Hope in a Time of Fear: Lessons Learned from HIV/AIDS for COVID-19

By Perry A. Jansen, MD, MPH

Fear and denial. Inaction and over-reaction. Discrimination and solidarity. 

These polar reactions to Covid-19 are not new to the realm of pandemics.

In 1991, I began my family medicine residency at the epicenter of the HIV/AIDS pandemic, the Los Angeles area.  I vividly remember the hopelessness in the eyes of an emaciated young man in his twenties who was admitted with multiple infections and wasting syndrome. Fresh out of med school, I remember the helplessness I felt when dealing with a disease that was only partially understood and had no effective treatment.

Fast forward almost 10 years to 2000 and  I find myself living and working in the new epicenter of HIV/AIDS, Sub-Saharan Africa, the small country of Malawi, to be specific. 

Over two-thirds of my patients were coming to me with undiagnosed, advanced AIDS. Once again, I remember the hopelessness in their eyes and the helplessness in my heart.  In the intervening years, effective treatment had been developed thanks to passionate activism, focused philanthropy, and dedicated scientists. Referred to then as highly active antiretroviral therapy, these triple-therapy regimens, now referred to as ARVs, had dramatically reduced HIV-related deaths in the U.S. and other wealthy countries.  But no one could afford them in Malawi, and the health system could seemingly never cope with such a complex medical regimen. 

“Doesn’t anyone care that people are dying here?” I cried in desperation.

Fast forward again 10+ years and it’s a different story. People did care. Thanks again to social action, focused philanthropy, diligent science, and governmental action, these antiretroviral therapies were now not only available but free, in Malawi and throughout much of the globe. Lessons learned from developed countries were contextualized for Africa, and hopelessness seemed to be vanquished. In place of helplessness were field-tested solutions, tests, and therapies.  HIV+ people were being rescued from the edge of death, back to health, and fruitful life.

Here we are another decade later…another pandemic; this one seemingly on fast-forward, spreading at the speed of a commercial airliner.

Once again, we’re dealt a disease that is only partially understood and one for which there is currently no treatment, vaccine, or natural immunity.  The worst-case scenarios are frightening, especially when the solution calls for solidarity in a season of division, for global action where the natural response is too often nationalism and protectionism.

My heart is, and always will be, in Africa.  I shudder at the thought of the impact this COVID-19 might have in countries where 2/3 of the children are malnourished, where rates of HIV have fallen but are still too high, and health systems are struggling to provide even basic health services. 

Families pack into small shanty homes in overcrowded townships without access to safe water and sanitation.  Unprecedented numbers of displaced persons are living in squalid conditions that would be like dried kindling to a fire if, or when, COVID-19 arrives.  Living “hand-to-mouth”, much of the “majority world” cannot shelter in place as we do.  If they don’t work, they don’t eat.

But worst-case scenarios don’t take into account the power of the human spirit when motivated by love for neighbors, wherever in the world they may be.  It doesn’t take into account the power of solidarity and collective action, or the impact we all can have through acts of kindness and compassion.  Let us all be compelled to rapidly apply the best of the lessons we learned from HIV/AIDS and other epidemics.  The true legacy of COVID-19 will be written in how we, as a global community, come together to fight a common enemy.  

We are not powerless in this fight.

We can all contribute by following guidelines for protecting our selves and others from getting infected.  We can look for those people in our community who are vulnerable, to bless the healthcare workers, first responders, and everyone who helps keep our lives going.  We can smile from behind our masks, be kind to those who seem stressed, and give our time and treasure to those at the frontlines both here and abroad. Pray for our world, even for those we might normally consider our enemies.

Let us all accept the challenge to begin seeing more clearly how we are more alike than different, how we are better together, and how we are best when we are generous and motivated by love, not fear. 

Photograph by Hailey Sadler