An international crisis in health: Reflecting on responses to the HIV and COVID pandemics

WITH THE INTERNATIONAL RULES BASED ORDER in disarray today and as parameters of governance are undermined across the world, the crisis in health is looming large. Having been through two major pandemics in the recent past - HIV and Covid - it is now instructive for health activists to reflect and understand  what the future holds for us.  

The responses to the two epidemics have been very different in terms of the role of the affected communities and whether they were objects or subjects in the response, and the role of the State and the pharmaceutical (pharma) companies in making the treatment available and accessible. 

HIV: From an isolationist to an integrationist response

In 1981 when HIV hit the world, it was an unknown ailment, wreaking havoc to the lives of the affected, first in the US and then all over the world. It was a “disease of the wretched of earth” first affecting gay men (initially in the US), and later sex workers, and drug users, all marginalized and stigmatised groups of the population. Because of those initially affected, the response was based on prejudice and therefore very negative towards the affected populations. It was what I termed as the ‘isolationist’ response - testing for HIV was often done without consent, confidentiality of the person reporting positive was regularly breached and then they were isolated. Statutes around the world were based on that. The Goa Public Health (Amendment) Act and the Bombay High Court’s decision in Lucy R. D’Souza v. State of Goa (1989) precisely dealt with these issues. 

In that period the gay movement in the US developed the ‘buddy system’ for HIV affected persons to help each other during the often lonely final days of this fatal disease. People living with HIV who had been disassociated from the family and even with their loved ones were given succour in their lonely road to death. 

Communities’ involvement based on scientific studies

Based on validated scientific and rights-based strategies, rights of the communities - gay men, sex workers, and drug users, who are most vulnerable to HIV, were respected, protected and advanced, preventing the further transmission of HIV. Most importantly these communities were actively involved in the decision-making processes. ‘Nothing about us without us’ became the slogan of the movement as the communities came to the forefront of the fight against the HIV pandemic.

Harm reduction was the tool that was deployed to involve the communities. The idea was to use tools which would prevent the transmission of HIV, the key goal, without casting aspersions or prejudice upon the affected communities. Sex workers and gay men were trained to negotiate the use of condoms with their clients and partners. Injecting drug users were urged to exchange used syringe needles. Eventually, because the affected communities were empowered and actively involved in the global fight against the HIV pandemic, the disease’s prevalence was brought down internationally.