unknown parameters and our inability to predict exactly how it will affect human society over time. Will it flare up and fade away, like the SARS virus? Or will it become a new ongoing scourge for us to navigate? The new virus was quickly identified using modern molecular biology approaches. Will a vaccine become available sometime soon? In time, we hopefully will be able to answer some of these questions.

Meanwhile, HIV simmers after decades of infection among people worldwide. Africa, where the virus originated, harbors the majority of people living with HIV. Various social, economic, and political factors have shaped the story of HIV over the years. But ultimately, HIV is a particularly problematic virus because it has the potential to decimate the human immune system. And while infection with HIV is not necessarily the death sentence it first was, thanks to new antiviral treatments, much work remains to be done to provide education, testing, and access to medication for people around the world.

Amidst the news of COVID-19, three stories about HIV in the past few weeks caught my eye after I finished reading Shilts’s book.

The first article addresses the latest chapter in a disappointing, decades-long effort to create a vaccine that would prevent HIV infection. None has been successful. This latest human trial, in South Africa, was working so poorly that researchers stopped the study early. What will it take to create an effective vaccine for this viral attacker? Decades after the first HIV cases made the news, we still don’t know.

The second article examines how education efforts to avoid contracting HIV may need to extend beyond some traditional groups. Older adults—including those recently divorced after a long marriage, for example—may be newly at risk of contracting HIV through sexual contact. And their perspectives on the infection and treatments may need to be updated from what they remember from the 1980s. For example, treatment with antiviral medication can extend lifespan and reduce the risk of passing along the virus to others.

The third article discusses the aftermath of a controversial needle-exchange program that was adopted in a nearby county in Indiana a few years ago, when HIV infection rates soared in the wake of increasing intravenous drug use and opioid addiction. Drug use and powerful addictions continue to be challenging public health issues. Helping people lower their risk of HIV infection by avoiding contaminated needles has been a focus of a number of local public health efforts to try to avoid compounding medical problems in various communities.

So, if we can’t yet vaccinate against HIV, can we seek to prevent new infections in better ways? How can we best treat infected people, so they live healthier lives, and, importantly, not pass along the virus to others? What will it take to reach and help all the people around the world who are likely at risk of HIV exposure, or who are living with HIV? How will this monumental task be accomplished? What have we learned since the 1980s and the legacy left behind in Randy Shilts’s words? And how can our improved understanding of epidemics and viruses—and global communication—help us deal with the COVID-19 outbreak?

Global challenges are hard. Medicine is hard. And I’m not a virologist, epidemiologist, or health practitioner, so I’m not on the front lines of solving these challenges. But as a biologist, an educator, and a member of a species that has been ravaged by viruses over its history (and will be again), I care. I came of age in the early days of HIV/AIDS, and I’ve watched and listened and tried to learn from experts as we grapple with concerns related to this and other epidemics in an era of global connectedness. I hope that what connects us can also help us be more responsive, and to learn from the challenges, mistakes, and successes of the past to lead us to a more healthful future. For my own part, I’ll try to keep learning from different perspectives and sharing in conversations about science with my students as well as people in my community—maybe once again over a drink, some food, and another book.

HIV release from immune cell. (Image credit: Bette Korber at Los Alamos National Laboratory / Public domain)

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