Una Mullally: The rhymes between HIV/Aids and Covid-19 are multiple

‘Illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

In Illness as Metaphor (1978), Susan Sontag examined the language used around tuberculosis and cancer. It’s interesting to revisit her writing now, as the Covid-19 pandemic lends itself so obviously to metaphor. In many ways, we cannot really think or write without metaphor in order to ascribe meaning.

We have a respiratory infection in a world that keeps forgetting to breathe, and is also choked by pollution. We have a virus in the viral age. The metaphors used to discuss tackling the pandemic are loaded with rhymes and responses to our already chaotic times, where disconnection, end-stage capitalism, burnout, individualism, the destruction of nature, borders, the disappearance of community, the essentiality of the working class, and on and on, are all rolled into a scramble for meaning, compounded by the fact that truth – and along with it meaning – has often collapsed in recent years, as nonsensical political events unfolded and technology pursued dystopian surrealism.

The most tempting metaphors regarding Covid-19 are that it is somehow egalitarian – a leveller – and also a matter of warfare. Political leaders talk about how the disease disrespects everyone equally. Of course that is not true. One of the gravest “underlying issues” with regards to Covid-19 is probably poverty. And anyway, many illnesses hit people without respect for their class, ethnicity, or geography. This isn’t gout or malnutrition we’re talking about.

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In Aids and Its Metaphors (1989), Sontag questioned the use of the term “plague”.

“The plague metaphor is an essential vehicle of the most pessimistic reading of the epidemiological prospects,” she wrote. “From classic fiction to the latest journalism, the standard plague story is of inexorability, inescapability.”

Sontag’s preference to dissociate Aids from the term “plague” is interesting, considering that the term was used by many who believed that Aids was not confronted or framed with the gravity and urgency required, so “plague” became a sort of reclamation and declaration of the disease’s catastrophic impact, especially when earlier terminology around Aids, such as “gay cancer” apportioned a sort of demographical blame.

In the context of Covid-19, however, the “plague” metaphor may be used by societies to defend themselves from their own incompetence and inadequate responses. How can you be expected to deal with the overwhelming nature of a plague? And, as Sontag wrote, “One feature of the usual script for plague: the disease invariably comes from somewhere else.”

Bitterness

Learnings from the HIV/Aids crisis are oddly absent in this moment. When this pandemic was taking hold in the US, I read with interest the social media updates of friends in New York who survived the HIV/Aids crisis. The justified bitterness they were expressing with regards to how (at least at initially) seriously this pandemic was being taken in the US was in stark contrast with the neglect experienced by gay men in particular during the initial stages of the Aids crisis.

The rhymes between the HIV/Aids pandemic and Covid-19 are multiple. It was the discovery of “clusters” of Kaposi’s sarcoma and pneumocystis pneumonia amongst gay men in the very early 1980s that alerted the medical and gay community to the disease. Indeed, around that time, the US misguidedly turned to border control, as it does now, to attempt to keep the infection “out”.

Travel restrictions remained a component of the stigmatisation of HIV. It wasn’t until 2010 that one’s positive HIV status was removed as a mitigating factor in granting or refusing travel visas to the US. When they were introduced the US also had a dangerous president in charge, Ronald Reagan, and an administration whose faulty and delayed response to the HIV/Aids crisis was steeped in homophobia. Activists had to fight for healthcare. David Wojnarowicz, one of the great artists of his time who later died from Aids, painted the back of his denim jacket with the words, “If I die of Aids – forget burial – just drop my body on the steps of the FDA.”

Like Aids, Covid-19 has become personified as a grim reaper, a serial killer stalking buildings, homes and streets, and the body itself. Like Aids, we are learning more and more about the multifaceted complex manifestations of Covid-19 in the body. Like Aids, we protect ourselves from Covid-19 by changing our interactions. But was there a more intimate and profound piece of behavioural change in the 20th century than the increased use of condoms in response to the HIV/Aids crisis? It kind of puts our awkwardness around physical distancing in the shade.

We have much to learn from those who traversed the HIV/Aids crisis, and those who live with HIV now, for whom terms such as “viral load” are well understood. In 2018, a person was diagnosed with HIV in Ireland every 17 hours. This was the highest number of diagnoses on record, higher than during the Aids crisis of the 1980s and 1990s. By listening to those impacted by that pandemic, we have much to learn, about community, stigma, resilience, collective grief, and – most importantly – survival.