Coronavirus: Aids changed us. Will Covid‑19 do the same?

 This virus is to social life what HIV was to sexual life

Social mores change more than you think. If a time machine could take you back to 1981, you would be shocked by how much people smoked, for example, and how much time they spent standing outside telephone boxes that stank of urine, jingling coins in the pockets of their nasty flares or drainpipes, grinding their nasty yellow teeth. If you are a woman, you would be appalled by the overt sexism of male conversation. If you’re not white, you’d be revolted by the casual racism. And if you’re gay . . . well, more about that later. Not that these prejudices have been eradicated, but they were worse then.

So let’s ask ourselves how much social mores are going to change as a result of the Covid-19 pandemic. In the past week, I’ve had several conversations on the topic of “the world after Covid-19”. My immediate response has been: “Why do you use the word ‘after’? Why not ‘with’?”

Yes, there is undoubtedly a benign scenario in which one of the more than 70 teams working on a vaccine against Sars-CoV-2 collects the prize. If all goes well, that vaccine could jump through all the scientific and regulatory hoops, go into mass production and be available some time in the second half of 2021.

In this same happy-ever-after scenario, there are also breakthroughs in Covid-19 therapies. New research confirms that the disease doesn’t do anything much to endanger the lives and health of younger people, and if they do get infected, they get lasting immunity. Summer comes to the northern hemisphere and the contagion recedes. As lockdowns are lifted and people return to their normal gregarious habits, there is no second wave of the pandemic. Far from devastating the southern hemisphere, the disease proves a minor event in Africa.

And — still looking on the bright side — stock markets rally and economies surge to a high-speed V-shaped recovery that makes me, and others who worry about a protracted depression, look silly.

All this is possible, and devoutly to be hoped for. But it is by no means a 100% certainty. Just consider the odds against a successful vaccination. Do we have one for malaria? No. Tuberculosis? No. HIV-Aids? No. (After 40 years of toil, there have been just a handful of phase 3 clinical trials, one of which made the disease worse. The best had a success rate of just 30%.) How about rotavirus, the most common cause of diarrhoea among infants? Yes, they did find a vaccine for that — after 15 years.

Even if a vaccine is found, there will be multiple risks associated with the current rush to devise and deploy one. And even if there are no setbacks, it might turn out to be like influenza: you can get your flu shot each year, but there’s no guarantee you won’t get some other strain than the ones you were vaccinated against.

That’s why we need to give at least some thought to the not-so-nice scenario of living with Covid-19 — at best, the way we live with flu, which delivers its regular seasonal bump in the mortality rate; at worst, the way we have slowly and painfully learnt to live with HIV-Aids.

Which takes us back to being gay in 1981, the year the New York Native newspaper published the first article about gay men being treated in intensive care units for a strange new illness. (The headline was: “Disease rumours largely unfounded.”) It was more than a year later that the term Aids (acquired immune deficiency syndrome) was proposed for the all too real disease.

Here’s a thought experiment. Imagine a world in which Covid-19 — which still has a long way to go before it catches up with Aids as a killer — has the same effect on social life as Aids had on sexual life. That would be quite a different world, and more visibly so (as changes in sexual behaviour largely take place behind closed doors).

Imagine a world in which we routinely wear masks on public transport and in offices; a world in which we greet one another with a wave, not a hug or a handshake; a world in which grandparents see their grandchildren only on FaceTime; a world in which to cough or sneeze in public is as shameful as to fart; a world in which we rarely eat in restaurants or fly; a world without theatres and cinemas (other than a few retro drive-ins); and a world in which football is played in silent, empty stadiums. (Will there be canned cheering, just as there used to be canned laughter in sitcoms?)

I’m not the first person to notice that there are some lessons to be learnt from the last really lethal pandemic caused by a virus, despite the important differences between HIV and Sars-CoV-2, and between Aids and Covid-19. One nurse has recalled the similar ways the authorities responded — at first with complacency and then 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”.

Yet the lesson of HIV-Aids is not quite that it “changed everything”. The really striking feature of the history of the Aids pandemic is that behaviour only partly changed after the recognition of a new and deadly disease spread by sex, needle-sharing and blood transfusions. An early American report noted “rapid, profound but . . . incomplete alterations in the behaviour of both homosexual/bisexual males and intravenous drug users”, as well as “considerable instability or recidivism”. By 1998, just 19% of American adults reported some change in their sexual conduct in response to the threat of Aids.

The advent of antiretroviral drugs that stop HIV carriers succumbing to Aids has somewhat diminished the fear factor. Even so, one might have expected a bit more fear to persist. A 2017 paper showed that fewer than half of at-risk men had used a condom last time they had sex. According to a recent British study, sustained campaigns of public and individual education are necessary to discourage gay men from having sex without condoms. In Africa, the “ABC” — abstain, be faithful and “condomise” — approach has had limited success.

Yes, there have been changes in sexual behaviour. According to the psychologist Jean Twenge, millennials have fewer sexual partners on average than earlier generations. Another American study concluded: “Promiscuity hit its modern peak for men born in the 1950s.” And let’s not forget the invaluable UK National Survey of Sexual Attitudes and Lifestyles, the most recent version of which revealed a marked decline in the frequency of sex in Britain.

Yet few if any of these changes can be attributed to HIV-Aids. The return of “No sex, please, we’re British” mainly affects married and cohabiting couples, and, according to the definitive analysis in the BMJ, is most likely due to “the introduction of the iPhone in 2007 and the global recession of 2008”.

Social mores change more than you think. In the face of a deadly disease, however, they also change less than you might expect.

Niall Ferguson is the Milbank Family senior fellow at the Hoover Institution, Stanford, and managing director of Greenmantle

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