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What AIDS should have taught us about how to deal with diseases like Ebola

Kaci Hickox, a nurse who recently returned from Sierra Leone — where she worked with Doctors Without Borders treating Ebola patients — only to be quarantined.
Kaci Hickox, a nurse who recently returned from Sierra Leone — where she worked with Doctors Without Borders treating Ebola patients — only to be quarantined.
Spencer Platt/Getty Images

When long-time HIV researcher Rick Elion looks at America's hysterical reaction to Ebola, he says it almost gives him post-traumatic stress disorder. Just after HIV/AIDS was discovered, in 1983, schools closed down, patients were treated like untouchables, and fear-based policies were enacted to isolate those suspected of carrying the virus.

Even though there have only been a handful of Ebola cases in the US, history seems to be repeating itself. We've already seen what are essentially witch hunts targeted at returning Ebola health-workers, welcome mats pulled out from under Ebola researchers trying to attend tropical diseases conferences and advance science in their field, and a very political push for Ebola quarantines and travel bans.

Unlike AIDS then, Ebola today is not new. The virus was identified in 1976. But, until this year's epidemic, we had never had a case in America, and it took Ebola reaching our shores to remind the research community of the early, fear-filled days of HIV/AIDS. I talked to Elion, the clinical-research director at the Whitman-Walker Clinic in Washington, DC, about the parallels between the two viruses, our reactions to them, and the lessons we seem to keep missing when it comes to responding to disease outbreaks.

Julia Belluz: When you're watching the public fear and discussion about Ebola today, what are you thinking given your experience with early HIV?

Rick Elion: I get almost post-traumatic stress disorder. It's the same discussion: people want to wall off what they're afraid of. With HIV, the victims were seen with derision, seen to be responsible for their disease.

At least in America, the victims of Ebola have been mostly occupational exposures — nurses who got sick on the job — so the public is more sympathetic. But we're seeing that desire to isolate Ebola victims.

JB: PTSD is a strong choice of language. What else is bringing you back?

RE: It's watching multiple generations die. We see pictures of babies, teenagers, grownups, adults, and grandparents, all dying from the same virus. That really brings me back to HIV, and it's something we don't see anymore with other diseases. It brings about this stew of emotion. That stew of emotion reminds me a lot of HIV, that moment in time.

With AIDS, we're talking much larger numbers affected, an entirely different magnitude than Ebola. But there's that same tension between our desire to help and our desire to run, and that's where we have to bring humanity into that equation. That's what we learned from HIV: the longer we didn't bring humanity into the equation, the more the disease flourished. And the more we did the more we got it under control.

The heart bursts with sympathy and sadness, and anxiety and fear about protecting you and your family. There's that tension between your humanity and your preservation, and that is the core of the terror about these diseases.

JB: With this Ebola epidemic, especially as mid-term elections approach, we're hearing a lot of talk about isolationist policies: quarantines, travel bans. These were tried with HIV, and of course, they didn't work. Why does history seem to be repeating itself, 30 years later?

RE: When I hear congress talking about quarantining flights from the countries, it's the same thing we heard before with HIV. It doesn't work. Borders are porous. People can leave their country and fly another way. It's much better to keep the borders porous and regulate who is moving.

We had the same lessons with HIV trying to quarantine positive people if they were at risk for spreading HIV to others, even though it was not any contact — but specific sexual contact or blood exposure — that led to HIV.

The quarantine policy is irrational and will impair the ability of help to flow to that population. The quarantines are a metaphor and a policy. The metaphorical aspect is that it would keep us safe and out of harm's way. It represents security in troubled times. The problem is that this initial quarantine policy would be counter-productive in that it dissuades health care personnel from volunteering as it places unreasonable and unsustainable rules on them.  We know that afebrile people are not likely to be transmitting virus and there is no rationale for quarantining them.

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