Lord Fowler calls for more HIV awareness

It was a truly terrifying advert.

Millions watched in early 1987 as a volcano exploded on their TV screens.

A large metallic gravestone was seen being engraved with the single word "Aids", the chiselling made to sound like a death knell.

To a background of monastic chanting, the voice of actor John Hurt told the public: "Protect yourself."

It warned: "If you ignore Aids it could be the death of you, so don't die of ignorance."

Most people over the age of 30 will remember this apocalyptic public information film, commissioned by Margaret Thatcher's Conservative government.

Every household in the UK was sent an accompanying leaflet, explaining how HIV is contracted, why it becomes Aids, and the appropriate measures to prevent its spread.

'Off the boil'

Rates of contraction of HIV, which attacks the immune system, fell for the next couple of years, suggesting the £90m campaign had got through.

But, in the years since, much has changed.

Improved drugs mean HIV is no longer necessarily regarded as a "death sentence". Mainstream media campaigns on the issue are fewer.

However, the number of infected people in the UK had risen to an estimated 86,500 by 2009 - a threefold increase on the 2000 level.

It is thought that a quarter of those with the virus have not had it diagnosed.

Norman Fowler, then the health secretary, was the political force behind the 1987 attempt to raise awareness.

Now 73, he has set up a House of Lords committee to investigate this "major public health problem" once more.

On a fact-finding visit to Brighton, a city with one of the highest rates of HIV in the UK, Lord Fowler told the BBC New website: "My concern would be that this issue has come off the boil. We are in a position in this country where almost 100,000 people are living with HIV.

"We don't seem to be doing enough to warn people of the dangers."

He added: "It's a big issue. But it's not necessarily a popular issue with politicians at the moment."

Much of today's efforts is focused specifically on groups with higher infection rates, such as the gay community and immigrants from sub-Saharan Africa.

The thinking is that this will reduce the spread caused by unsafe sex.

Lord Fowler has some criticism of the "targeted" approach.

'Bigger impact'

Following a briefing from medics at Brighton and Sussex University Hospital's HIV research unit, he said: "I think most people who lived through the 1986/1987 period remember the campaign. There were criticisms but I don't have any apologies over that campaign. We saw the impact of it. HIV rates went down.

"The way it works these days is that we have very targeted campaigning, which is often a shorthand way of saying we are not going to spend much money on it.

"That's fine up to an extent, but targeting is actually quite difficult to do effectively. It's not the easiest thing to do to target particular areas and parts of the population.

"I'm all for trying to have a bigger impact on areas of the country and the population but it's good if it's seen by the population generally. We need a wider sense of sexual education. That's a bit lacking at the moment."

He added: "I think we would never do another campaign in the same style as we did in the 1980s. In the 80s there was no real treatment. I remember going to the United States, where there were people dying and they could do nothing about it. That justifies the very dramatic way we used the advertising at that stage.

"Campaigns in this area have changed. The important thing is you need to continue to have a campaign."

These days late diagnosis is one of the biggest contributing factors to death and illness among those with HIV.

Early use of drugs can help protect the immune system.

Mark, a 36-year-old HIV-positive patient at the Brighton hospital, was diagnosed with the disease in 2006, having declined to be tested earlier.

He said: "I would say to anyone who's thinking of going for testing that they should get it done. I shied away from the issue. It was a bit like not looking at your bank statement, even though you know it's there. When I was tested my immunity had fallen to such an extent that I was at risk of all sorts of nasties, like pneumonia."

Mark now takes a course of antiretroviral tablets, which suppress the HIV virus, each morning and is able to lead an otherwise normal life.

He said: "I remember the 80s awareness stuff, having watched the TV advert, and it was hard-hitting. But I was a child back then. I hadn't become sexually active.

"Later, when I wasn't in a relationship I wasn't always 100% careful."

'Looking at us'

Lord Fowler remembers some of the harrowing experiences which informed the 1987 campaign.

"I went round a hospital and there was a ward predominantly full of young men waiting to die.

"We went to San Francisco and we could see people who were obviously dying sitting in restaurants. But the authorities there were not doing what we were doing. In the end the Americans saw that we had had some success in cutting rates and started looking at what we were doing."

HIV patients who are diagnosed and treated early are now expected to live a "near normal" length of time.

Surely, though, raising awareness among the wider population, not just the highest risk groups, will help prevent its spread?

Giving evidence to the committee, the Department of Health's director general for health improvement and protection, Professor David Harper, said: "We've moved over the years, particularly since the 1990s, from a blanket approach, the sort of 'Don't Die of Ignorance' approach, to something more targeted."

He added: "It's not something we can relax about. We need to find new and better ways to reach some of the people who are often some of the hardest to reach."

Prof Harper said spending on HIV awareness, which is expected to be £3m this year, had to be more "cost-effective", but said: "It's not about spending less money for the sake of spending less money. It's about getting more effect from what we spend."

'Sustained effort'

Genevieve Edwards, head of communications at the Terrence Higgins Trust, a sexual health charity, praised Lord Fowler's original campaign as "truly groundbreaking".

She added: "Anyone of my age and above remembers it. But the people who are out and about this weekend won't have been born the last time the advert aired.

"It was a really brave thing to do, but there has a been a steady decline in resources put into HIV awareness over the years. We need lots of different efforts to raise the issue.

"I don't think a single campaign on its own will do the trick. It runs for however long and then it ends. We want a more holistic approach.

"No company worth its salt would go off-air for more than 20 years and expect people to know it's there.

"Lord Fowler is right that we have to raise awareness, but what we need now, and I'm sure he would agree, is a sustained effort."

After his interview, Lord Fowler was keen to emphasise that he was speaking in a personal capacity and that the opinions expressed would not necessarily be those of the committee, which is expected to report its findings by the end of July.

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