Safety in Numbers

Chapter 5

Why was AIDS de-gayed?

It is important to understand the ways in which responses to AIDS changed in the mid 1980s if the reasons for the de-gaying of the epidemic are to be fully appreciated. As Weeks describes:


In Britain there had been virtually no government response until 1984. Only then was there intervention to prevent the further contamination of the blood supply (and by implication, prevent the spread of AIDS to 'the innocent'). In 1985, the government took powers compulsorily to detain in hospital people who were perceived as likely to ignore medical advice and were at risk of spreading the disease. Both these measures were dictated by a fear that AIDS might infiltrate the so-called general population. But in 1985 only �135,000 was set aside by the government for education and prevention. By the end of 1986, with the dramatic adoption of a new policy in November of that year, this had leapt a hundredfold. (7)

In other words, until late 1986 the epidemic was perceived as a threat to society at large only from without. Strategies intended to prevent the spread of the epidemic aimed to place various kinds of barrier between those infected with HIV, on the one hand, and a wider community perceived as currently untouched. This approach should be seen in contrast with later education strategies adopted by government, such as the Health Education Authority advertisements using the slogan 'AIDS: You're as safe as you want to be'. Here, AIDS has become the enemy within, against which individual action is necessary, rather than the policing of borders.

The British government's new policy to educate the public about AIDS was announced in parliament by Norman Fowler, Secretary of State for Social Services, on 20th November 1986. The policy acknowledged that:


there was a difficult balance to be struck. At present the infection was virtually confined to the few, relatively small, high risk groups. In this country there had been 565 cases of which 284 had died, however it was estimated that there 30,000 carriers, of whom 25 to 30 percent and possibly more, would contract the disease and die. So unless all took action, it would spread more widely into the heterosexual population. That meant striking a balance between warning everyone of the risks, while not causing unnecessary panic. (8)

As the Don't die of ignorance television and poster campaign was launched in January 1987, Fowler held a press conference at which he warned that 4,000 deaths from AIDS were predicted in Britain over the next three years alone. (9) "Aids was still confined largely to particular groups such as homosexuals and drug misusers, but it could spread more widely into the general population, as it had in Africa, unless people changed their behaviour and took the necessary precautions". (10)

Weeks argues that the "key precipitating event" in this generalization of risk was the publication of the US Surgeon-General C. Everett Koop's report on AIDS on 22nd October 1986. Koop was far from being a liberal: he was a Reagan appointee with a track record as a prominent anti-abortion campaigner. But the Surgeon General's Report on Acquired Immune Deficiency Syndrome, described by Randy Shilts as "a watershed event in the history of the epidemic", (11) warned that:


Heterosexual transmission is expected to account for an increasing proportion of those who become infected with the AIDS virus in the future.. The country must face this epidemic as a unified society... AIDS is a life-threatening disease and a major public health issue... It is the responsibility of every citizen to be informed about AIDS and to exercise the appropriate preventive measures. (12)

It should be stressed that the new urgency in AIDS policy was primarily based on an intention to prevent a heterosexual AIDS epidemic, rather than to respond to the existing epidemic among the "few, relatively small, high risk groups". As The Guardian's medical correspondent Andrew Veitch pointed out, "The Government has recognised that while it missed the chance to protect homosexuals, and the 1,000 haemophiliacs who have been infected by contaminated blood products from the US, it can help the rest of us to protect ourselves".(13) In summing up a seminar on Future Trends in AIDS organised by the Department of Health and Social Security in London in March 1987, Professor Healy of the London School of Hygiene and Tropical Medicine described:


three epidemics in progress with loose links between them... The main epidemic, numerically speaking, is in male homosexuals... Next comes the epidemic, linked to the first, in intravenous drug abusers... Thirdly, we have the epidemic that frightens us all, that in the heterosexual population. The numbers potentially involved are far greater, and here we seem to know almost nothing. Nobody, as I understand it, can tell me whether or not such an epidemic exists or not at the present time. Some heterosexual people are becoming seropositive or manifesting the disease, but whether or not there are enough to maintain an epidemic seems quite uncertain. One main objective of public health policy should presumably be to prevent this epidemic from happening at all. (14)

The general lack of information over the size and nature of the epidemic among heterosexuals was highlighted by later epidemiological reports. The 1988 report on Short-term prediction of HIV infection and AIDS in England and Wales, known as the Cox Report after its principal author, concluded that "The predictions in this report are subject to considerable uncertainty arising in part from natural biological variability but more particularly from the absence of or limitations on relevant data"; however, it suggested that "some 6,000 to 17,000 heterosexual adults might now be infected indicating a significant potential source of infection for other heterosexual adults..." (15). In 1990 the Day Report was published, updating Cox's predictions. Again, it concluded that "major uncertainty exists in the direction the epidemic is taking among those infected by injecting drug use and through heterosexual contact", and it modified downwards the estimated number of infected heterosexuals at the end of 1988, to within the range of 750 to 3,750. (16)

It is not the purpose of this summary to argue that the limited available information on the impact of HIV on heterosexuals should have inhibited government and non-governmental organisations from alerting the population at large to the potential threat, and to the wisdom of safer sex. As Dr Anne Johnson of London's Middlesex Hospital pointed out at a Symposium on current and future spread of HIV in the UK in November 1989:


there are still many unknowns as to the potential for future spread. At a public health level, I believe that we have a responsibility to track the level of HIV in the population over time with valid scientific methods; but to sit and wait to see whether further spread occurs is not a viable option. We have a responsibility to the public to inform and to educate about the extent and potential extent of the spread of the virus within the population, and this information must include saying where uncertainty lies. This involves the dissemination of accurate and understandable information to the general population as well as imaginative programmes directed to those who may currently be at highest risk of infection. (17) (emphasis added)

The problem was that rather than reflecting this balance, education initiatives were almost entirely diverted to alerting heterosexuals, while interventions for those at highest risk of infection were almost entirely neglected. Indeed, some argued that it was necessary to play down the existing and worsening epidemic among gay men in order to reinforce warnings about the predicted epidemic among heterosexuals; in discussions at the Symposium:


The view was expressed that health education about HIV should concentrate more on what people actually do rather than on their sexual orientation or membership of any risk group. This presented problems in the targeting of health education programmes, but concentration on 'risk groups' carried the danger that the general population would fail to comprehend the relevance to themselves of messages about the risks of HIV infection. (18)

A significant factor which affected the new approach to AIDS in the late 1980s was extrapolation from the AIDS epidemics unfolding in other countries. Simon Watney has cautioned that AIDS is not experienced homogenously throughout the world; rather, the global phenomenon of AIDS is "a complex sequence of unfolding and overlapping epidemics, affecting different population groups, relative to different modes of transmission, and differing degrees of access to health education, clean needles, drug treatments, and general standards of health care and social service provision". (19) Nevertheless, comparisons between the British and the American epidemics figure quite prominently in epidemiologists' discussions of the likely future experience in the UK. (20)

At the 1989 Symposium, Dr Anne Johnson noted that the early evidence of the rapid spread of HIV among gay men in America had allowed voluntary groups in the UK to initiate education campaigns which, as discussed in Chapters 1 and 2 of this book, helped prevent the development of a similarly devastating epidemic among British gay men. (21) The lesson that epidemiologists and policy-makers appear to have learned from this was that the indications of significant heterosexual transmission in other parts of the world were a warning of the possibility of a similar, heterosexual epidemic in the UK. Social historians Virginia Berridge and Philip Strong agree that "Lessons from abroad B in particular the danger of heterosexual spread of the disease B also weighed heavily. Dispatches from the British ambassador in Kinshasa had drawn attention to the rapid heterosexual spread in Zaire and the possibility that Britain might share the same fate". (22) In the Commons debate on AIDS in November 1986, Norman Fowler stated that "Unless we all act to protect ourselves it will not be long before we find the numbers infected rising as high here as in other countries".(23)

Berridge has argued that the media also had a significant influence on the policy process in three interrelated ways: first, playing a key role in alerting the gay community, especially through articles in the gay press; secondly, being used symbiotically by the emerging 'policy community' of gay men, clinicians and scientists to stress the potential threat to the whole population, in the hope of spurring the government into constructive action; and thirdly, to define and reinforce the issues for politicians:


The period of high-level government reaction over the disease in late 1986 was preceded by a spate of media presentations on the threat of AIDS... It is said that government ministers at the Department of Health were stimulated by these programmes into seeing AIDS as an urgent issue which merited a government response. Certainly the programmes were reacting on a very media-conscious government, one which was sensitive to what was in the press and especially what it saw on television. (24)

Compared with the press coverage of the early eighties, which Berridge has described as "the classic period of 'gay plague' presentation in the press", in 1983-1985 "the focus within the press shifted to encompass the possibility of heterosexual transmission", with considerable interest in both the safety of the blood supply and the view that the disease might have originated in Africa. (25) Thus during 1985,


Just as interest by reporters had begun to grow in the area of AIDS, so the selection and presentation of news started shifting emphasis, from a simplistic, but highly 'newsworthy', view that AIDS is a 'gay plague', to a more threatening and comprehensive - and equally 'newsworthy' - realisation that AIDS could strike at anybody and anywhere. (26)

Events such as the first death from AIDS in May 1985 of a British baby, for example, merited prominent coverage in all the national newspapers. New predictions of the likely impact of the epidemic on heterosexuals were reported extensively. The First International Conference on AIDS in April resulted in reports that "The spread of the deadly AIDS epidemic to heterosexuals in Western industrial countries is inescapable...". (27) The Chief Medical Officer, Sir Donald Acheson, sent medical advice on AIDS to all doctors, and was quoted saying that "Although only 159 cases have been reported, Aids will undoubtedly become substantially more frequent in the immediate future and cases will occur more widely throughout the country". (28) As the media reconstructed AIDS as a 'newsworthy' threat to everyone, so anxiety and concern about the epidemic increased among the population at large.

Likewise, Cindy Patton has identified that the American media played a significant role in leading public opinion and concern about the implications of AIDS for the population at large:


A significant perceptual shift, at least in the mass media, occured (sic) in 1985 with the death of Rock Hudson. The virtual media blackout which had permitted only a handful of sensational or highly specialized medical articles to be published ended as the public began to perceive that "heterosexuals" - the term that referred not to drug users, who were desexualized by the epidemiologic categories, but to other, "ordinary" heterosexuals - could acquire, indeed had been acquiring HIV. Suddenly, a constituency in the position to demand a government response was asking for "the facts" about AIDS. (29)

By the end of 1985, the British public's thirst for information on AIDS had become intense: a recorded telephone help-line established by the College of Health in December received well over 20,000 calls from the public in the space of just one week. (30) It was against this background that the government launched the Don't Aid AIDS information campaign which ran throughout 1986, and was expanded at the end of the year with the Don't die of ignorance campaign.