COVID-19 and HIV Are Not the Same. But They’re Similar in Many Ways That Matter.

Since the COVID-19 pandemic first crept up on us in the early months of 2020, two opposing tensions have been alive both on the pages of the internet and inside my own heart. On one side, in the search for some framework from which to understand what my therapist calls “these strange times,” many have looked to the AIDS epidemic for lessons, for some kind of guidance on how we get through a time of mass death, hysteria, and fear. On the other side, because of the peculiar beast that the AIDS epidemic was, there’s an instinct to keep it like a cabinet curio, behind plate glass, and to leave it undisturbed.

These two tensions came to a head on Twitter on March 23 when ACT UP New York shared side-by-side images of the infamous early-AIDS-era David Wojnarowicz denim jacket with the words, “If I die of AIDS, forget burial, just drop my body on the steps of the FDA,” with a new image: a meme of a cloth mask with a pink background with the words, “If I die of COVID-19, forget burial, drop my body on the steps of Mar-a-Lago.”

Since the image first made its way online, hundreds of accounts have lambasted ACT UP New York for the comparison, for various reasons. Some have said that using Mar-a-Lago to stand in for the entire federal government pins a systemic problem too squarely on Trump and is ultimately counterproductive. Others feel that it is disrespectful to Wojnarowicz, people with HIV, and the history of the AIDS epidemic to compare the two. In fact, every time the COVID-19 and AIDS comparison comes up, similar arguments follow behind: COVID-19 is not specifically affecting queers the way that AIDS did. Nor is it a stigmatized illness that has led people to be disowned from their families, or for people to not be allowed to share forks or knives at dinner. It is not a virus that is closely linked to a stigmatized group or set of stigmatized groups, as HIV was in its early days.

Since that first image, ACT UP New York has doubled down and released a second image on Instagram, an update on the famous Silence = Death Gran Fury image of a pink triangle on a stark black background. This time, nodding to Trump, the background is still black, but the triangle is orange, and the words say: “Trump = Death.”

That image, too, has earned the veteran activist group its detractors, especially for those who feel that harping on Trump misses the original beat of ACT UP’s own drum: that structural change is needed now. But the more the internet roared against ACT UP New York and the more I checked in with those I love, both inside and outside the group, I saw the need for the comparison, both of the images and of the epidemics.

Before I go into the comparisons, I want to acknowledge first that I recognize that these viruses are different scientifically: HIV and COVID-19 have little in common as to how they are transmitted and how they affect the human body on the inside. But, in the way that they affect the body politic, the citizenry, they have dusted up many of society’s worst impulses: the need to blame, to criminalize, to lock each other up. And it is in these comparisons where we can look to what we know from the AIDS epidemic as guidance.

COVID-19 and HIV Both Affect Those Who Are Most Marginalized

From the beginning of the AIDS epidemic, there was the notion that HIV affected groups known as “the 4H club”: homosexuals, Haitians, heroin users, and hemophiliacs. Let’s extend that larger and just say: queer and trans people, Black people (and other people of color), people who use drugs, and people with disabilities. That covers most of the groups that are still susceptible to HIV today, and it is for a good reason: Bodily health has very little to do with our own bodies. Bodily health is most often not a product of individual choices, and it is often out of our own hands. If you tell me what zip code you were born in, I could tell you what illnesses you are most at risk for.

While images of the early AIDS crisis often focus on white gay men, the truth is that a much wider swath of people were affected by, responded to, died in, and survived the epidemic. And when you look at who is still being diagnosed and who is still dying from AIDS now, the people for whom the epidemic is still alive, it is Black and Brown trans people and queer people. For these communities, AIDS is not a cabinet curio behind plate glass; we’re still living through it. Adam Geary opens his book, Anti-Black Racism and the AIDS Epidemic with the sentence, "The color of AIDS in America is Black." So, too, we are beginning to see, is the color of COVID-19.

While New York continues to garner headlines as the epicenter of the United States–based epidemic, there’s another state that is being overwhelmed by COVID-19 and whose infrastructure is even less able to respond: Louisiana. While New York has the highest number of cases, it’s important to look at Louisiana and how it is disproportionately being impacted by the virus because of its lack of access to medical care and medical equity. In 2017, the Commonwealth Fund ranked Louisiana’s health care 49th out of the 50 states and Washington, D.C. By the end of March, the number of fatalities per capita from COVID-19 in Louisiana rivaled that in New York. On Thursday, April 2, the state recorded 2,726 new cases of the virus, a record rise of 42% from the day before. As of right now, New Orleans is on track to run out of hospital beds by Easter and ventilators by April 9.

This story has much in common with the story of HIV in Louisiana. The state has the fourth highest rate of new infections in the country. Two of its biggest cities—Baton Rouge and New Orleans—rank in the top 10 (fourth and sixth, respectively) for their rates of new HIV diagnoses nationally.

And it's not just Louisiana. Despite comprising only 29% of Chicago's population, Black people account for 70% of its COVID-related deaths. In Milwaukee, where Black people make up 26% of the population, Black residents comprise half of the city's cases and 81% of its deaths.

While others might see the AIDS epidemic as an epidemic that happened and has since ended, and the coronavirus as one that is now happening and will one day end, remember Louisiana, a state that is still dealing with them simultaneously, alongside racist policies like mass incarceration and the realities of poverty and climate change, both of which affect Americans across racial lines.

Personal Responsibility

I’ve already spoken about the peculiar American philosophy behind health. But let’s return to it. In America, many people believe that whatever happens to you, health-wise, is your own fault. That’s why we don’t have universal health care and why people believe that we should pay out the wazoo just to keep our human bodies running.

That is not the case. Much of our response to any virus stems from fear. Viruses expose our own mortality to us. Most of the time, many of us can keep our own mortality at bay, but that’s not the case during an epidemic. The AIDS epidemic was a lesson for many queer people, trans people, and people of color that still sticks in our psyches to this day: that, at any moment, our sexuality could lead us to perhaps get sick and die. When I came out as gay to my family, I was told not to get AIDS. At the time, I didn’t know that my father was living with HIV: all because had struggled with a drug addiction since he was as young as 13 years old.

Now, in the time of COVID-19, I see many people online shaming others who go outside, who see loved ones. As a gay man, I see lot of gay men shaming others not just for wanting to hook up, but also for being on Grindr. Let me be clear: None of these are good personal or public health practices. I would caution anyone from going outside for a non-essential reason and would encourage people to find ways to explore a healthy sexuality during this time: phone sex, camera sex, masturbation. Whatever floats your boat.

At this time, I continually see myself looking to my AIDS heroes for guidance. One, journalist Steven Thrasher, recently wrote on Twitter about how shaming is not a useful public health tactic. While these people may not be practicing great public health, it’s just as important to know that we are all going through a time of great trauma, and people are coping the best they can.

If we can look again to the AIDS epidemic for a lesson, it should be that shame is not an effective public health intervention. Shaming gay people for their sexuality didn’t work. People had sex (without protection!) during an epidemic because they needed to feel close to other people at a time when our futures were uncertain. Once again, I am not condoning hooking up right now. But one thing I’ve learned in therapy is that other people’s actions are out of your hands. What you can control is how you react. I hope we can react with less shame.

Another lesson from AIDS came from my friend Jeremiah Johnson, the HIV project director at Treatment Action Group, an organization born from ACT UP. In a recent Facebook status, he wrote a useful checklist for an order of targets for directing anger in an epidemic, from which I’ll quote here:

1. The virus itself

2. The politicians, systems, and social structures that inhibit our ability to effectively respond to the virus

3. The lack of effective tools to stop the virus

4. Individual behaviors that contribute to the spread of the virus

Too often, I feel we inverse this list—overly focusing on human behavior because that is the one target over which we believe we have the most control—inadvertently forgetting to hold our political leadership accountable for broken health care systems and/or ineffective responses to the epidemic—and forgetting that the main villain in the story is the virus itself.

COVID Is Being Criminalized

America not only blames people for acquiring illness, they also love to place blame on people who are already ill for getting other people sick. In the land of mass incarceration, illness is akin to a weapon. Despite the realities of pre-exposure prophylaxis (PrEP), treatment as prevention, and other scientific advancements, several dozen states still criminalize people living with HIV for doing things that don’t transmit HIV, like spitting. Other states don’t have HIV-specific statutes, but will enhance criminal sentences if the person convicted is living with HIV.

There are already reports in America and in other countries of people being arrested and jailed for “intentionally” spreading coronavirus. In the United States, they could face criminal charges under federal anti-terrorism laws. A sick person is not a terrorist.

HIV criminalization laws are bad public health. They represent our worst fears and ideologies sanctioned by the state. They are a means to control marginalized people—and these new ways to criminalize COVID will be used the same way. As we already know from the little data we have, Black communities are once again being ravaged by this health crisis. This will no doubt be used as an excuse to over-police communities of color, whether it be for sneezing, being unable to pay rent, or going to the supermarket.

Intimacy

Humans are social creatures. We need each other to live. Our connections with other people—familial, romantic, friendly, sexual—sustain us. AIDS upended people’s sexual networks, either through people dying, people feeling shame about their sexuality, or people abstaining from sex for fear of dying. This fear birthed texts like How to Have Sex in an Epidemic, one of the first texts to frankly discuss how gay men could have sex with one another and live.

We live in a very different media landscape. In the time since the onset of COVID-19 and the reality of social isolation, I’ve seen a lot of helpful journalism about what it will mean to feel intimate with others, and keep our sanity, in a time when we are being told to keep our distance from one another. People have written about digital sex parties, how to have intimacy in a time of distance, and how to masturbate when you don’t have the privilege of a locked door.

We are all re-learning how to keep sex alive, and we are leaning on each other for lessons. We must stay six feet away at the very moment when we need to fuck the pain away.

Our Government Is a Fucking Disaster

As you get by now, all illness is structural. One of the most-repeated lines about the governmental response to HIV is that it went beyond apathy into cruelty. The Reagan administration laughed at the deaths amassed during the AIDS epidemic. There is no leaked audio of Trump laughing at this epidemic, but there is ample proof that the president has no qualms about letting poor Americans die so that big businesses can survive. Many families can no longer afford rent and groceries. The government has responded with a $1,200 check that, while it is something, may not arrive until September for some and won’t be enough to cover rent and basic needs for many.

And because we live in a country that believes in personal responsibility, people are already being saddled with massive medical bills simply for contracting COVID-19 and being treated. As Bernie Sanders often says, we live in a country that believes in socialism for the rich (a coronavirus stimulus bill that bails out companies) and rugged individualism for the poor (bills for being cared for during the COVID pandemic).

ACT UP Is Still Responding

In the minds of many, ACT UP probably disbanded once the heyday of the (mainstream, white) AIDS epidemic subsided. That is not the case. A friend and fellow ACT UP member, Andy Velez, who died in 2019, always used to say that once you’re in ACT UP, you’re always in ACT UP. No one “leaves.” I still get ACT UP emails and can tell you: Much of the infrastructure of the COVID activist response comes from networks that exist because of the health and queer activism born from the AIDS epidemic.

So many of my friends who are part of the ongoing collective response to AIDS are once again being called to fight, against COVID, because they see the common strands. We are facing a virus for which there is not yet effective treatment. It is causing people to point blame at one another. We are frightened to be intimate. The cracks in our terrible health care system are showing. Rather than seeing COVID and AIDS as separate epidemics, many are seeing COVID as a sort of sequel, proving that the Avengers-style fight against a terrible health care system is not over.

Shortly after the initial online drama against the ACT UP meme broke out, I subtweeted those who were attempting to call out ACT UP New York. “Here's a stray observation,” I wrote. “While white queers were arguing about the optics of an ACT UP meme, I've seen COVID take at least four QPOC [queer people of color] lives in the last week. Everything old is new again.” The sentiment behind the tweet was true: Much like HIV, COVID is going to affect those in our society who are most marginalized, which still means queer people.

The whole fiasco turned me off in many ways. Rather than extending compassion or focusing on those who are dying, people chose to tweet cheap dunks at an activist group who was working to fix the problem. In talking with a friend, he reminded me of the art poster, “Your Nostalgia Is Killing Me,” created by artists Vincent Chevalier and Ian Bradley-Perrin in 2013.

In an interview, Bradley-Perrin says that the poster is a reaction to nostalgia around AIDS (what I’ve called the “cabinet curio” scenario, where AIDS history is canonized, untouchable, almost sterile) and the “role [nostalgia] has played in overwriting the realities of the period with visual cues of comfort and community.”

He adds, “When we think about the ’80s and the ’90s and we talk about the ashes action and the public funerals, and we uproot them from their historical specificity—when we say things are different for us now—we are not thinking about the ways in which criminalization is exacting a ‘death’ on poz people today.”

I understand and empathize with people for whom the comparison between pandemics feels farfetched or, on a personal level, disrespectful. Each of us, especially queer people, people of color and those, like me, at that intersection, have an intensely personal relationship to the AIDS epidemic. Each of our traumas around it is as individual as our fingerprints. The comparisons drawn between it and the COVID pandemic may not be perfect, but I can't let the perfect be the enemy of the good. And I do think that talking about the failings of our health system, blatant disregard for human life and what emotions those comparions dust up inside us all fall under good.

Compared to the length of human history, our time spent indoors isolated from one another will be a speck. But this will loom large on our collective psyches. Everyone will remember what it was like to feel helpless, scared, lonely, and cut off. We will attend funerals, memorials, many of them digital, and learn new lessons in grief. We will have a shared sense of trauma; we’ll need each other to recover. The lessons we learn from this will be useful. Here’s to hoping we don’t put them on a shelf.