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Lessons In Handling Health Crises The U.S. Can Learn From AIDS Epidemic


Today is World AIDS Day, a reminder that COVID-19 is not the only fatal virus the U.S. is fighting right now. Professor Steven Thrasher of Northwestern's Medill Journalism School argues that these two diseases are exploiting similar weaknesses in our society, such as divides along lines of race, class and power. And he says we can apply lessons from the AIDS crisis to the COVID-19 pandemic.

Steven Thrasher, welcome to ALL THINGS CONSIDERED.

STEVEN THRASHER: Thanks so much for having me, Ari.

SHAPIRO: For years now, there have been good treatments for people with HIV. Antiretroviral therapies can make it nearly impossible to transmit the disease. And there are also very effective ways for people to protect themselves against infection, including a daily pill. But in spite of that, the CDC says about half of all Black men who have sex with men in the U.S. will get HIV in their lifetime. Why is that still the case?

THRASHER: In a word, it's capitalism. There's a lot of money to be made in not addressing this pandemic more head-on. And we don't care about the people who are being affected. So as you were saying, there's been very effective medication that's been around since 1996. But as I've been seeing in my research lately, the majority of the 33 million people who have died from AIDS over the past four decades have actually died since there was medication.

SHAPIRO: You know, last year, I did some reporting in Mississippi, which has one of the highest HIV rates in the U.S. And I met a doctor named Leandro Mena, and he told me this.

LEANDRO MENA: It's heartbreaking. I mean, science has given us, you know, the tools to win the HIV epidemic. The challenge that we have is that we need to make sure that those tools can reach those who actually need it most.

SHAPIRO: So professor Thrasher, do you think that a year or two from now we may be saying the same thing about coronavirus treatments and vaccines, that they are not reaching these people who are disenfranchised from society, who, in some sense, need this the most?

THRASHER: Absolutely. The people who are most at risk are going to have the least connection to institutions and, of course, the financial resources, maybe, to get the drugs that they need. At a very practical level, one of the things I think that's most worrisome is that some of the vaccinations that potentially might come to market are going to require multiple doses. And so if you can track somebody down and get them medication once, you're lucky. But if you have to find somebody who's recently become homeless; they've moved into a shelter; they're living in their car - how are you going to get them a dose of a medication weeks apart to make sure that they actually become not only safe themselves, but not transmittable to the rest of their community?

So in a couple years, we could be looking back and saying, all right, the people who can afford a coronavirus vaccine - the particular populations where it's been given to you - they might be doing pretty well. But the virus could actually start to move up in populations that are not getting the vaccine. And we might see the disparities that are already so awful getting even worse.

SHAPIRO: Now, in a piece that you wrote about this for Scientific American, you refer to an anti-racist, anti-capitalist medical intervention. What does that look like?

THRASHER: It looks like not saying we're going to have one approach for everybody in the United States. So as I hear public health officials and scholars talking about vulnerable populations, I often - and people who need the vaccine perhaps first - I often hear them talk about first responders, people working in medical institutions, elderly people in nursing homes. And of course, these are important people to vaccinate.

I never hear anyone talk about vaccinating people in prisons. And that's very strange - or jails - because when you go through the data of the sites that have the most transmission, prisons almost always top the list. They're the bulk of the sites that have the most transmission. And prisons not only are a place where people get sick - and jails where they get sick - jails are ways that viruses move into communities, right? People get arrested. They're booked into a jail. They might be there for a few days. And then they go back into their community.

SHAPIRO: We know the distribution of an eventual coronavirus vaccine is going to be up to the states. And so is this something that has to be addressed in 50 different places, or can it be a national priority?

THRASHER: It needs to be an international priority, actually. And I'm hoping that the Biden administration, which is planning to rejoin the World Health Organization - I'm hoping that they will join international efforts to get the vaccination to everyone on Earth 'cause as long as this virus is circulating on the globe, it's going to prove a danger to almost anyone else on the globe. And we can't think about it as individual states. We can't even think about one country. This virus moves across borders. Viruses don't see borders in the ways that we often like to imagine them to be.

And again, looking back at AIDS, it took seven years from the time ART therapy came to market before it started getting to every country in the world. And during that time, HIV continued to circulate and, thus, continued to climb. And so if we want to tamp down this virus, we need to have a transnational, international approach that's going to help the most vulnerable all over the Earth unless we all want to be just in our houses and not traveling for the next few decades.

SHAPIRO: That's Dr. Steven Thrasher. His upcoming book is called "The Viral Underclass: How Racism, Ableism And Capitalism Plague Humans On The Margins."

Thank you for talking with us.

THRASHER: Thank you so much, Ari.

(SOUNDBITE OF TYCHO'S "SOURCE") Transcript provided by NPR, Copyright NPR.