The Viral Underclass: COVID-19 and AIDS Show What Happens When Inequality and Disease Collide

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As the Omicron version of the coronavirus captures headlines around the world, December 1 also marks World AIDS Day whose motto is ‘End inequalities. End AIDS. End Pandemics.’

Although news reports are not making the connection between the two viral-driven pandemics – AIDS and COVID-19 – people who make a living trying to control them are, and their positon is this: Either control AIDS in Africa or risk a never-ending COVID-19 pandemic.

On Monday it was put this way by the Joint United Nations Program on HIV/AIDS (UNAIDS:): “if the transformative measures needed to end AIDS are not taken, the world will also stay trapped in the COVID-19 crisis and remain dangerously unprepared for the pandemics to come.” (Their emphases.)

A Nature paper that came out today backs up UNAIDS and explains that the fundamental issue is prolonged infection by the coronavirus: the longer it stays in you the more it replicates; the more it replicates the more it mutates; and the more it mutates the greater the chance of coming up with a more threatening variant than Delta – one that is more contagious, more severe, and more likely to evade the COVID-19 vaccines – the very concerns we have about Omicron.

This is where AIDS patients come in. Because of their weakened immune systems they can be infected with the coronavirus for several weeks or months versus the two weeks or so it takes to clear an infection in a healthy person, thus giving the coronavirus every opportunity to evolve a more dangerous variant.

It’s also a numbers game. Sub-Saharan Africa is home to two out of every three people living with HIV worldwide. And 8 million people with HIV in sub-Saharan Africa (around 21% of the 37.7 million people affected worldwide) are not receiving antiretroviral therapy.

What’s more, the COVID-19 pandemic is decimating HIV treatment and prevention programs. For instance, a UNICEF report that came out this week says over 300,000 children were newly infected with HIV in 2020 – one child every two minutes – and about half of those kids didn’t receive any treatment.

Yet despite Africa’s worsening situation we’ve deserted them. Canada has fully vaccinated 76% of its population, the US 60% – and Africa a mere 7%.

Can we even begin to imagine the mess we’d be in if only 7% of the people in Canada and the US were vaccinated?

We did this to Africa once before near the beginning of the AIDS crisis. As Professor Steven Thrasher, PhD, of Northwestern University, explained in Scientific American today:

In some ways … disparities speak to how the Global South has borne the brunt of AIDS deaths. The U.S. got access to antiretroviral drugs in 1996, and its rate of AIDS deaths immediately plummeted. . . . Yet the same drugs did not begin to be rolled out on the African continent until 2003, by which time HIV had created countless orphans and needlessly infected millions of people.

And here we are again. But with a different virus, one that moves faster between people and mutates more quickly than HIV. With the upshot that, according to the Nature paper, we’re giving the coronavirus in Africa every possible opportunity to evolve a more dangerous variant, as Omicron well portends.

To be clear, it’s not Africa that’s at fault here. Vaccine developers Pfizer, Moderna, and Johnson & Johnson are all US companies and they’re not sharing their vaccines (Chelsea Clinton weighs in) with poor nations, notably Africa.

Prof. Thrasher has a book coming out, tellingly titled The Viral Underclass: The Human Toll When Inequality and Disease Collide. In an interview this morning on Democracy Now he said explicitly who’s responsible for the continuing collision of COVID-19 and AIDS: “We have the vaccines, we have medications that are very effective, and they’re again being held from the Global South to protect the profits of pharmaceutical corporations.

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