When America’s top disease prevention official compared Ebola to AIDS during a meeting of the World Bank in Washington, D.C. last week, he raised more than a few eyebrows.
“In the 30 years I've been working in public health, the only thing like this has been AIDS,” said Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). “We have to work now so this is not the world’s next AIDS.”
Reactions to his comment ranged from fear to anger. Some argued that the United States should no longer allow travelers from Africa into the country lest the disease spread. Others were offended, noting that it took more than one dead patient before the U.S. government responded to HIV/AIDS in the 1980s and '90s.
President Ronald Reagan did not speak to the nation about AIDS until six years after the first recorded deaths, according to the Kaiser Family Foundation.
In fact, the Ebola virus and HIV are similar, said Dr. Amesh Adalja, a representative of the Infectious Diseases Society of America (IDSA). A top official at a large U.S. AIDS services organization agreed, saying that to deny the similarities is to stigmatize Ebola in much the way the U.S. did with AIDS.
HIV and Ebola are both viruses. Both emerged in Africa, Adalja noted, neither has a vaccine, and both are fatal if left untreated. Both are carried by host animals and then transmitted to humans, and both may have made that transition when hunters ate bush meat.
Viruses Spread Through Bodily Fluids, but Not the Same Ones
“This is an aggressive, unprecedented approach,” Adalja said of the CDC’s response to the Ebola virus when it was recently brought onto American soil by a Liberian traveler named Thomas Eric Duncan. But Adalja also stressed that the virus is spread only through contact with body fluids.
So how did a nurse treating a patient in full protective gear become the second Ebola case in the United States? The transmission may have occurred when the nurse was dismantling her gear, Adalja said. That’s what authorities believe may have happened during an Ebola transmission in Spain, as well. The Spanish nurse admitted that she may have accidentally touched her face while taking off a contaminated glove.
“The virus only spreads through contact with body fluids,” Adalja told Healthline. “We have to use appropriate personal protection equipment, and we have to know how to take it off properly. What happened in Spain may have happened in Dallas. There may have been inadvertent contamination taking off the equipment.”
The CDC maintains that Ebola “is not spread through the air or by water, or in general, by food.”
For the virus to be transmissible through the air like the common cold, it would have to mutate. “We know the virus hasn’t changed,” Adalja said. No virus that infects humans has ever been known to mutate and change the way it spreads, Reuters reported Monday.
HIV can only be transmitted through blood or breast milk, or via sexual intercourse, according to the CDC. Ebola is slightly easier to spread, but is still much less transmissible than more common infections like the flu.
Ebola can be spread by blood and sexual fluids, too, as well as through urine, saliva, sweat, feces, and vomit, according to the CDC. The fluids have to come into contact with broken skin or mucous membranes, such as the eyes, nose, or mouth, in order to infect another person.
The two viruses are different in that HIV has a long latency period. Someone can be infected and not show symptoms for as long as 10 years; all the while they are able to transmit the disease. There is a much shorter latency period for Ebola — typically shorter than 21 days. Symptoms appear quickly, and a person needs to be actively exhibiting symptoms in order to spread the virus, Adalja said.
Stigmatizing the Sick, Pointing Fingers ‘Not Helpful’
Daliah Mehdi, chief clinical officer for AIDS Foundation Chicago, told Healthline that those who don’t want Ebola compared to HIV are actually stigmatizing people with HIV.
“We need to stop thinking of HIV as this special, untouchable, unique disease,” she said. “Here’s something that in some ways mirrors our experience with HIV and could potentially come down the same road. To stigmatize it as one of a kind, we’re not taking our collective experience and trying to get best practices out of that, and I think that’s a terrible mistake.”
AIDS was first discovered in the United States in 1981 among a handful of gay men in Los Angeles. The media and even health officials labeled it “gay-related immune deficiency,” or GRID. The moniker stigmatized gay people and suggested that only gays were at risk from the disease.
To think that Ebola only will affect poor Africans and African immigrants would be doing much the same thing, Mehdi said.
Arguing that if funding cuts had not been made to the National Institutes of Health (NIH), we would already have a vaccine for Ebola, as NIH Director Francis S. Collins told the Huffington Post on Friday, is also not helpful, Mehdi said. “Is it useful to now sit and point fingers at who made those cuts? What is helpful is to examine how to redirect funding,” she said.
Blasting the U.S. government for allowing sick citizens to come home for Ebola treatment is also “ridiculous,” she added.
“They’re American citizens. What are we going to do; exile them? You come home and you rely on your healthcare system to treat you,” she said. She argues it’s no different than if an American had contracted dengue fever while hiking in Thailand.
Mehdi said she believes the CDC and NIH are doing the best they can with the crisis.
“I think we need to build up society’s trust in the government bodies that have been preparing to deal with this and who have knowledge — perhaps not as much as we’d like — but there’s still knowledge, and we need to be supportive of it and not use it for political leverage,” she said.
Dr. Tom Frieden, director of the CDC, is decontaminated as he leaves an Ebola treatment unit. Photo courtesy of Athalia Christie for CDC Global/CC