The death of Rock Hudson

It was the death of movie star Rock Hudson in August 1985 which paradoxically began to change public perceptions of who was at risk for AIDS and how much of a public health priority AIDS ought to be.

Rock Hudson's death triggered huge media interest in AIDS, presaging the extent to which future coverage of AIDS would hinge upon its impact on celebrities. AIDS ceased to be regarded as a minority issue after Hudson's death, as speculation increased about the extent of the epidemic likely to occur amongst heterosexuals. This was highly ironic, given that Hudson was the victim of the epidemic occurring amongst gay and bisexual men, but his heterosexual image continued to deflect attention away from his sexuality even in death.

The emerging heterosexual epidemic 1985-87

In the second half of 1985 several factors combined to create a renewed AIDS panic, this time focused on fears that HIV was breaking out into the heterosexual population via 'bridging groups' - injecting drug users and bisexual men. In the United States HIV was beginning to be diagnosed amongst the female partners of injecting drug users with increasing frequency, leading to speculation that a chain of transmission could develop amongst heterosexuals who did not inject drugs, and that AIDS would 'break out' of the high risk groups by this route.

Public health officials also looked to Africa with growing concern, where available evidence suggested that an HIV and AIDS epidemic was occurring amongst heterosexuals. In September 1986 the British ambassador to Zaire warned in a dispatch to the Foreign Office of the frightening possibility that HIV might behave in the same way amongst heterosexuals in the developed world.

Armed with this limited knowledge, public health officials and journalists began to speak in terms of tens of thousands of AIDS cases amongst heterosexuals unless sexual behaviour changed. In October 1986 the US Surgeon-General Everett Koop published a report on the US AIDS epidemic which predicted that AIDS would increasingly become a heterosexual problem in the United States. A major public education campaign was launched, to be followed a few months later by a similar initiative in the United Kingdom. British efforts were characterised by an extraordinary degree of co-operation between government and broadcasters as television networks planned a week of programmes for February 1987 in collaboration with the Department of Health. AIDS was treated in practice as the greatest national emergency since the Second World War, the first occasion on which broadcasters had sought to co-ordinate their programmes to ensure that all viewers would be exposed to the message 'Everyone Is At Risk'.

One of the key effects of this campaign was to create widespread anxiety amongst heterosexuals over minimal HIV risks and to create a new category of those in need of services, the `worried well'. This panic did not exist before the Government advertising campaigns, yet the massive increase in the number of people needlessly seeking tests has been interpreted as an indicator of the success of public education! Any rational public health analysis would see this as a grotesque misallocation of resources, and any rational public health policy would not have continued to panic people unnecessarily, long after the point at which it became evident that the risk to the general population was relatively minimal.

The formation of AIDS policy in the UK

The Public Health Laboratory Service (as it was then called) began to monitor AIDS in the UK in August 1982 and by 1983 it was clear that public health measures would be necessary in order to respond to the disease. The first area in which public policy was developed was with regard to blood transfusions and blood products. In August 1983 the Blood Transfusion Service issued an appeal for donors from high-risk groups to refrain from giving blood, and in late 1983 the Chief Medical Officer Donald Acheson first met with representatives of the Terrence Higgins Trust to put on record his concern over the spread of AIDS.

Acheson was to be the key figure in the British government response to AIDS during the 1980s. It was he who convinced Government ministers of the importance and urgency of AIDS as a public health issue, and it was he who steered the Government away from panic measures through the recruitment of an Expert Advisory Group on AIDS (EAGA), composed of specialists already working in the field.

EAGA was convened in early 1985 to guide the Department of Health in the formulation of policy and the development of health education messages. EAGA recommended that no special measures were required to control people with HIV and AIDS, and that existing VD and infectious disease legislation was adequate to monitor and control the disease. In years to come this decision was to be condemned by right-wing writers as a capitulation to the gay lobby, but in truth the Terrence Higgins Trust had little influence on this decision. It was taken by medical professionals and civil servants, who saw not only the danger of driving underground those suffering from the disease, but also how anomalous this would be in the history of post-war public health.

Coercive public health measures had declined during the 20th century after a lively history of implementation during the early years of the public health movement. Legislation which could be used to quarantine people with infectious diseases had developed during the 19th century, but as democracy developed during the 20th century and infectious disease declined in incidence, coercive public health measures were less likely to be used. During the 1970s public health had become more politicised as a political analysis began to develop of the relationship between inequality and health and of the power of the medical profession.

Whilst the Government took the advice of EAGA on matters of public health policy, it was reluctant to accept the advice of EAGA and the associated Advisory Group on Health Education and AIDS when it came to setting the tone of health education. One member of the Health Education group reported that the unanimous suggestions of the group were invariably rejected by politicians, resulting in delays and obscure advertising which did more to confuse than inform the public (see Garfield). 'There will always be limits to what can be said in national advertisements' the Chief Medical Officer told EAGA members in July 1986, but the coyness of early advertising was laughable. Department of Health officials devised the phrase `rectal sex' to describe the most high-risk activity. 'Why not use words like bumfucking?' asked Tony Whitehead of the Terrence Higgins Trust when the first adverts were published.

In October 1986 the Government's view of the severity of the problem was transformed with the publication of the Surgeon-General's Report in the United States, and civil servants and ministers moved swiftly from foot-dragging to crisis mode. Cabinet Secretary Robert Armstrong is reported to have remarked that nothing had caused him greater loss of sleep during his career as a public servant than the threat of AIDS, and in late 1986 he could be forgiven for sleepless nights. Predictions of the likely spread of AIDS based on extrapolations from Africa and New York were terrifying; the disease could engulf Western societies within a decade, decimating the most productive generations, claimed newspaper reports.

Within weeks civil servants had agreed with broadcasters that unprecedented steps would be taken to put across the message to the general public that AIDS was potentially a risk for everyone, and at the beginning of 1987 an advertising campaign together with a leaflet drop to every home in Britain took place. 'Don't Die of Ignorance' was the message, the iceberg its metaphor for the invisible threat of AIDS. The leaflet stressed that AIDS was `not just a homosexual disease', a line supposed to quell prejudices that AIDS was a gay disease. Donald Acheson was concerned that unless correctly handled, one of the major effects of the campaign would be to increase prejudice against gay men. But given the degree of prejudice that had already been unleashed by media coverage of AIDS, it is hard to see how things could have got any worse - unless the Government were to give in to demands for punitive action against the gay community and people with HIV, who were blamed for visiting this scourge upon society. Were fears of the imminence of open repression amongst the gay community well founded, and was the Chief Medical Officer already alert to sympathy with such views amongst Government ministers?

In March 1987 TV channels co-operated to broadcast a week of programmes on AIDS, an unprecedented move in peacetime. Virtually none of these programmes were able to speak frankly to gay men; it was easier to speak frankly about injecting drug use than to approach the taboo subject of anal intercourse on the air.

Government policy was to continue to be formed by an alliance of experts and civil servants throughout the late 1980s and early 1990s. Yet there was never any coherent national plan for fighting AIDS, or a sense of long-term planning. This was to become painfully evident in the early 1990s.

Further reading

Keith Alcorn: The Public Sphere of AIDS in Taking Liberties, Serpents Tail, 1989.

Virginia Berridge: The early years of AIDS in the United Kingdom 1981-6: historical perspectives in Epidemics and ideas: essays on the historical perception of pestilence, Cambridge University Press, 1992.

Michael Fumento: The Myth of Heterosexual AIDS, Basic, 1990.

Simon Garfield: The End of Innocence (Chapter Six), Faber and Faber, 1994.

Edward King: Safety In Numbers (Chapter Five), Cassell, 1993.