The AIDS panic that took off in the late 1980s and surged through the 1990s was the greatest health-related scare of our time. A phenomenon of much wider significance than the novel viral infection on which it was based, the panic was both a product of the peculiar insecurities of the historical moment in which it emerged and a force which intensified them.
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While the panic provoked private fears of a deadly disease, it also fostered new institutions embodying new forms of solidarity, and promoted, in the form of the safe sex code, a new moral framework. It encouraged an already growing preoccupation with health, or, to be more precise, with disease. The contemporary obsession with illness and death, so powerfully reinforced by the AIDS crisis, increased the dependence of patient on doctor and strengthened the authority of the state over the individual.
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My first encounter with the AIDS scare followed the death of Rock Hudson in 1985, before the panic had really taken off. This former matinee idol had succumbed after the devastating impact of AIDS had led to the public confirmation of both the nature of his illness and his homosexuality. A middle-aged woman - a former fan, who had closely followed the news story - went into a panic attack when she realised that she had shared a coffee cup with a gay man at work and came rushing in to the surgery.
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I heard several similar stories after the panic proper took off towards the end of 1986, and then again after the death of pop singer Freddie Mercury in 1992, and again with each upswing in the level of popular anxiety. I remember a teenage boy who came in following a series of TV programmes designed to boost public awareness. Despite his negligible sexual experience, he was worried he had developed Kaposi's sarcoma, a once-rare skin cancer that now appears in some people with AIDS. He reckoned that the red patch on his chest looked exactly like the one exhibited in the cause of public health promotion, by an AIDS patient on TV. In fact, he had ringworm.
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I remember, too, a man in late middle age who was terrified that he might have acquired HIV in the course of a single homosexual experience while in the services during the Second World War. The 'worried well' became a recognised disease category, their anxieties accepted as a price worth paying for heightened AIDS awareness.
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So what was the truth about AIDS? How did this panic take off?
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In November 1986 the UK government launched the 'biggest public health campaign in history' about the threat of the Acquired Immune Deficiency Syndrome (AIDS) resulting from the Human Immunodeficiency Virus (HIV). Advertisements ominously featuring 'tombstones' and 'icebergs' appeared on TV, in cinemas, on high street hoardings and in the press; the 'Don't die of ignorance' household leaflet followed in early 1987.
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The central theme of this campaign was the risk of a major epidemic of HIV disease in the UK resulting from heterosexual transmission. The promotion of 'safe sex' justified by the risk of AIDS became the central theme of a barrage of propaganda through the 1990s, culminating in the development of National AIDS Day as an annual event, marked by the wearing of a red ribbon of AIDS awareness.
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In February 1987 I wrote that there was 'no good evidence that AIDS is likely to spread rapidly among heterosexuals in the West' - a judgement that has been fully vindicated by subsequent developments (1).
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- In 1988 a government working party of top epidemiologists and statisticians predicted that, by 1992, AIDS cases would be running at around 3600 a year, though the press seized on its more alarmist projections that the number of cases could reach 12,000 (2).
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- As it turned out, fewer than 1500 cases were recorded in 1992. By the end of 1999, some 15 years after the beginning of the epidemic in the UK, the total number of AIDS cases had reached around 17,000 (3).
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- More than two thirds of these cases were among gay men (who had accounted for almost 90 percent of cases in the late 1980s).
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- The number of cases spread by drug abusers sharing needles was around 1000 (a number that had grown much more slowly in the late 1990s).
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- There had been a substantial growth in cases acquired by heterosexual transmission, up to around 3000, but 2500 of these had become infected abroad (2000 in Africa).
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- Of the remainder, fewer than 300 had become infected through contact with somebody in a recognised high risk group (bisexual/drug user). These figures confirmed as groundless fears that bisexuals and drug users would provide 'a bridge' over which HIV would travel from the recognised high risk groups into the wider heterosexual population.
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One small group remained: 252 cases of AIDS - in 15 years - in which infection had taken place through heterosexual contact in the UK. Of these, 81 had become infected through sex in the UK with somebody who had themselves become infected abroad, outside Europe. The remaining 171 had become infected in the UK through contact with somebody who had become infected in Europe.
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These 171 cases can be regarded as the central focus of the officially sponsored AIDS panic which was explicitly targeted on the threat of routine heterosexual spread in Britain. Of course, the promoters of the panic claim that the fact that this number remained so low confirms the value of their campaign.
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A more likely explanation is that it confirms that the great heterosexual explosion was never going to happen.
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Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
(1) The Truth About the AIDS Panic, by Michael Fitzpatrick and Don Milligan, 1987, p8
(2) Short-Term Prediction of HIV Infection and AIDS in England and Wales (Cox Report), Department of Health, 1988
(3) AIDS/HIV Quarterly Surveillance Tables, 45 (99) 4 (March), Public Health Laboratory Service
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