Dr Nick Lee, who worked with Norman Fowler on his book AIDS: Don’t Die of Prejudice reflects on thirty years since Fowler’s influential 1987 public health campaign AIDS: Don’t Die of Ignorance.
World AIDS Day 2017 marks 30 years since the UK Government launched the Don’t Die of Ignorance campaign to raise awareness of HIV and AIDS in the United Kingdom. The campaign – which can currently be seen as part of the Wellcome Collection’s Can Graphic Design Save Your Life? exhibition – consisted primarily of a grim television advert voiced by John Hurt and directed by Nic Roeg and an information leaflet which was delivered to every household in the country.
The campaign was the brainchild of then Health Secretary Norman (now Lord) Fowler and was achieved in the face of opposition from the Prime Minister Margaret Thatcher. Thatcher’s main objection to the campaign – which included some graphic detail of how HIV was contracted – was that exposing people to risky practices might make them more likely to engage in them. Her concerns were unfounded as rates of not only HIV but other sexually transmitted diseases declined after the campaign.
Whilst critics have suggested that the campaign caused a climate of fear around sex (particularly in the gay community) it undeniably helped to raise awareness of the issue of AIDS, and at a time when there were no effective drugs to treat or prevent the spread of HIV. The only answer was to inform people of the risks and attempt to alter their behaviour.
Today the situation has changed drastically. Effective and affordable drugs are available: Anti-retroviral drugs which allow people with HIV to live long lives and, through viral suppression, greatly reduce their chance of passing on the infection; PrEP, a prophylactic which greatly decreases the chance of contracting HIV from an infected partner.
However, the simplest and cheapest way that the spread of HIV can be combatted today is though access to testing. If people know their status then they can act decisively on that information. Public Health England estimates that in the UK today there are 10,400 people living with undiagnosed HIV. These are the people who are at highest risk of passing on the virus.
And the greatest barrier to coming forward for testing is fear, stigma and prejudice. As Norman Fowler’s 2014 book AIDS: Don’t Die of Prejudice has demonstrated, stigma around HIV and often those groups most affected by it (injecting drug users, transgender people, men-who-have-sex-with-men, for example) is the greatest single factor preventing people from coming forward for testing and adhering to treatment regimes. As Fowler shows, education and understanding are the only effective means by which stigma and prejudice can be combatted. If there is one thing that links Don’t Die of Ignorance to Don’t Die of Prejudice it is this clear focus on education and evidence-based decision-making.
The UK is in a relatively good position. Action by the UK Government, the NHS and groups such as the National AIDS Trust (NAT) and the Terrence Higgins Trust (THT) has helped to reduce the impact of the epidemic. Globally, however, the picture is quite different. Internationally 36.7 million people are living with HIV with only 19.5 million accessing anti-retroviral therapy; since the start of the epidemic 35 million people have died of AIDS related illnesses, 1 million in 2016; AIDS is the single biggest killer of women of child-bearing age (15-44). Whilst progress is being made, there is still a lot to do if we are to reach the UNAIDS target of 90-90-90:
“By 2020, 90% of all people living with HIV will know their HIV status. By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.”
In thirty years a lot has changed. Whilst HIV is no longer a death-sentence in the UK, it is still widely stigmatised. As medical outcomes have improved, the focus on education has wavered. However, educating people and encouraging them to come forward for testing is still the best way to reduce the spread of the virus. NHS Scotland estimates that £360,000 is saved in life-time treatment costs by the prevention of a single case of HIV transmission. And recent efforts to reduce transmission rates and increase testing have been successful. In 2015 there were 6,184 new diagnoses of HIV in the UK; in 2016 that had fallen to 5,164. But these gains are now threatened by further cuts to sexual health services which will only reduce access to testing.
If these successes are to be maintained there needs to be, as Norman Fowler’s Don’t Die of Ignorance campaign demonstrated thirty years ago, clear political will and the money available to put it into practice.
Post author: Nick Lee