Aids panic in disarray

For five years the fear of an Aids epidemic among heterosexuals in Britain has gripped the nation. But now figures showing the slow rate of spread of HIV over a decade, and reports of experts questioning the link between HIV and Aids, are creating growing scepticism about the Aids panic.

Dr Michael Fitzpatrick is co-author of The Truth about the Aids Panic, which first exposed the irrationality of the official campaign as far back as 1987. Here he surveys the new challenges to the Aids orthodoxy and the official response

Reports published by the Communicable Disease Surveillance Centre (CDSC) show that, of around 5000 cases of Aids notified in England, Wales and Northern Ireland between 1982 and 1991, some 400 were thought to have acquired HIV infection through heterosexual contact. However, 80 per cent of these were infected abroad, largely in countries in Africa where heterosexual transmission is the most common mode of infection. Some 10 per cent (designated as 'first generation' cases) became infected from contact with recognised high-risk partners, mainly intravenous drug abusers and recipients of infected blood products. The remaining 10 per cent ('second generation'), a total of 47 cases, were infected by heterosexual partners outside recognised high-risk categories in Britain.

The incidence of heterosexual Aids outside high-risk categories is running at a rate of a handful a year. The parallel figures from the CDSC for individuals who are HIV positive by 'second generation' contact are 131 out of a total of 15 000. It is worth noting that though there has been a slow but steady increase in 'second generation' heterosexual Aids cases, reports of parallel HIV positive cases declined between 1990 and 1991. The results of anonymised surveys conducted at antenatal and sexually transmitted disease clinics confirm the low prevalence of HIV outside known high-risk groups and people who have been sexually active in Africa.

A number of important points follow. First, the Aids epidemic in Britain is not following the African pattern of rapid heterosexual spread, facilitated by other sexually transmitted diseases and prostitution. Second, the much-vaunted 'bridges', provided by bisexual men and drug abusers, between currently infected communities and the heterosexual world are carrying very little traffic in Britain. Indeed, the prevalence of HIV among British drug abusers remains low. The CDSC's April Communicable Disease Report concludes that 'current evidence does not suggest that the American pattern is occurring here'.

Whatever is happening in Africa, south-east Asia, the USA, or even in southern Europe, in Britain Aids remains an uncommon disease. At the end of its first decade it is still remarkably closely confined to recognised high-risk categories. Despite all the scares, among British heterosexuals who do not conduct their sexual relations in sub-Saharan Africa, Aids is very rare. For the vast majority of British people the risk of HIV infection is roughly on a par with that of being struck by lightning.

Moral crusade

Why has the British government chosen to launch the biggest and most costly public health campaign in history to alert the nation to what is, for most of the population, a non-existent threat? We gave our answer in The Truth about the Aids Panic, when the government campaign was launched, and reiterated it in a recent article in the Guardian:

'The government's Aids panic is not a public health campaign at all, but a moral crusade. It is a means of promoting sexual and moral conformity by manipulating public fears about a rare but fatal disease. At a time of economic recession and social crisis, conventional morality and traditional family values provide a much-needed source of cohesion and stability. Aids has provided the most effective vehicle for the drive to restore Victorian values in the Britain of Mrs Thatcher and her successors. The breadth and depth of the consensus around 'safe sex', even when its irrationality has been exposed, is a testimony to the fact that for the government the Aids panic is worth every penny spent on it.' (10 April 1992)

While in 1987 the consensus around the Aids panic held firm, today experts in the Aids field are openly critical of the government's 'safe sex' campaign. Dr Caroline Bradbeer, genito-urinary consultant physician at St Thomas' hospital says that 'the idea that everybody is equally at risk is nonsense - and it is a waste of money telling people that' (quoted in the Sunday Times, 1 March 1992). The more the true pattern of the spread of HIV/Aids in Britain becomes apparent, despite all the attempts to obscure it and the numerous statistical scams used to exaggerate the scale of second generation heterosexual spread, the more people come to question the official campaign - and the more, too, the establishment's ulterior moral purpose is exposed.

Rearguard action

The exposure of the myth of the imminent explosion of heterosexual Aids in Britain has provoked a defensive response from the Aids establishment. Dr Anne Johnson, first lieutenant to professor Michael Adler, commander-in-chief of the British Aids panic, devoted a lengthy editorial in a recent issue of the British Medical Journal to a rearguard action:

'Preoccupation with second generation transmission reflects concern about the possible size of a purely heterosexual epidemic in the British population who do not inject drugs. But getting caught up with this issue gets us nowhere. We cannot regard the heterosexual British population as isolated from the drug-injecting population or people from other countries.' ('Home grown heterosexually acquired HIV infection', BMJ, 2 May 1992).

But we are preoccupied and caught up with the issue of second generation heterosexual spread because, for five years, the government, backed all the way by doctors like Adler and Johnson, has bombarded the public with propaganda emphasising this very issue.

New metaphysics

Now that the figures confirm the absurdity of this preoccupation, those who promoted it seek to direct attention elsewhere. While many Aids commentators try to keep alive the heterosexual scare by raising the spectre of Bangkok, Mombasa or New York, Johnson prefers an obscure parallel with the spread of syphilis in fifteenth-century Europe. Her assertion of intimacy between heterosexuals and members of high-risk groups has the metaphysical quality of Donne's 'no man is an island'. The epidemiological evidence of a decade confirms that, apart from a few unfortunate cases, the heterosexual British population is indeed isolated from HIV-infected drug abusers and foreigners.

A key distinction affecting the pattern of HIV spread is that between 'random' and 'assortative' sexual contact, as examined by RM Anderson and RM May in a recent article ('Understanding the Aids pandemic', Scientific American, May 1992). In demonstrating the role of mathematical models in grasping the spread of HIV, the authors emphasise the different pattern that results if it is assumed that members of a particular society engage in sexual contact in a random manner (anybody may have sex with anybody else) or in an assortative manner (people have sex only within closely circumscribed social groups). The projected epidemic is much worse with random mixing as the infection spreads through the whole population.

Though Anderson and May are largely concerned with Africa, it is striking that the 'everyone is at risk' notion promoted by the government in Britain encourages the prejudice that rapid random spread is the likely course of the epidemic. In reality, of course, British society is characterised by a highly assortative mode of sexual interaction. Elderly married couples in Hull do not commonly engage in partner-swapping weekends with inner-London heroin addicts. Young people in Ipswich are not likely to have dates with HIV-positive Ugandan refugees; even in London, the legendary inhospitality of British society ensures that most foreigners keep to themselves. Nor are straight East End teenagers inclined to mix much with the West End gay scene.

Like partners

Anderson and May draw out the prospects for HIV in a society in which most people have sex with people like themselves:

'If mixing patterns are highly assortative, an approach aimed at high-risk groups is particularly worthwhile. It may even turn out that the rates of sexual partner change in the general heterosexual population are insufficient to maintain the transmission of HIV.'

A rational assessment of the likely pattern of HIV spread in Britain suggests a much less gloomy scenario than that universally painted by the panic promoters. It also suggests an approach to containing the spread diametrically opposite to that followed by the government and its medical advisers - targeting high-risk groups rather than trying to terrify the entire population.

Dr Anne Johnson now pleads that earlier official forecasts emphasised uncertainty rather than indiscriminate heterosexual spread. It is no doubt true that in the small print of official reports lower as well as higher estimates can be found. But what is striking is the consistency with which the media and the politicians extracted the higher figures and broadcast the bleakest doomsday scenario for general public consumption. We cannot recall angry letters to editors from Johnson and her colleagues demanding more balanced reporting. Indeed Adler, in particular, was always ready with a quote hyping up the heterosexual threat, with never a hint of uncertainty in his voice.

Saved by syphilis?

Now the figures are out, all is uncertain, it is much too early to tell: 'it is as erroneous to arrive at conclusions in the early 1990s about the eventual prevalence of HIV as it would have been to expect fifteenth-century epidemiologists in the decade after the introduction of syphilis to predict its devastating impact throughout Europe in subsequent centuries.' Once again, syphilis to the rescue! Here its role is to enable Johnson to move the goalposts: we never really suggested apocalypse today or even tomorrow, but perhaps in the next century, or in Johnson's epochal perspective, 'the next millennium'. The Aids panic is now sustained by the argument that 'we don't know what might happen in the future, but we can't be too careful'. According to this logic, everybody should stay at home in case they get run over by a bus, or perhaps, you never know, hit by a meteor.

Aids and Amsterdam

Another challenge to the prevailing Aids orthodoxy comes from professor Peter Duesberg and other scientists who assembled for an 'alternative' Aids conference in Amsterdam last month. Duesberg refutes the view that HIV is the cause of Aids, emphasising the role of recreational drugs such as poppers and crack. Others at Amsterdam accepted that HIV plays some role in the genesis of Aids, but only in association with 'cofactors' such as other infections. They were, however, united in condemning the transformation of the HIV/Aids hypothesis into a dogma, the censorship and distortion of alternative theories and the suppression of funding for research into such alternatives. Whatever the scientific merits of Duesberg's case, which are certainly debatable, there can be no doubt that he has exposed the climate of irrationality that surrounds the whole issue.

Shaken up

The Duesberg challenge, partly supported by Luc Montagnier, the French discoverer of HIV, and by a number of other distinguished scientists, has shaken the Aids establishment. He has been denounced by the secretary of the Medical Research Council for 'irresponsibility bordering on the criminal' for dismissing the contribution of safe sex to the prevention of Aids. The government's chief medical officer Kenneth Calman could only bluster that Duesberg's thesis had been 'extensively discussed and refuted in both the scientific and lay press' without seriously engaging the argument himself (Sunday Times, 24 May 1992).

Though Duesberg and the rest are a destabilising element in the Aids world, their emphasis on drugs, homosexuality and other 'deviant' behaviours means that this position on Aids can be contained within the wider moral panic. In the short term, however, the Amsterdam conference has contributed to the wider climate of questioning of the Aids panic, and to the growing backlash against the Aids establishment.

Forward ever

In conclusion, it is important to emphasise that, although the Aids panic has lost momentum and its promulgators are currently in disarray, it is likely to persist at a lower level of intensity. The government and many other backers of the Aids establishment have invested too much in the Aids scare to allow it to collapse. When David Frost confronted Virginia Bottomley, the newly appointed health secretary, with the passage from the article in the Guardian quoted above on the moralistic character of the government campaign, she made clear that the government intended to continue promoting the panic despite diverse public expressions of scepticism. Facts alone will not stop the panic, but they are a start in mobilising resistance against the atomising and demoralising impact of the fears and insecurities generated by the Aids panic.