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HIV experts provide lessons for mitigating COVID


For COVID-19, federal officials seem to have adopted a refrain.


UNIDENTIFIED PERSON #1: We have the tools.

UNIDENTIFIED PERSON #2: We have the tools and protocols...

UNIDENTIFIED PERSON #3: Do we have the tools we need...

UNIDENTIFIED PERSON #4: We have the tools.

FADEL: Three years ago, before COVID-19 even began, officials in the Trump administration said the same thing about the HIV epidemic.


ALEX AZAR: We have the tools. This is an historic opportunity.

FADEL: That is the former health and human services secretary Alex Azar speaking with NPR in 2019. But those who've worked on HIV for decades say to stop a pandemic, it's not enough to have the tools. NPR's Selena Simmons-Duffin reports.

SELENA SIMMONS-DUFFIN, BYLINE: Stephanie Brooks-Wiggins is 76 years old. She lives in Baltimore. She was diagnosed with HIV in 1986. Back then, there were no tools to help her.

STEPHANIE BROOKS-WIGGINS: There was no treatment. There were no drugs. You would go to the clinic, and the psychiatrist would talk to you to keep you from going off the deep end.

SIMMONS-DUFFIN: Over the decades, scientists developed many HIV treatments. And they got better and easier to take, she says. But HIV has not ended in the U.S. as these tools became available. A stubbornly high number, more than 30,000 people, are diagnosed with HIV every year. Only 25% of people who might be eligible actually take a preventive pill called PrEP. And even with accurate and at-home options for testing, over 150,000 people in the U.S. are HIV positive but don't know it.

ADAORA ADIMORA: Scientific discoveries are a necessary but not sufficient factor to completely eradicate disease.

SIMMONS-DUFFIN: That's Dr. Adaora Adimora, a physician and professor at the University of North Carolina at Chapel Hill. She first started treating people with HIV in the 1980s. She says the tools to combat HIV have come a long way. There are now topical gels and easy-to-take pills and even injections.

ADIMORA: I don't know that I ever greeted any of these new advances saying, this is the thing that's going to end HIV.

SIMMONS-DUFFIN: That's because she's seen the barriers to access and implementation, she says, barriers like the high cost of prescription drugs and the maddening patchwork health care system. The barriers to COVID's tools, like tests and vaccines and therapeutics, have been different.

But A. Toni Young says there are parallels and common mistakes. She lives in West Virginia and runs the Community Education Group, which does public health outreach.

A TONI YOUNG: We keep doing the same thing over and over and over again, saying, it's over there, why don't you go get it?

SIMMONS-DUFFIN: That attitude hasn't worked to fight HIV or COVID, Young says. It doesn't work for people who don't have access to health care, who don't trust the medical system or who don't think they're at risk. As she sees it, when it comes to the COVID-19 pandemic, the country has missed out on the chance to make the most of the vaccine by failing to understand and work with people in all their complexity.

YOUNG: It was an all-or-nothing approach. You're either with me on this vaccine, or you're not. You're either on my side, or you're my enemy when it comes to the vaccine. You're either a vaccine denier, or you're a vaccine getter. And there is a whole lot of room between those two.

SIMMONS-DUFFIN: The frame of us versus them is implicit in a lot of the rhetoric these days about getting back to normal. It's in terms like pandemic of the unvaccinated and telling people they've done the right thing by getting vaccinated and should therefore have special privileges, like not being punished with things like indoor masking and testing requirements.

That way of talking about public health, says Steven Thrasher, creates the conditions for pandemics to last longer. Thrasher is a professor of journalism at Northwestern and author of the forthcoming book "The Viral Underclass." With HIV in the mid-1990s, when treatments became much more effective...

STEVEN THRASHER: People who got access to the drugs began to pull away and take their political capital and go home because they didn't need to be in the fight anymore. And the virus continued to pool in what I call a viral underclass in the United States.

SIMMONS-DUFFIN: This was a sad and lethal mistake in the fight against HIV, he says. And now it's happening again. The lack of political will in Congress to pass more COVID-19 funding is a perfect example, he says. And those still at particular risk are those who are warehoused away, out of sight.

THRASHER: People who are in nursing homes as elderly people or who are in convalescent centers as disabled people, and, of course, people who are incarcerated - they're already out of public view, and people are not listening to them.

SIMMONS-DUFFIN: Those settings can act as epidemic engines, he explains. People visit their loved ones in these places. Staff come and go back into the community. And so the pandemic drags on, and lives are needlessly lost. He is disappointed that policymakers seem to be centering the people who have the most access to tools to protect themselves, not the least.

THRASHER: I really hoped that that would be different this time.

SIMMONS-DUFFIN: This is not to say no one is trying to get the available tools out to people who don't have as much power and access. A. Toni Young in West Virginia has one idea for how to do it.

YOUNG: We want to hit people in the face with the COVID vaccination because we're in the middle of the pandemic. But maybe I got to slow walk you to that COVID vaccination.

SIMMONS-DUFFIN: Here's how that might go.

YOUNG: If you got five kids and y'all are hungry, you need to figure out where you're getting your food from. You don't care about my vaccine. Let me help you. What do you need from me? If I can get you the food that you need, when we do the follow up - hey, did the food voucher work out for you? Great. Can we talk to you now about - again - about the COVID vaccine?

SIMMONS-DUFFIN: Her organization has a $3.5 million cooperative agreement with CDC to use this approach to vaccinate people against COVID-19 and influenza in West Virginia. Young hopes CDC will continue funding this for three years so they can expand. She also hopes to spread one of the lessons from HIV - that people and their relationship to health is complicated, and the public health response needs to be ready to meet them where they are.

Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF THE ACORN'S "RETURN TO BLACKNESS (FOR GB)") Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.