I CANNOT REMEMBER with any clarity the first time that the Aids issue came onto my desk. I can remember much more exactly the time I became seriously frustrated about the way we in Margaret Thatcher’s government were handling the crisis. It was almost thirty years ago and I was Health and Social Security Secretary in her Cabinet. By the beginning of 1986, Aids cases were beginning to increase alarmingly. We were struggling to explain to the public the danger they faced and also to persuade other ministers that urgent measures were now needed. My view was that we needed a direct advertising campaign explaining how the virus was contracted and warning that there were no drugs or vaccinations that could be used to counter it. The prospect for those who ignored these warnings was death. It was that which justified (or so I thought) the government going into detail on sexual practices and drug taking – information that was a million miles away from the usual advertising emanating from Whitehall. It was not a time to be too delicate. People needed to understand and to protect themselves, but this approach landed me in immediate and potentially fatal trouble. Standing in the way of such a blunt approach was the Iron Lady herself.

Our aim was to mount a newspaper advertising campaign in the early part of 1986. In February I circulated a draft advertisement to all the ministers represented on the General Home Affairs Committee of the Cabinet (‘H’) which took the major decisions on domestic policy. I also sent it to Margaret Thatcher’s office at 10 Downing Street. I warned that of the 275 cases of Aids reported by the end of 1985, 144 had died. My warning was that, on present trends, there would be over 20,000 people, mostly men, infected with the HIV virus by 1988. Most would be unaware of their condition and would continue to spread the infection. In an attempt to smooth the way past ministers, I explained that the warning advertisements would have to ‘strike a balance between being too explicit and too anodyne’.

That explanation did not carry the Prime Minister. On the morning set for the ‘H’ committee meeting, we received a phone call from Margaret Thatcher’s office. She had read my paper and had responded with a terse comment. ‘Do we have to have the section on risky sex?’ she asked. ‘I should have thought that it could do immense harm if teenagers read it.’ Her fear was that young people would in some way be contaminated by this knowledge. The ‘risky sex’ section of which the Prime Minister was complaining started with a warning on the dangers of sexual intercourse with an infected person and repeated what was to become our familiar message on the importance of using a condom. It went on: ‘Anal (back passage) intercourse involves the highest risk and should be avoided. Obviously any act that damages the penis, vagina, anus or mouth is dangerous, particularly if it causes bleeding. Even wet kissing with an infected person may be risky.’

It brought us up against some of the basic questions concerned with any public education campaign on Aids. Were we to muffle our message so that the chance of causing offence was minimised? Did we really believe as a government that by describing hitherto unknown sexual practices we encouraged innocent young people to follow suit? Or did we take the view that these fears were fanciful and that unless we did describe what we were talking about we would fail in our task? Although these questions may seem dated, they raise some of the same issues that stand in the way of a sensible policy on sex education in British schools to this day. To do justice to the ministers on ‘H’ committee back in 1986 (and in spite of the attempted steer from No. 10), they not only approved the draft advertisement but asked me to look at extending the campaign to other media. Willie Whitelaw, the chairman of the committee and leader of the House of Lords, summed up, albeit with a nod to Mrs T., that ‘the committee agreed that the campaign should proceed as planned and thought that the explicit references to sexual practices were a regrettable necessity’.

The advertisement, which, frankly, was hardly earth-shattering, limped towards publication – but not before Margaret Thatcher had launched one further depth-charge. A week after the committee had agreed to the text, my office received a letter from her principal private secretary, Nigel Wicks. There was no beating about the bush.

These, I was told, were the Prime Minister’s ‘firmly held views’ and that now I might ‘wish to consider showing the Prime Minister an amended advertisement which omits the parts which, in the Prime Minister’s view, would be likely to offend’. History had, in fact, already proven the efficacy of blunt sexual health advice. There had been public health campaigns about sex long before we went into this apparently forbidden territory. In both the First World War and the Second there had been campaigns which had warned against venereal disease and which had resulted in no known harm to young people. In the 1939–45 conflict, the chief medical officer actually went on BBC radio to warn the public – young and old – of the dangers. All the evidence was that the campaigns had reduced sexually transmitted disease. As for the Prime Minister’s idea of confining messages to public lavatories and surgeries, there was no evidence that in the late 1980s, with all modern communication techniques at our disposal, this was remotely the best we could do. The world had moved on.

The unaltered newspaper advertisements went ahead in March and April of 1986 without much comment. We received very few complaints and there were no instances of readers burning The Times or Daily Mail in protest. My concerns about the campaign were very different from those of the Prime Minister. It had taken weeks to get to publication, even though the whole point of what we were saying was that this was an emergency. Nor was I convinced that closely written text – rather like the instructions on a medicine bottle – delivered the goods. It was an inauspicious start to what was to become the biggest public education campaign ever staged in Britain.

In June I circulated the draft of a new, shorter and simpler newspaper advertisement, which repeated the risky sex message of the first advertisement. It warned ‘the more partners – especially male partners – someone has, the more likely it is that they will have sex with an infected person’. The sharp-eyed would also have noticed an attitude to drug taking which was appreciably softer than the conventional warning that ‘drugs are wrong and we will prosecute you’. The advertisement said: ‘For those who cannot give up, it is very important not to share needles or other equipment. Injecting just once with a needle that carries the virus could mean catching Aids. Best of all, don’t inject.’

However, it was not the difference in tone that was picked up when the draft of this advertisement was sent around to ministers. This time the objection came from the undoubted Grand Old Man of the Thatcher government, Quintin Hailsham, the Lord Chancellor. A wayward but brilliant man who could easily have been Prime Minister, he objected not so much to the message as such but to the language being proposed. His objection was to the phrase ‘having sex’. He wrote:

Grammatically, the Lord Chancellor could not be faulted. The phrase was changed (only to reappear later on) and eventually, in July 1986, the second series of newspaper advertisements was published. It had modest success but did not match the increasing public concern that there was on the spread of Aids. We did not lack advice on what we should do.

Donald Acheson, the chief medical officer, who, with the Health Minister Tony Newton, gave me invaluable support throughout these fraught months, sent me a note on what had happened in the First World War. At one stage the British had distributed a leaflet to troops going on leave in Paris in an attempt to reduce the incidence of sexually transmitted disease. The leaflet said: ‘In this new experience you may find temptations both in wine and women. You must entirely resist both temptations and while treating all women with perfect courtesy you should avoid any intimacy. Do your duty, fear God, honour the King.’

This message was less than successful. A fifth of 5,000 troops on leave in Paris became infected. The later approach was to issue prophylactic packs containing calomel ointment, and treatment rooms were set up for soldiers where they could receive urethal irrigation within twenty-four hours of exposure. Subsequently, 300,000 troops visited Paris and only 3 per cent were infected.

Yet, over half a century later, Margaret Thatcher had undoubted supporters for her untypically ‘softly, softly’ approach. The party chairman, Norman Tebbit, was a sceptic about whether the government should be seen to raise the profile of an issue which he judged was treated with distaste by many in middle England. As for middle Scotland, the former Scottish Secretary, George Younger, was a consistent doubter, particularly when it came to drug users, as too was the Scottish Health Minister John Mackay. And with a dominating leader like Margaret Thatcher there were always going to be ministers who would fall into line behind her on virtually any subject.

Some columnists and writers who were strong Thatcher supporters went further. Woodrow Wyatt, who had started life as a Labour MP and ended to the right of most Conservatives, left his News of the World readers in no doubt about his views: ‘The start of Aids was homosexual love making. Promiscuous women are vulnerable, making love to promiscuous bisexuals. They then pass Aids on to normal men.’ He added, ‘Labour councils give grants to homosexual centres. They encourage children to experiment with sex. This is murder.’ Sir Alfred Sherman, who was a close supporter of the Prime Minister and another émigré from the left, wrote to The Times saying that Aids was a problem of undesirable minorities: ‘mainly sodomites and drug abusers together with numbers of women who voluntarily associate with the sexual underworld’.

Another writer who received attention was Christopher (now Lord) Monckton. In 1987, he wrote an article for the American Spectator entitled ‘A British View’, where he argued that ‘there is only one way to stop Aids. That is to screen the entire population regularly and to quarantine all carriers of the disease for life.’ He was supported by the Conservative Family Group, which proposed that people with Aids should be put into isolation units.

The most consistent attack, however, was that we were wrong to treat Aids as essentially a public health issue. Above all, our critics said, it was a moral issue. It was useless for me to reply that we were not ignoring these issues. From the beginning I had said that sticking to one faithful partner was the best advice we could give, but this was never enough for some religious leaders. An outspoken example was the then Chief Rabbi, Sir Immanuel Jakobovits, whose views on Aids were practically identical to those of Margaret Thatcher. Later in the campaign we met and he handed me an aide-memoire which, in passing, praised the ‘urgency, boldness and effectiveness’ of the campaign but then set out in dramatic language a view which was held by many of the so-called moral majority. Among his dozen objections to the advertising campaign, the Chief Rabbi’s aide-memoire said:

The aide-memoire ended: ‘Say plainly: Aids consequence of marital infidelity, premarital adventures, sexual deviation, and social irresponsibility – putting pleasure before duty and discipline.’

It was stirring stuff but it went smack against all experience. Two world wars had shown that practical advice (together with protection) was the best way of combating sexual disease. We would lack credibility with the people we wanted to influence if we were thought to be preaching. Our internal research showed that among the people we needed to convince were gay men, who took an almost cavalier attitude to the disease, and drug users, who could be apathetic to their fate. Moreover, many heterosexuals regarded Aids as not relevant to them, in spite of the advice of the chief medical officer that the potential for its spread in the heterosexual community was real. Generally, men and women – gay and straight – became more and more concerned as they read in the press or saw on television stories about the advance of Aids. They too wanted to know the medical facts as we knew them at that time. It all argued for a single campaign of education. In the words of our research document: ‘There is a need for a clear accurate statement of what behaviour will lead to transmission.’

There was of course another entirely practical reason why it needed to remain a public health message. An attempt at the kind of moral message that the Chief Rabbi wanted would have been exploded instantly by the first minister revealed to be having an extramarital affair. Later, we learnt that in spades with John Major’s ‘back to basics’ campaign in the 1990s, which was wrongly interpreted as calling for some kind of moral regeneration. My view was – and remains – that governments have authority when they put scientific or medical facts before the public, backed by the best experts at their disposal. They certainly should not undermine the churches, but they are entitled to expect that the churches themselves will continue to preach their messages on the importance of family and marriage. They never had a better opportunity than in the first years of the Aids crisis.

In the main, our course was accepted by the media. Television and radio, both independent and the BBC, ran their own programmes, and in the early days their reports were more effective than our publicity. As for the press, you paid your money and took your choice. Some newspapers pressed us to do more, others suspected we were doing too much. There was also a contrast between what the broadcasting organisations and the newspapers felt was possible for them to do. Both George Thomson, the head of the Independent Broadcasting Authority, and Alasdair Milne, the Director General of the BBC, instantly offered me support when I went to see them. Richard Marsh, the chairman of the Newspaper Publishers Association, whom I later joined in the House of Lords, was less forthcoming. He said that usually it was as much as newspapers could do to agree on the time of day but on one point they did speak with a united voice – they never gave free advertising.

As for the public generally, the criminal law forbidding homosexuality may have been scrapped in 1967 but that had not altered attitudes overnight. Many people treated the idea of gay sex with hostility and distaste, and thought that the victims of Aids should be left to their fate. In particular, they could not understand why the government insisted on putting out a general message on Aids addressed to all when everybody knew that it was just ‘a gay disease’. The accusation was that we were simply pandering to the ‘gay lobby’ when there was next to no chance of HIV being contracted by ‘normal’ heterosexual men sleeping around. Today, there are as many new cases of HIV in the United Kingdom coming from heterosexual sex as from men having sex with men.

For me it was decision time. How far was I prepared to push this campaign? Although I knew little about the gay community and at that stage had few gay friends, one reaction made me increasingly angry. I could not understand (and still don’t) why there was this opposition to gays and lesbians purely on grounds of their sexual orientation. I suppose I came from the 1960s generation, whose motto, in the main, was ‘live and let live’. But my major objection was the rank injustice of it. Why should they be treated as second-class citizens? I saw Aids as an issue quite apart from the usual run of health issues, like waiting lists and health service funding, which I dealt with daily. My critics said it became an obsession and perhaps it did. People were dying and my concern was that artificial barriers and prejudice should not stand in the way of doing all we could to prevent the spread of HIV.

At the Department of Health we determined to move on from our rather innocuous newspaper advertising of early 1986 to something infinitely more direct. Our next plan of action was to send leaflets explaining Aids to all 23 million households in the country. (That leaflet is included at the end of this book and still serves as an introduction to some of the basic issues of Aids.) A leaflet drop of this kind had never been attempted before with a public health campaign, and I was under no illusion about the difficulties of getting the proposal through the creaking government machine.

You did not need much imagination to forecast the objections. Would it not come smack up against Margaret Thatcher’s concern that we would be teaching young people all kinds of things that they never knew before? After all, when the leaflet went through the letterbox, anyone in the household could read it. As for the language, there was a massive opportunity for objection. The words had to be direct for otherwise we would run into criticism that we were pulling our punches. On the other hand, if the words were too direct and the descriptions of sexual acts too detailed, then we would be attacked from the opposite direction. In August 1986 I wrote to ‘H’ committee ministers with the proposed text of the leaflet, and my fears quickly proved only too correct.

Quintin Hailsham replied that the more he reflected on my leaflet the more doubtful he became of the wisdom of proceeding. ‘The appearance on every doormat of the document in question is liable to cause controversy and even offence and might well spread panic.’

From Scotland John Mackay, the Health Minister, replied: ‘We run the risk of being heavily criticised both for delivering sexually explicit leaflets to every household in the country whether the occupiers wish to receive this or not and for the inadequacy of the guidance in the leaflet.’

From the Treasury, Peter Brooke, the Minister of State, urged a proper evaluation to ensure that the cost could be justified. The cost was a few million. Inevitably, he added: ‘There could, of course, be no question of additional funding.’

Against these three senior ministers, the Home Secretary Douglas Hurd, the Northern Ireland Secretary Tom King and the Education Secretary Ken Baker supported the communication attempt. Hurd used words with which I totally agreed. ‘We must not put ourselves in the position of having neglected our duty when that duty was clear.’

Nevertheless ‘H’ committee was split and Margaret Thatcher left little doubt where her sympathies lay. Her private secretary at No. 10 wrote to ministers: ‘The Prime Minister is concerned that there are various risks attached to the proposal.’ She proposed instead a new full-scale meeting of ‘H’ committee with a full draft text, together with professional advice on the likely impact. It all meant further delay and brought us to a crunch point in the campaign. It was obvious that the government machine as it stood was not up to the task of rapid response. Speedy action was impossible and all the time the position was deteriorating.

Among my team at the Health Department there was increasing frustration but there emerged also the genesis of a solution. Rather than a general committee, we thought, why not have a special Aids Cabinet committee with ministers thoroughly briefed on the position and capable of making quick decisions which could be then translated into action? There was, however, one problem. Separate Cabinet committees of this kind would most likely be chaired by Margaret Thatcher herself and be held at No. 10. Given her views, this did not seem a massively good idea. Any Cabinet minister knew what would happen. We had all experienced the Thatcher treatment. Speaking personally, it had taken me several months to get my proposals on social security reform past her. I knew exactly what would happen on Aids. The Prime Minister would ask for changes and, worst of all, reports that would need to be presented at the next meeting, which would make quick decisions – and action – impossible. The obvious solution was to have another chairman. As I was taught in my army days, ‘if you come up against an immoveable object, try to go around it’.

It was at this point that two of the most skilled civil service warriors in Whitehall took a decisive hand. The first was Sir Robert Armstrong, the Cabinet Secretary and head of the civil service; the second was Sir Kenneth Stowe, who once had been the principal private secretary to the Labour Prime Minister Jim Callaghan and was now my Permanent Secretary in the department. Armstrong was entirely convinced of the seriousness of the issue and it was he who persuaded Margaret Thatcher that she had neither the time nor the need to chair this specialist committee, and that this could be done by her deputy, Willie Whitelaw, the leader of the Lords.

In the Thatcher government Whitelaw was the man everybody went to in times of trouble. He had unrivalled experience as both a former Chief Whip and Home Secretary, and was the irreplaceable number two to Margaret Thatcher herself. What no one seemed to know was that sexual health was not an entirely new area for him. Nick Edwards, the Welsh Secretary (now Lord Crickhowell), remembers that at one stage in his army service during the war Whitelaw had had oversight of sexual services for the forces in Cairo. In those days there was no debate about the message to be given: it was about proper precautions, not moral advice – and non-observance brought in the full might of military discipline. As it happened, most of the men around the table at our special Cabinet committee had done at least some military service, which perhaps explains in part their pragmatic attitude. I certainly remember being marched in as a young national serviceman to watch a public information film on sexual disease which made my efforts seem rather like the vicar’s monthly newsletter.

As might be imagined, Whitelaw treated Aids very much as the old soldier might. He was not going to make moral judgements. He wanted to see the public protected and he wanted to make progress. It was an inspired appointment from my point of view. The committee was set up with some of the most powerful members of the Cabinet on it, but without either Quintin Hailsham or Norman Tebbit. We met for the first time on Tuesday 11 November 1986 in the large ministerial conference room in the bowels of the House of Commons. The change was almost instantaneous. Proposals that were blocked – like the Aids leaflet – suddenly became unblocked. The committee shared ownership. Rather than a prevaricating response of ‘I am not sure about that’ the reaction became ‘we must make progress’.

In less than two months we took a series of decisions which entirely transformed the government’s position. The leaflet for the letterbox drop was approved without opposition, and their delivery, and an accompanying media campaign, was planned for January 1987. The only flak came from outside government. At a party meeting in Manchester I was told by one questioner that I was simply encouraging safe promiscuity and by another that she would burn any leaflet that came to her house to keep it away from her fifteen-year-old daughter. Then, in an intervention which lacked all compassion, James Anderton, the then chief constable of Manchester, used a training seminar in December 1986 to accuse homosexuals, drug addicts and prostitutes who had Aids ‘of swirling in a cess pit of their own making’. At a conference in Scarborough of the Young Conservatives, one speaker received what sounded like thunderous applause for echoing Anderton’s views. The noise from Anderton’s supporters may have been great but, when it came to the vote, the motion backing the government’s position was passed overwhelmingly. It confirmed my view that the public thought the matter was too serious for fake remedies and were on our side.

There is an intriguing postscript on Anderton which resulted from the publication in early 2014 of declassified government papers from 1986. The Manchester Evening News discovered that Margaret Thatcher had come to his support when it was proposed that to avoid fresh disasters he should set out his future speaking engagements. Margaret Thatcher’s private secretary wrote to the Home Office saying: ‘The Prime Minister has commented that it would be outrageous if the chief constable were required to seek clearance for all his public speaking engagements.’ At a meeting with Home Office officials, Anderton said that he was ‘governed in all that he did by his religious beliefs and that indeed police officers were daily called upon in court to take an oath on the Bible. Religious beliefs and police work could not therefore be entirely separated.’

On another issue the Aids Cabinet committee was split: how to deal with injecting drug users. My diary takes up the story:

In those months back in late 1986 and the beginning of 1987, it was the opposition of the Scottish Office to the policy of clean needles which was the most difficult to overcome – and also the most difficult to understand. In the autumn of 1986 an expert committee actually set up by the Scottish Health Department had reported that HIV infection among intravenous drug users was higher in Scotland than in the rest of the United Kingdom. The committee found there was a particular problem in Edinburgh, where the police confiscated syringes and needles from anyone found in possession of them, and this had resulted in widespread sharing of equipment. There was no doubt about their recommendation.

The committee found that there was also a prevailing medical opposition to maintenance prescribing, even though this had a double benefit in that it usually meant prescribing methadone, which not only is taken orally but also brought the user into contact with drug services. None of this persuaded Scottish ministers, and it was only when Michael Forsyth became health minister after the June 1987 election that the policy of clean needles and methadone was conclusively endorsed.

Almost a month after our December meeting on drug use I ran into fresh opposition from No. 10. I had proposed that there should be a ministerial broadcast to warn of the dangers of Aids but this was not at all the Iron Lady’s view. My diary again takes up the story:

Tuesday 30 December 1986. Christmas comes to an end … Willie Whitelaw and the Aids committee had approved our plan to have a ministerial broadcast on Aids. Late in the afternoon the news comes through that the Prime Minister has vetoed the idea. She hasn’t had a ministerial broadcast on any subject over the last seven years and does not intend to start now with Aids. She believes it would give an impression of panic and crisis. It is a great pity that we didn’t know this before as we already have a crew lined up to produce it and I have approached Michael Meacher [the shadow Health Minister] on the basis that this is not party political controversial. He has agreed that Labour don’t want a right of reply. My main fear is that the story of the change will leak and the whole campaign will be dented on the basis that Margaret is distancing herself from it.

Wednesday 31 December 1986. My view is that we are both missing an opportunity and also running the risk of a leak by cancelling our plan for the broadcast. I get Nigel Wicks to ring me. He is at his most bureaucratic and says that it is in the notes of procedure that the Prime Minister must be consulted before any official approach is made: the consent of a Cabinet committee is not enough. I growl at him that we are rather past that point now and that unless we are careful we will be embroiled in a public row on the cancellation. Wicks obviously feels ‘and whose fault is that?’ – but is tactful enough not to say so. He suggests more constructively that the best approach to the PM is by pointing out that the ministerial broadcast is a public health message and not just a minister speaking straight to camera. I say the issue is urgent and I better see her as soon as possible. Back comes the message an hour later – come to No. 10 at 7.00 p.m.

It is a curious way of celebrating New Year’s Eve but I go to No. 10 and up to her study where she offers me a whisky. She says that she is not doing anything in the evening – ‘too much work to be done’. It becomes clear after one minute flat that she will not be changed on the ministerial broadcast. She says that she has not had one on the Falklands, on the riots or on any other health issue. She thinks I will get quite enough publicity from news broadcasts and it is more effective. On some issues it is worth having an argument but this is not one of them. There is no prospect of her changing her mind. I hate to admit it but we would have saved ourselves a lot of trouble had we found this out before. This part over we then talked more widely. She was at her best – relaxed, intelligent, sympathetic. She has difficulties in her attitude to Aids. She recognises it as a profoundly serious health threat but another part of her would like to see us putting all our efforts into reducing waiting lists or giving further help in other disease areas. At one point she says to me: ‘You mustn’t become known as just the minister for Aids.’ Her (kind) point was that my party conference speech had gone exceptionally well and there were other frontiers in politics. True as this may be I think I have a duty (if that doesn’t sound too pompous) to inform the public of the dangers. My fear would be that unless we do this then in five years’ time the judgement will be that the government ‘didn’t do enough’. I do not believe that can be said now but we must ensure that it remains the case.

As it happened we were not pursued by the press on the ‘U-turn’ over the broadcast, which was just as well. I saw much later the guidance given to our press officers. The only answer they were to give if journalists asked why the broadcast had been cancelled was: ‘It was a government decision’; if they were asked whether Margaret Thatcher had vetoed the idea, their only instruction was: ‘Do not be drawn further.’

In January 1987, as the leaflets arrived in households throughout the country, our campaign went even more high profile. Posters had been going up on billboards up and down the country, proclaiming ‘AIDS. DON’T DIE OF IGNORANCE’ accompanied by the message: ‘Gay or Straight. Male or Female. Anyone can get Aids from sexual intercourse. So the more partners, the greater the risk. Protect yourself. Use a condom.’ To accompany the leaflet-drop, we commissioned a television campaign. Before Christmas, the advertising agency TBWA had showed us what they had come up with, but as I wrote in my diary ‘they were too reminiscent of trailers for a horror film – Apocalypse Three’. Changes were made and what went on screen were the now-famous ‘tombstone’ ads. A drill cut out the word ‘Aids’ on a slab of rock: the sepulchral voiceover of John Hurt warned: ‘There is now a danger that has become a threat to us all. It is a deadly disease and there is no known cure.’ The advertisement ended with a bunch of white lilies on top of the gravestone and the picture of our leaflet. ‘Read this leaflet when it arrives. If you ignore Aids it could be the death of you.’ We followed this up with an advertisement showing the present problem as the tip of the iceberg: ‘Unless we act now it’s going to get much, much worse.’ As these appeared on both TV channels, the agency ran campaigns for cinema and radio. The campaign was inevitably criticised by some as being over the top and altogether too Hollywood. My reply is that, in all the comments that have been made to me over the years that followed, there is no doubt that it was the television advertisements which had most impact and did most to save lives.

Throughout our campaign I sought lessons from abroad. My view has always been that this was one of the best ways of getting a perspective on the problems we face in Britain. In my period in government I was surprised how little this was done. ‘The Foreign Office is there for “diplomacy”,’ I wrote in my diary at the time. ‘We have them now thinking commercially but not yet on social policy.’ I travelled to the World Health Organization in Geneva where Jonathan Mann, the founder and first director of the WHO’s Global Program on Aids (who died tragically early in a 1998 air crash) told me that in his estimate there would be between 500,000 and 3 million deaths over the next five years. One of the warnings he gave was against ‘sex tourism’ where men from the developed world travelled to the Third World with the promise of sexual partners, male or female, to be provided. I went to Berlin with its dividing wall and its eerie, flood-lit no man’s land between East and West. There, a gay rights organisation complimented us on our campaign (to the amazement of at least one British journalist there) and hoped the German government would follow suit. In my diary I wrote:

In Amsterdam I saw in action the ‘methadone bus’ which went direct to drug users and exchanged dirty needles for clean ones. ‘It seems to work well here,’ I wrote, ‘but that does not necessarily mean that it will work well in Edinburgh.’ Then, early in January 1987, I left for the United States to seek guidance from their experience, given that they had a much greater problem than we in Britain. My hopes were high that this usually imaginative and innovative nation would have further answers. I was disappointed. My diary gives a glimpse of how the epidemic was being handled then across the Atlantic.

San Francisco

Sunday 18 January 1987. San Francisco has by any standards a major Aids crisis. The city – probably the most beautiful in the United States – became a centre for the gay population during the 1960s and ’70s. The consul general says ‘they became respectable’. They never were accepted, of course, by everybody and Aids has led not only to a backlash against them but confirmed the opposition of those who were always reluctant to accept them in the first place. Many of the health workers here compliment me as a minister taking a lead. This was seen as being in contrast to their position. Nobody can remember President Reagan ever having said anything about Aids.

Tuesday 20 January 1987. Press and television interest hits a new high. It is not something we have sought. Indeed my fear was that they would interrupt the briefing sessions. In fact they have not intruded and if some of the messages we are receiving are transmitted back home then that would be very positive health education. The scale of the problem is coming through to the reporters and not all of them enjoy covering the subject. There is at least one writer who has asked his office not to put him on Aids again. But without fail the press and television party are taking the visit seriously and are not attempting to score points.

Inevitably the point of attention for the media is my visit to San Francisco general hospital – an early twentieth-century complex of red-brick buildings on what was once the edge of the city. I talk to the nurses who are working under stress but with enormous commitment. The girl who has worked there longest – almost three years – is obviously going through something of a crisis herself. She has seen her patients die without being able to do anything to intervene. We will see what she does. My guess is that in spite of all the difficulties she will stay. On average staff stay longer in the Aids unit than other parts of the hospital. I then went into the patient ward. One of the patients had agreed to be televised and photographed as we shook hands. He was a young man in his thirties – the average age in San Francisco for Aids cases. He was remarkably cheerful and anxious to talk. He had been a shipping clerk but now there was no prospect of him working, although his employer would have been happy for him to come in for an hour or so a day. We talked for a few minutes. I was photographed shaking hands and I left to continue the tour. He was a brave man who would be dead in the next two or three months.

Washington

Thursday 22 January 1987. We stay the night at the residence in Washington and Anthony Acland [the British Ambassador to Washington], a rather aloof withdrawn man, welcomes us. I do not get the impression that Aids is top of his list of interests and I suppose inevitably his mind is on American and particularly Washington politics. We have the biggest embassy of any in Washington which always strikes me as showing an exaggerated view of our international importance. I suppose my real feeling is that the Foreign Office take a rather superior view of the domestic problems of Britain and regard themselves as a cut above everybody else in Whitehall – ministers included. Overnight it has started snowing. The big Cadillac cannot make it down the drive to the residence and on the roads the traffic is slow moving. We just about make it to Bathesda to talk research at the National Institute of Health. Our talks confirm a number of impressions. In particular in spite of the unprecedented effort being made to develop a vaccine and a cure, no one is optimistic of any immediate break-through. The other message is also clear: in Britain we may be doing a great deal on public education but the Americans are devoting enormous resources to research. When we make our way back to downtown Washington the road conditions are chaotic. Our driver tells us that government departments have been sent home because of the snow. However we do manage to keep an appointment with Otis Bowen, the US Health Secretary. He is a doctor himself but now over seventy. I had met him before both in Washington and Geneva and liked him as gentle and restrained man. What, however, is clear is that neither he nor the administration intend to take a lead on public education. ‘That’, says Bowen, ‘is a matter for local decision.’

New York

Friday 23 January 1987. Washington airport is shut so instead we take the Amtrak train up to New York. The problem in New York is drugs. The city health department paint a bleak picture of New York in 1987. They estimate that there are about 200,000 intravenous drug users. Some of them can be influenced not to share needles, but everybody believes that drug users are a more difficult group to influence than homosexuals. Many gays are well-educated, middle-class and certainly do not want to die from Aids. Some drug users are the same, but the fear is that many are apathetic about their prospects. A third of HIV cases are drug addicts, but the numbers are increasing. Beneath the surface there are tales of pure tragedy. So far 165 babies have been born with Aids: most have died within five years.

Saturday 24 January 1987. We visit the Roman Catholic run St Clare’s Hospital. I speak to two women patients. One is twenty-three with a small baby; the other just over thirty with two children. They are both injecting drug users and they will both be dead in the next six months. Happily the children are not infected, but what a waste. Both women are articulate and intelligent – eminently capable of being good mothers. In both cases what will happen is that the children will be brought up by their grandparents.

Sunday 25 January 1987. Back at Heathrow Donald Acheson and I shake hands, although we will be seeing each other tomorrow. I think he realises that this trip has been for me both physically and emotionally gruelling.

Monday 26 January 1987. Back to the Department. A mountain of press cuttings on the American trip awaits me. The other ministers at the morning meeting tell me of the television coverage which they say was both massive and good. I gather this feeling is not shared at either No. 10 or Central Office. A Daily Mail report says that Margaret Thatcher and Norman Tebbit are ‘exasperated’ by the education campaign. I guess that this has come from Norman himself who over the years has used this particular Mail correspondent to report his unhelpful views. But it is too late for them to intervene now. The campaign is launched and it cannot be reversed. Frankly if they do not like it they can lump it.

It was shortly after my return from the United States that we had one enormous fillip. I visited Middlesex Hospital, which was one of the major Aids hospitals in London. A new ward had been created. It was light and airy and was to be opened in March by Princess Diana, and there was now much press speculation about whether she would shake hands with patients, as I had done in my visit to patients in San Francisco. It was a mark of the apprehension that still prevailed, in spite of all our efforts to say that Aids could not be passed in this way. Of course Diana did shake hands and, in photographs that sped around the world, demonstrated that the fears were based on ignorance. There was never a better ambassador than the young princess.

So what were the overall results of our work? It certainly showed that the government machine was capable of swift decision-making. In a matter of a few months we had implemented a massive public education campaign, communicated directly to the public what they should do to avoid the all too likely death sentence which came from Aids, and had started a policy to help one of the most unpopular groups in Britain – injecting drug users. But, more than that, I would claim that we also demonstrated that public education campaigns can be effective. Our Aids campaign was regularly checked by attitude research carried out by Gallup. In my last weeks at the Department of Health (before I moved to the Employment Department after the June 1987 election) Gallup produced their latest report. Well over 90 per cent of the public had seen the advertising, 94 per cent thought that the government was right to be doing the advertising they had seen and only 7 per cent found some of the things ‘offensive’; knowledge of what caused Aids and what did not had massively increased and condom use had increased, with a third of the sample believing that the main message was that using a condom reduced risk. There was even an answer to the Chief Rabbi, with a third taking the view that the main message was ‘don’t sleep around / few partners / stop permissive behaviour’.

Later research showed that, as well as a reduction in HIV, there was a marked fall in sexual disease generally. One public health analyst commenting today on the campaign said: ‘Within the space of a couple of years there was a dramatic fall in gonorrhoea and syphilis. No other change could explain this drop.’ Sadly this did not persuade succeeding governments to follow suit. Getting resources from the Treasury for advertising is always difficult and getting them for something as ‘sensitive’ as sexual disease is even more so. It can leave a government open to attack and even in my time at the Health Department there were grumbles from the inside that I had robbed other policy areas of their ‘fair share’. So, rather than the campaign on Aids being properly continued and developed into sexual health generally, the message faded. No one claims that exactly the same tactics would work year after year – that is why you have advertising agencies to develop campaigns. As it was, the most successful public health campaign since the Second World War was followed by years of inaction.

In the end, the most permanently successful result was the decision to introduce clean needles. This secured a lasting reduction in the numbers of new infections by the injecting drug route. In Britain a tiny proportion of drug users – around 1 per cent – now acquire HIV through shared needles. Nor has there ever been any evidence that the policy has increased drug misuse. When I chaired a House of Lords Select Committee on HIV in 2011 I specifically asked this question of the chief constables. They had received no complaints of that kind. The initial fears had been misplaced.

And Margaret Thatcher? Over the years I have pondered on my New Year’s Eve meeting at Downing Street with the Prime Minister and her remark that ‘you mustn’t become known as just the minister for Aids’. I fear that my diary interpretation of her words was too generous. Her words bore the obvious meaning. She meant: ‘Go and do something else.’ Her aim was that by use of charm and flattery she could move me on and away from Aids. I am unrepentant about my refusal to go. In the department we did not neglect the other health issues, but at that point Aids needed very direct political intervention. I was immensely helped here by the two men to whom I dedicate this book. The effort also established one other point. Over the 1980s we had had one health policy dispute after another. Aids showed just what the health service could achieve when we were all working on the same side. I am afraid none of these arguments convinced the Iron Lady, and Aids remained conspicuously absent from the memoirs of her years at No. 10.

I should make one point clear. I do not claim that Britain was unique in the early action we took to combat the Aids pandemic. There were other countries making similar efforts. If you had travelled to Sydney at that time you would have found a vigorous public education campaign beginning and, in the years that followed, you would have seen determined efforts to stem the spread of the disease. In India there would be a prevention campaign which culminated in the formation of a special organisation to combat Aids; and in Berlin and Amsterdam there were enormous efforts to communicate with drug users and not isolate them. The United States might have been doing little in public education but financially they were devoting more money to research than any other country. In Europe, France also was putting emphasis on research. So I neither claim international leadership nor that Britain was successful in every aspect of policy. Take testing in prisons. Back in 1986 I commented approvingly in my diary that the Home Secretary refused to be stampeded into instant decisions on this. I should have known better. The idea of stampeding the Home Office into anything is highly optimistic. In the end, it took them almost thirty years to stumble to a policy on testing.

What I do claim is rather different. By an early stage in the epidemic, without the help of drugs or a vaccine, we knew what could work. We knew that publicity could bring home to people the dangers. We knew it could alter attitudes and successfully promote the use of condoms. Those results were also established at the centre of the worldwide epidemic in sub-Saharan Africa when Uganda (ironically, given their later performance) ran effective public health publicity, notably with their ABC campaign – Abstain, Be faithful, use a Condom. It also became clear in country after country that the struggle to introduce clean needles and substitute methadone was achieving dramatic success. The figures from around the world could not have been clearer. Even at that early stage there was evidence that could have been used to stem the disease.

But of course Margaret Thatcher was not alone among political leaders of the 1980s and 1990s in looking the other way. As a political issue Aids promised few rewards. There was the potential embarrassment of becoming involved in intricate issues of sexual health, while the good being done was to groups who were not notably popular – gays, lesbians, drug users and sex workers. Surely, too many leaders thought, a few local campaigns could settle the matter? Millions of deaths later, the answer to that question is obvious, but at the time Ronald Reagan in the United States refused to acknowledge the seriousness of the position and turned the other way. Even worse, in South Africa Nelson Mandela may have guided his nation through its first post-apartheid government, but he failed to respond to the tragedy that was enveloping his country. Margaret Thatcher may have grumbled but, with the exception of the cancelled ministerial broadcast, she did not veto our efforts. Albeit reluctantly, she allowed me to get on with the job.