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Aids: Don’t die of prejudice by Norman Fowler, book review: All a splutter in the shires


It is Norman Fowler’s distinction that he was the longest serving Health Secretary since the Second World War, having held the post for six years from 1981 to 1987. This was when Aids emerged as a global threat and developed into the worst pandemic of modern times.

His survival was remarkable given the turbulent times in the NHS as the money ran out – much like today. His successor, John Moores, lasted a year before being sacked by Mrs Thatcher, who six months later announced the biggest reform in the NHS’s history, ushering in the market and competition that remains controversial today.

The question many people asked at the time was: did Aids save Fowler or did Fowler save us from Aids? On the evidence of this book, written with passion, we must say Fowler helped save us from Aids.

Although the 1980s tombstone ads with the legend “Don’t die of ignorance” were mocked at the time, it is to Fowler’s credit that they made it to the air waves. Thatcher was queasy and wanted to axe the section on risky sex. Others in the Cabinet pressed for a moral line – promiscuity, infidelity and “sexual deviation” (i.e. homosexuality) were routes to catastrophe, they said. Fortunately, many members of the Cabinet were ex-military, and knew there was only one way to protect soldiers from VD – proper precautions not moral advice.

Without doubt, however, Aids also saved Fowler. It provided him with a public health issue of the gravest importance which distracted attention from the growing turmoil in the health service. Aids helped make him, and now he is repaying the debt.

He travelled to nine cities and reports that, despite a huge expansion of treatment, the prejudice he encountered in Thatcher’s Cabinet is alive and well – and still threatening lives. Stigma – against gays, sex workers, drug users and anyone who is HIV positive – is a key factor sustaining the epidemic.

It is a pacey read and its insistence that tolerance and harm reduction are the only way forward is bound to make Tory-supporting colonels in the shires splutter. For that alone, it is to be warmly commended.

But this overarching strategy, while unimpeachable, fails to acknowledge the diversity of Aids. At the end of his world tour, Fowler concludes that Sydney has the best policy on Aids. Yet two pages later he writes of the “relentless rise in new infections”, up 10 per cent in 2012, the biggest increase for two decades. Something is still being missed.

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