72 Books & arts The EconomistJune 27th 2020
I
n the early1990s, at the end of every workday, Mat-
shidiso Moeti would lock a notebook in her desk at
Botswana’s ministry of health. Written inside were the
names of Botswanans who had tested positive for hiv.
The stigma of having the virus that causes aidsmeant
there had to be the “deepest secrecy”, she recalls.
Soon a single notebook was not enough. By the end
of the 1990s more than a quarter of Botswanans aged
15-49 had the virus, the highest rate in the world. Be-
tween 1986 and 2001 life expectancy fell by more than a
decade, from 61 to 50 years—lower than when the
country became independent in 1966.
The hiv/aidspandemic was the formative experi-
ence for many of the doctors leading the response to
covid-19. Dr Moeti is director of the World Health Org-
anisation’s Africa region. Anthony Fauci, who advises
President Donald Trump, earned his spurs during
America’s aidscrisis. “I draw on hivfor just about
everything we do,” says Salim Abdool Karim, who ad-
vises President Cyril Ramaphosa of South Africa.
The two great pandemics of the past 50 years are
very different. hivis usually spread via sex, can take
years to cause disease and if untreated is highly lethal.
In Cameroon it was called le poison lent, the slow poi-
son. sars-cov-2, the virus that causes covid-19, is less
deadly, but spreads and manifests much more quickly.
Nevertheless hiv/aidsis a constant reference point.
When Dr Moeti reads the latest covid-19 case numbers,
she thinks of those notebooks.
An understanding of hiv/aidsmatters for another
reason. It is a reminder that pandemics do not readily
disappear. Life-prolonging treatments have turnedhiv/aidsinto a mostly chronic disease. New infec-
tions have decreased for 25 years. Yet 1.7m people were
newly infected in 2018. Globally 32m people have died
from aids. Despite biomedical advances there is no
cure and no vaccine. Human behaviour and norms had
to change. Tens of millions deal with the vast indirect
impacts, especially in sub-Saharan Africa. The worst of
the pandemic may be over, but its effects endure.
The history of hivin humans began around a cen-
tury ago. Scientists think that the virus responsible for
the vast majority of cases, hiv-1, crossed the species
barrier from chimpanzees in the 1920s or earlier in cen-
tral Africa. It spread slowly for decades, before trans-
mission accelerated worldwide in the 1970s.
In 1981 the Centres for Disease Control and Preven-
tion (cdc), an American public-health body, warned
about outbreaks of pneumonia and a skin cancer, Ka-
posi’s sarcoma, in gay men, as well as a number of “op-
portunistic infections” taking advantage of a break-
down in the body’s immune system. When other cases
were soon reported among Haitian migrants, haemo-
philiacs and heroin users, as well as babies of infected
women, what had been Gay-related immunodeficien-
cy disease (grid) became Acquired immunodeficiency
syndrome (aids). Diagnoses followed in other parts of
the world. In 1983 hivwas discovered as the cause.
The early years of the pandemic were characterised
by confusion and fear. Once aidssymptoms emerged
people typically died within 12 months. By the end of
the 1980s it was one of the leading causes of deathfor
young men in many rich countries. Andrew Sullivan,a
gay journalist who is hivpositive, recalls “witnessingJOHANNESBURG
How the last great pandemic changed the worldThe lessons of HIV/AIDSSlow poison
Perspectives is
an occasional
series in which our
correspondents
put the pandemic
in context1