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More than a quarter of a century ago, a high-profile campaign on British television, followed by a mailshot to every household in the country, shaped a generation’s views on a frightening new disease. To the deep, sobering tones of the actor John Hurt, a tombstone was engraved with the word “AIDS”, accompanying a slogan that stressed prevention as the only way to avoid death after infection with HIV: “Don’t die of ignorance”.
More than any other politician, it was Norman Fowler, health secretary in 1987, who was behind one of the most controversial public health messages in recent decades. As he relates in AIDS: Don’t Die of Prejudice, Fowler encountered resistance from many of his colleagues in Margaret Thatcher’s Conservative government: from prudishness and fears that Middle England would revolt at the perceived promotion of immoral behaviour, to the Lord Chancellor’s more prosaic concerns that the phrase “having sex” was illiterate.
Despite Thatcher’s own distaste, with warnings to Fowler that he should avoid becoming known simply as “the minister for Aids”, he persisted with the information campaign, also embarking on numerous foreign trips to study the best approaches and publicly shaking hands with HIV patients to fight stigma.
Fowler maintained his commitment long after the defeat of the subsequent Conservative government of John Major. He has since headed a parliamentary committee on HIV, and joined the boards of related charities including the Terrence Higgins Trust and the International Aids Vaccine Initiative.
His new book provides a whistle-stop tour of Aids “hotspots” around the world: from the best practice of Sydney, which ran a contemporaneous “Grim Reaper” public health campaign in the 1980s and has an enlightened approach to sex workers and injecting drug users; to the worst of Russia and Uganda, which have rejected international evidence on how best to respond to infection.
Fowler rightly (if not originally) highlights ironies in the history of the epidemic: that, as US president, George W Bush did far more to fund HIV work around the world than predecessor Bill Clinton; and that, in South Africa, president Jacob Zuma has proved more progressive on HIV than Nelson Mandela and notably Thabo Mbeki.
There are no great revelations for those who follow HIV issues, and few obvious omissions. Fowler’s recommendations include the need for more HIV testing, earlier treatment, more “harm-reduction” through measures such as the provision of clean syringes for injecting drug users, and less intolerance – notably from religious groups.
Fowler writes clearly but, as a former journalist, he could have spent longer in his research, uncovering original stories rather than blandly paraphrasing reports and interviews conducted during rapid trips.
Furthermore, while he provides some fresh insights into his own period as health minister, and clearly remains proud of the “Don’t die of ignorance” campaign (even reproducing the original leaflet in the book), he does little to engage with the lively debate on its legacy. Critics have argued that its message of fear further stigmatised HIV; that a single nationwide campaign was insufficiently targeted to reach those most in need; and that its impact on reducing infections was limited.
Nonetheless, Fowler’s message of tolerance and pragmatism, and his continued commitment to the field, is creditable in a world that still has a long way to go in fighting prejudice, and as a result in ending the scourge of HIV.
Andrew Jack is the FT’s deputy analysis editor and a former pharmaceuticals correspondent
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