Norman Fowler was Secretary of State for Health in Margaret Thatcher’s government from 1981 until 1987, during which time he headed the department’s response to the AIDS epidemic, overseeing the implementation of the groundbreaking ‘Don’t Die of Ignorance’ awareness campaign, aka the ‘tombstone’ adverts. He became Lord Speaker in 2016. Here he comments on the progress achieved so far.
We have come a long, long way. Thirty years ago, when I was Health Secretary, a diagnosis of HIV was a virtually certain death sentence. There were no drugs to counter the AIDS virus. The result was that on both sides of the Atlantic (and, of course, much wider) there were hospital wards full of predominantly young men who were dying without either doctors or nurses being able to intervene.
Against such a background, fear and prejudice were commonplace. I was at the centre of a fierce public debate about what government should do. I did not lack advice.
Hitherto sensible people proposed that all those with HIV should be effectively segregated away from the general public. Another popular suggestion was that we should do nothing and leave the sick to their fate. The Chief Constable of Greater Manchester, in an outburst for which he should have been sacked, said that people with AIDS were “swirling around in a human cesspit of their own making” and that they “should be punished until they repent of their sins.”
My view, supported by my excellent Chief Medical Officer, Donald Acheson, was entirely contrary to all this. I took the view that although we could do little for those who were already infected with the virus, we could warn those who were not so affected to take sensible precautions. The result was that in 1986 we mounted the biggest public health campaign the country had ever seen. We used television, radio, posters and the press to get over our message: “Don’t Die of Ignorance”, coupled with the advice to use a condom.
It was a campaign, however, that faced influential opposition. The Prime Minister, Margaret Thatcher, wondered whether “it would be better to follow the VD precedent of putting notices in doctor’s surgeries, public lavatories etc,” while the Chief Rabbi charged that the campaign “tells people not what is right, but how to do wrong and get away with it.”
When it came to policy on drug users who were injecting, we were told that to issue clean needles would be condoning crime. It was advice we ignored. Clean needles were issued and the result was that transmission by this route reduced to a very small percentage and has remained so ever since. Likewise, our general campaign led to a major reduction in HIV – and in other sexual diseases. Never let them say that public education campaigns don’t work; we established that they could. We also established that public opinion generally could be changed. In the follow up research to the campaign, over 90 per cent of the public said they approved of what we had done.
So now, let us move forward 30 years. We now have antiretroviral drugs to allow all those with HIV to live long and successful lives. Our progress has been so marked that the latest Public Health England report is headlined: “Towards elimination of HIV transmission.” The latest figures are impressive, but does that mean it’s all over bar the shouting? The answer to that is an emphatic “no”.
We still have over 10,000 people who have the HIV infection but are undiagnosed – with all the risks that means to them and to others. Above all there is still a reluctance to test and the major reason for that is the stigma that still attaches to the whole area.
We may have progressed from prosecuting gay people, like Alan Turing in the 1950s, to today when equal marriage is the law of the land. But that does not mean that all the public go along with these changes, particularly when it comes to HIV.
We all know that improvements can be made in Britain, and certainly this is not the time to cut back. But we should also remember that the position in many other countries is far, far worse – and the challenge for us is also to see how we can help. Just to remind ourselves:
One million people a year die from AIDS related illnesses around the world and almost two million new HIV infections are diagnosed every year
Around 37 million people are living with HIV but only 20 million are on anti-retroviral treatment
And in an array of countries homosexuality is prosecuted and in others there is deep discrimination. It is not just an issue in Africa; it also disfigures countries like Russia
So what is my conclusion? It is that we in Britain are in an excellent position to lead in the global context. We will not do that by lecturing other countries, which is always counter-productive. But we can do it by example and by showing the progress we have made. We should establish that a country which was once mired in prejudice is transforming itself.
The Rt Hon. The Lord Fowler