Care During Crisis

The following is a summary of a conversation between Victoria Fletcher, MSN, ARNP, FACNM and Nikki Duffney, NSRH Director of Membership about the similarities from her history and lived experiences between the HIV/AIDS crisis and the COVID-19 pandemic. Edits have been made for length and clarity.

Victoria Fletcher, MSN, ARNP, FACNM is a certified nurse-midwife, NSRH founding member, and NSRH board member. She was contracted in 1990 to provide health education to healthcare professionals in the beginning of the HIV/AIDS crisis. Topics included etiology, transmission, prevention, treatment and caring for patients with HIV/AIDS. We sat down with her to discuss her experience working in healthcare during the HIV/AIDS crisis and COVID-19 pandemic, and what similarities and differences she has noticed between the two.

In the early days of the HIV/AIDS crisis and the COVID pandemic when little information was known, it invoked similar human reactions: stigma, shame, and fear. Health outcomes were driven by lack of evidenced based information, limited access to care, and health disparities. There are overlapping emotions that came to light as these two very different pathogens took hold of populations:


Stigma toward the population that seemingly started it or had/has the highest incidence of infection was felt during both crises. HIV/AIDS saw initial stigma pointed at gay men and the LGBTQ populations, and Chinese people and government had the global finger pointing at them as the source or reason for the COVID-19 pandemic. Some even called COVID the “Chinese” virus, which can be directly tied to the increase in Asian-American Pacific Islander hate crimes.

Unknown transmission

At first, people didn’t know how HIV/AIDS or COVID-19 was transmitted and this ignorance led to fear, wide-ranging theories of transmission, and irrational ways to prevent transmission and to treat the diseases. Since there was early information about HIV/AIDS compromising immune function, the first AIDS patients who were hospitalized were cared for in protective isolation; staff and visitors had to gown and glove before entering their rooms to prevent a vulnerable person from contracting infections from staff or visitors. This changed as people received effective treatment for HIV/AIDS, hospitalizations were decreased and severe immune compromise avoided.

Having celebrities and athletes testing positive for HIV/AIDS gave the general population a different perspective on who could get the virus and how the virus could be transmitted. Magic Johnson, a pro-basketball player and considered a vision of health, revealed his status in 1991. Freddie Mercury died from AIDS related illnesses in 1992, the same year pro-tennis player Arthur Ashe’s status was revealed and traced to a blood transfusion. One year later Philadelphia, the first major Hollywood production on the topic of AIDS, was released.

Actor Tom Hanks contracted COVID-19 while filming in Australia in March, 2020. A study found that public opinion surrounding the then-new coronavirus shifted after he was diagnosed, with some individuals taking the coronavirus more seriously as a result. Most participants wrote that the virus now seemed like more of a serious threat in their minds, and one said they felt “panicked” because Hanks “is rich and protected. He can get it. Anyone can get it.” (source: Huffington Post, 2/6/21)

Lack of education

There was a surprising lack of education and research available to professionals. Treatment options available in both the AIDS crisis and the pandemic were under-shared and left people uncertain about their options. Studies have shown that it can take up to 10 years for new medical guidelines and practice standards to reach doctors and nurses and become the standard of care. That timeline must be shortened, as we don’t have the luxury of time in situations like the AIDS crisis or COVID-19.

With COVID, there is a similar lack of information about transmission and treatments. There are Rx options like monoclonal antibodies for people who test positive that could lessen the virus’ impact and prevent hospitalization and death. Many healthcare providers and potential recipients don’t know about this option, and the treatment modality is not universally available throughout the US. Where is the standardized training related to COVID-19? What education and training needs to be mandated and required for all healthcare workers?

I wish I could believe that similar diseases are not on the horizon and it would be another lifetime before we encounter novel diseases such as the two discussed above. What is needed are rapid cycle strategies to identify new potentially devastating infectious diseases, mechanisms to crack the code on mode of transmission, identify prevention modalities and evidenced based treatment options. Also required is a clear, accurate communication plan for healthcare professionals and the general public especially the most vulnerable populations. We need to broaden our definition of emergency response to include protracted crises that last several months or even years. If we can accomplish this and reside in a state of perpetual readiness, then there is hope that we can learn from past experiences and improve response to the next pandemic or crisis.

This story is shared to capture the personal experience and feelings of a nursing professional that has offered support and care through these two unique and difficult periods. 

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