Safety in Numbers

Chapter 5

Public education campaigns

As the new concern about AIDS was more precisely a concern about the potential dangers to heterosexuals, rather than the continuing problem amongst gay men, the Department of Health and Social Security's (DHSS) public health education campaign which began in Britain in March 1986 was addressed entirely to a heterosexual audience. The initial Don't Aid AIDS campaign featured a series of full-page advertisements signed by the four Chief Medical Officers to the Health Departments of the United Kingdom. The aim was clear: to persuade heterosexuals that AIDS was not 'just' a disease affecting gay men. The adverts were also placed in gay publications such as Capital Gay newspaper, as though the Government believed that the information needs of gay men, who had by then been living at the epicentre of the epidemic for a number of years, were identical to those of heterosexuals brought up on a diet of tabloid AIDS misinformation. This resulted in messages which were frankly contradictory to a gay readership, such as advice that "Using a sheath reduces the risk of AIDS and other diseases", immediately followed by the warning "Rectal sex involves the highest risk and should be avoided". Indeed, the campaign seemed determined to play down the impact of the epidemic on gay men, who were mentioned only in the insultingly dismissive observation that "Up until now, AIDS has been confined mainly to small groups of people", and in the question "Does AIDS only affect homosexuals?", to which the full answer, in capitals, is the single word "NO". (49) These adverts were to be "widely criticised for poor presentation and lack of public impact" (50).

Other advertisements in the Don't Aid AIDS series appeared at the end of 1986. One published in the 'youth press' between December 1986 and February 1987 asked "HOW GAY DO YOU HAVE TO BE TO CATCH AIDS?". Rather than attempting to get accurate and helpful information to gay teenagers before they started having sex, this poster addressed itself exclusively to straight boys, warning them vaguely that "the higher you rate your pulling power with women, the more danger you could be in". The adverts' approach remained, as Simon Watney put it, "clearly anti-sex, drawing on an assumed rhetoric concerning 'promiscuity' as the supposed 'cause' of AIDS, in order to terrify people into monogamy". (51) It was therefore entirely in character for the Department of Health to condemn as "very irresponsible" a motion debated at the annual conference of the National Union of Students in December 1986, which correctly pointed out that "Promiscuous behaviour alone cannot and does not spread Aids. It is the practices involved not the number of partners which is relevant". (52)

At the same time, the now infamous Don't Die of Ignorance newspaper, television and billboard advertisements appeared. As Watney observed:

 

The worst poster of all coyly offers the question, "AIDS: HOW MUCH BIGGER DOES IT HAVE TO GET BEFORE YOU TAKE NOTICE?". The question however which we should all be asking six years into this epidemic is how large did it have to get before they took any notice? ...Millions of pounds have been spent on a crude loud-hailing exercise which directs itself to nobody in particular, and least of all to those most urgently in need of positive, supportive health education. That is why the didactic call not "to die in ignorance" is so insufferable, coming from a government which has efficiently kept gay men in ignorance about Aids throughout the 1980s... (53)

And if there remained any doubt that official concern rested almost exclusively with the predicted threat to heterosexuals rather than the very real and present threat to gay men, it should have been dispersed by the comments of junior health minister Edwina Currie, reported in The Sun in February 1987, that "attention given to homosexual deaths hid the spread of AIDS among heterosexuals" (54). On 10th March 1987, Norman Fowler told the House of Commons during Question Time that the advertising in the next stage of the AIDS publicity campaign would at last target gay men and drug users. (55) In December 1985, when the first advertisements were being planned, and when the second round were being developed in April 1986, the Terrence Higgins Trust called for the specific targeting of safer sex advice to gay men. (56) As recounted later in this chapter, these adverts were not to appear until 1989. In some ways, of course, this may have been a good thing, as there is little evidence that the government had any appreciation of the nature or methods of the essentially sex-positive nature of the successful gay community-based safer sex campaigns of the preceding years, as discussed in Chapters 2 and 3 of this book. When officials had anything to say to the members of high risk groups, their advice tended to be insultingly na�ve and ill-informed; for example, in September 1985 the new Health Minister Barney Hayhoe, speaking on television, "said everyone in high risk groups should be encouraged to confine their sexual activities to monogamous or very stable relationships... the best defence would be to cut out casual sex of any kind". (57) It was people like Barney Hayhoe who should have been taking advice from gay men, rather than the other way round.

On April 1st 1987 the independent Health Education Council, which had been "one of the few statutory bodies outside teaching hospitals to challenge government negligence over AIDS" (58), was reformed as the Health Education Authority (HEA) and given a specific remit for, among other campaigns, public education on the epidemic. (59) The HEA was given increased responsibilities and budget and promised "sturdy independence" by Secretary of State Norman Fowler (60); however, it soon became clear that this was incompatible with the "clear line of accountability to ministers and Parliament" (61) which was also imposed. By October 1988 HEA staff had come into conflict with the Department of Health over the use of television adverts; staff were quoted as believing that "(. . .) independence is a myth. We no longer have any misconceptions about that". (6)2 In respect of community based work, in 1989 the HEA was instructed by Health Minister David Mellor to "work fully within government policies"; by this stage the Authority had already been instructed to use more euphemistic language in its gay press advertising. (63)

From the start, gay men had grounds to view the HEA with suspicion: in March 1987 Ann Burdus, the incoming Deputy Chairman of the HEA with responsibility for its AIDS campaigns, attacked the "lunatic antics" of gay activists in a Radio 4 interview, prompting Capital Gay newspaper to wonder "...what lunatic behaviour she had in mind B whether it was the gay community's initiative in establishing the Terrence Higgins Trust, the health education campaign mounted by the gay press or the widespread regional network of AIDS advice lines set up by London Lesbian and Gay Switchboard, local switchboards and Friend branches". (64) With only two exceptions to date, advertisements placed in the mainstream press have eschewed the opportunity to communicate with gay or bisexual men who do not read the gay press, and have continued to ignore or downplay the impact of the epidemic upon gay men. As part of the 1988/9 AIDS: You're as safe as you want to be advertisement series, one poster made the campaign's indifference to those most affected by the epidemic quite explicit, asking "IF AIDS ONLY AFFECTS 0.002% OF THE POPULATION WHY IS THIS ADVERTISEMENT APPEARING IN EVERY NATIONAL DAILY NEWSPAPER?", and explaining "...while it may still only affect a few people, its spread is something that now concerns us all." In response to the campaign launched by the Health Education Authority in February 1989, Evening Standard reporter Annalena McAfee asked "Is the AIDS advertising so frightened of being thought anti-gay, that it is directed at the wrong target?", but got the answer "No, says the Health Education Authority: heterosexual young men are now most at risk". (65) The 1990 Experts speak about HIV and AIDS series of television and press advertisements was "aimed at reminding the general public how HIV is spreading in the UK" (66), yet its focus remained strictly on heterosexuals, rather than gay men. One press advertisement featured Sir Donald Acheson, Chief Medical Officer at the Department of Health, saying "It may not seem very serious now but if we don't act it could have a disastrous effect on the future of our children and our grandchildren" (emphasis added). (67) With hindsight, it is clear that the de-gaying of public health education campaigns has had considerable harmful consequences for the sustenance of safer sex among gay men. From 1986 onwards, public, government and media attention were firmly fixed upon the threatened heterosexual explosion of HIV infection. Although newspapers like the Sunday Times and the Daily Mail, and far right-wing groups such as Family and Youth Concern and the Conservative Family Campaign continued to question the likelihood of the epidemic affecting 'low-risk' heterosexuals and to insist that AIDS was a disease of homosexuals, drug users and others who indulged in 'deviant' behaviour, this did not reflect any genuine concern for or interest in the epidemic that nearly everyone agreed did exist. (68) HIV workers followed the lead set by the Department of Health and prominent epidemiologists, and placed their energy and resources into supporting the 'Everyone is at risk' approach. Likewise, strategies were drawn upon and budgets were allocated, targeting prevention funds to groups such as young people, women and professionals who were assumed to be uniformly heterosexual. The need for specific, targeted interventions for men who identified proudly and openly as gay went unmet.

From 1987 onwards, prevention initiatives for gay men were hardly ever discussed, let alone funded. Occasionally gay men's safer sex achievements in the 1980s would be held up as an example of a successful response to HIV; so, for instance, Minister of State for Health Virginia Bottomley observed in 1989 that "the gay community has set a good example in changing its behaviour". (69) But ironically, as gay men became the role models for behaviour change, their own ongoing needs for education and support were largely ignored. One consequence has been the perception that gay men are in no greater need of education and support than the rest of the general population B or even at less need. The over-riding perception is that the epidemic has somehow lifted up and moved on, taking away any significant risk to gay men, when in reality it has merely expanded, with gay men still right in the epicentre, still most at risk. (70)

Worse, there are some indications that this mistaken message has also been picked up by many gay men themselves. In 1991, when the Terrence Higgins Trust undertook an informal evaluation of an educational campaign by conducting a survey of men in gay pubs and clubs, a significant proportion of respondents argued that the Trust should be prioritising heterosexuals instead. In 1992 a District HIV Prevention Coordinator in South-East England approached a local gay group for help in developing an educational campaign, only to be told that gay men didn't want to be targeted, and that the money should be spent on heterosexuals who were now the most at risk. One can only speculate on the extent to which such views are accompanied by a sense of decreased personal vulnerability, and consequently an increased risk of unsafe sex.