Saying the unsayable

It is just ten years since the government finally steeled itself. Aids, it was thought, was a plague that would engulf us by the million and, distasteful as Mrs Thatcher found it, her government would have to talk to the nation about sex. Heaven knows ho

Exactly ten years ago, Margaret Thatcher's cabinet realised it would have to talk to the electorate about that most delicate of subjects: sex. This was not a prospect which it viewed with any degree of optimism or confidence.

Aids had been a factor of British life for four years. There were only 250 reported cases in this period, but all the evidence from the United States suggested the epidemic might soon touch us all. This was the period when everyone was seen to be at risk, when HIV was an equal opportunity virus. Predictions ran wild: there would 100,000 dead in the next five years, perhaps a million by the end of the century, as many heterosexuals as homosexuals.

We now know it didn't turn out like that. There have been more than 11,000 cases of Aids reported in Britain since 1982, and 25,000 cases of HIV. More than 75 per cent of those who have died of Aids are gay men. The anticipated explosion in heterosexual transmission has not occurred. But at the end of 1985, genuine concern at the Department of Health and Social Security soon transformed itself into national panic and fearful hysteria. The after-shocks are still being felt: today it is clear that the government's first attempts to tackle Aids set in motion a process that has revolutionised the way we talk publicly about sex, a thing we never even talked about publicly before.

A decade on, it is hard to appreciate how tortuous were the early meetings at the DHSS to discuss the first national campaign to alert the country to a fatal sexually-transmitted virus. Ministers were not used to addressing such concerns: the last time this was necessary was during the Second World War, when the topic of discussion was syphilis.

The first Aids campaign was to take the form of straightforward full- page newspaper advertisements: this is the disease, this is what you do to avoid it. But as draft followed draft (there were at least seven) and as wording went back and forth between the DHSS, Downing Street and an expert advisory group of doctors, it became clear that no one had much idea how to proceed. The only agreements seemed to be on what you could not do - no mention of the penis, for example, let alone more colloquial expressions. What was needed was nothing less than a new language, for the words that those most at risk might understand were judged unsuitable and offensive. An endless stream of scribbled amendments and deletions served to make the final version barely comprehensible to anyone who lived in the real world.

Discussions were stifled by inhibitions. One DHSS official remarked of one minister that he "had real problems. He was deeply ignorant about sexual matters - he was unable to pronounce 'vagina'. You've no idea what a problem it is to talk to someone who doesn't believe in sex anyway."

What readers finally saw when they opened their papers on Sunday 16 March and the following day was almost unrecognisable from the fifth draft submitted by the advertising agency TBWA only a month before. The opening statement, "Aids has attracted an enormous amount of attention from the media", was changed to "Aids is a serious disease". This was followed by a warning, signed by the four chief medical officers, that what was to follow "may shock but should not offend you as we are talking about an urgent medical problem".

How quaint this all seems now. In one section, headed How Is Aids Spread?, the approved newspaper version reported two ways: sexual intercourse with an infected person and blood-to-blood transmission most common through needle sharing. What it omitted was the detail present in the draft: "During sexual intercourse, minute breaks may occur in the walls of the vagina. It is through these that the infected semen passes. As the rectum is far more delicate than the vagina, it is more easily damaged. This means anal intercourse is the easiest way of becoming infected."

This was excised on the firm instruction of Margaret Thatcher. On her insistence, the term "anal intercourse" became first "back passage intercourse" and finally the approved "rectal sex".

Mrs Thatcher had serious misgivings about mounting a campaign at all, although she had finally been persuaded that some action was necessary by the Chief Medical Officer Donald Acheson and Social Services secretary Norman Fowler. "The department tried to keep her out of it as much as possible," one civil servant remembers. "At one point, after she had seen a draft, we got a message from Nigel Wicks [her Principal Private Secretary], which said, ' she wants to know if they have to fgo in the newspapers'. We asked him where alse they were supposed to go. He said, ' she was wondering about lavatory walls'." The advertisement made one mention of how a "sheath", a word that few people cruising the nightclubs had ever heard before, might reduce the risk of Aids. The words "condom" or "rubber" or any form of trademarked brand were considered too explicit. But even the bland language was too much for some. Lord Hailsham, the then-Lord Chancellor, wrote to Mrs Thatcher objecting to the use of the words "having sex". "I am convinced there must be some limit to vulgarity!" he wrote. "Could they not use the literate 'sexual intercourse'. If that is thought to be too narrow, then why not 'sexual relations' or 'physical practices', but not 'sex', or, worse, 'having sex'."

These days Norman Fowler acknowledges that the advertisements "had next to no impact whatsoever". Worse, they may even have had a damaging effect. A few months after the campaign appeared, the British Medical Journal printed the conclusions of a survey conducted at Southampton General Hospital. It was a small, random sample (about 300 people), but it produced startling results. Respondents were questioned before and after the press campaign. Only 31 per cent had seen the adverts, but it appeared that the campaign caused confusion, rather than dispelled it. Before it, five per cent thought there was a vaccine against Aids; after it, ten per cent did. Before, ten per cent believed the infection was spread by sharing washing, eating and drinking utensils; after, this had risen to 14 per cent. Before the campaign, 48 per cent didn't know what the initials Aids stood for; after it, 59 per cent didn't.

The next campaign was far more memorable: the tombstones and icebergs and a leaflet sent to every home in the country. Now fear was the key. Everyone was still at grave risk, and they could no longer be relied upon to read wordy newspaper advertisements; now the bad news would be spread on television, with the voice of John Hurt. "There is now a deadly disease," he began. "It is a danger to us all. Anyone can catch it through sex with an infected person. You can't always tell if someone is infected. You should protect yourself against it. Don't die of ignorance." This was accompanied by images of an exploding mountain, a tombstone on which was chiselled the word Aids and a bunch of flowers. They didn't tell you much, other than something terrible was going to happen, and something was going to come through your letterbox.

This was principally the work of Sammy Harari, of the agency TBWA, a young but rising star in the advertising world. When Harari had been with the agency Yellowhammer he had masterminded the "Heroin Screws You Up" campaign, the accompanying posters from which soon became collectors items in student bedsits. Harari's Aids portfolio already included some snappy efforts. In one, the word "Aids" was gift wrapped in festive paper, and beneath it ran the words "How many people will get it for Christmas?" Another showed a T-shirt with "Sex & Drugs & Rock'n'Roll" scrawled across it; beneath was the message "At least rock'n'roll can't give you Aids". Yet another appeared in the shape of a heart: "Your next sexual partner could be that very special person... The one that gives you Aids".

These days Harari [? check orig] concedes that the television campaigns, which also included the notorious "icebergs" image, were "maybe a bit too Hollywood, a bit too doom and gloom", but points to a far greater miscalculation. "We were about six months late," he says, suggesting that in the period between the conception of the advertisements and their broadcast, the public had learned a lot about Aids from other media, and were thus ahead of the game.

He regrets that the cabinet committee did not feel itself able to run a bolder campaign. A year later it was comparatively easy to gain approval for his more explicit drug-related campaigns, even the one which read "It only takes one prick to give you Aids".

The mass leaflet drop provided ministers with more sleepless nights; again this was new territory. A draft had been printed two months earlier, but then scrapped. "Anal sex," this first effort explained, "when a man's penis enter's his partner's anus (back passage), nearly always causes damage. This means it is easier for the virus in the semen of an infected man to get into his partner's bloodstream than in other kinds of sex." Then, in bold capitals, "Avoid anal sex...Do not take part in any sexual activity which may damage the penis, vagina, anus or mouth of your partner." Health officials then had second thoughts: they concluded this advice would not play well in the shires. The rewritten leaflet made no mention of the words "penis" or "anus" or "back passage" or any activity which may cause skin trauma.

"There was talk of not sending leaflets to the elderly; before this was ruled out as too impractical, it was suggested the guidelines should be withheld from anyone whose first name was Gladys, Albert or Daisy.

"Then there were problems of interpretation. Edwina Currie, a junior health minister before her salmonella eggs gaffe, believes that it was John Major, then Secretary of State for Social Security, who pointed out that it would be helpful if they could all decide on the same meaning of some of the more important words. How would people define "promiscuous"? One minister defined it as sleeping with more than one person. Currie, recalling her student days, believed it meant more than five a year. "It was clear", Currie concludes, "that we had no idea what view the general public would have, and we were going to have to take a real leap in the dark." Or as the Lancet put it a year later: "Medical science knows more about the molecular structure of the HIV virus in a leucocyte than it knows about human sexual behaviour in the bedroom."

The leaflet was part of a pounds 20 million package announced by Norman Fowler in November 1986. He had a terrible time trying to get this money. Mrs Thatcher maintained that if the traditional family was to be reclaimed as the backbone of British life, it necessarily followed that any "deviant" behaviour was to be condemned. This applied to anything that was seen to have been invented in the Sixties: promiscuity, homosexuality, drug- taking. For some backbenchers, and others who influenced party policy, Aids couldn't have come at a better time. Geoffrey Dickens, MP for Littleborough and Saddleworth, suggested in a television interview that homosexuality should be made illegal again. The Conservative Family Campaign wrote to Lord Whitelaw, Deputy Prime Minister, asking the Government to put people with Aids in isolation units. James Anderton, the Chief Constable of Greater Manchester, claimed that God had been speaking through him when he issued his famous comment that homosexuals were "swirling around in a cesspool of their own making". Sir Alfred Sherman, who had retained a close relationship with Thatcher ever since they had founded the Centre for Policy Studies in the Seventies, wrote to the Times in a language of his own generation: Aids was a problem of "undesirable minorities... mainly sodomites and drug-abusers, together with numbers of women who voluntarily associate with this sexual underworld". Soon many newspaper columnists would huff their own disapproval. Aids was primarily a gay disease, they observed, so why is the Government spending so much of our money on something that is self-inflicted. In retrospect, the first part of their comment was correct: many more gays were affected than straights. And was it any wonder that this trend continued? The catch-all nature of the campaigns obscured the fact that the Government and its agencies were ignoring the educational needs of those most at risk. Centrally funded campaigns targeted specifically at gay men did not appear until 1989.

Nowadays we talk about these matters very differently. We may know little more about sexual behaviour in the bedroom, but Aids advertisements no longer shy away from these matters with prudish euphemisms. The large amount of sex talk on late-night television is a direct result of the need to talk about disease ten years ago; during World Aids Week at the end of this month it will be hard to avoid people slipping condoms on cucumbers.

Advertisers call it "condom normalisation", the process of moving from an illicit, bike-shed perception to one where condoms became an essential fashion accessory, multicoloured and multi-flavoured. In cinemas, humour has replaced fear: for several years we have been encouraged to "Keep Mrs Dawson busy" on her condom production line; we learned of Mr Brewster's efforts to use what he called his Geronimo, which, compared with today's condoms, was like wearing the inner tube of a bicycle.

But the main change in Aids advertising has come through targeting those most at risk: the promiscuous, the young, ethnic minorities, gays and bisexuals - something organisations such as the Terrence Higgins Trust had been doing for years, but which the Health Education Authority (HEA), the quango that took over the government's Aids campaigns in 1987, considered a low priority.

The gay campaigns from the HEA began in 1989 with handsome pictures of handsome men (one textual detail: "They used to say masturbation was bad for you - now it could save your life"), and became progressively bolder, to the point when "fuck" was used in 1991 and was subsequently censored, having been judged to be unsuitable even for use in the gay press. But the amount spent by the HEA on gay campaigns remained proportionately very low - only pounds 1.7m out of a total spend of pounds 9.3m in 1990/91. This split has narrowed in subsequent years, but the total spend has declined. In 1994-95, the HEA spent just under pounds 2.5m on all HIV and sexual health work.

To counteract this shortcoming, an organisation formed in 1992 calling itself Gay Men Fighting Aids (GMFA). Funded not by central government, but by local authorities, its campaigns are as explicit as British law will allow. Many of them refer back to the campaigns of a decade ago, pointing out that . those most at risk in November 1985 are those still most at risk now - young gay sexually active men who do not necessarily respond well to despairing images of tombstones.

Many of these men believe Aids is a disease of the older generation, an Eighties' affliction once awarded top priority by the Government, now mainstreamed alongside other modern illnesses. In some ways this is understandable, for the doomsday scenarios have not materialised and there are hopeful signs that the rate of growth of the British epidemic is slowing. A total of 1,622 cases of Aids were reported in the 12 months to 30 June 1995, a fall of seven per cent compared with the 1,752 cases reported in the previous 12 months. The fastest growing group is women, but the total is still small: there were 228 new female cases of Aids in the 12 months to June 1995, compared to 1,394 men.

The continued risks to gay men was highlighted last month by a report from Ford Hickson, a member of the sexual behaviour research group Project Sigma. From an anonymous survey of about 1,500 gay men conducted at last summer's Gay Pride march, about one-third said they had had unprotected sex in the last year. This figure has not changed since 1992. Hickson suggests one reason for this: the still inadequate nature of the education campaigns made up of "safe, tired and ineffectual materials that titillate but do not challenge". Hickson regrets that "this appalling disfiguring disease has been pushed out of the picture by images of happy, healthy, hunky gay men having happy, healthy, hunky gay sex."

There are hunky men in some of the adverts from GMFA, but also much straight talking. It is the nature of the epidemic that its material still risks causing offence, but not to those already HIV-positive. One advertisement suggests that you can have sex with an infected man as often as he wants, any style ("with a condom and water based lube of course"). You could also "massage him, tickle him, French kiss him, walk his dog, be his dog..." Certainly no one mentions sheaths any more.

The End of Innocence: Britain in the time of Aids by Simon Garfield is published by Faber at pounds 7.99. A documentary based on the book will be broadcast on BBC2 on 5 December