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comparing the epidemics
2020-Dec-01, Tuesday 03:15 pmDecember 1st is World AIDS Day. It's a good time to reflect on our newest COVID-19 pandemic, seeking comparisons to the previous AIDS one. There's a lot of emotional baggage to unpack, so I apologize for the unusual length of this piece.
Throughout this year, I've been pondering how this disease compares to the previous one, both in terms of societal response and individual reaction. There are similarities. There are differences.
So what do these differences feel like? What do they mean within a household?
The rest of the world is learning to cope with the idea that they could unintentionally kill their loved one by transmission of a virus. It's a dark thought. Covid-19 is less complicated in human minds, though, because simple proximity can be responsible for sharing. Just breathing in the same air space is sufficient. You can equally infect family members or passing strangers that you never actually meet. AIDS is different. It is primarily intimacy that leads to contagion. (Also blood transfusion, needle sharing, or a few other means of exchanging bodily fluid.) With HIV, the intimacy is the risk, so the subjective emotional stress is much more problematic. It is specifically when you are trying to share a moment laced with emotion that you could potentially kill someone. That realization does weird things to intimacy. I much prefer the simple requirements of social distancing and masking during covid-19.
The rest of the world is learning to cope with the changing dynamics of safety requirements. How much distance, how many people per room, what kind of mask, etc. Recommendations vary depending on the prevalence of community transmission in the local community at the time. I remember having recurring discussions with Carl about what intimacy would look like in any given month. We were both prone to getting canker sores, and each recurrence meant no kissing for a while. Our sex life had to change frequently to ensure my safety. (It worked. I never seroconverted.) Again, it's weird that someone you care about could kill you. Don't underestimate what that truth does to your mental landscape. It's complicated, yet life persists and emotion endures.
The rest of the world is learning what this crisis will cost them financially. Medical care is especially ruinous in the USA, due to the "greed is good" wealth worship that informs our economic policies. In Texas during the late 1990s, I remember one especially poignant example. Gay men dying of AIDS needed hospice care. Having already exhausted their liquid assets, the only source of wealth some of them still had available was their home. At the time, Texas law did not allow a reverse mortgage for them. It was the Republican legislators who changed that law to make it permissible. At least one newspaper noted some of those legislators had investments in companies that would handle those reverse mortgages. They wouldn't lift a finger to help gay men dying of AIDS, but those ghouls were perfectly happy to lift the wallet from someone's back pocket as people fell into their graves. Earning a buck from a crisis is repulsive. The experience will repeat, and it remains vile to see.
The rest of the world is learning what this crisis will cost them emotionally. Much of my demographic (gay men born in the 1960s or earlier) is gone. It's missing. They died. Gay men my age or older in the USA are less common than they should be. This new epidemic is more varied in the casualties that it claims. The deepest cut of grief and change this time may occur among healthcare workers who simply aren't prepared for daily death and suffering at this scale and duration. Real life is simply not like M*A*S*H on television. We are not that well adjusted to persistent trauma.
HIV changed the world. Everyone learned from gay men (especially those in ACT UP) to stop whispering about their poor health, to stop acquiescing to professionals for choices of care, to stop accepting mediocrity from the government that we pay taxes to support. Everyone learned from us to take control of our treatments, to educate ourselves so we can make our own informed decisions, to demand better personal care from our doctors and nurses, and to demand better response from our medical institutions. No longer do people whisper with sad expression, "He has cancer"; now, the announcement is stated with determination, "He's taking chemo to fight his cancer!" Anthony Fauci responded to these demands on the USA bureaucracy and helped lead that reformation here.
SARS-CoV-2 also will change the world. We're still waiting to learn all of the ways that life will be different.
Throughout this year, I've been pondering how this disease compares to the previous one, both in terms of societal response and individual reaction. There are similarities. There are differences.
| Topic | HIV | SARS-CoV-2 |
| Total Deaths | 675,000 USA and 32 million globally have died of AIDS. | 228,000 USA and 1.2 million globally have died of COVID-19, as of 2020 November 01. |
| Mortality | HIV is 100% fatal. Untreated, it eventually kills. There is no cure. Well, technically, exactly 2 (but maybe 3) humans have ever been cured of HIV. | There is wide variability (from 0% to 28%) in national fatality rates, but it is currently estimated at 1.9% globally. |
| Vaccination | There is no vaccine. | There are several vaccines in progress, using several kinds of technology to produce them. |
| USA federal response | Famously, Ronald Reagan refused to acknowledge that AIDS even existed, for 3 whole years, while over 5,000 American citizens died without comment from the White House. There was even laughter at the topic. It's always amusing when only the right people die. | Donald Trump talks about COVID-19 frequently, but mostly just to claim that it will disappear, real soon now, honest. Trust me. Would I lie to you? Stop mentioning that over 250,000 Americans have already died. Fake news. |
| USA social denial | Many people died of AIDS that was never acknowledged as the cause. Coroners would limit their statements to the opportunistic disease that overwhelmed the patient, instead of naming HIV. One of these causes was sometimes Kaposi's Sarcoma, a kind of cancer. Lots of AIDS deaths are surely named as cancer because the truth was too unpalatable. Famously, Roy Cohn falls into this category of reframing, and he may have influenced Donald Trump. | Apparently taking the cue from Republican leadership, including the President and his former-favorite faux news, vast swaths of Americans deny that covid pandemic is real. Both nurses and doctors are trying to heal people who deny the danger even exists. It's equal parts baffling and infuriating. |
| Intentional Transmission | My ex-boyfriend (HIV-positive) and I (HIV-negative) had discussions about the weird mindset of people who joined "poz parties" where participants knew some people were HIV-positive and maybe joined the sex events specifically to gain or spread infection. Again, baffling and infuriating. | In an almost similar manner, conservative governments worldwide seem perfectly okay with aiming for "herd immunity", seeming not to comprehend (or just morally do not care) how many people will die unnecessarily with that approach. Ignoring danger makes you idiotic, not brave. Volunteering strangers for this sacrifice is corruption. |
| Dying and Corpses | Early on, both medical practitioners and funeral directors were known to refuse to handle bodies infected by HIV. It was because they despised what the bodies represented, as imagined within their own minds. It became clear fairly early that casual contact didn't spread the disease, but they refused to do their jobs. In response, a few rare businesses promised to perform their duty respectfully anyway. Remember, lesbians helped gay men here when others refused. | Due to overwhelming demand for services, authorities have temporarily left someone dead in their home, established temporary morgues to handle all of the bodies, and even hired prisoners to haul the many corpses. |
| USA social commemoration | The AIDS Quilt. So many lives remembered of people who were denied recognition, even while alive. I've visited a large portion of it once. At 48,000 panels, it's now too large to ever display in whole. This year, it went virtual. | Unclear. Instead of being concentrated within a specific community, the artistic response this time may be more universal and dispersed. |
So what do these differences feel like? What do they mean within a household?
The rest of the world is learning to cope with the idea that they could unintentionally kill their loved one by transmission of a virus. It's a dark thought. Covid-19 is less complicated in human minds, though, because simple proximity can be responsible for sharing. Just breathing in the same air space is sufficient. You can equally infect family members or passing strangers that you never actually meet. AIDS is different. It is primarily intimacy that leads to contagion. (Also blood transfusion, needle sharing, or a few other means of exchanging bodily fluid.) With HIV, the intimacy is the risk, so the subjective emotional stress is much more problematic. It is specifically when you are trying to share a moment laced with emotion that you could potentially kill someone. That realization does weird things to intimacy. I much prefer the simple requirements of social distancing and masking during covid-19.
The rest of the world is learning to cope with the changing dynamics of safety requirements. How much distance, how many people per room, what kind of mask, etc. Recommendations vary depending on the prevalence of community transmission in the local community at the time. I remember having recurring discussions with Carl about what intimacy would look like in any given month. We were both prone to getting canker sores, and each recurrence meant no kissing for a while. Our sex life had to change frequently to ensure my safety. (It worked. I never seroconverted.) Again, it's weird that someone you care about could kill you. Don't underestimate what that truth does to your mental landscape. It's complicated, yet life persists and emotion endures.
The rest of the world is learning what this crisis will cost them financially. Medical care is especially ruinous in the USA, due to the "greed is good" wealth worship that informs our economic policies. In Texas during the late 1990s, I remember one especially poignant example. Gay men dying of AIDS needed hospice care. Having already exhausted their liquid assets, the only source of wealth some of them still had available was their home. At the time, Texas law did not allow a reverse mortgage for them. It was the Republican legislators who changed that law to make it permissible. At least one newspaper noted some of those legislators had investments in companies that would handle those reverse mortgages. They wouldn't lift a finger to help gay men dying of AIDS, but those ghouls were perfectly happy to lift the wallet from someone's back pocket as people fell into their graves. Earning a buck from a crisis is repulsive. The experience will repeat, and it remains vile to see.
The rest of the world is learning what this crisis will cost them emotionally. Much of my demographic (gay men born in the 1960s or earlier) is gone. It's missing. They died. Gay men my age or older in the USA are less common than they should be. This new epidemic is more varied in the casualties that it claims. The deepest cut of grief and change this time may occur among healthcare workers who simply aren't prepared for daily death and suffering at this scale and duration. Real life is simply not like M*A*S*H on television. We are not that well adjusted to persistent trauma.HIV changed the world. Everyone learned from gay men (especially those in ACT UP) to stop whispering about their poor health, to stop acquiescing to professionals for choices of care, to stop accepting mediocrity from the government that we pay taxes to support. Everyone learned from us to take control of our treatments, to educate ourselves so we can make our own informed decisions, to demand better personal care from our doctors and nurses, and to demand better response from our medical institutions. No longer do people whisper with sad expression, "He has cancer"; now, the announcement is stated with determination, "He's taking chemo to fight his cancer!" Anthony Fauci responded to these demands on the USA bureaucracy and helped lead that reformation here.
SARS-CoV-2 also will change the world. We're still waiting to learn all of the ways that life will be different.