The Perfect Enemy | Contributor: On World AIDS Day: Lessons Drawn From HIV, MPOX, and COVID-19
February 8, 2023

Contributor: On World AIDS Day: Lessons Drawn From HIV, MPOX, and COVID-19

Contributor: On World AIDS Day: Lessons Drawn From HIV, MPOX, and COVID-19  AJMC.com Managed Markets Network

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I’m an almost 60-year-old gay man, who came out in 1981 and knows no adult life without AIDS. I’m also an infectious disease scientist, making my relationship to viral diseases like HIV, and more recently, MPOX (aka monkeypox) and COVID-19, complex and multifaceted. My personal experiences as a young gay men man in New York City, depicted with emotional intensity in the most recent American Horror Story, have filled me with excitement and nostalgia, as well as dread, retraumatizing me—in great part because the character of Adam was living a life at that time very much like mine. These same experiences also have shaped my professional career, which has focused on preventing diseases by viewing humans as people who engage in health behaviors often directed by desire and shaped by social and economic conditions, as well as their emotional lives.

Serving as dean of a leading school of public health that has been on the frontlines of the COVID-19 pandemic, I have witnessed the injustice and inequity experienced by marginalized populations, whose life conditions catalyzed the acquisition of COVID-19 and who could not access care or vaccines as readily as those with power and privilege. Case in point: LGBTQ people of color were twice as likely as White non-LGBTQ people to test positive for COVID-19. I’ve also had the unfortunate experiences of witnessing way too many deaths of my young gay male friends and partners over the last 4 decades to AIDS-defining illnesses. This year, my ire was heightened when the federal government was ill prepared to address the MPOX outbreak in a timely and equitable manner. The response to MPOX once again made many gay men feel cast aside, particularly gay men of color, who continue to be unduly burdened.

All of this could make me feel disheartened, jaded, and distrustful; however, unlike recent data detailing ongoing misinformation surrounding the COVID-19 pandemic—I know all too well that the power bestowed by science is our only way out of these population health challenges and ones bound to emerge in the near future.

You see, science is power if it is harnessed. But obstacles obscure science for too many Americans. Here’s why…

The managements of HIV, COVID-19, and other pandemics have too heavily relied on the biomedical understanding of health rather than the array of social, structural, psychological, and behavioral factors intertwined with the biomedical that perpetuate disease. Medical professionals, most well intentioned, assume that prescribing, vaccinating, and giving directions is all their patients need. But their patients are human beings with complex lives, thoughts, and emotions requiring that biomedical practices be coupled with motivation, compassion, empathy, and a reckoning of people’s life conditions.

No one wants to become infected with any pathogens. The logic of science leads to our power to combat viruses, but the illogic of humans and the social institutions we create and oversee—whether they be political entities or inequitable health care systems—create pandemics. My own recent and mild COVID-19 infection illustrates this.

In Fall 2022, despite my 5 vaccinations for COVID-19, I acquired the infection once again. I certainly was not happy when I started feeling sick and my antigen test was positive. But here’s the thing: I was infected with COVID-19 in March of 2020. At that time, prior to any real scientific advances, my body was fatigued, my muscles ached, my fever spiked to 100.4°F, the back of my head was painful, and my throat felt like there were razor blades in it. I was incapacitated for a week, and for 2 months my taste was eradicated. I was sick, but not sick enough to go to the hospital. I did not know if this was all due to infection with SARS-CoV-2, but I assumed so (with an antibody test that May providing confirmation). This time, in October 2022, I was slightly congested, and while this was a nuisance, the fact of the matter was that the vaccines that I have taken provided protection for me and for those around me from getting extremely sick. The tests that I had handy, thanks to the Biden administration, would confirm a diagnosis in a few minutes and direct me to isolate to protect the health of others.

Humans make bad health decisions based on emotion, what feels good, and at the urging of their peers. How else could you explain why people continue to smoke cigarettes, use meth, overeat, reject vaccinations, and/or choose to hold overcrowded holiday gatherings while a virus mutates and percolates? This is a reality that we all witness in ourselves and others. Yet in trying to curtail viruses, we continue to operate from a framework that is too dependent on good sense and sensibility, which believes that human beings are logical and will fully follow the directions of health professionals.

The pandemics and outbreaks since 1918 evidence the great strides made in microbiology and the management and treatment of infectious disease. Still, very limited strides have been made in understanding and managing health behavior and the public’s health.

But consider this: Gay men approached MPOX somewhat differently, guided by generations of AIDS-related trauma, fear of disfigurement, high levels of motivation to not become infected, and a responsibility toward our community, coupled with a respect for science. In turn, MPOX was controlled. There are lessons to be learned here.

So, what’s the parable? Viruses and other pathogens will emerge in our global society. Microbiology will respond in time to manage these outbreaks. We in public health and health care must in tandem manage the humans with whom we work, appealing to the whole person and uplift the psychological, psychosocial, social, and structural factors that drive people to create pandemics.

Perry N. Halkitis is dean, Hunterdon Professor of Public Health and Health Equity, and distinguished professor of biostatistics and epidemiology at the Rutgers School of Public Health.