Telescope: The New AIDS Epidemic is a deep-dive investigation into the modern face of a disease that transformed the world and changed the most intimate aspects of our lives.

By Sarah Wheaton | @swheaton | Send tips here | View in your browser

Welcome to the eighth installment of POLITICO’s Telescope: The New AIDS Epidemic. We’re coming to you from the couch, once again looking at the links between HIV and this even newer pandemic.

Experts have been preaching the “test, test, test” mantra about the coronavirus virtually since it emerged this year.

It took the HIV community a while to get there. Fear of discrimination — and the sense that there was no point in knowing, because you’d die of an untreatable disease anyway — fueled broad reluctance to get checked years ago. But these days, “know your status” is HIV orthodoxy.

My colleague Aitor Hernández-Morales takes a close look at how some lessons learned the hard way in the fight against AIDS could help us overcome COVID-19. Testing will be key to any lasting liberation from lockdown, especially while we lack either a treatment or a vaccine. Over the years, HIV taught us ways to track down hard-to-find cases and, before the days of apps for contact tracing, getting HIV-positive people to communicate with those they’re close to about the potential risk.

Aitor’s article reminded me of one of the most searing coronavirus stories I’ve read in weeks (and I’ve read a lot). When it comes to the coronavirus, we could see a pretty sharp reversal from the fears of discrimination that people with HIV face. Antibody testing could — eventually — tell us who has immunity against the bug, and those immune people would be able to work, while the rest of us will be trapped at home.

A New York Times article from over the weekend contemplates this future. It envisions people purposely exposing themselves to COVID-19 in hopes of riding out the sickness and coming out on the other side with that precious immune status — able to work again.

Surely no one would do that for HIV, right?

Sadly, history reminds us of the risks impoverished people are willing to take.

Cuba’s 80s-era AIDS solution was to isolate HIV-positive people in camps. Those camps weren’t so bad, complete with medical care and art classes. Before treatment, they were essentially a pleasant place to die. Yet dozens of homeless young people purposely got themselves infected, through sex or even blood injections, to gain entry, Cuba’s top AIDS expert told the New York Times.

And that’s why one of Aitor’s closing lessons really hits home: In the race for innovative treatments and vaccines, there are already signs that rich countries will get priority. Will we be doomed to re-learn this lesson from the early AIDS epidemic, too? Read the article.

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2020 ≠ 1980s: time to put an end to stigma around HIV

You may recall from an earlier newsletter that I detected some surprising ambivalence about self-testing for HIV from the experts at our Paris roundtable in November. The concern was that while the privacy and convenience might encourage more people to get tested, they might not know how to respond to the results — positive or negative.

So my colleagues Carmen Paun and Judith Mischke looked into it. Here’s Carmen’s dispatch:

The idea behind HIV self-tests is that they increase diagnosis rates by reaching people who wouldn’t have otherwise get tested due to fear, stigma or the lack of access to testing facilities. Makes sense. But, some five years after self-tests first became available in many pharmacies in Europe, researchers have yet to gather enough evidence to back up that hypothesis beyond a reasonable doubt.

That may be about to change, with data from Belgium offering potential good news.

“Since 2016, the year in which self-testing was officially allowed, the [proportion of infections being detected] has had a strong increase,” a Belgian health ministry spokesperson said.

Nearly 20,000 self-tests were sold in Belgium between November 2016 and the end of June 2019. Of some 19,200 people with HIV diagnosed in 2018, some 1,700 would not have been diagnosed without them, according to the spokesperson.

“HIV self-tests are worthwhile,” said German HIV group Deutsche Aidshilfe. Some 50,000 tests were sold in Germany the first year after they became available in pharmacies in the fall of 2018, according to the group, which called for them to be reimbursed by health insurers.

In France, which was the first country in the EU to make self-tests available in September 2015, there have been on average 74,000 sold per year in 2016, 2017 and 2018, according to Santé Publique France.

Gilead Sciences Belgium is committed to fighting stigma around HIV

*Disclaimer: While effective viral suppression with antiretroviral therapy has been proven to substantially reduce the risk of sexual transmission, a residual risk cannot be excluded CDC (Centers for Disease Control and Prevention) states that there is effectively no risk of sexual transmission of HIV in individuals with an undetectable viral load.

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