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Abstract
This article proposes correlations and parallels in UK newsprint media coverage of the COVID-19 and HIV/AIDS pandemics through engagement with Michael Rothberg’s model of multidirectional memory. It achieves this via qualitative and quantitative analysis of newsprint media during selected timelines of the respective outbreaks. Although the COVID-19 outbreak, which originated in Wuhan, China in 2019 and spread globally, has prompted reference to a number of previous traumatic events, including 9/11 and the Holocaust, one might contend that it correlates most closely with HIV/AIDS given the latter’s ongoing nature and worldwide reach. COVID-19, having infected 629 million people since December 2019 with 6.5 million deaths by November 2022, still presents a global threat through which we might read the trauma of HIV, a disease that has thus far seen 32.7 million deaths and has infected 75.7 million people worldwide. This relationship exists despite the fact that the two viruses and their effects differ markedly: HIV is a retrovirus, has a long incubation time, is transmitted via bodily fluids, has a low risk of infectivity via everyday contact and, to date, no fully effective vaccine has been developed. Contrastingly, COVID-19 is a coronavirus, has a short incubation time, is transmitted via contact and airborne respiratory aerosols, has a high risk of infectivity via everyday contact, and investment in vaccine development has been significant, with several vaccines now successfully developed. Nonetheless, while the two viruses and their prognoses are quite different and government strategies have followed highly divergent trajectories, certain parallels are apparent to the extent that one might read HIV/AIDS through the lens of COVID-19. It is therefore argued here that the connections between these two traumatic events constitute what Rothberg terms ‘multidirectional memory’ whereby we understand one traumatic event through another.
- HIV/AIDS
- COVID-19
- Medical humanities
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Introduction
This article proposes correlations and parallels in UK newsprint media coverage of the COVID-19 and HIV/AIDS pandemics through engagement with Michael Rothberg’s model of multidirectional memory (2006, 2009). In his model, which addressed how Holocaust memories were prompted by the Algerian War, Rothberg contends that histories and their memorial legacies do not compete with each other and block each other out. Rather, they are productive and ‘cut across and bind together diverse spatial, temporal and cultural sites’ (2009, 11). Here, I apply Rothberg’s concept to the COVID-19 pandemic and how it has triggered memories of the HIV/AIDS pandemic, as well as other traumatic histories. I achieve this via qualitative and quantitative analysis of newsprint media during selected timelines of the respective outbreaks. The first part of the article reviews scholarly and critical literature to contextualise the respective pandemics in relation to media reactions, government responses and public effects. This contextualisation is used to identify possible crossovers between COVID-19 and HIV/AIDS and to select potential keywords to search news media. The second part then analyses news media coverage of the two pandemics in response to the selected keywords.
Indeed, although the COVID-19 outbreak, which originated in Wuhan, China in 2019 and spread globally, has prompted reference to a number of previous traumatic events, including 9/11 (Rhodes 2020) and the Holocaust (Babwin 2020; Sharp 2021), one might contend that it correlates most closely with HIV/AIDS given the latter’s ongoing nature and worldwide reach. COVID-19, having infected 629 million people since December 2019 with 6.5 million deaths by November 2022 (World Health Organization (WHO)) still presents a global threat through which we might read the trauma of HIV, a disease that has thus far seen 32.7 million deaths and has infected 75.7 million people worldwide (joint United Nations programme on HIV/AIDS (UNAIDS) 2019). This relationship exists despite the fact that the two viruses and their effects differ markedly: HIV is a retrovirus, has a long incubation time, is transmitted via bodily fluids, has a minimal risk of infectivity via everyday contact and, to date, no fully effective vaccine has been developed. Contrastingly, COVID-19 is a coronavirus, has a short incubation time, is transmitted via contact and airborne respiratory aerosols, has a considerable risk of infectivity via everyday contact, and investment in vaccine development has been significant, with several vaccines now successfully developed. Nonetheless, even though the two viruses and their prognoses are quite different and government strategies have followed highly divergent trajectories, certain parallels are apparent to the extent that one might read HIV/AIDS through the lens of COVID-19.
This is especially the case because, despite numerous epidemics and pandemics over time, these two are the most significant outbreaks in the past 40 years in terms of infection and mortality. Although HIV/AIDS is still a major public health concern in particular regions, scientific breakthroughs and prophylactic drugs now render the virus as less threatening in public consciousness. Even so, certain aspects of COVID-19 reported by news media recall the earlier days of this pandemic. It is therefore argued that COVID-19 triggers multidirectionality of memory, as theorised by Rothberg (2006, 2009).
Multidirectional memory
Rothberg proposed his theory in relation to the writings of Nazi concentration camp survivor, Charlotte Delbo, whose volume None of Us Will Return, the first of a trilogy, documented the traumatic impact of the camps. Although Delbo had completed this soon after the Liberation, she did not publish it until 1965. This was somewhat later than her 1961 publication, Les Belles Lettres, which documented the Algerian War (1954–1962). Rothberg suggests that the reason she began to publish in the 1960s, rather than immediately after World War II, was due to ‘the urgency of the charged political climate of the 1960s, with its anti-colonial struggles that tore at the fabric of Europe’ (2006, 159). He contends that the emergence of Holocaust memory into the public sphere ‘took place through dialogue with – instead of opposition to - proximate histories of violence’ (2006, 160). Rothberg therefore dismisses notions of competitive memory, which understands collective memory ‘as a zero-sum struggle over scarce resources’ (2009, 3). Rather, as he argues, memory works ‘productively through negotiation, cross-referencing and borrowing; the result of memory conflict is not less memory, but more – even of subordinated memory traditions’ (2014, 176). A second aspect of his theory is that ‘collective memories of seemingly distinct histories are not easily separable from each other, but emerge dialogically’ (2014, 176). Third, he claims that the relationship between identity and collective memory is unfixed such that ‘the borders of memory and identity are jagged’ (2014, 176).
Rothberg refers to several literary and filmic examples aside from Delbo’s trilogy to illustrate his conceptualisation of multidirectional memory, these including a novel by French detective fiction writer Didier Daeninckx, the film Caché (Haneke, 2005) and a novel by French-Algerian writer Leila Sebbar. His model of implicating one traumatic experience with another through memory has also been adopted by various other scholars, these usually referring to histories of violence and articulated via discussions of memory practices through channels such as memorials (Hollis-Touré 2016), literature (Günay-Erkol and Şenol-Sert 2017) and film (Bayraktar 2019; Luckhurst 2010). For example, Roger Luckhurst analyses torture scenes in the film Pan’s Labyrinth (Del Toro 2006) in relation to the revelations of torture at Abu Ghraib that had emerged two years earlier and proposes that ‘Pan’s Labyrinth is watched […] through the filter of Iraqi occupation, another strange post-war condition where the war is seemingly without end [where] the scenes of torture that invade so rudely into the ‘arthouse’ register feel like intrusions of very contemporary disorders of violence’ (2010,18). Likewise, Nilgun Bayraktar examines the ways that contemporary essay films about migration, such as Havarie (Scheffner 2016), promote mnemonic associations with other experiences of displacement ‘including those produced by European colonialism, transatlantic slavery and postcolonial conflict’ (2019, 1). So too does Isabel Hollis-Touré draw on Rothberg’s theory to discuss notions of remembering the Charlie Hebdo attacks (2016).
In examining HIV/AIDs and COVID-19 in terms of multidirectional memory, it is acknowledged that there are possible dangers in equating the deliberate victimisation of particular groups and individuals to the indiscriminate spread of disease. Nonetheless, while Rothberg conceptualised multidirectional memory in relation to histories of extreme violence, his argument has relevance here in regard to the relationship between contemporary experiences of COVID-19 and traumatic memories of HIV/AIDS. This relevance specifically lies in the way that the recent pandemic does not block memories of HIV/AIDS, or any prior traumatic history (such as 9/11, the Holocaust, the two world wars or other previous pandemics) but rather, through the many news media references to these in the context of COVID-19, illustrates how memory is ‘multidirectional: as subject to ongoing negotiation, cross-referencing, and borrowing: as productive not privative’ (Rothberg 2009, 3). Moreover, in Rothberg’s model, as well as several of the aforementioned applications of his theory, there is not necessarily an explicit link between contemporary texts (such as film and literature) and the historical traumas with which these are associated through multidirectional memory. For instance, Pan’s Labyrinth is set in the immediate post-Spanish Civil War period, yet Luckhurst suggests a connection to the torture that took place at Abu Ghraib in the post-9/11 period. Neither do these academic accounts of multidirectional memory consider actual collective responses to the events of the Algerian War or to representations of trauma in literature and film. Rather, they tend to be implicit, formed through broader dialogical associations (such as torture and migration), and often focus on how individual literary or visual works potentially reflect collective memory. In the case of the media coverage of HIV/AIDS and COVID-19 examined here, there are both explicit and implicit associations made between them that negotiate with, borrow from and cross-reference the past (including other histories of crisis), strengthening an argument for the application of multidirectional memory. Like the prior scholarly examples of multidirectional memory, this analysis of media coverage does not take into account how readers and viewers actually perceived news reports but rather considers how media coverage of COVID-19 either potentially resonated with memories of HIV/AIDS, or forged clear links between the two pandemics, which indeed, at times, were transmitted and consolidated across diverse media outlets. This was especially the case in comparisons made between New York City as Ground Zero in the events of 9/11 and the spread of coronavirus (Bryant 2020). As Nick Bryant of BBC News notes ‘Once again, this city has become Ground Zero: that haunting phrase from the attacks of 11 September that New Yorkers hoped would never be applied here again’ (2020), thereby illustrating the proximity of seemingly disparate and distinct histories.
It is within such a framework that I consider HIV/AIDS and COVID-19 and their connections, parallels and differences as conveyed in news media. Like the nature of the two viruses, media coverage of the two pandemics initially appears dissimilar, with distinct differences in language used and in responses to those affected by the respective viruses. This parallels government reactions to the two diseases. Even though HIV and its progression to AIDS were often fatal in the early days of the outbreak, government action in the UK (as well as the USA) was extremely slow to materialise, with public health campaigns taking six years to be implemented. Indeed, key figures in government sought to distance themselves from the disease while media reporting reflected not only a lack of knowledge about the virus, but also discriminatory language given the fact that HIV/AIDS initially appeared to target the gay community. In contrast, COVID-19, a virus that seems almost indiscriminate in its targets, has attracted substantial UK government and public support from the outset. This has led to nurses being labelled as heroes (Mohammed et al. 2021), whole communities clapping front-line medical staff, a centenarian raising £38 million for the National Health Service (NHS), and the country appearing to unite behind former Prime Minister, Boris Johnson, himself afflicted with the disease, despite apparent failings in dealing with the pandemic. Overall, while there are specific differences in how the two pandemics have been reported in news media, examination of media discourse associated with the two outbreaks proposes several commonalities and crossovers.
As well as media discourse on the crossover between the various viruses, there are numerous scientific studies on HIV/AIDS, tuberculosis (TB), malaria and COVID-19 co-infection and comparative treatment regimes as well as scholarship on how COVID-19 is impacting engagement with HIV testing in certain countries and disrupting HIV programmes in sub-Saharan Africa. However, it is beyond the scope of this article to review them here. Further works consider some of the lessons to be learnt in terms of social and behavioural responses and disease management strategy (Eaton and Kalichman 2020; Edelman et al. 2020; Holtgrave et al. 2020); public health responses and stigma mitigation (Logie 2020; Logie and Turan 2020) and the spread of misinformation and medical mistrust (Bogart et al. 2021; Mian and Khan 2020). In comparison, there is little comparative analysis of the two outbreaks in terms of media coverage, although Summer Hoagland-Abernathy (2020) broadly outlines certain similarities between the two pandemics, and Jonathon Catlin (2021) examines analogies between COVID-19 and HIV/AIDS in American public memory. While Catlin also situates the COVID-19 pandemic in a multidirectional mnemonic frame through reference to the HIV/AIDS epidemic in the USA, which in turn drew on memory of the Holocaust, the research here differs in its focus on the responses of UK media texts.
Seeing HIV through COVID-19: the contexts
Media responses to HIV and COVID-19
The news media have played a significant part in public perception of the two pandemics, with particular controversy attached to certain early tabloid responses to HIV/AIDS and the spread of misinformation. COVID-19 too has been subject to erroneous and changing advice, especially in terms of treatments (for example, the suggestion of hydroxychloroquine as a suitable remedy) and the use of protective face masks. Both circumstances reflect an initial lack of knowledge concerning the respective viruses. In the case of HIV/AIDS, preliminary media responses that appeared during the 1980s promoted the idea of a ‘gay cancer’, with a New York Times headline in 1981 stating ‘Rare Cancer seen in Homosexuals’ (Altman 1981) while newsprint references to the disease as ‘GRID’ (gay-related immunodeficiency) in 1982 further failed to take account of intravenous drug users, haemophiliacs and Haitian immigrants into the USA who also had the virus (MacKinnon 1992, 149). Indeed, its viral origins were not established until 1983 when Luc Montagnier and Françoise Barré-Sinoussi discovered that HIV was the causative agent for AIDS (Abbott and Brumfiel 2008, 712). Thereafter, media responses projected an aura of threat. For instance, Life magazine ran front cover headlines in July 1985 (Anon 1985). Here, the word ‘AIDS’ is in large bold red typeface, the headlines accompanied by three photographs: one of a teenager, a second of a couple (heterosexual) and young child, and another of a black soldier in uniform. However, many of the tabloids continued to fuel the marginalisation of certain groups and, as MacKinnon indicates, ‘Homosexual men were defined in the eighties within a largely hostile, homophobic British popular press by their associations with AIDS’ (1992, 163). Typical examples of such headlines include: the Sun’s ‘I’d shoot my son if he had AIDS says vicar’ (Lisners 1985) and the News of the World’s ‘My Doomed Son’s Gay Plague Agony’ (Anon 1984). The News of the World’s headlines also declared ‘Public Enemy Number One AIDS’, with AIDS in large red bold typeface (Anon 1983). The text here is significant in that it corresponds with a similarly phrased headline reported in the Los Angeles Times: ‘Reagan calls AIDS Enemy No. 1, advises abstinence’ (Gerstenzang 1987). It is also more recently replicated by the director general of WHO, who stated ‘Coronavirus should be seen as public enemy number one’ (Boseley 2020).
The broadsheets too referred to terms such as ‘gay plague’ but tended to avoid its use for purposes of sensationalism. Rather, newspapers such as the Observer and Guardian distanced themselves from its use for such purposes. For instance, when describing the panic surrounding AIDS, Robin McKie reports on an individual who ‘believed he had contracted AIDS, the deadly disease labelled the “gay plague” by tabloid newspapers’ (Anon 1985)⇓. In a later 2003 edition of the Guardian, the inclusion of ‘gay plague’ in the headline is again to criticise its use. Here, Younge (2003) describes how a Christian conservative who was selected to serve on the US presidential council on HIV/AIDS withdrew his name because of protests against his reference to the ‘gay plague’. As Virginia Berridge points out, however, this ‘type of ‘gay plague’ coverage […] was in fact both media and temporally specific. It was confined to the newspaper press, both tabloid and quality, and was particularly a feature of the earlier years of reporting on AIDS’ (1996, 63). Nonetheless, since then, the introduction of pre-exposure prophylactic (PrEP) drugs for HIV has prompted further tabloid controversy owing to cost. Relatedly, while there is a global drive to end HIV (Europe PMC Funders Group 2013), Anthony Fauci and Clifford Lane acknowledge that there is a ‘need to overcome barriers inherent in the healthcare system and other aspects of society that limit access to high-quality care’ (2020, 3).
Such ambition resonates with the UK COVID-19 climate in which there have been calls to address inequalities that have contributed to higher rates of infection and mortality in certain groups (Iacobucci 2020) although unlike the early press coverage of HIV, this has tended to attract sympathetic rather than discriminatory language. However, an air of fear and stigma surrounds the primary source of COVID-19, with marginalisation of certain groups analogous to the gay community regarding HIV. Often this stems from comments made by former US President, Donald Trump, who referred to COVID-19 as the ‘China virus’, leading to anti-East Asian racism (Budhwani and Sun 2020) evidenced through online harassment, verbal and physical abuse, and racial targeting (Roberto, Johnson, and Rauhaus 2020, 370). Hoagland-Abernathy also identifies major similarities between Ronald Reagan and Donald Trump’s presidencies, noting that ‘Ronald Reagan was president, and it took him several years of death and dying to even say the words AIDS’ (Hoagland-Abernathy 2020, 34). In a similar scenario she reports that ‘By August, Trump said the coronavirus “is what it is”’ (2020, 34). Likewise, Catlin notes certain cultural borrowings circulated on social media from early AIDS Coalition To Unleash Power political group’s (ACT UP) New York posters; for example, a 1987 ‘Aidsgate’ poster is recast as ‘Covidgate’ with an image of Donald Trump replacing Ronald Reagan ‘as the culprit behind the political scandal of government inaction and neglect’ (Catlin 2021, 1451).
Also, like HIV, media coverage of COVID-19 expresses uncertainty, especially concerning the abovementioned discussion of its origins. The nature and outcomes of the illness were unknown, and the prognosis and future implications for those infected remain unclear. While the virus at first seemed different to HIV in terms of long-term affliction, and indeed, was likened to influenza by both Boris Johnson and Donald Trump, it is becoming apparent that there are long-term and possibly permanent physical and psychological effects (Mahase 2020). As Kristen Malecki, Julia Keating and Nasia Safdar note ‘The lack of familiarity around COVID-19 has also shaped public perception and response, with some in the public becoming extremely anxious, although others downplayed risks by equating it to something more familiar such as influenza’ (2021, 701).
Government reactions
AIDS first came to public attention in 1981 with five cases of Pneumocystis carinii pneumonia and 26 cases of Kaposi’s sarcoma which were associated with immune deficiency and found initially in gay men. In 1982, the New York Times published an article under the headline ‘homosexual disorder’ which reported spread to heterosexual groups. The article indicated that, according to the Centers for Disease Control, the disease was a matter of urgent public health (Altman 1982). However, as Samuel Hallsor notes, the UK and US governments at that time were slow to intervene. For Hallsor, ‘The early 1980s also saw the emergence of the “New Right” movement under Margaret Thatcher’s conservative government in the UK and the Ronald Reagan administration in the US, which was to have an undeniable influence on shaping the response to AIDS’ (2017, 57). As Hallsor further notes, however, while the Reagan administration maintained a focus on innocent victims and advocated personal responsibility in terms of health, the UK overcame its initial inertia and took a more liberal approach (2017, 61). In 1985, the UK government instigated a range of AIDS measures that included funding to specific health regions (Street 1988, 491). This increased in 1986–1987 but was mostly allocated for publicity rather than research (Street 1988, 492). Policy focused on four areas: education, research, treatment and prevention with Berridge (1996) identifying four key stages in policy-making: policy from below whereby certain groups (gays in particular) were involved in policy-making (1981–1985), the wartime response, a period of emergency which mobilised the mass media and major research initiatives (1986–1987), normalisation and chronic disease (1987–1989), and the re-politicisation of AIDS (1990–1994).
Insofar as education was concerned, the government ran several campaigns, beginning in January 1986. The first of these publicised advice and had a classroom approach (Street 1988, 493) while the second, the ‘Don’t Die of Ignorance’ campaign, was more hard-hitting. It was launched in December 1986 and entailed both television-adverts and leaflets circulated countrywide. In conversation with Norman Fowler, health secretary at that time, Tim Jonze reports Fowler as stating ‘We had no knowledge of this disease and no drugs with which to treat it. I was reading a note the other day from the chief medical officer at the time and some of the predictions were terrifying – we were talking millions and millions of people becoming infected’⇓. The campaign centred on two key television adverts, AIDS: Monolith (Roeg 1987a) and AIDS: Iceberg (Roeg 1987b) and was more impactful than the first campaign, each advert employing the iconography of the horror film (Pheasant-Kelly 2019). As Fowler explains ‘the death part was important […] Scaring people was deliberate’ (in Jonze 2017). Later UK initiatives by the Health Education Authority included the Gay Men’s Campaign and the Black and Minority Ethnic Campaign. These had ‘Expert’ and ‘Personal Testimony’ formats (1989–1992), which, as noted by Tim Brown, again centred on the notion of AIDS as a hidden threat (2000, 1281). The invisibility of the disease in its initial stages was therefore a key aspect, an element that also characterises COVID-19 in that many infected individuals have no symptoms.
Similar campaigns have followed the outbreak of COVID-19. Like responses to HIV/AIDS the disease was marked by inertia from the Conservative government, led by Boris Johnson. He also at first downplayed the severity of the disease, an approach which reversed as the virus spread rapidly and deaths accumulated much more quickly than in the case of HIV/AIDS. Johnson himself stated that the virus was merely like influenza and continued to shake hands, stating in a Government televised brief on 3 March 2020, ‘I was at a hospital the other night where I think there were a few coronavirus patients. I shook hands with everyone you’ll be pleased to know and I continue to shake hands’ (Johnson 2020)⇓. The Prime Minister’s actions, along with his statement, clearly intend to mimic the parallel scenario when Princess Diana opened the first purpose-built AIDS ward in the UK and thus reflects Rothberg’s claim for memory’s ‘cross-referencing and borrowing’ (2014, 176). A clip from the programme ‘Witness’ includes BBC newscaster, Frank Bough, who states ‘just one question dominated the day - would she or wouldn’t she wear gloves’ (BBC News 2017), thus indicating the fear of AIDS being passed by casual contact. However, while AIDS cannot be transmitted through shaking hands, COVID-19 is highly contagious, leading the former Prime Minister to be hospitalised with the virus several weeks later. Given the importance attached to Princess Diana’s lack of gloves, and Boris Johnson’s complacency about hand contact, the analogous scenarios illustrate the degree of misinformation and lack of knowledge about the respective viruses. Even so, noting that the UK Scientific Advisory Group for Emergencies had the same day advised ‘against greeting such as shaking hands’ (in Mason 2020), one might equally correlate Boris Johnson’s actions with the early unconcerned views of the Thatcher government.
Despite this initial inaction, the short incubation of the disease along with a rapidly rising death rate has precipitated more dynamic government action than did the unfolding HIV/AIDS catastrophe. Notwithstanding failures concerning personal protective equipment (PPE), test and trace initiatives, care-home negligence, complacency in initial reaction time to an unfolding global crisis and, at one point, the highest death rate in the world, the UK government has implemented several lockdowns. They have set up appropriate support for furloughed workers, provided funding to develop a vaccine within one year, prioritised those most at risk for vaccination, and promoted a series of slogans and campaigns, the most effective of these being ‘stay at home, protect the NHS, save lives’ (2020).
Public reactions
The effects of both HIV and COVID-19 on the British public have been extensive and diverse, involving, for example, responses of denial, activism and resistance, anxiety and distress, loss of livelihood, antisociality, panic, restricted travel and personal freedom, marginalisation of certain groups, bereavement, and a dependence on science. There are thus numerous points of possible intersections between the two pandemics. HIV/AIDS had two elements of denial: that of professionals, and that of potentially susceptible groups, especially the gay community, but also including heterosexual individuals. For instance, despite the identification of HIV as the causative virus for AIDS in 1983, scientists such as Professor Peter Duesberg continued to suggest that lifestyle was responsible (Clews 2017, 217). Contrastingly, activist groups such as ACT UP played a crucial role in pushing the political agenda of AIDS and implementing drug trials. This scenario therefore differs markedly to treatment for COVID-19 which has witnessed the development of several vaccines within 12 months, with the UK Government having originally secured deals for 340 million doses of vaccine (Torjesen 2020) and to date, having vaccinated a major proportion of the population. Nonetheless, similar elements of denial, and ‘anti-vaxxer’ and antilockdown protests have dominated news reports.
Another point of crossover is the loss of livelihood for certain groups, with Yang Hu observing that ‘compared with UK-born white British, black, Asian and minority ethnic (BAME) migrants in the UK are more likely to experience job loss during the COVID-19 lockdown, while BAME natives are less likely to enjoy employment protection such as furloughing. Although UK-born white British are more likely to reduce their work hours during the COVID-19 pandemic than BAME migrants, they are less likely to experience income loss and face increased financial hardship during the pandemic than BAME migrants’ (Hu 2020). Inequality associated with COVID-19 also extends to hospitalisation rates associated with lifestyle, with physical inactivity, smoking and obesity in specific groups leading to higher risk of serious illness (Hamer et al. 2020) and higher mortality rates in BAME and elderly individuals. A crucial aspect of both pandemics is the dependence on science: whereas the UK government (like the US) was slow to act, and research into and progress with treatment of HIV/AIDS was initially negligible, the prognosis for those living with HIV/AIDS is now much improved. Medical and scientific advances occurred in various key stages beginning in 1987 when zidovudine was the first anti-HIV drug to be approved. By 1996, highly active antiretroviral therapy was implemented, leading to major reductions in mortality (Tseng, Seet, and Phillips 2014, 182). In addition, there have been recent reports of ‘cures’ for HIV involving early intervention, these including cases known as ‘the Mississippi Baby’ (2013), ‘the French Teenager’ (2015) and ‘the Visconti Group’ (2012) (Mahon 2019). By 2020, the Lancet also reported evidence for HIV-1 ‘cure’ following haemopoietic stem-cell transplantation in an AIDS infected individual known as ‘the London patient’ (Gupta et al. 2020, 1). This followed documentation of a similar case known as ‘the Berlin patient’, Timothy Brown (Lopalco 2010). In addition, PrEP offers a new avenue for restricting the transmission of HIV. In March 2020, the UK government announced that local authorities would receive £16 million in 2020–2021 to deliver PrEP to high-risk individuals (Collins 2021; UK Government 2020). Yet, despite this improved scenario, HIV/AIDS remains a major public health concern, especially in certain regions such as sub-Saharan Africa. Moreover, no vaccine or complete cure exists which has to some degree undermined the status of medicine (Sontag 1991, 158). While the rapid development of a COVID-19 vaccine has arguably mitigated this diminished status, there is still mistrust of medicine, with certain countries having vetted several vaccines because of possible links with thrombotic adverse reactions, and thus further eroding confidence in science. Moreover, medical mistrust associated with systemic racism is prominent in black Americans (Bogart et al. 2021). As Russell T Davies, writer of Channel 4 drama about the lives of gay men in the 1980s, It’s A Sin, remarks ‘it’s still the old, rich, white people in charge, and even now I think you can see the same patterns recurring of the Home Counties being protected, and if you’re on a minimum wage or no wage at all, you’ve had it. It’s the same process of marginalisation, really’ (in Singh 2021). Echoing these sentiments, UNAIDS’ chief states ‘in tackling COVID-19, we must learn the painful lessons from a history of unequal access in dealing with HIV. We learnt from HIV that when companies are allowed to use intellectual property rights to monopolise their technology people die’ (in Kelly-Linden 2020a). There are thus direct connections made between the two pandemics, exemplifying Rothberg’s concept of ‘how memory works productively’ (2014: 176).
A further point of intersection is in the implementation of protective measures—condoms in the case of AIDS and face masks in the case of COVID-19. Both forms are subject to controversy. Malecki et al observe that issues with face masks have been twofold: namely, the initial uncertainty of their value, and second, the political implications of wearing a mask. As they explain ‘Despite clear evidence that wearing masks can reduce transmission of COVID-19, the acceptability of and adherence to wearing masks varies greatly. In the United States, mask wearing has become more of a political issue than a fact-based intervention’ (2021, 699).
Arguably, however, one of the most significant crossovers between the two pandemics is that of mental suffering, with severe psychiatric illnesses triggered by the public health campaigns and news media reports about HIV/AIDS (Lupton 1994; McKie 1985). There is a parallel association between COVID-19 and psychiatric disorders and suicide although this may be related more to the broader effects of the pandemic than to fear of the virus itself (Li and Wang 2020; Sher 2020) and its media coverage.
In summary, an examination of the literature pertaining to government reactions, media responses and public effects as they relate to the two pandemics indicates implicit links as well as explicit crossovers. These entail references to various plagues, sexual identity, drug abuse, the implementation of antiretrovirals, heroism, disease as ‘public enemy’, several historical traumas (including the Holocaust, 9/11, World War I and World War II), protective measures taken, discrimination against specific groups, certain aspects of lifestyle, and mental health issues associated with the two viruses.
Methodology
Using Rothberg’s concept as a framework, and through access to the British Newspapers Archive, Newspapers.com and Proquest Newsstand, UK news reports were examined for evidence of crossover between the two diseases using the timeframes March 2020 to April 2021 for COVID-19 and 1981–2021 for HIV (corresponding to the onset of the respective pandemics). While it is recognised that these timeframes appear disproportionate, they reflect the aforementioned differences between the two pandemics, namely, the accelerated responses to COVID-19, including almost immediate identification of the virus (Wu et al. 2020), development of a vaccine within one year, the instigation of lockdown in the UK within several months of the outbreak, as well as a rapidly rising death toll, presenting a much compressed timeline compared with HIV/AIDS. In marked contrast, effective treatment for HIV/AIDS took 15 years, with, thus far, four decades later, no suitable vaccine yet developed, together with a much longer incubation time for AIDS to manifest, leading to a slower accumulation of deaths, and several years before the causative virus was identified. Moreover, it is recognised that not all news media analysed were in publication at the start of the HIV outbreak or may not have been digitally accessible. Numbers for 1981–1990 are therefore likely to be a slight underestimate. Regardless, the timeframes used here clearly reveal evidence of Rothberg’s model of multidirectional memory, which does not necessarily demand that associated traumatic events have equal duration. Indeed, temporal asymmetries between different histories exist in Rothberg’s analysis of the relationship between the Gaza War and the Warsaw Ghetto (Rothberg 2011). Searches were completed for a series of terms that are broadly associated with either or both pandemics as determined by the survey of literature in the earlier contextualisation of the two outbreaks. The searches first quantify news media reports using keywords as a function of time. Search terms, as derived from the initial literature review, included the following: HIV, HIV and COVID-19, plague, gay, drug abuse, antiretrovirals, hero, enemy, wartime, protection, discrimination, lifestyle and mental health. Each keyword was searched in media content in adjunct with either HIV or COVID in the document title. HIV was selected over AIDS as this tended to bring up non-AIDS-related use of the word. The numbers for the top five main subjects for each search were recorded, along with any relevant additional subjects. Peaks were identified in relation to these searches, and then the specific news media generating these peaks were qualitatively examined, the aim being either to identify commonalities in the way that newsprint media responded to the two pandemics or aspects that were distinctive to each pandemic but had parallels with each other. In short, the searches primarily aimed to ascertain if COVID-19 prompted direct reference to HIV/AIDS, as well as other historical traumas (such as the Holocaust, 9/11, Ebola) and to analyse coincidental crossovers that also have the potential to galvanise multidirectional memory. Blogs, website, wire feeds and trade journals were excluded as were non-UK and local and regional newspapers. The following UK newspapers were included: Telegraph, i, Independent, Daily Mail, Daily Mirror, Daily Express, Sunday Telegraph, Guardian (online), Times, Financial Times, Express (online), Sun, Daily Star, Mail on Sunday, Observer, Sunday Independent, Telegraph.co.uk and Express on Sunday.
Results of news media content analysis
Search 1. HIV
Main subjects
Human immunodeficiency virus – hiv=1373, acquired immune deficiency syndrome – AIDS=571, human immunodeficiency virus=206, HIV=201, acquired immune deficiency syndrome=162, COVID-19=31.
Analysis
The main peak occurs in the fourth decade of the disease and constitutes 3266 news reports (figure 1). Analysis of this decade reveals the highest number of reports occurred in 2015 and 2019. The November 2015 peak focuses on various events, notably the fact that actor Charlie Sheen reveals that he is HIV-positive, the suggestion that HIV vaccine trials will be in place by 2020, and Prince Harry’s involvement in HIV-infected children. In light of Sheen’s admission, one article’s headlines state ‘We can’t go back to the deadly HIV stigma of the 1980s’ (Jones 2015). Examination of the 2019 peak reveals a spike in September and mention of a ‘cure’ numerous times with reference to the aforementioned ‘London Patient’. A further contribution to the September spike is the fact that rugby player Gareth Thomas reveals his HIV status. Positive interventions by Princes Harry and William concerning Thomas’s admission contribute to the high profile of the report (Perkins 2019). Discussion of the London patient recurs in March 2020 when he reveals his identity, thus contributing to a peak in that month (Anon 2020). Also adding to this is coverage of an announcement that PrEP will be available during 2020 (Woolcock 2020). Cross-referencing with COVID-19 occurred between March 2020 and March 2021, with peaks of n=5 in July 2020 and n=5 in December 2020. The July peak centres on concerns that COVID-19 will lead to more HIV deaths because of the disruption to vaccination programmes (Kelly-Linden 2020a) while the December peak cross-references HIV in the headline ‘How the lessons the world learned in the fight against HIV can help us defeat Covid’ (Sands 2020). HIV is therefore linked directly to COVID-19.
Incidence of ‘HIV’ in headline, 1989–2021.
Search 2. HIV and COVID-19
Main subjects
COVID-19=16, coronaviruses=14, pandemics=10, HIV=8, AIDS=6.
Analysis
Figure 2 shows that there is little direct overlap in the two terms in article titles although all articles show clear links between the two viruses. The peak in June 2020 refers to a series of reports on vaccine development for dengue fever identifying a potential setback for any vaccines, a phenomenon known as ‘antibody-dependent enhancement’. The report mentions all the recent major viral outbreaks, including Ebola, HIV, dengue fever, SARS and MERs in discussing the COVID-19 outbreak (Ahuja 2020). Another Telegraph report notes ‘Fight against malaria, TB and HIV hit as resources diverted to COVID-19, survey shows’ (Gulland 2020) while the i notes ‘Anti-HIV Drug rollout delayed because of COVID-19 pandemic’ (Butterworth 2020). Overall, all 16 reports discuss how HIV treatment is being impacted by the COVID-19 crisis and there is direct correlation in a report titled ‘Don’t repeat mistakes of 1980s HIV crisis with COVID-19 Response, UNAIDS warns’ (Kelly-Linden 2020a). One article also details how HIV drugs are to be trialled in the treatment of COVID-19 (Knapton 2020). The references to prior viral outbreaks as well as the ‘mistakes of the 1980s HIV crisis’ indicate the ‘cross-referencing’ (2014, 176) that Rothberg describes in relation to multidirectional memory.
Incidence of ‘HIV’ and ‘Covid’ in headline, March 2020 to February 2021.
Search 3. HIV + plague
Main subjects
HIV=23, AIDS=18, infections=7, vaccines=7, Ebola=6.
Analysis
This search did not pick up headline instances of ‘gay plague’ featured in many of the aforementioned news media as these did not have HIV in the title (figure 3). Neither did it determine any cross-references to COVID-19 although these are implicit in certain headlines but there is cross-reference to Ebola. Even so, analysis of the 2009 peak reveals that the Sun refers to HIV as a modern plague (Gaunt 2009), the Daily Mail as ‘gay plague’ (Philpott 2009), and there are several references to the ‘plague of our time’ (Anon 2009) in articles that focus on development of an experimental vaccine for HIV. The peak in 2019 derives from several reports: discussion of the ‘London patient’; the inquiry into NHS contaminated blood supplies; the outbreak of HIV at a children’s hospital in southern Russia during the 1980s; and rugby player, Gareth Thomas, revealing that he is HIV-positive. As noted, Thomas’s admission achieved high profile coverage as both Prince Harry and Prince William openly supported him (Blakely 2019) and was followed by a BBC documentary Gareth Thomas: HIV and Me in September 2019. Three of the four cases for 2021 included reports on It’s A Sin, with Times’ headlines stating ‘There’s another virus we should not forget: Watching Russell T. Davies’s series set in the 1980s brings back memories of friends who died in secrecy from HIV/AIDS’ (Thomson 2021), thus implicitly linking COVID-19 to HIV, while the Sun’s headlines stated ‘We were told they got cancer, stigma of HIV was so bad’ (Sweeney 2021).
Incidence of ‘HIV’ in headline and ‘plague’ elsewhere in text, 1992–2021.
Search 4. COVID + plague
Main subjects
coronaviruses=421, COVID-19=413, pandemics=287, disease transmission=105, vaccines=81.
Analysis
In figure 4, the peak in March 2020 reflects news comparisons to AIDS, bubonic plague and the Black Death. The term ‘gay plague’ is not used, with sources tending to refer to biblical plague and Nostradamus’s plague predictions. References to plague are pronounced in certain publications with the Express (online) including articles almost daily during March. The ‘great plague’ is also referred to by the Sunday Times—the article ‘Trump may shrug off the virus but America won’t: Covid −19 threatens his presidency’ (Ferguson 2020) has a number of references to past crises. Ferguson, for instance, not only compares COVID-19 to AIDS, Ebola, severe respiratory distress syndome (SARS) and Middle East respiratory syndrome (MERS), but also comments that ‘The great plague narratives of the past were concerned with diseases that were highly lethal’. Ferguson then describes how COVID-19 is ‘so difficult to detect in its early stages, when many carriers are both infectious and asymptomatic’, noting a direct similarity to AIDS. At the time of writing, the author states ‘there’s no vaccine and there’s no cure’ before going on to discuss how Trump played down the risk, claiming that ‘this is a flu’ (in Ferguson 2020). Ferguson further draws on cultural memory in mentioning 9/11 as an example of apocalypse before stating ‘A COVID-19 outbreak in one or more large American cities would inflict a September 11-level hit on the US economy and a Hurricane Katrina-level hit on Trump’s popular approval’ (2020a). Ferguson also comments on the financial crisis of 2008 and the war in Iraq. Overall, his article therefore draws on all the major crises of the new millennium as well as historical traumas, illustrating Rothberg’s contention that it is the ‘convoluted, sometimes historically justified, back-and-forth movement of seemingly distant collective memories in and out of public consciousness that […] qualify as memory’s multidirectionality’ (2009, 17).
Incidence of ‘Covid’ in headline and ‘plague’ elsewhere in text, March 2020 to February 2021.
Search 5. HIV + drug abuse
Main subjects
human immunodeficiency virus – hiv=26, acquired immune deficiency syndrome – aids=18, HIV=22, substance abuse=11, COVID-19=1, coronaviruses=1.
Analysis
In figure 5, most of the 68 results for 2010–2019 are attributable to reports on Charlie Sheen’s drug abuse and positive HIV status which he admitted in a television interview in 2015 (Dey and Harlow 2015). A second contributing factor to the 2019 peak is the contaminated blood scandal, with the Daily Mail’s headlines stating ‘NHS tainted blood scandal ‘hushed up by health chiefs’: Drug addict donors passed on HIV in 1980s. Now victims could sue over cover-up’ (Borland 2017). Several articles reported on a ‘drug link to HIV scare’, referring to an outbreak of 79 HIV cases in Indiana, connected to intravenous prescription drug abuse (Anon 2015). Overall, there is limited cross-referencing to COVID-19.
Incidence of ‘HIV’ in headline and ‘drug abuse’ elsewhere in text, 1980–2021.
Search 6. COVID and drug abuse
Main subjects
COVID-19=74, coronaviruses=71, pandemics=57, hospitals=11, SARS-COV2=2.
Analysis
Online supplemental figure S1 shows no apparent crossover with HIV or AIDS in the main subject areas. However, there is cross-refencing between COVID-19 and AIDS in respect of denialism and disinformation, with headlines stating, for instance, ‘Trump’s quack theories have parallels with Aids denialism’ (Stegling 2020). The article refers to President Trump’s comments regarding ultraviolet light and injections of disinfectant. Stegling notes that ‘After a long and successful career as a leader in the global fight against HIV and Aids, this certainly won’t be the first time Dr Birx [US coronavirus response coordinator] has encountered these kinds of quack remedies. They have been a hallmark of the Aids epidemic since its earliest days, with the promise of “miracle cures” ranging from light therapies and magnetic waves to crystals and electric shocks – and yes, injections of bleach’ (2020). The article also mentions AIDS denialist Peter Duesberg and includes references to other viral diseases such as hepatitis C. Furthermore, several reports are significant in relation to mental health (discussed later). The peak in November correlates with the second lockdown in the UK which commenced on 5 November and highlights how COVID-19 has affected mental health. Headlines during the peak state, for example, ‘Coping with addiction: For many, the COVID-19 outbreak has intensified problems with alcohol and drugs’ (Jacobs 2020). A second aspect of drug abuse involves illegal raves and drugs parties, with headlines stating ‘Covid-test regiment breached lockdown at illegal drugs party’ (Hughes and Perriera 2020). A third aspect of the November peak is the parallel drawn between postwar zeitgeists and the current pandemic in ‘History suggests the roar of rebellion will follow Covid’s suppression’ (Heffer 2020). The article draws on various historical traumas, including World War I, World War II and the Glorious Revolution of 1688, and suggests periods of repression result in decadence and disruption. Heffer notes of World War II that ‘the years immediately following were marked not just by crime, but by cracks in society’ while after the Great War ‘[a]t one end of society, recreational drug abuse and extra-marital sex became commonplace, and at the other, industrial unrest and demands for a better standard of living culminated in the General Strike’ (2020). He goes on to add that ‘[b]ut the society that confronted the Covid pandemic was far less used to authority, deference and conformity than its forebears who went to war in 1939. Nor, in that war, were people controlled to the extent where they could not visit their families and friends; could not go to the pub; could not run a basic business […]; could not meet more than a limited number of people outside, or visit them indoors. Nor was their any doubt about the strength of the enemy’ (2020). The article therefore demonstrates a distinct intersection between different historical traumas and illustrates how ‘[t]he model of multidirectional memory posits collective memory as partially disengaged from exclusive versions of cultural identity and acknowledges how remembrance both cuts across and binds together diverse spatial, temporal and cultural sites’ (Rothberg 2009, 11).
Supplemental material
Search 7. HIV + gay
Main subjects
HIV=414, AIDS=194, gays and lesbians=133, men’s health=51, infections=146.
Analysis
In online supplemental figure S2, the two peaks in 2016 and 2019 are attributable to PrEP-funded controversy, and revelations concerning Gareth Thomas’s HIV status, respectively. Reports also centre on Prince Harry and Prince William’s support of Thomas. Many of the articles implicitly or explicitly celebrate Thomas’s bravery and also fitness. For example, the Times’ headline states, ‘Rugby star reveals he has HIV – then finishes gruelling triathlon’ (Blakely 2019). While there is no explicit link to COVID-19 in this search, the heroism associated with Thomas’s admission of his HIV status has broad parallels with the way that heroism was associated with certain figures in relation to COVID-19.
Search 8: COVID + gay
Main subjects
COVID-19=85, coronaviruses=79, pandemics=44, vaccines=19, Christmas=15, AIDS=12, HIV=9.
Analysis
Both AIDS and HIV crop up significantly in articles about COVID-19 and homosexuality, with peaks occurring in June 2020 and February 2021 (online supplemental figure S3). The June 2020 peak includes an article about Peter Piot’s experience of COVID-19 (McNeil 2020). Known for his research on viruses, he was president of the International AIDS Society, and the first director of UNAIDS. The report therefore comments on Ebola, SARS and AIDS, with Piot stating, ‘My mistake was to think it [COVID-19] was like SARS […] or that it was like influenza’ (in McNeil 2020). Piot also mentions the avoidance of handshaking in the case of Ebola and describes giving the ‘Ebola elbow’, a now familiar feature of COVID-19. A further comparison to Ebola occurs in his wife’s account of Piot’s hospitalisation: ‘When I saw Peter going through the double doors on that cart – I had the same feeling as the Ebola families we knew in Sierra Leone’ (in McNeil 2020). The June peak includes reports that feature ‘gay’ in non-homosexual contexts, references to storylines in ‘the Archers’ radio programme and in Netflix series, and one describing how COVID-19 was pushing voters towards Conservatism in Italy. The February 2021 peak refers almost entirely to the Netflix series It’s A Sin, with Russell T Davies drawing direct comparisons between COVID-19 and AIDS (Singh 2021). Significantly, the first episode was screened on 22 January, 2 days after the 20 January peak (and overall peak) in UK deaths from COVID-19 when 1820 deaths were reported (Marsh 2021) and thus potentially resonated prominently in societal consciousness. The February peak also includes an article on COVID-19 denial, further mentioning It’s A Sin. Ellie Harrison notes ‘it is striking how many of the issues faced by the public in Russell T. Davies’s new drama, set during the Aids crisis in the eighties, are so prevalent in 2021. It’s A Sin addresses misinformation, conspiracy theories, fear, blame culture, and the government’s slow and flawed response to a fast-spreading disease’ (2021). Harrison interviews lead actor Callum Howells who states ‘[COVID-19] is similar to the Aids crisis in the sense that people didn’t think it was real’ (in Harrison 2021). So too does Barney Calman’s article refer expressly to connections between COVID-19 and AIDS, its headline stating, ‘TV advert that proved scaring us witless isn’t the way to beat Covid’ (2020). Referring to the ‘Don’t Die of Ignorance’ campaign, Calman identifies a series of similar horror tactics deployed in public health advice on COVID-19: ‘There was ‘don’t kill granny’ and the ever-refreshed ‘worst-case scenario’ projections. And No 10’s horror-movie-effects department has also been working overtime, coming up with ever more disturbing ‘awareness-raising’ ads’ (2020). Calman also discusses Kaposi’s sarcoma and the stigmatisation of people with AIDS through the campaigns, noting that ‘ideas like forced screening, quarantining and even tattooing those who had the virus were not unheard of’, some of which are circulating with regard to COVID-19. Ferguson makes further analogies, with headlines including ‘Aids changed us. Will Covid do the same?: The Coronavirus is to social life what HIV was to sexual life’ ⇓, while the Independent highlights a return to discrimination against gay men: ‘Gay men being unable to donate Covid plasma is dangerous discrimination’ (Jenkin 2020). An important comparison is made concerning unequal access to treatment with one article citing UNAIDS: ‘In tackling COVID-19, we must learn the painful lessons from a history of unequal access in dealing with HIV […] Millions died of Aids-related illnesses while there were medicines available that could have saved their lives. This should not happen with Covid’ (in Kelly-Linden 2020a). Miller (2021) also reports on reactions to a comparison made between Boris Johnson and Princess Diana, the article stating ‘Edwina [Currie] argued: ‘The Prime Minister shook hands as a reflection of what Diana did during the HIV problems […] When Diana went into the hospitals in order to shake hands with patients and to say to them “You are not being stigmatised.” That I think is what he was doing’ (2021). Overall, this search reveals explicit links between the two viruses via multiple channels, again illustrating how multidirectional memory arises from ‘seemingly distinct histories (that) are not easily separable from each other, but emerge dialogically’ (Rothberg 2014, 176).
Search 9. HIV and antiretrovirals
Main subjects
HIV=32, AIDS=17, antiretrovirals=7, infections=6, bone marrow=5, pandemics=1.
Analysis
Unexpectedly, the search failed to identify news reports prior to 2000, with a main peak occurring in 2019 and several smaller peaks in 2010 and 2013 (online supplemental figure S4). The 2019 peak (n=11) focused on announcements that an undetectable virus count means that the virus is effectively untransmissible (Stoppard 2019) while another report notes how HIV is uncontrolled in women aged 15–24 years in sub-Saharan Africa (Nuki 2019). The word ‘cure’ appears in various headlines, these relating to gene-editing in connection to the survival of ‘the London patient’ (Newey and Gulland 2019). Cure is also in the headline ‘Fifty years of HIV: how close are we to a cure?’ (Siddons and Graham 2019) which tracks the treatment of HIV from the first death to recent reports of the London patient, elite controllers and PrEP. The 2013 peak concerns several reports of HIV-positive surgeons who are cleared to operate while another, authored by Francoise Barré-Sinoussi, Nobel prize-winner for the discovery of HIV, refers again to functional cure in a baby from Mississippi (Barré-Sinoussi 2013). The 2010 peak reflects conflicting reports that state ‘the world is slowly winning the battle against HIV, says UN: 1.2 m more lives saved, but report warns of shortfall, Tipping point is close, says WHO’s Aids chief’ (Boseley 2010). In contrast, other headlines state that ‘We could lose more people to Aids than to decades of war’ (Whipple 2010). Overall, there is limited crossover with COVID-19 although an association emerges in search 10.
Search 10. COVID and antiretrovirals
Main subjects
Coronaviruses=5, COVID-19=5, disease transmission=5, pandemic=5, generic drugs=4.
Analysis
There is limited crossover with HIV through mention of antiretrovirals, with the April 2020 peak including several reports: ‘Maverick French doctor stirs cure frenzy: Research. Pandemic hope. Proposed use of old malaria drug to treat Covid-19 garners support and heavy criticism’ (Abboud 2020) (online supplemental figure S5). The reports focus on the championing of chloroquine by virologist, Didier Raoult, and subsequently, by President Trump. However, the article also references Francoise Barré-Sinoussi, significant, as noted, because she was a co-recipient of the Nobel Prize for the discovery of HIV. The article further discusses HIV and antiretrovirals in the context of testing a range of drugs for Covid-19. The single article in August also features crossover between the two pandemics, with a citation from the director of the Pan American Health Organization stating ‘we are beginning to see warning signs of the devastating impact [of Covid-19] on other diseases’ (in Newey 2020), the report then going on to identify issues around drug supply ‘with 11 countries set to run out of antiretrovirals for HIV within three months’ (Newey 2020).
Search 11. HIV + hero
Main subjects
HIV=20, rugby=13, AIDS=10, stigma=6, coronaviruses=2.
Analysis
The 2019 peak relates to the fact that Gareth Thomas declares that he has HIV, with headlines stating, ‘Harry hugs HIV hero’ (Andrews 2019). In 17 of the 2019 reports, Thomas is described as a ‘hero’, ‘courageous’ or ‘HIV warrior’, illustrating the much-changed reception of HIV in the media (online supplemental figure S6). Reference to coronavirus occurs in the 2020 articles with the Telegraph headlines stating that ‘San Francisco’s HIV experience may have saved lives now’ (Rudgard 2020). The article explains how political leaders in San Francisco rapidly mobilised ‘shelter in place’ orders, requested residents to wear masks and set up a contact tracing force before many other US cities in response to COVID-19. The article notes that San Francisco was at the centre of the US HIV outbreak with Dr Paul Volberding, HIV specialist, stating that ‘There are parallels to today’s epidemic […] what we did was really to build up a trust between the medical, the political and the gay community, the people at the highest risk’ (in Rudgard 2020).
Search 12. COVID + hero
Main subjects
coronaviruses=954, COVID-19=937, pandemics=556, vaccines=150, disease transmission=120.
Analysis
The April 2020 peak shows two key dates, 1 April (n=17) and 3 April (n=13), and all results for these two peaks include the words ‘Brave NHS heroes’, reflecting attitudes towards the NHS (online supplemental figure S7). The February 2021 peak relates to Captain Thomas Moore, a British Army officer who became a national hero by raising £38 million for the NHS and who died on 2 February 2021. Overall, there is significant cross-referencing to previous pandemics (n=556).
Search 13. HIV + wartime
Main subjects
HIV=3, wartime=3.
Analysis
In marked contrast to COVID-19, the three results here incidentally mention wartime, with the articles providing various details regarding HIV unconnected to wartime measures (online supplemental figure S8).
Search 14. COVID + wartime
Main subjects
coronavirus=175, COVID-19=174, pandemics=124, vaccines=36, disease transmission=28, World War 2=27, war=23, World War 1=4.
Analysis
The February 2021 peak refers to a series of unconnected wartime scenarios that do not centre around a particular event but more on the spirit of the nation (online supplemental figure S9). They include numerous comments of ‘wartime measures’ in the vaccination programme; reference to Valentine’s day with comments such as ‘wartime was more dangerous but at least you could pick up a sweetheart at a dance […] Never before has touching a consenting adult […] constituted a crime’ (Turner 2021); and, reflecting the COVID-19 downturn in long-haul flights, ‘The battle for Britain’s industrial soul’ which states ‘Rolls’s reactors power Britain’s fleet of nuclear warhead-armed submarines […] Its Merlin engines won the Battle of Britain’ (Collingridge 2021). Another article aligns the measures taken during the pandemic with wartime actions with the suggestion that ‘measures taken to combat the pandemic may also, whatever the assurances of ministers, have an unwelcome afterlife once the crisis is over’ (Aaronovitch 2021). This statement employs the word ‘combat’ while overall, the words ‘war’, ‘wartime’ or ‘save the world’ appear in 13 of the 31 headlines for February 2021. Thus, while there is limited association with HIV specifically, there is correlation with previous pandemics and wartime generally.
Search 15. HIV + enemy
Main subjects
AIDS=4, bacteria=3, HIV=3, medical research=3, meningitis=3, pandemics=2, COVID-19=1.
Analysis
The 2004 peak includes four unrelated reports, two of which personify HIV as an enemy (online supplemental figure S10). For instance, in commenting on children and HIV/AIDS, one article states ‘the HIV virus knows no boundaries, it needs no visa, it has no ethnic background and no gender. It is an enemy we cannot see’ (Taylor 2004). HIV is similarly described as an enemy in an article titled ‘She’s finally met the man of her dreams. There’s just one problem – he’s HIV positive’ (Frostrup 2004). The text describes having ‘the advantage of knowing your enemy’. The 2015 peak also references four articles, three of which state ‘We normally think of viruses as the enemies of mankind but it is their ability to infect and kill human cells that make them such promising cancer treatments’ (Manger 2015). The single mention of COVID-19 in the search is titled ‘Earth’s deadliest enemy’ (Vidal 2021) and begins the report with mention of It’s A Sin. John Vidal then comments ‘As the series progresses, of course, the story becomes much darker. It is a chilling reminder of the last time our world was confronted by a mysterious and lethal virus trailing thousands of deaths and devastation in its wake. Of course, the Aids virus, HIV, and the COVID-19 virus are hugely different, not least in terms of transmission and their impact on the body. And yet there is a fundamental link between the two that has potentially catastrophic implications for the future health and survival of our ever-expanding population […] That’s because both HIV and the Covid virus, along with a host of other deadly microbes, originated in animals and jumped the species barrier into humans’⇓. Vidal mentions other contemporary threats—the war on terror, the threat of nuclear war, climate change—as well as a catalogue of deadly diseases, including Ebola, Lassa fever, Marburg and Simian viruses, SARS, Chagas, Machup and Hantavirus, Henra and MERS. He also refers back to the Black Death, thus aggregating many of the major current and historical crises. Overall, there are explicit associations with HIV as well as other traumatic events and diseases, evidencing Rothberg’s claim that ‘the borders of memory are jagged; what looks at first like my own property often turns out to be a borrowing or adaptation from history that initially might seem foreign or distant’ (2009, 5).
Search 16. COVID + enemy
Main subjects
coronaviruses=413, COVID-19=392, pandemics=219, vaccines=105, disease transmission=63, AIDS=9.
Analysis
The April peak (n=67) includes reports on conspiracy theory, non-COVID patients and coronavirus as the enemy with reference to AIDS in several of these (online supplemental figure S11). Simon Kuper identifies parallels between COVID-19 and AIDS in his report ‘Opening Shot: The Covid conspiracies’ (2020) where he outlines various conspiracies in relation to COVID-19—a bioweapon created by China, caused by 5G technology, or a hoax made up by Donald Trump’s enemies—and compares these to AIDS. As the report notes ‘in 1983, a small Indian newspaper, the Patriot, published an anonymous letter headlined: ‘Aids may invade India: Mystery disease caused by US experiments’. The letter, supposedly written by a ‘well-known American scientist and anthropologist’, blamed Aids on ‘the Pentagon’s experiments to develop …. biological weapons’ at an army research facility’ (Kuper 2020). Kuper comments that ‘we’re back in that territory now’ referring to the way that there is belief that the virus originated in a laboratory. Alongside this conspiracy theory is a disregard for recommended safe behaviour. As Kuper continues ‘when people turn on the news, they see distrusted politicians reciting false numbers [….] flanked by scientists who can’t make up their minds. Someone who mistrusts the authorities will also mistrust their instructions to change behaviour. We saw this during the Aids epidemic, when many South Africans and Americans who believed conspiracy theories about the virus continued to have unprotected sex and didn’t get tested or take antiretroviral drugs’ (2020). There is a clear analogy here with the refusal to wear masks or socially distance by certain groups during the COVID-19 pandemic. Other reports adopt wartime parallels, with COVID-19 as the enemy. The article titled ‘Britain is plucky but national morale is low’ ⇓features an array of wartime terminology such as the ‘nation is at war […] and the National Health Service on the front line. It is a war we will win’. The report, written by General Nick Houghton, goes on to include words and phases such as ‘victory’, ‘pluckiness’, ‘national stoicism’, ‘winning’, ‘mission’ and ‘defeating coronavirus’, all associated with war and picking up on the previously identified wartime parallel. The virus as enemy also occurs in April 2020 reports about the sidelining of non-COVID patients (Hoenderkamp 2020).
Search 17. HIV + protection
Main subjects
HIV=101, AIDS=40, sexually transmitted disease=20, men’s health=14, condoms=13.
Analysis
Unexpectedly, the peak occurred in 2009 (n=44), with 16 of the 44 reports in September 2009 (online supplemental figure 12). These all related to articles on an experimental vaccine for HIV (Lister 2009). The 2009 peak also included reports concerning a rise in UK HIV cases with ‘record levels of HIV infection over 2 years’ (Carvel 2009). The crossover with condoms refers to several cases of men deliberately infecting others through unprotected sex (Anon 2018), while others relate to the extra protection offered by funding the introduction of PrEP (Anon 2016). While there is no explicit link to COVID-19, one might draw parallels with the controversies around face masks and vaccines during the COVID-19 pandemic (to be discussed next).
Search 18. COVID + protection
Main subjects
coronaviruses=3356, COVID-19=3010, vaccines=1700, pandemics=1263, disease transmission=1096, PPE=147, masks=128.
Analysis
The search prompted a significant response, with subjects such as PPE, masks and vaccines cropping up (online supplemental figure 13). The February 2021 peak (n=574) centred on vaccine reports and analysis shows that 3 February was the highest for that month (n=48). All 48 reports were concerned with vaccines reflecting the fact that, while the vaccination programme started in December 2020, it gathered momentum in the UK during February and March 2021. Analysis of crossover with PPE indicates a focus in early 2020, rising again to a November peak and corresponding with the shortages of PPE as well as approximately tracking the first two lockdown periods. Articles report that ‘some staff wore bin bags as makeshift protection’ (Gilbert, Kirk, and Riddy 2020), and ‘Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded’ (Campbell and Busby 2020). Analysis of crossover with ‘masks’ (n=128) also shows a March-April 2020 peak corresponding to the first lockdown, and reports centre on the efficacy of wearing masks and two-metre distancing (Gross 2020).
Search 19. HIV + discrimination
Main subjects
HIV=39, AIDS=21, stigma=14, gays and lesbians=8, AIDS=6, pandemics=4, coronaviruses=3, COVID-19=2.
Analysis
The 2001 peak (n=17) relates to a discrimination case brought against an employer by an employee with HIV who was made to wear a boiler suit and gloves while at work (Sengupta 2001) (online supplemental figure 14). The 2019 peak (n=18) corresponds to a number of reports concerning a large trial for PrEP which shows that men whose HIV infection was fully suppressed prevented HIV transmission. One such article states that ‘this powerful message can help end the HIV pandemic by preventing HIV transmission and tackling the stigma and discrimination that many people with HIV face’ (Boseley and Devlin 2019). Also contributing to the 2019 peak are reports on Jonathan Van Ness’s admission that he is HIV-positive. The article states that he went public due to ‘perceived LGBT discrimination in the US’ and then reports that ‘The Netflix star has been inundated with messages of support after sharing his HIV status’ (Anon 2019). Crossover with COVID-19 (n=2) refers to two articles that describe the marginalisation associated with provision of funding for HIV prevention for certain communities. One article comments about the extra difficulties caused by COVID-19 (Kelly-Linden 2020a) while the other warns about repeating the mistakes of the HIV crisis in responses to COVID-19 (Kelly-Linden 2020b).
Search 20. COVID + discrimination
Main subjects
coronaviruses=175, COVID-19=160, pandemics=89, vaccines=58, immunisation=33, racism=23, age discrimination=16, minority and ethnic groups=15, sex discrimination=8, HIV=4, AIDS=4, learning disability=3.
Analysis
The February 2021 peak (n=40) shows diverse references to discrimination including lack of financial support for those who are self-employed, potential discrimination arising from vaccine passports, claims of structural racism, and a claim that women are disproportionately affected by COVID-19 (Sands 2021) (online supplemental figure 15). The February peak itself peaks on the 14th with six results concerning ‘do not resuscitate’ notices for patients with COVID-19 with learning disabilities (Tapper 2021), and vaccine passports. Further articles around discrimination include ‘Fighting Covid racism’ which reports on east- and south-east-Asian communities who have faced increasing ‘racially-aggravated violence and discrimination’, because the virus originated in China (Ng 2021). Reports also refer to the virus practising severe age discrimination (Oswald 2020), and to the structural racism of the UK. In respect of the latter, Nazia Parveen’s article notes ‘The TUC [trades union congress] general secretary, Frances O’Grady, said “This pandemic has held up a mirror to the structural racism in our labour market and wider society”. She said that workers of colour had withstood the worst of the economic impact of COVID-19, losing their jobs twice as quickly as white workers. “When BME [Black and minority ethnic] workers have held on to their jobs, we know that they are more likely to be working in low-paid, insecure jobs that put them at greater risk from the virus […] which has led to a disproportionate BME death rate’’’ (Parveen 2021). A final point of discrimination relates to gay men who, as Matthew Jenkin claims, are unable to take part in vaccine trials or donate plasma. As his report states ‘No matter how you look at this policy, it’s homophobic and out of touch. It’s taken years for the gay community to shake off the stigma of the Aids epidemic of the 1980s (an event which directly led to the current NHS guidelines on gay blood donation), yet here we are in 2020 facing a virus which does not discriminate, only to be told we are still somehow contaminated’ (Jenkin 2020). Other crossovers with HIV include likening government messages around COVID-19 to the fear generated by the 1980s ‘Don’t Die of Ignorance’ public health campaigns, and how then, grassroots organisations were crucial in lobbying for an end to discrimination (Calman 2020).
Search 21. HIV and lifestyle
Main subjects
HIV=39, AIDS=29, social networks=9, men’s health=8, infections=7, gays and lesbians=6, sexual behaviour=6, drug addiction=3, condoms=2, sexually transmitted disease=2, activism=1, transgender persons=1, coronavirus=1, COVID-19=1, bisexuality=1.
Analysis
The distinctive double peak of 2015 and 2016 mostly refers to news concerning the fact that the NHS are to prescribe the HIV PrEP drug, with mixed support for its provision (online supplemental figure S16). Several Daily Mail headlines state ‘What a skewed sense of values’ (Borland and Spencer 2016) while The Times said, ‘Women get the pill, so why not gay men too?: Moral outrage over the new HIV drug is unjustified because many other ailments are caused by our self-indulgence’ (Turner 2016). The second key headline around lifestyle of 2016 concerns Charlie Sheen who is described in one article as having a ‘hard partying lifestyle fuelled with orgies’ (Okey 2016). Crossover with COVID-19 (n=1) occurs in Ferguson’s report ‘Aids changed us: Will Covid do the same?’ and asks the reader to ‘imagine a world in which Covid-19 […] has the same effect on social life as Aids had on sexual life’ (2020b). Ferguson then recounts certain other similarities—complacency by the authorities followed by ‘stigmatising victims (for ‘the Chinese virus’ read ‘the gay plague’). Last month, the New York Times published an article asking, ‘are facemasks the new condoms?’—destined to become ‘ubiquitous, sometimes fashionable [and] promoted with public service announcements’ (2020b). The final contributing factor to the 2016 peak concerns questions about whether Prince’s death was due to AIDS (Leonard 2016). There are therefore explicit links between HIV and COVID-19 as well as indirect parallels concerning lifestyle (see discussion).
Search 22. COVID + lifestyle
Main subjects
COVID-19=351, coronaviruses=341, pandemics=190, vaccines=55, obesity=47, diabetes=40, overweight=20, cardiovascular disease=19, blood pressure=18, physical fitness=16, diet=15, weight control=12, vitamin D=11, hypertension=10, body mass index (BMI)=7, alcohol=6, cholesterol=6, heart attacks=6.
Analysis
The findings indicate that the news media placed considerable emphasis on physical health in terms of COVID-19 with diverse references to obesity, vitamin D supplementation and the advocation of lifestyle changes (online supplemental figure 17). Obesity was a key issue in many publications (n=47), contributing 25% to the total February 2021 overall peak and reflects Boris Johnson’s personal experience of COVID-19. Headlines included ‘PHE [Public Health England] study shows obesity can raise risk of Covid death by 90pc’ (Donnelly and Yorke 2020) and ‘Boris puts the nation on a diet’ (Pickles 2020), with the latter report stating ‘Mr. Johnson, who ended up in intensive care with coronavirus, is said to be convinced that his weight was to blame’ (2020). Lifestyle also cropped up in reports concerning Gwyneth Paltrow’s health advice on COVID-19, with several newspapers critical of her advice (Kelly 2021).
Search 23. HIV + mental health
Main subjects
HIV=46, AIDS=26, criminal sentences=8, court hearings and proceedings=6, mental health=6, coronaviruses=2, suicides and suicide attempts=2.
Analysis
Results indicated diverse causes for discussion of mental health with few focal issues (online supplemental figure 18). The 2018 peak corresponded with headlines ‘Women with HIV sidelined because focus is on gay men, says charity’ (Anon 2018) while reference to mental health assessment was also discussed in articles on trainee pilots with HIV: ‘Ban on trainee pilots with HIV could be lifted’ (Batchelor 2018). Crossover with suicide occurs in relation to an article on Gareth Thomas in which it is stated that ‘Throughout his career, Thomas has been outspoken about his struggles with mental health […] and how close he came to suicide’ (Godfrey 2020).
Search 24. COVID + mental health
Main subjects
coronaviruses=1624, COVID-19=1538, pandemics=923, mental health=491, vaccines=320, mental disorders=116, anxieties=85, post-traumatic stress disorder (PTSD)=46, dementia=40, suicide and suicide attempts=25, loneliness=22.
Analysis
The search revealed substantive coverage of mental health, the peaks coinciding with the three UK lockdowns and reflecting the impact of isolation and the susceptibility of certain groups (online supplemental figure 19). As noted by Rishi Sunak in the Mail on Sunday: ‘The pandemic has had a major impact on mental health because of increased isolation and uncertainty. This funding [£500 million] will make sure those who need help get the right support as quickly as possible, so they don’t have to suffer in silence’ (Owen and Mikhailova 2020). The importance attached to mental health is apparent in the fact that the words often appear in headlines as well as article content. The November 2020 peak also reflects attention to the after-effects of the virus whereby ‘Almost 20 per cent of patients develop psychiatric condition after Covid, study suggests’ (Knapton 2020b).
Discussion
Generally, there are frequent references to pandemics, HIV and COVID-19 in the main subjects of searches. Specifically, the term ‘plague’ is used in the contexts of both viruses and in comparisons with previous pandemics such as the Black Death, while mention of ‘gay plague’ in relation to HIV remains, although infrequently. Notably, links to other postmillennial major crises were apparent, including 9/11, Hurricane Katrina, and the 2008 financial crash as well as more distant historical events. Unexpectedly, there were associations with the term ‘gay’ for COVID-19, and commonalities with HIV identified in relation to public health campaigns and messages, denialism, discrimination against gay individuals (in terms of being unable to donate plasma for COVID-19 patients), and changes to social life, with COVID-19 being equated to changes in sexual life for individuals living with HIV/AIDS. Further analogies became apparent regarding fears about iniquities of access to AIDS medicines recurring with COVID-19. There were also parallels between the two pandemics in terms of misinformation and ‘quack’ remedies, as well as crossover in the way that COVID-19 has impacted negatively on treatment for AIDS in certain countries. At the same time, media coverage of the two pandemics displayed certain differences—whereas HIV did not tend to involve wartime comparison, discussion of COVID-19 was replete with references to war and wartime. Indeed, in her April 2020 address to the nation, Queen Elizabeth II herself referred to child evacuations of 1940 and alluded to Vera Lynn’s wartime song in her words ‘we will meet again’ (Foster, Bashir, and Dewan 2020), illustrating how multidirectional memory is ‘concerned simultaneously with individual and collective memory […] and the interaction within specific historical and political contexts of struggle and contestation’ (Rothberg 2009, 4). The Queen’s address also demonstrates how multidirectional memory ‘draw[s] attention to the dynamic transfers that take place between diverse places and times during the act of remembrance’ (Rothberg 2009, 11). Correspondingly, COVID-19 was strongly associated with the word ‘hero’, mainly to describe NHS staff and Captain Tom Moore. References to hero in respect of HIV were distinctly fewer with only one significant year which reflected Gareth Thomas’s admission of his HIV status, and which did not parallel reports about COVID-19 sufferers. Relatedly, reports on both HIV and COVID-19 use the term ‘enemy’, though COVID-19 more so. There is a further correlation drawn between the scaremongering ‘Don’t Die of Ignorance’ campaigns of the 1980s and the public health messages concerning COVID-19, in particular, its ‘don’t kill granny’ messages, and worse-case scenario projections, alongside visual horror effects (Calman 2020).
The term protection also generated more hits for COVID-19, likely reflecting media coverage of masks, PPE and vaccination updates, especially in 2021 when the vaccination programme was fully mobilised. Comparisons, however, were noted between masks and condoms in a number of articles and the equivocation about wearing these. In particular, there are parallels between COVID-19 and HIV in terms of the marginalisation of certain groups as well as the association of certain groups with risk. Specifically, the focus on the words ‘Chinese virus’ or 'China virus' mirror the initial association of HIV/AIDS with gay communities as frequently appeared in press reports. However, as noted, the suggestion of biblical plague attributed to HIV also occurred frequently in relation to COVID-19. Likewise, reports highlighting and promoting change in lifestyle were evident in connection to both pandemics, with physical fitness encouraged in relation to COVID-19 and safe sexual behaviour for HIV. In a similar vein, mental health has greater coverage for COVID-19 than for HIV, possibly because of the extended periods of isolation for the entire population, suggested by the high incidence of ‘loneliness’ search subjects (n=22), but also greater societal consciousness of mental health than in previous decades, partly owing to support from Prince Harry and Prince William. Nonetheless there is crossover in that mental health is a major factor in individuals living with HIV.
It is acknowledged that the study has certain limitations. These include the fact that not all newspapers are fully digitised, especially during the era 1980–1989 and some were not in publication at that time. The searches could have been made more specific and extensive but then risked excluding certain articles so broader terms were employed. AIDS was excluded from headlines and so has likely excluded articles. In general, it was beyond the scope of the essay to extend searches further although there are other areas for comparison that may prove of interest, such as that of reactions to celebrity infection. Significantly, in relation to Rothberg’s concept of multidirectional memory, it is apparent from the results that there are considerable parallels and crossovers between the two pandemics, as well as mention of other major viral outbreaks, including Ebola, SARS, MERS, the Black Death and bubonic plague with constant cross-referencing between them. In addition, there is repeated negotiation with past international crises, both recent, as in 9/11, and distant as in World War II and beyond. Despite residual antipathy towards the provision of PrEP, attitudes towards HIV appear considerably changed with COVID-19 prompting both reflection on reactions to HIV, and on lessons to be learnt. Overall, there are obvious parallels and similarities between the two pandemics although these are not always overtly referenced in news media. Other times, there are explicit connections and cross-references made between them, as well as connections forged to a range of other traumatic histories. In other words, histories and their memorial legacies do not compete with each other and block each other out. Rather, as Rothberg contends, they are productive and ‘cut across and bind together diverse spatial, temporal and cultural sites’ (2009, 11).
Please note that patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Bibliography
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Footnotes
Correction notice This article has been corrected since it was published Online First. Some missing text was added and some errors in the text were removed.
Contributors FEP-K is the sole author of the paper.
Funding This study was funded by University of Wolverhampton.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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