The truth about the Birmingham Aids panic

The case of the 'HIV Romeo' in Birmingham has become the focus for another wave of media and medical hysteria about the heterosexual spread of Aids. Ian Scott and Dr Michael Fitzpatrick investigate the story behind the headlines

Doctors at the centre of the case of the Birmingham man alleged to have infected four women with the Aids virus have consistently emphasised their refusal to confirm his identity and their commitment to confidentiality. Representatives of the South Birmingham health authority and the Birmingham Aidsline have also maintained a posture of aloofness from the tabloid furore. Condemnations of the Birmingham Aids authorities for their refusal to publicise the man's name or to initiate legal action against him have reinforced the impression that the whole affair was whipped up by the media and that the medical role was merely reactive and defensive.

Betrayal of trust

Closer investigation of the Birmingham story reveals that the impression that the lead came from the media is a myth. This myth conveniently disguises the betrayal of trust by doctors and others in the Birmingham Aids team that really launched the outbreak of Aids hysteria. Some of the Birmingham doctors may have been embarrassed by the intensity of the national response, and by the prurience of the tabloid coverage. Yet there can be little doubt that, on balance, the Birmingham Aids authorities judged the whole affair successful in terms of raising awareness of HIV.

In their response to the case, the local Aids authorities were influenced by a number of overlapping concerns. Those workers in closest contact with the individual at the centre of the controversy were preoccupied by the question of how to deal with him. Following the death from Aids of a 20-year old woman in the city in early May, doctors came to suspect a chain of infection linked to a 24-year old haemophiliac. He had been HIV positive for seven years, since receiving a contaminated transfusion. However, it seemed that he had consistently refused to accept 'safe sex' counselling. Indeed he was already so notorious that his case was discussed in general terms at a training session for local GPs last year. The prevailing sentiment among Aids workers was summed up by one 'source close to the case' who declared that 'something must be done to stop this bastard' (Birmingham Post, 22 June).

Somebody in the Birmingham Aids team, with privileged access to the confidential details of the case, decided that the only way to stop him was to expose him in the press. They contacted Jason Lewis of the Birmingham Post and provided him with the full story.

The more senior figures in the Aids establishment in Birmingham saw the case in a wider regional context. There is evidence from a number of sources that, long before the recent furore, they were concerned that the limited spread of HIV infection in the West Midlands was undermining their efforts to maintain a high level of public concern around the issue.

'Not a major problem'

In its internal report to the Department of Health in 1991, the West Midlands regional health authority, which includes South Birmingham, noted that 'the "slow" development of the epidemic in many districts means that in the forthcoming years particular work will need to be done to address the special problems of sustaining preventative work in areas of low prevalence'. The West Midlands was one of the authorities which underspent its 1990 Aids budget (by £2.8m) because of the relatively small number of local cases.

As recently as March of this year, the director of social services acknowledged in a special report that 'Birmingham, unlike London or Edinburgh, has a significant, but not a major problem with HIV infection and Aids'. He also noted that 'surveys of the West Midlands population suggest that the level of knowledge of HIV issues is low and that safer sex is not being widely practised'. He emphasised that it was 'important to take advantage' of the 'limited breathing space' resulting from the slow spread of the disease 'to further develop prevention and care services'.

Growing scepticism

It seems that the Birmingham Aids authorities decided that it was important to take advantage of the recent case to raise the profile of HIV prevention in the area.

Another set of concerns united Birmingham Aids workers and members of the national Aids establishment: all were alarmed at the growing public scepticism about the real extent of the risk of heterosexual Aids in Britain. As official figures have appeared to contradict earlier forecasts, and future projections have been scaled down, various critics of the scare have begun to get a wider hearing (see Dr M Fitzpatrick 'Aids panic in disarray', Living Marxism, July). Both Peter Bellamy, local HIV services manager, and Dr Bernard Crump, director of public health, condemned what they described as 'irresponsible' press reports in recent months which had played down the risks of heterosexual spread (Observer, 28 June). Dr Patrick Dixon of Aids Care Education and Training, one of the key government-sponsored Aids organisations, also complained about 'months of nonsense in the press about Aids', quoting claims that '"promiscuity may be safe"' and that '"the threat of Aids to heterosexuals is a myth"' (Sunday Times, 28 June).

Dr Dixon wrote that, for him, the Birmingham case was 'no surprise', meaning that he was not surprised that people were now ignoring 'health messages' and acquiring HIV infection. Yet the Birmingham case was no surprise in another sense: it provided the Aids authorities, locally and nationally, with what they badly wanted - a focus around which to challenge what they regarded as mounting complacency about Aids. When Dr Surinder Bakhshi, Birmingham's infectious diseases consultant, declared that 'this is the kind of nightmare scenario we have all feared', he seemed to relish the opportunity it provided to revive the Aids scare. Local Aids specialist Dr Sue Drake said that she was 'quite happy' that the case demonstrated 'very clearly that heterosexual Aids is alive and well and being transmitted in Birmingham' (Daily Mail, 24 June). Health authority spokesman Paul Castle eagerly struck a familiar note of alarm when he insisted that the Birmingham case was 'just the tip of an iceberg' (Observer, 28 June).

Medical mole

Hence it was not surprising that when Lewis contacted the health authorities for an official response to his scoop, he found them ready to confirm every detail, apart from the man's name. Thus the story broke, on Monday 22 June, without the name. However, the Post's sensational front-page story provoked one of the man's alleged contacts into confirming his identity. The way was now clear to name him in Wednesday's paper, without implicating the 'medical mole', thus enabling the authorities to preserve a fig leaf of confidentiality. The Birmingham Aids panic was under way.

Though health authorities are not known for skilful media management, the Birmingham publicity machine operated with a degree of efficiency and purpose that suggested, if not advance planning, at least an agency eagerly seizing an opportunity. The first detailed press statement appeared on the same day as the Birmingham Post exclusive and was followed by several more over the next week. Busy doctors and administrators were made available at two major press conferences and for numerous media interviews. The local Aids team was the key source of details about the case and relevant background material in all the early newspaper accounts.

Aids agenda

The health authority confirmed that 'there is a case of an individual with HIV, four of whose sexual partners are known to have been infected and one of whom has since died'. This formulation carefully avoided stating that these partners acquired HIV from this man, an assumption made in the media, but one for which there is only circumstantial evidence. Once these details were publicly identified with a named man, the authority's refusal to disclose the name became a mere formality. In addition to these points of substance, the health authority spokesmen emphasised three themes.

First, they entered into public discussion of the moral conduct of the individual concerned. They condemned his 'regrettable irresponsibility' for failing to comply with offers of counselling, though absolving him of 'a wilful intention to infect' (23 June). They declared their intention to 'encourage him to readdress his lifestyle and to act more responsibly'. They later confirmed that he had 'received further counselling and advice on the need for a responsible attitude towards sexual intercourse and the use of a condom' and reported that his 'response to counselling had been positive' (30 June). Trial by media was thus complemented by the Birmingham medical inquisition's demand for public penance.

Then the inquisitors moved on to consider 'what, if any, action' could be taken 'to prevent the further spread of the infection by the individual concerned'. Options considered, and ruled out as impracticable, included compulsory treatment under mental health and public health legislation. They concluded that prosecution would 'be a matter for the Director of Public Prosecutions should complaints be made to the police' (23 June).

Finally, they seized the opportunity in every statement to emphasise the danger of heterosexual transmission of HIV and the need for safe sex. The first press release stressed that 'the best defence against acquiring HIV infection is through the practice of safer sex by using a condom' (23 June). When some newspapers began to speculate about the role of anal intercourse in the supposed network of cases in Birmingham, the health authority particularly emphasised the hazards of vaginal intercourse.

'Loveless, drunken rutting'

What is striking about the media coverage of the Birmingham case is that, while it amplifled the hysteria, it followed the broad themes laid out by the health authorities remarkably closely. 'Aids maniac on the loose with a mission to kill' was the opening headline in the Birmingham Post on 22 June, and the national press carried on the demonisation of the 'HIV Romeo'. Just as the devil often appears as a plausible rogue, this evil man was described, by Mark Bestel, manager of Birmingham Aids Lifeline, as 'an ordinary, charming young bloke' (Sun, 23 June). Yet, 'doctors say' he is engaged on a 'twisted revenge plot'. Different newspapers added their distinctive twist to the character assassination. For the Sunday Times, he was a typical dissolute product of the inner-city underclass (28 June); the Sunday Express focused on a 'grotesquely irresponsible subculture of promiscuity', 'a frantic, loveless, drunken rutting among the amoral young'; the News of the World hinted darkly at 'unnatural', 'illegal', 'kinky' acts (28 June).

'Blessing in disguise'!

Politicians and lawyers had numerous suggestions for methods of coercion. Local Tory MP Jill Knight proposed detention in a mental hospital; local Labour MP Clare Short wanted names and photographs of offending men publicised. This suggestion was also favoured by a legal contributor to the Guardian who drew a parallel with media warnings against poisoned food in supermarkets (24 June). The Sun said that castration was one of several proposals that 'merit urgent study' (24 June). Professor Leonard Leigh of the London School of Economics suggested using the rape laws; Professor John Smith of Nottingham University recommended a charge of GBH.

All of the press took up the call for safe sex as the only safeguard against the heterosexual transmission of HIV. 'There is one grim lesson from the Birmingham furore' proclaimed a sombre Guardian editorial: 'the importance of engaging in safe sex unless you are 101 per cent sure of the health of your partner.' (24 June) On the same day, the Sun put the same point more dramatically. In a report from a Birmingham disco headlined 'We are all living like nuns', it noted that 'even the most hunky men were given the cold shoulder as pubs and clubs were swept with the climate of terror'. At the more respectable end of the spectrum, an editorial in the Observer recalled that 'before the war many women either refrained from extra-marital sex or insisted that their partners be protected' (28 June). It concluded that 'society will have to turn the clock back if it is to protect itself from Aids'. The Observer and the Independent, as well as some of the tabloids, fiercely condemned those newspapers, particularly in the Murdoch stable, which had earlier played down the risks of heterosexual spread.

Surveying the Birmingham Aids panic towards the end of its first week, Aids Lifeline spokesman Mark Bestel was well pleased:

'It is strange but I think this case could be a blessing in disguise. We hope it will make people think before getting into bed without a condom.' (Guardian, 26 June)

This is an extraordinary and revealing statement. By this time, the man at the centre of the controversy and his wife had been forced to abandon their home and go into hiding. A factory at which the man had worked was described as being in the grip of an 'Aids panic'. Local haemophiliacs experienced a sense of being further stigmatised; according to one member of the local haemophilia society, attendance at a Birmingham haemophilia clinic that week was decimated. But for the Birmingham Aids establishment this wave of scapegoating and hysteria was 'a blessing in disguise'.

Satisfactory panic

What Bestel meant was that, whatever the wider consequences of the panic, for the Aids establishment it was a blessing. It fulfilled local Aids workers' desires to 'do something' to curtail one man's sexual activities. Dr Crump was confident that the newspapers would have the desired effect on the recalcitrant haemophiliac: 'Because of the media coverage I am sure he is re-evaluating the situation himself.' (Sun, 24 June) Furthermore, the panic satisfied the national Aids establishment's need to discover some focus around which to revive fears about the heterosexual spread of HIV. It is important to recall that not only has this fear been the central theme of five years of official Aids propaganda, it has also provided the main justification for the employment of around 2500 people in promoting HIV awareness.

Who benefits?

Who benefited from the tip-off to the Birmingham Post? Who had access to the relevant information? All the questions lead back to the local Aids establishment and the medical authorities. The health authority has confirmed that there is to be no inquiry and no attempt to identify or discipline the 'medical mole'. While it remains unclear at what level the decision to inform the press was taken, it is clear that all the senior figures in the health authority and local Aids establishment were complicit in an outrageous breach of confidentiality.

The Birmingham affair raises a number of wider issues concerning the public response to Aids in Britain. It reveals above all the way in which HIV infection and Aids are no longer regarded as disease states, but as essentially moral conditions. People suffering from other diseases are regarded as deserving of sympathy and support from society, and care and treatment from doctors. People with HIV and Aids, by contrast, are judged according to the degree of their individual responsibility for their condition: 'innocent' babies infected by their mothers and recipients of contaminated blood; 'guilty' people who have become infected through drug abuse and homosexuality. The Birmingham case emphasised the moral distinction between people who practice safe sex, and those who don't. As Mark Bestel pointed out, it was not only one man who had acted irresponsibly: 'If all these women had protected themselves, this situation wouldn't have arisen.'

Dark ages

Amid the Birmingham furore Jonathan Grimshaw, co-founder of Body Positive, explained how the discovery that he was HIV positive had led him to change his sexual behaviour (Guardian, 26 June). Yet, he admitted, 'there have been times when, because of the anger and despair associated with the diagnosis, I have not acted responsibly'. He added that 'a failure to act responsibly 100 per cent of the time is not confined to people with HIV'. But in the self-righteous world view of the Aids zealots, people - especially HIV positive ones - must be made to act responsibly 100 per cent of the time. If they fall short of this lofty goal, they must endure courses of moral correction (counselling) or face exposure. Doctors, MPs and newspaper editors, of course, always behave 100 per cent responsibly, especially in matters of sexual morality.

The transformation of a disease, which is caused by a virus, into a marker of a defective character signifies a return to the pre-scientific dark ages of medical practice. The Birmingham panic shares many features with medieval responses to the plague: the scapegoating of carriers of infection, the suggestion of demonic influences, the mass hysteria. It is also accompanied by a degradation of medicine. The major role of doctors in relation to Aids is no longer to treat sick people, but to make healthy people virtuous in the hope that this will enable them to escape contamination, or at least limit the scale of contagion. The moralistic climate created by the Aids panic enables doctors to justify violating elementary standards of confidentiality in the cause of promoting righteous behaviour, in one individual and in society more widely.

The Birmingham case has reduced the debate about HIV/Aids in Britain to the question of what form of legislation could best be used to coerce one individual. Some of the solutions proposed recall the notorious Contagious Diseases Acts of the 1860s, which tried to prevent the spread of venereal diseases, particularly in the armed forces, by locking up prostitutes. These laws were viciously oppressive towards women but quite ineffective in preventing VD. The fact that the government rejected calls for new legislation in response to Birmingham should not disguise the fact that the panic gives it greater authority to intervene in matters of sexual morality, and more widely in curtailing civil liberties.

Conform or else

The Birmingham case illustrates how fears of a rare but devastating disease can be manipulated to promote a climate of public opinion conducive to sexual conformity and state repression. It confirms the urgency of separating Aids the disease from the moral discourse in which it has been enveloped. This would enable people with HIV and Aids to receive the care and treatment to which they are entitled, and allow the rest of society to carry on life free from irrational fears and state intrusions.

No 'nightmare scenario'

The Birmingham scare has been used as proof that the 'nightmare scenario' of a major heterosexual epidemic is taking place in Britain. In reality, it illustrates the opposite. The fact that it has taken this long for the promoters of the Aids panic to find one individual around whom to publicise their 'nightmare scenario' suggests that heterosexual spread remains rare.

For five years the authorities have emphasised the danger of HIV spreading from high-risk groups into the heterosexual mainstream. First bisexuals were identified as the potential 'bridge', then drug addicts: neither of these nightmare scenarios has happened. Now the Birmingham case has focused attention on haemophiliacs. In the first decade of Aids in Britain, up to the end of 1991, some 1200 haemophiliacs were infected with HIV. Heterosexual spread from this group has led to six cases of Aids and 51 HIV positives. According to some press reports, the 'HIV Romeo' personally infected 20 or even 30 women in Birmingham - that is, around half the national spread from haemophiliacs!

Those scared by the hysterical press coverage of the Birmingham panic could have found an antidote in the July issue of Living Marxism, where we published the facts about the heterosexual spread of Aids and HIV in Britain. In case you missed them, we reprint them here.

'Reports published by the Communicable Disease Surveillance Centre show that, of around 5000 cases of Aids notified in Britain 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 for individuals who are HIV positive by 'second generation' contact in Britain 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.'

(From Dr M Fitzpatrick, 'Aids panic in disarray', Living Marxism, July 1992)