Biggest obstacle to tackling HIV is prejudice

Stigma makes LGBTs, drug users & sex workers extra vulnerable

Evening Standard – London – 12 June 2014

AIDS – Don’t die of prejudice. By Norman Fowler. Biteback Publishing, £14.99

Peter Tatchell, Director of the Peter Tatchell Foundation, writes:

Worldwide, 35 million people are living with HIV. Of these, 18 million don’t know they are infected. Not surprisingly, there are a staggering 2.5 million new infections and 1.5 million deaths every year. Since the beginning of the HIV pandemic in 1981, 36 million people have died of the disease.

This is a human tragedy more deadly than either of the two catastrophic world wars. Like war, HIV has cut down mostly young, productive people in the prime of their lives; creating vast personal, social and economic loss – particularly in developing countries where health care and education resources are limited.

In this powerful book, Norman Fowler, a former Secretary of State for Health in the 1980s under Margaret Thatcher, argues that the biggest obstacle to tackling HIV is prejudice. He blames stigma around the disease and the particular stigmatisation of sex workers, intravenous drug users and lesbian, gay, bisexual and transgender (LGBT) people – all of whom are criminalised by many, if not most, countries.

Based on his investigation and global travels, Fowler concludes prejudice “encourages secrecy and facilitates the spread of HIV.” The marginalised and despised are afraid to come forward for testing and treatment. Usually unaware they are infected, they spread the virus.

Why are so many countries still allowing prejudice to thwart proven effective strategies against HIV?

Fowler’s testimony begins with Britain in 1986, making no mention of the previous three wasted years, during which the government failed to protect the blood supply and provided little or no funding to the pioneering HIV prevention and support organisation, the Terrence Higgins Trust.

He picks up the story as he planned the government’s first newspaper, leaflet and TV adverts to warn the public about the danger of HIV. Fowler reveals that Thatcher opposed his explicit hard-hitting message; forcing him to manoeuvre to circumvent the Iron Lady’s attempts to water-down the campaign.

With the support of Willie Whitelaw, he adopted an evidence-based approach; citing the example of successful anti-VD campaigns during WW1 and WW2 to show why a combination of shocking facts and condom provision was necessary and effective.

The resulting ‘Don’t die of ignorance’ adverts and leaflets – especially the ghoulish tombstone TV images – received less than universal approval but they did encourage safer sex and were followed by a significant fall in sexual diseases.

Despite high-level government resistance, Fowler went on to pioneer clean needle exchanges, which dramatically cut infections and deaths among injecting drug users.

Having shown that policies based on scientific and medical facts worked, he was vindicated.

Sadly, his book reveals that many governments are still driven by prejudice, moralising and repression. A homophobic backlash in parts of Africa and the ex-Soviet bloc countries is denying gay men HIV prevention information and deterring them from coming forward for testing and treatment. In Russia, the government’s harsh anti-drugs policies are having a similar disastrous impact among intravenous users. India’s discriminatory caste system and the marginalisation of transgender people exacerbates the spread of HIV. Condom provision for sex workers and harm reduction programmes for drug users are deprived of government funding in the US.

Fowler concludes with a call to global action: including more funding for prevention programmes (the UK spent less than £5 million in 2011) and for testing, early treatment, needle exchanges and vaccine research; plus the decriminalisation of sex work and improved sex and relationship education to encourage wise, responsible sexual behaviour. All very good proposals. Are you listening David Cameron?