The first deaths in EnglandIn the UK, news of this disease filtered through and the first deaths occurred. One of these was of Terrence Higgins, a 37 year old computer programmer who died in St Thomas’ Hospital in July 1982 surrounded by strict infection control techniques (double barrier nursing) and fearful staff. His death led to the founding of the ‘Terry’, later Terrence Higgins Trust, one of the first voluntary organisations in the AIDS field.After this, an organised gay response developed: the Lesbian and Gay Switchboard was important in providing information on this unknown disease, as well as the organisation Body Positive. Cases began to appear in London hospitals and a diverse range of clinicians and scientists developed early expertise. They ranged from specialists in the sexual health field, to immunologists and virologists, with epidemiologists providing early information about who was suffering and dying from the disease.
The discovery of the virusThere was also an attempt to understand what the agent causing this disease might be, and an inkling that it might be a virus. In 1983 and 1984 the viral agent responsible for AIDS was discovered in France and the US. At the time it was given various names which ultimately coalesced into the agreement to call the virus HIV (human immunodeficiency virus). Soon after, it became possible to test people for the virus and it became apparent that there were wider dangers of spread, apart from men who have sex with men, to the general population.
Blood and drugsA particular concern was the threat to the blood supply because of contaminated donation. In particular, there was concern about the treatment of haemophiliacs with HIV contaminated blood products.Testing also made the extent of HIV infection among drug users visible. In Scotland in 1985 when the blood of drug users in Edinburgh was tested, 83 out of 164 heroin users were found to be seropositive (HIV+), a rate of 50%. Such a rate of spread had worrying implications.
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A History of Public Health in Post-War Britain
High level political interest 1986-87In 1986, a sense of national emergency materialised, and developed high-level political interest on the subject. A Cabinet committee on AIDS was set up, a major health education campaign was initiated, funds were released for research, and the main health education body, the Health Education Council, was reformed as the Health Education Authority. Despite this progress, there were still powerful calls for a punitive approach, such as when the Chief Constable of Greater Manchester, James Anderton, spoke of people ‘swirling in a human cesspit of their own making’. However, the general tenor of the government response was pragmatic- focussing on safe sex rather than no sex, and safer drug use rather than no drug use. This liberal response was influential at the international level too and was promoted through AIDS specific organisations set up as part of the World Health Organisation (WHO) and the United Nations (UN).
AIDS as a chronic diseaseThis high-level response lasted throughout 1987, but later it faltered. The threatened epidemic did not happen and fears of a ‘national emergency’ died away. Politicians began to wonder whether they had over reacted, although the lack of an epidemic was credited to the thrust of the government response.Eventually, the view of AIDS as a public health issue began to normalise, and the condition was seen as more of a chronic disease. Advances made in HIV/AIDS research underpinned this drastic change of view. Although, the much heralded AIDS vaccine did not appear, advances in treatment began with the use of AZT (azidothymidine), a drug initially developed during the 1960s by Burroughs Wellcome. The trials and treatment of the early 1990s forged a new identity for HIV/AIDS, at least in western countries, where treatment with a combination of drugs became possible. AIDS was a global issue by that decade and in non-western countries the responses and the issues at national levels were rather different.1
A History of Public Health in Post-War Britain
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