What can HIV teach us about the pandemic we face today?
Peter Doherty says the fight against HIV is informing the scientific battle against COVID-19, and vice versa. Credit:Luis Ascui The challenge in these kinds of epidemics is to win the confidence of the people, to co-operate with them. In many ways its more difficult with a situation like the present one, but I think if I have a criticism of the government its that its rather fallen down in getting the community behind its program. And for scientists on the front lines of the fight against both diseases, COVID-19 has provided a rare chance to apply the lessons of one epochal pandemic to a second one. Nobel laureate Professor Peter Doherty says the fight against HIV is informing the scientific battle against COVID-19, and vice versa. But he cautions that science can only do so much. The idea that theres always a technological fix, and we dont have to change behaviour or inconvenience ourselves in any way, is really not a helpful perception. As his institute colleague Dr Sharon Lewin puts it: Behavioural messaging is so important around stigma, because stigma cant be addressed scientifically. [In a] major public health crisis, there are lots of unknowns. When you have unknowns with infectious diseases, it often generates hysteria and misinformation and stigma.  Professor Ian Gust, who became Australias chief medical and scientific adviser on AIDS, recalls that HIV was at first a medical curiosity that would soon stun the scientific community. Everybody who got infected died, and their deaths were particularly horrible, he says. For those working in the front lines it was a totally new experience. As infectious diseases physicians whod been trained after the Second World War, we were used to saving most of the patients who had infections because we had vaccines and antibiotics. Here was an infectious disease like something from the 1800s, that you had no tools to protect against, and which was invariably fatal. And so you ended up seeing a lot of healthy young men die. And going to a lot of funerals. David Menadue and Phil Carswell both estimate they attended more than 100 funerals for people claimed by AIDS. Many died shunned by family and friends. It was seen as Gods wrath on the gay community and intravenous drug users, Gust says. And in the case of COVID, theres been the attempt to deflect responsibility to Chinese incompetence or malfeasance. There has always been the search for scapegoats.  That AIDS scapegoating happened against a backdrop of media hysteria and community fear as the virus infected the blood supply. A turning point was the deaths in 1984 of three babies who had been given blood transfusions in Queensland. The tragedy was announced in the final days of the 1984 federal election campaign. For the next half dozen years, [AIDS] very much dominated medical politics, Blewett says. His stewardship of the response is considered a model of how governments should respond to a public health crisis  with one exception. The Grim Reaper ad campaign  in which the Reaper knocked down people in a bowling alley  spread awareness but also fear, and at the cost of greater stigma for those suffering. One of the things  was learning what a deleterious impact it had on many of them. Thats a regret I have about it, Blewett says. But the key was to change behaviour: condoms then, masks now. There are major differences, of course. As Peter Doherty says, HIV was basically a matter of [changing] sexual behaviour. But with COVID, you cant decide not to breathe. In 2020, Thorne Harbour Health (formerly the Victorian AIDS Council) did something to counter COVID-19 that it had not done even at the peak of the fight against AIDS: it urged people to stop having casual sex. In 40 years, the message had gone from safe sex to no sex. The state was talking about lockdowns, says Simon Ruth, the organisations chief executive. We just decided, all right, for the first time ever we need to say we have to have a break from sex to stop the spread [of COVID-19]. Now, eyes turn to the great white whale of HIV research, a vaccine and a cure. Pharmaceutical giant Moderna  which has developed a COVID-19 vaccine  has announced phase one trials of an HIV vaccine for later in 2021. Blewett says some in the field are optimistic. Im not saying theyre overconfident, but there is a degree of confidence that they will be able to get a vaccine within the next decade.