“There is now a danger that has become a threat to us all,” the soundtrack begins. “It is a deadly disease and there is no known cure…”
A volcano erupts, a hail of boulders rains down a cliff, and to the sound of wild, funereal music a pneumatic drill and a chisel carve from the solid rock a tombstone bearing the single word AIDS, on which a bunch of lilies is thrown.
This must be one of the most frightening public information films ever made, directed by Nic Roeg, voiced by John Hurt, and intended to strike fear into viewers and get them to read the “Don’t Die Of Ignorance” leaflet which was distributed to 23 million households.
On World AIDS Day, it is worth recalling that in the 1980s another pandemic struck: a lethal and mysterious illness for which there was no cure.
The parallels between AIDS and Covid-19 should not be pushed too far, but are nevertheless illuminating, and in the fulness of time have even become encouraging, for the HIV Commission today publishes its plan for England to become by 2030 the first country in the world to eliminate the transmission of the HIV virus, which causes AIDS.
The Commission’s key recommendation is “test, test, test”, and as one of its members, Steve Brine MP (Con, Winchester), yesterday told ConHome, “in the context of the last nine months, you really get what we’re saying”.
Both pandemics struck during periods of Conservative government, and posed enormous troubles for the Prime Minister of the day.
In August 1975, when there had been 206 confirmed cases of AIDS in the United Kingdom, of whom 114 had died, Margaret Thatcher was told by the Chief Medical Officer, Sir Donald Acheson, that it was likely AIDS could be transmitted heterosexually as well as homosexually.
What message was to be given to the public? In his brilliant account, beginning on page 71 of Herself Alone, the third volume of his life of Thatcher, Charles Moore quotes David Willetts, then a member of Thatcher’s Policy Unit, who told her, “We have to walk a difficult tightrope between being accused of bureaucratic inertia, and being so active as to whip up public hysteria,” and went on:
“We simply don’t know whether everybody with the virus will eventually go down with the symptoms of the disease. So we would be telling people that they may get the clinical disease, but we don’t know; and if they have got it, we can’t cure it. That’s not a very satisfactory message, but seems to be the best course out of several unattractive alternatives.”
The problem was rendered still more difficult by the close association which emerged between AIDS and homosexuality. Some people seized the chance to express the disgust and hatred they felt for homosexuals: as Willetts warned, there was a danger of fomenting public hysteria.
Some Conservatives, and some religious leaders, urged the Prime Minister to preach the virtues of abstinence.
Thatcher declined to treat AIDS as an opportunity for moralising. For her it was a scientific and medical problem. As Moore writes, she was happiest “when she had a concrete and exact point to advance”.
She was a Tory pragmatist: she wanted to solve the problem, not prate about it. Those who have insisted on understanding her in ideological terms have often overlooked how practical she was.
But part of being practical was framing a public message about the dangers of anal sex, and here she took some persuading, which was done by the Health Secretary, Norman Fowler, who in March 1986 told her that the advice to avoid anal intercourse, “which has been linked with 85 per cent of AIDS cases so far”, must remain in advertisements to be placed in the press, or else these would lose all “medical authority and credibility”.
Lord Fowler, who has worked to this day to reduce and at length eradicate HIV, has recalled how difficult things were in the 1980s, and why at the start of 1987 a yet bigger public health campaign, which included the television advertisements, was warranted:
“We had no knowledge of this disease and no drugs with which to treat it. I was reading a note the other day from the Chief Medical Officer at the time and some of the predictions as to what could happen were terrifying – we were talking millions and millions of people becoming infected. That’s why we launched what is still the biggest public health campaign there’s ever been in this country with leaflets sent out to every home.”
In the 1980s, the predictions of the scientists did not always prove accurate. So too today. Nevertheless, Boris Johnson and Matt Hancock prefer to present themselves as following the science, than as adherents of a theory of freedom which would allow them to ignore what the scientists were saying.
They too are Tory pragmatists, most interested in what works, even if that has to be discovered by an agonising process of trial and error.
Thatcher was always worried, and with good reason, that although she and her colleagues insisted “the Health Service is safe in our hands”, the voters would not believe them. Johnson can be seen guarding at every turn against that danger.
Caroline Slocock, the first female private secretary at Number Ten, has described a visit Thatcher eventually undertook to an AIDS hospice, without any press in attendance, partly because she did not wish to seem to be competing with the well-known work already done in this field by Diana, Princess of Wales.
The first patient she sees is clearly “very ill and has no hope of recovery”. Slocock goes on:
“I feel out of my depth. I have never been at the bedside of a dying person before and I feel strongly that family and friends should be there at this moment, not us… She [Thatcher] responds by taking a seat by his side, asking questions, expressing sympathy, connecting in a simple and genuine way, to which he responds sweetly. She comes across as more of a mother than a Prime Minister…
“After about ten minutes, we leave him and go into the second room. Inside, sitting in a chair beside his bed, is a young American man, also extremely thin. The virus has attacked his brain too, as it does in the final stages, we are told afterwards, and he is excited and confused. At first he thinks she must be a creation of his own mind, a delusion. But then he begins to believe that she really is Margaret Thatcher, but sent to him miraculously to hear his thoughts and to pass them on to President Bush. He tells her to ring the President. It is imperative that action is taken now to help people like him – that is his message. He is overexcited, it is very difficult to know how to respond, and it is very, very sad.
“I desperately want to get out of the room. I feel responsible for putting them both through this awkward scene. Margaret Thatcher is unfazed and behaves as if she has all the time in the world. She places her hand on his arm, asks him a few questions about his life and listens, in a way that demonstrates that she is real, not a phantom, and is there because she cares and wishes him well. He calms down in response. It is simple, human stuff, but I am in awe of it.
“When we leave them, we ask the staff about their families. It turns out that neither have felt able to tell their parents that they are gay, let alone that they have AIDS, and so they are dying alone.”
For a quite different reason, the need to prevent infection, many sufferers from Covid-19 have lived and died alone.
While reading about the 1980s, it struck me that there was often no correlation between a politician’s views on other questions, and what he or she thought about AIDS.
This elementary point has sometimes been overlooked in coverage of the present pandemic. The urgent need to get things done, in order to avert or relieve suffering, trumps whatever abstract views one may have about the right way to set about this.
In January 2019, when Steve Brine was serving as Public Health Minister, and three charities – The Elton John AIDS Foundation, National AIDS Trust and Terrence Higgins Trust – came to him with proposals for the eradication in England of HIV, he gave the Government’s support and approval to what they wanted to do, as did Matt Hancock, the Health Secretary.
Brine said yesterday:
“We had a policy decision, we had the science that allowed us to approve it. The science of PrEP [Pre-Exposure Prophylaxis], which has been a huge game-changer, now allows us to finish the job.”
A connecting thread of pragmatism links the 1980s to the present day. Lord Lexden, the Conservative Party’s official historian, traces this tradition of unmoralistic pragmatism further back:
“‘Sanitas sanitatum, omnia sanitas’: Disraeli’s famous misquotation from the fourth century Vulgate in the course of his great three-hour speech in Manchester in April 1872 defining modern conservatism rings down the years. He understood that moral censoriousness had no more place in health policy than in private life. In this respect, Boris Johnson, like successful Tory leaders before him, follows in the great Disraelian tradition.”