By World AIDS Day, this gap has grown. Nearly 800,000 people are known to have died of COVID-19. If current trends continue—and they don’t have to—hundreds of thousands of people could die of COVID in the U.S. in 2022, while perhaps 15,000 people living with HIV may die next year of any cause.
These dire numbers are worth comparing and considering, with a few caveats.
First, judging deaths in bulk numbers flattens what is actually happening. It is hard to do justice to the more than 100,000 people in the U.S who died by drug overdose last year (a 30 percent increase from the previous year) and the hundreds of thousands who have died from HIV and SARS-CoV-2. Every person who has died in these pandemics is worthy of being known as they lived and loved in their time on this earth.
Also, we will never truly know precisely how many people have died of AIDS or from COVID.
And yet, this milestone is important in its scale. I have known so many people for decades who have lost and mourned loved ones to AIDS; I have seen quite intimately the toll this takes on those who have survived the AIDS pandemic since 1981, and how their individual and collective grief has shaped U.S. politics, protest and queer community. It is significant and worrying to see four decades of such grief compressed into less than two years. How can U.S. society process such a scale of grief so quickly—especially when COVID has allowed far fewer forms of collective mourning?
The comparative COVID–AIDS death tolls in the U.S. also beg a comparison of global COVID deaths to global AIDS deaths. And here, we see something very different. While COVID deaths are now about 110 percent of total AIDS deaths in the U.S., global COVID deaths—about five million and growing—are less than 20 percent of the more than 36 million people who have died of AIDS.
In terms of virology, the potential for the novel coronavirus to lead to human death much faster than HIV is to be expected. SARS-Co-V2 is a much more efficient virus than HIV, it transmits far more casually, and everything about it is faster than HIV. The novel coronavirus moves through social networks quickly, can take hold in (and transmit through) people in mere days, and can lead to death in weeks (rather than years). According to UNAIDS, annual global deaths from AIDS peaked at about 1.7 million in 2004—about 23 years into that pandemic. COVID has already surpassed this total in a tenth of the time.
And yet, that doesn’t explain why COVID has already surpassed total AIDS deaths in the U.S., but is less than a fifth of them globally. In some ways, these 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 (among people in in the U.S. who got the drugs, anyway). 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.
What I find perplexing in some ways is that, similarly to its early access to antiretrovirals, the U.S. had various head starts with SARS-Co-V2 over other countries—more, by some metrics. HIV was first noticed in the U.S. long after people were infected and dying; but with the novel coronavirus, the U.S. could have learned from China and Italy, whose earlier experiences gave the U.S. time to prepare. The U.S. also had some of the first COVID medicines and vaccines and, after a rocky start, rolled them out rapidly—at one point vaccinating four million people a day. But it stalled and is currently below number 50 among nations’ vaccination rates. Yet through it all, the U.S. has continued to have the highest number of total coronavirus infections and coronavirus deaths (and at times, the highest per capita deaths). Despite being 5 percent of the world’s population, the U.S. presently accounts for about 15 percent of the world’s COVID deaths and has, at times, accounted for as much as 25 percent.
I think these divergent trends are affected by who was perceived to be the most at risk for HIV and COVID in the U.S. HIV initially transmitted most frequently within the U.S. through anal sex, injection drug use and blood transfusions. Those most affected were marginalized people who had long built solidarity among themselves. And so, even though the transmission modes were stigmatized, queer and Black people and users of injection drugs quickly began using condoms, creating sterile syringe exchanges, and engaging in peer-to-peer education about how to avoid HIV.
But by the time the U.S. had gotten antiretrovirals in the mid 1990s, HIV was circulating in the Global South not just through anal sex, proximity to prisons and the use of injection drugs but, increasingly, through vaginal sex and vertical transmission, from parent to child. At that time in America, many people could get access to good HIV medication, and the virus was pooled within certain communities who couldn’t get the drugs; meanwhile, in the Global South, HIV was circulating through a much more general population, while no populations had any access to the drugs for nearly a decade.
A different dynamic is developing with COVID in the U.S. While the same kinds of people are most vulnerable to COVID as to HIV, a not-entirely-incorrect perception among rich people is that they, too, are susceptible to COVID. HIV required marginalized people to collectively care for their communities in very specific ways (such as by using condoms and sterile syringes) during very specific activities. But COVID requires that the entire U.S. population alter many behaviors to protect each other—and here, the U.S. general population diverges extensively from marginalized populations within its own borders as well as with many societies in the Global South. For instance, at the height of AIDS deaths in the U.S., gay men overwhelmingly took on new practices to protect one another, even though they were often accused by straight moralists of “bug chasing”—intentionally trying to get HIV, a desire practiced by an extremely niche group and one never endorsed by formal gay leaders. Yet with COVID, bug chasing has been completely normalized and championed by major conservative radio hosts and politicians.
Thinking about the comparative U.S. and global rates of COVID and AIDS also shows the folly in thinking of the United States as a single entity. Health outcomes vary greatly between regions, and the HIV and COVID pandemics within the U.S. are concentrated the most in the southern states.
Of course, all of this might look very different in the year 2060—the year as far from the first known COVID death as we currently are from the first known AIDS death. For all we know, the U.S. may stabilize with COVID while people in other countries perish without vaccines. But on this World AIDS Day, in addition to remembering the dead and supporting the living who are affected by HIV, let us remember there is no contest between these two pandemics. It’s not a competition. Despite the particulars of the two viruses, they affect a similar viral underclass. The making of a world free of AIDS would make a world free of COVID (and vice versa), because the same underlying causes are driving both pandemics.