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The truth about the Day report

A major report published in June was supposed to reveal the hard facts about the spread of Aids and HIV in Britain. In reality, however, the debate about the Day report has created yet more confusion and misinformation.
Dr Michael Fitzpatrick, who has challenged the message of the official 'safe sex' campaign from the start, confronts the myths old and new about Aids in Britain

The report of the working group chaired by Professor NE Day on 'The incidence and prevalence of Aids and severe HIV disease in England and Wales' was finally published in June. It has been widely reported as vindicating earlier forecasts about the likely course of the epidemic and as justifying the continuing official emphasis on the risk of heterosexual spread.

In fact, far from vindicating earlier forecasts, the report reveals their alarmist character and exposes the irrationality of the government's Aids campaign. The appropriate comparison is not with the 1990 Day Report, though this is the one on which the current report - and much media commentary - concentrate. This was a 12-page, duplicated academic bulletin, published by the Public Health Laboratory Service.

The important comparison must be with the 1988 Cox Report, 'Short-term prediction of HIV infection and Aids', an 88-page booklet produced by the Department of Health and published by Her Majesty's Stationery Office, with a popular introduction, summaries and conclusions. Whereas the 1990 Day Report attracted little media attention, the 1988 Cox Report received major publicity.

'British Aids deaths "will reach 17 000"' (Guardian, 1 December 1988); '17 000 may die from Aids by 1992' (Times), '17 000 could die of Aids in next four years' (Sun), 'Thousands more will die of Aids report says' (Independent). Headlines like these - only two years after the launch of the government's major Aids publicity campaign - greatly intensified popular fears.

Day 1993 concludes that the number of cases of HIV/Aids acquired heterosexually is 'low, but is rising', noting that 'there are major uncertainties over the future course of an epidemic currently dominated by infection acquired overseas'.

The report concedes that on the question of heterosexual transmission when neither partner is in a high-risk group nor comes from a country where the major route of transmission of HIV is through heterosexual intercourse, there are too few cases for the rate of increase in HIV transmission 'to be measured with any accuracy'.

The experience of the first 11 years of the Aids epidemic in Britain (up to the end of 1992) confirms very slow spread of the disease outside recognised high-risk categories. Of 2237 people who acquired HIV heterosexually, 1643 acquired it abroad (usually in countries where heterosexual transmission is the norm), 291 acquired it from high-risk partners in Britain (mainly drug abusers, also bisexuals, people infected by blood products) and a further 82 were probably infected by a partner who became infected overseas. Some 117 people became infected by a partner with none of these risk factors, leading to 63 cases of Aids. Aids is a terrible disease, but in Britain a rare one, of negligible risk to the vast majority.

Cox's alarmist 1988 projections, amplified by a compliant media, contributed to a climate of anxiety and fear around the Aids issue which had already been fostered by the government's 'icebergs and tombstones' advertisements and its 'everyone is at risk' propaganda. The Day report seeks to draw a veil over the discredited speculations of the past and attempts to restore public confidence in a scaled-down version of the Aids panic. In a striking contrast with the dissembling tone of Day 1993, one of the key contributors to this and both the earlier Day and Cox reports, Professor Roy Anderson, concedes in the small print of a letter to the Lancet that the projections of the Cox report 'grossly exaggerated the picture which subsequently emerged' (15 May 1993).

It was not until 1990, some three years after launching the biggest public health campaign in history, that the government had any accurate projections about the likely shape of the epidemic. This makes clear that the government's promotion of the Aids scare was not based on any scientific evidence about the likelihood of rapid heterosexual spread in Britain. Indeed, if the government was genuinely concerned about heterosexual spread of HIV, distributing a leaflet about safe sex to 23m homes, one third of them occupied by either a single person over 60 or an elderly couple, seems a particularly absurd way of tackling it.

The development of the Aids epidemic in Britain confirms the argument of The Truth about the Aids Panic, written by myself and Don Milligan, and published in March 1987. This was the first book to challenge the irrationality of the heterosexual Aids scare. It remains distinctive in challenging the official campaign from a perspective which repudiates the repressive moralism of 'safe sex' and upholds the demand for gay rights as the most effective means to resist the impact of HIV on gay men.

Our argument was that the government had taken up the Aids issue, not out of any concern for public health, but as a convenient vehicle for advancing its wider moral agenda: the backlash against the 'permissive society' of the 1960s and the return to conventional standards and traditional family values.

Absurd scare

According to a recent parliamentary statement, the government alone has spent £886m on Aids since 1985-86, the bulk of this money going into the campaign to raise 'HIV/Aids awareness' among heterosexuals. Now that the figures reveal the absurdity of the great heterosexual Aids scare, critical voices from a range of viewpoints, from Living Marxism to the Sunday Times, are increasingly heard. The promoters of the Aids panic, in the Department of Health and in the 'Aids establishment' - that enormous body of doctors, do-gooders, gay movement activists and publicists that has flourished on the free flow of government, drug company and charitable funding - have been thrown on to the defensive.

The response of the Aids establishment to the Day Report has been revealing. On the one hand, there have been attempts to keep up the heterosexual scare by manipulating the media presentation of the report and by rubbishing its critics. On the other hand, the more bare-faced panic promoters have tried to claim the credit for preventing the major explosion of Aids that was never going to happen. In an increasingly desperate quest to keep the Aids bandwagon on the road, its patrons and passengers are resorting to more and more cynical and incoherent arguments.

There has been a coordinated undercover operation to fudge the presentation of the Day Report. After first reports about its content appeared in April in a critical account in the Sunday Times, publication was delayed until the middle of June - after the extensive discussions of Aids around the Berlin International Conference which closed on 11 June. Meanwhile, remarkably similar features appeared in the Guardian, the Independent, and the Independent on Sunday, based on briefings by key figures on the Day committee: all emphasised the growing heterosexual risk and savaged those who claimed it had been exaggerated.

The increasingly abusive tone of these articles was well illustrated by a feature in the Guardian by Colin Spencer which, apart from numerous factual errors, lumped all critics of the official campaign together as homophobic 'moral zealots' (3 June 1993). Another Guardian feature reveals the growing incoherence of advocates of the official line.

The first part of a three-part serial 'The Story of Aids' by Mike Bygrave carries an introduction in large type that reads like a parody of the government's 'Don't die of ignorance' leaflet:

'Aids is a virus. It is not homophobic. It has nothing against heroin addicts. It doesn't care how many people its host has slept with. It kills indiscriminately. By now, we ought to know this. But we continue to behave as if we don't. New figures show that a quarter of British HIV carriers are heterosexual. Safe sex campaigns have clearly had limited effect.' (19 June 1993)

Several dense pages of text later, the following sentence suddenly appears: 'Almost certainly, there will be no heterosexual Aids epidemic in the West.' Well, if this is true, then why worry that safe sex campaigns have had limited effect?

In fact, it is not true. We have always accepted that there would be a heterosexual Aids epidemic in the West (an epidemic is said to exist when the incidence of new cases of a disease exceeds normal expectations). From the outset, however, we argued that there was no good evidence that this epidemic would be large or grow rapidly, and that promoting safe sex to the entire nation was not a rational response to such a rare disease.

Bygrave quotes Los Angeles Aids specialist Michael Gottlieb as saying that for heterosexuals HIV was 'a sniper' which picked off 'unlucky individuals'. Bygrave leaves his readers unclear whether he expects us all to reorganise our lives in such a way as to avoid the possibility of being the target of a random bullet.

'Our strategy has been extremely successful and effective', proclaimed health minister Virginia Bottomley, greeting the lowered projections and announcing cuts in funding to Aids organisations (Independent, 4 May 1993). Bottomley, and the Aids baronesses, Cumberledge and Jay, have assiduously promoted the line that the slow rate of spread of Aids in Britain, compared with earlier projections and Continental patterns, is a tribute to the government-sponsored Aids panic. This is nonsense.

Five reasons why

First, as the median incubation period of Aids (the time from infection to the development of the disease) is 10 years, current Aids figures cannot reveal the influence of a campaign that began in 1986. Second, looking at HIV figures, the key factor influencing the total is changes in sexual behaviour among gay men which were initiated within the gay scene itself long before the government took up the Aids issue. Third, the key variable in heterosexual HIV figures is not behaviour in Britain, but the entry of infected individuals from abroad, mainly Africa.

Fourth, the higher rates of HIV/Aids in Continental Europe are the result of different epidemiological factors, rather than the differential effects of government campaigns. In southern European countries, notably Spain and Italy, there is a much bigger pool of individuals infected by needle sharing among drug abusers. In France and Belgium, there are much larger pools of individuals infected in former colonies in the Caribbean and Africa, where heterosexual spread is commonplace and HIV prevalence is high.

It is interesting that little is now heard of the Aids epidemic in the USA. Though the pool of infected gay men and drug abusers is much higher than in Britain, and there has been some heterosexual spread among impoverished minorities in inner-city areas, the long-anticipated heterosexual explosion has failed to occur.

Fifth, contrary to claims that the government's safe sex campaign has been effective in changing behaviour, Aids experts are grappling with the results of numerous surveys that reveal the contrary. 'Why is the Aids message not getting through?', is the title of a paper produced by the cream of the Aids establishment assembled courtesy of the Wellcome Foundation at Leeds Castle for a brainstorming weekend last summer. The surveys reveal that young people are well-informed about Aids; they also show a striking mismatch between what they know and what they do. The results are more evident in the levels of teenage pregnancy and of other sexually transmitted diseases than in the transmission of HIV.

The Aids experts earnestly advance a progressive programme of enlightened sex education, emphasising that 'much more education about self-esteem and personal identity is needed' to offset the 'large disparity in "sexual power" between male and female'. They never ask themselves why it is that a government led by a party that has steadfastly resisted all attempts to extend sex education has now put Aids on the national schools curriculum.

The liberal grandees of the Aids establishment move from Leeds Castle to the House of Lords, where the document was launched, to their comfortable quango offices, television studios and senior common rooms, indulging fantasies about progressive sexual reform. Meanwhile, out in the real world, the message that most children are likely to receive in Aids awareness lessons approved by the government and school governors is that sex = disease = death.

Fear and guilt

Ironically, this is a message reinforced by the way that the liberals have endorsed the scaremongering at the heart of the government's Aids campaign. It will not deter young people from having sex - and from suffering the consequences. But it will restore to the sphere of sexuality some of the fear, shame and guilt which have declined since religious sanctions lost their influence. It will contribute to the climate of repression and conformity that has been developing in the Western world for a decade.

For its contribution to upholding the heterosexual Aids scare, the mainstream Aids establishment retains its value to the British government. The same cannot be said for the gay wing of the Aids movement, which in the past provided the government with a valuable radical chic endorsement for its moralistic campaign, but has now outlived its usefulness. As we wrote in The Truth about the Aids Panic, 'even for the professional Aids campaigners, establishment approval cannot last. Once the safe sex campaign has run its course and the backlash against homosexuality gathers momentum, the respectable leaders of the gay community too will suffer the consequences'. It is not surprising that Virginia Bottomley's response to the Day Report was to cut the grants to the Terrence Higgins Trust and the London Lighthouse.

A rational response to Britain's mercifully modest HIV/Aids epidemic today would concentrate resources on research into a vaccine and a cure and on caring for people with HIV/Aids. It would abandon the so-called prevention/education campaign, which can only promote unfounded anxiety and fear. A rational response to HIV/Aids would concentrate on the plight of the vast majority of those affected in Britain - gay men - by demanding an end to all forms of discrimination that contribute to the spread of such a sexually transmitted disease in a stigmatised section of society.


Cox's worst case scenario (taken up by the headline writers) was 17 000 deaths by 1992; his planning projection was 8000 deaths.
The total deaths from Aids by the end of 1992 was around 4000, less than a quarter of the headline projection.

Cox predicted 3600 new cases a year by the end of 1992.
There were around 1400 new cases in 1992, less than half the number predicted.

Cox estimated that at the end of 1987 there were between 20 000 and 50 000 people HIV positive in Britain.
Day 1993 estimates that at the end of 1991, four years later, there were around 23 000 people HIV positive. The actual number of people diagnosed as HIV positive and still alive at the end of 1992 was around 15 000.

Reproduced from Living Marxism issue 58, August 1993

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