HIV/Aids: Why were the campaigns successful in the West?

First aids poster

The arrival of HIV/Aids in the early 1980s led to predictions of deaths on a massive scale - yet developed countries largely avoided such a fate. What did the wave of urgent awareness campaigns get right?

Under darkened sky, a volcano erupts. Doom-laden images of cascading rocks give way to shots of a tombstone being chiselled.

"There is now a danger that has become a threat to us all," intones the actor John Hurt ominously in a voiceover. "It is a deadly disease and there is no known cure."

The word etched on to the blackened grave is revealed - Aids. "Don't die of ignorance," runs the slogan.

With its stark, unambiguous warnings ands bleak message, the advert shocked viewers when it appeared on British screens in 1986. Immediately, it faced accusations of panic-mongering and complaints that it would terrify any children who happened to be watching.

Tombstone ad 1987 The idea of the 'Tombstone ad' was to shake a nation into taking charge of its own sexual health

And yet the campaign - the world's first major government-sponsored national Aids awareness drive - would later be hailed as the most successful.

Its tactics were imitated around the world. France, Spain and Italy were all slower to react, the Terrence Higgins Trust (THT) has noted. Each of those countries has around twice the number of people with HIV as the UK, where there were an estimated 86,500 in 2009, according to the trust.

Those figures are in stark contrast to sub-Saharan Africa, where two-thirds of the world's 33.4 million people with HIV live. In the three worst affected countries - Botswana, Swaziland and Zimbabwe - around a third of the population lives with the virus, according to the Joint United Nations Programme on HIV/Aids.

Aids: Where now?

Man analysing blood samples

A series of features on Aids and HIV, as the UN marks World Aids Day on 1 December

The disparity between rich and poor nations can partially be explained by resources. However, the Department of Health spends £2.9m each year on national HIV prevention in England, part of the £10.6m spent on sexual health promotion in general. By comparison, in 2008 alone some $15.6bn (£10bn) was spent on HIV/Aids prevention around the world, mostly in developing countries.

Early campaigns are widely credited by experts with making the difference in the West by raising awareness and changing behaviour. And yet in the early 1980s, the UK would hardly have seemed an auspicious location for this revolution to begin.

As reports of a new, deadly virus filtered across the Atlantic from the US, British authorities were initially slow to react, argues Sir Nick Partridge, chief executive of the THT, the sexual health charity which was set up in response to the emergence of HIV.

30 years of HIV

Red ribbon
  • 5 June 1981: The US Center for Disease Control mentions a new virus in its weekly mortality report
  • 1982: The term Aids (acquired immunodeficiency syndrome) first used
  • 1984: Virus identified and named HIV
  • 1985: Rock Hudson dies of Aids, teenage haemophiliac Ryan White expelled from school because infected through treatment
  • 1987: First showing of Aids Memorial Quilt on National Mall in Washington DC
  • 1991: Jeremy Irons wears red ribbon and basketball's Magic Johnson has the virus
  • 1993: Philadelphia wins two Oscars
  • 2000: Infection rates in US among African Americans overtakes gay men
  • 2011: Global death toll 22m, infections 60m

The climate made this unsurprising. Some headlines spoke of a "gay plague". The fact that the groups most at risk were homosexual men and intravenous drug users meant outright hostility from certain quarters.

Between the 1982 Aids-related death of Terry Higgins, who gave the charity its name, and the government's decision to open needle exchanges for addicts in 1985, very little was done to tackle the growing list of fatalities, Sir Nick argues.

"Those three years of people dying seemed a long time," he says.

"There was a huge sense of anger - if Aids had hit any other group in society, there would have been an immediate response."

However, those in authority who wanted to take action had to confront high-level antipathy. The then-Chief Constable of Greater Manchester Police, James Anderton, referred to victims "swirling about in a human cesspit of their own making".

Nonetheless, Norman Fowler, now Lord Fowler, then health and social security secretary, and Sir Donald Acheson, the chief medical officer, were convinced that action had to be taken. By the middle of the decade, scientists were predicting that the cumulative total of UK HIV cases could reach 300,000 by 1992 if nothing were done.

"There were people in government and also people in the media who said, 'Why are you spending all this time concerned about gay people and drug addicts?'," Fowler recalls. "But that was a minority view."

Start Quote

It's an advantage it wasn't done at No 10 - it wasn't a natural subject for Margaret Thatcher”

End Quote Lord Norman Fowler Former health and social security secretary

As a result of the two men's lobbying, the government's drive against Aids was not run from Downing Street but instead co-ordinated by a cabinet committee chaired by the plain-spoken Tory grandee Willie Whitelaw.

"It was like he was running a VD campaign in the Army," recalls Fowler wryly. "I think it's an advantage it wasn't done at No 10. It wasn't a natural subject for Margaret Thatcher.

"We did it in an extremely pragmatic way. We treated it as a public health issue."

An advertising agency, TBWA, was commissioned to make adverts intended to shock the nation into action.

As well as the tombstone clip, another showed an iceberg which, beneath the surface, bore the legend Aids in giant letters.

The message of both was simple, but apocalyptic - a deadly disease was a threat to everyone, not just the "small groups" who had largely been affected by it so far.

Australia's Captain Condom The message correlates masculinity and responsible sexual behaviour

No-one doubted the strategy was bold and attention-grabbing. But all involved were acutely aware of the risks and the potential to backfire.

"It was done with considerable degrees of secrecy," remembers Sir Nick, who was consulted on the campaign. "I had to go to TBWA's entrance at 8pm and go through the goods entrance, such was the degree of political sensitivity.

"There were those who said the adverts increased fear more than understanding. I think they did both. They stopped a lot of people from having any sex at all for quite some time, but one upside was that they got everybody talking about sex and safer sex."

The iceberg and the tombstone were not all there was to the campaign. In addition, a leaflet was sent to every household in the country and a week of educational programming was scheduled at peak time on all four terrestrial channels.

But it was the television adverts which made the longest-lasting impression on the popular consciousness, instilling a sense of doom easily recalled by anyone over the age of 30.

"They were tremendously effective. They were visually so striking," says Dr Sarah Graham of Leicester University, who recently organised an exhibition of Aids poster campaigns. "People had to watch because it was so extreme."

The impact was so immediate that it was widely imitated around the world. Fowler recalls visiting the US in 1987 and discovering to his surprise that there was no national campaign.

"What we found, to our amazement, was the Americans saying, 'What we think we need to do is what you're doing in the UK,'" he remembers.

The British strategy was consequently imitated by other countries, although these varied according to cultural backdrop. For instance, it is difficult to imagine the focus of Australia's campaign, a muscle-bound, prophylactic-wielding superhero named Condoman, receiving official backing in Whitehall.

And in sub-Saharan Africa, the world's worst-hit area, running such an awareness drive is no easy matter. European HIV/Aids advertisements can be text-heavy as a means of getting information across, Dr Graham says. But she says this is simply not possible in national territories where dozens of languages and dialects may be spoken.

Moreover, antipathy from political leaders has prevented such campaigns in the countries which need them most, according to Simon Garfield, author of The End of Innocence: Britain in the Time of Aids.

2005 campaign in Nigeria A 2005 billboard campaign against HIV/Aids outside a university in the Niger Delta

"If you've got a head of state who's saying there isn't enough money and this doesn't happen here anyway, it's hard to make any headway," Garfield adds.

"You are talking about different educational cultures, different sexual cultures. But what you can say is that if there had been anything comparable it would have had a major effect."

For Fowler, however, the issue is not just about variances in national culture. Sexual health, he argues, will invariably be a topic that makes elected leaders unconformable.

Indeed, a House of Lords committee chaired by the peer concluded in August that HIV campaign efforts in the UK at present were "woefully inadequate", that a false sense of security had been allowed to set in and that a new awareness drive was needed.

"It's not a natural area for politicians to be in," Fowler says. "Sometimes religion comes into it, sometimes there are views about gay people. It's undoubtedly controversial and some people don't like being controversial in this area."

Here is a selection of your memories of the campaign and its effect.

I seem to recall that the Post Office played a major part in the UK campaign. Weren't all letters franked with the "Don't Die of Ignorance" slogan?

Ian Yorston, Abingdon, Oxon

The reason it succeeded in the UK was two-fold. Firstly, the ads did not tie the disease to any religion or superstition. It kept it medical, and in a country where women had a growing say in their own sexual health, it was an encouragement to responsible sexual health.

Jen, Edinburgh

I was at college when the campaigns started. To be honest, they had no effect on my (or indeed our) behaviour at all. We were young, had just discovered casual sex, and were very much of the view that AIDS affected different groups than middle-class college kids in England. If we wore condoms, it was to avoid getting anyone pregnant. Common sense, rather than hysteria, ruled. That said, if I was in that position today, I'd be more cautious now, as AIDS (and other STDs) is more widespread.

Rob, London

I was a teenager in the 80s and I remember the adverts very well. They scared the life out of me and made me conscious of the need to protect yourself when having sex. I have carried condoms with me ever since then and always insist on using them. 'No glove, no love', as was the popular saying a while back.

Chaz, Edinburgh

I was a child of the 80s and this advert scared the pants off me! It was so simple, yet hard hitting, that many of my generation were literally scared away from ever having sex. Unfortunately the message seems to have gotten lost and with the amount of teenagers getting pregnant it doesn't take a genius to figure out that they are, for the most part, not using contraception. We are now in real danger of young people becoming infected and passing that infection on to many others. There should be more publicity about AIDS and HIV as many young people today have no idea what these infections really mean or even what they stand for!

Boris, Somerset

I remember the campaign very well, but let's not be complacent. I work at an HIV service and there are new diagnoses every month, often from older people who would have seen the John Hurt AIDS campaign. There still seems to be a perception (even among gay people, who are well served in this town with free condoms and leaflets about STIs) that it's worth taking a chance with risky, [unprotected] sex. We must keep the pressure up regarding sexual health promotion, and this must start in schools for all children without exemptions,

John Gammon, Brighton

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