The human immunodeficiency virus warned us not to have unsafe sex. The novel coronavirus merely asks us not to have unwashed hands. But condom use is still not universal even though there were still 1.1 million AIDS-related deaths in 2018, 20 years after its peak. India has been ordered into a 21-day lockdown because on our own we were incapable of following the simple precaution of hand-washing and its follow-on, social distancing – the only way to rein in a catastrophe that’s running amok across the globe. Today’s is a bigger need. Unlike HIV, SARS-CoV-2 infection isn’t limited to sexual partners (and, sadly, their unborn offspring). The hapless bystander gets shot. Like that dreaded bell, it will take a toll on all of us.
Is there any less grim comparison? Well, at an individual level, Covid-19, the illness caused by SARS-CoV-2, will inflict less of the long-term traumas once suffered by HIV+ persons. From the little we know, this new mutation will not trigger those debilitating opportunistic infections of full-blown AIDS. The social stigma smeared on the HIV-afflicted were as destructive, and one hopes that early community sensitising will temper the anguish faced by Mumbai’s first Covid-19 case, his family and even their part-time help.
But the economic impact is staggering. Ironically so because those most susceptible to today’s virus are the elderly, not HIV’s reproductive age group which was also the most productive age group. Covid-19’s voracious appetite is knocking down an economy already on its knees. Yesterday’s hastily upped relief package of Rs 1.7 lakh crore is a small indication of the hit which will be taken by the economically most vulnerable.
Because this virus is so individually and nationally destructive, because as a people we physically can’t or irresponsibly won’t take the essential precautions, and because our rickety health network will collapse under the sheer weight of numbers, it’s worth learning what helped cage India’s HIV-AIDS. It isn’t a far-fetched comparison. While we were spared the devastating epidemic of Africa, it had gone beyond high-risk-behaviour categories.
Stigmatised sex workers dropped out of surveillance when they went underground and continued spreading infection; the kin of the Govandi woman who succumbed to Covid-19 are now untraceable. HIV-AIDS reached the tertiary stage – migrant workers/ truckers infected their wives who, in 33% cases, transmitted it to foetuses – because in the early controllable years we sanctimoniously dismissed it as ‘only a disease of the decadent West’. This time too we’ve been focussing on ‘travel history’ when the larger community has already been infected.
Five sparks emerged from the gloom of AIDS, and these could light our way out of Covid-19. These were foolproof testing, safe hospital practices, the cleaning up of blood supply, behavioural change and the empowerment of sex workers who, caught between life and livelihood, finally took control of their own destiny. Let’s see how each of these applies to our real and present danger.
One, testing is the primary weapon for those tasked with Covid-19 control. The lesson from AIDS is that there must be enough, and they must be reliable. False positives and false negatives were the bane of HIV’s frontline ELISA test. ICMR recently called for price quotes for 10 lakh more kits, and coopted 100 government labs plus 30 private ones. Their long footprint is not enough to keep up with the epidemic’s galloping pace.
Two, the terror of contracting HIV-AIDS forced hospital staff to treat every patient as a potential carrier of the virus. Self-preservation more than mandate led to proper disinfection, disposables and disposal protocols which were earlier heeded most cavalierly. The loose nuts and bolts have to be again tightened before the inevitable onslaught on hospitals.War-footing is needed going by the embattled condition of quarantine centres.
As for the lay precaution of washing hands, let me digress to Atul Gawande’s 2007 book, Better: A Surgeon’s Notes on Performance. The very first chapter deals with the difficulty of implementing correct hand hygiene in his prestigious Boston hospital. In the slim margin between good and perfect, ‘lives are lost’. We are correctly making a big deal of this frontline barrier to infection, but think about the millions without easy access to soap and water.
Third, safe blood-bank supply was the most quantifiable success of India’s AIDS control, and this cleanup continues to save lives generally. Blood from compromised donors was one way of the four ways of contracting HIV. It’s not as major a factor in Covid-19 control, but the lesson teaches us to ensure that the sick don’t get sicker thanks to something meant to make them better. Apparatus is in the hands of professionals, and therefore easier to sanitise than changing mulish human behaviour.
Which brings us to Factor 4. The new virus’s trusted accomplice is our determined resistance to personal hygiene and civic responsibility. Unlike with HIV, today’s high-risk behaviour is not confined to 3-4 groups, it’s a national trait. How do we sensitise an entire country to safe sneezing? In our ‘what goes of your father’ self-centredness, how can we load the prevention-bullet of hand hygiene, respiratory etiquette and physical distancing unless there’s a forced lockdown?
The answer lies in AIDS lesson 5, empowerment. Each of us today is in the 1990s predicament of sex workers, HIV’s worst victims. Individually and collectively we must ensure safe behaviour, and have the courage to call out anyone refusing to comply. Knowledge is our enabler. So, official strategy too must boost the proven strategy of information, communication, education. ICE, regularly and correctly applied, works as effectively for national afflictions.
DISCLAIMER : Views expressed above are the author’s own.