“Gay men have as much use for condoms as they do tampons,” was a joke you might have heard in the 1970s. For Jonathan Blake, one of the first people in the UK to be diagnosed with HIV, it quickly ceased being funny.
“I wanted to have sex but I had to stop—I didn’t want to infect anyone,” Blake recalls. While he abstained, his friends started to wear condoms. The behavioural change forced upon gay and bisexual men as a result of the Aids pandemic is remarkable both for its speed and scale. Prior to 1980, only 10 per cent of gay and bisexual men used condoms. By 1987, this had jumped to 78 per cent, according to one study.
The similarities between Aids and Covid-19 can be overdone. The two viruses are transmitted differently, and symptoms for the coronavirus materialise far faster than that of Aids. But where the comparison is most instructive is in thinking about the way in which condoms rapidly became a crucial pillar in the fight against HIV and Aids, and what lessons we can learn today as we seek to halt the transmission of Covid-19 through the widespread adoption of face coverings.
Perhaps the first thing to remember is that the success of Aids and condom campaigns had to be fought for, both by LGBT groups and certain politicians. Norman Fowler, who as Health Secretary at the time was widely credited for the UK government’s activist response, remembers having to fight or in some cases avoid Margaret Thatcher to ensure that government advice was as explicit and direct as possible.
“The prime minister wasn’t very keen on the language and detail we were going into… but we were able to manoeuvre past her,” Fowler says. “The result is we saved many lives because people took note.”
Boris Johnson’s reticence about face masks appears to follow in Thatcher’s footsteps. Rather than a prudishness about sex, Johnson is – or at least likes to think of himself as – temperamentally hostile to nanny-statism. This can be seen in his reliance on “good, solid British common sense” to combat the spread of Covid-19. But leadership, particularly in times of crisis, does involve telling people what to do and not to do. And such a belief overlooks the cornerstone of the Aids campaign’s success: clarity and consistency of message.
Take the rules on mandatory face masks in public. They have been changing, but only in increments and often as part of a series of u-turns. There was notably no mention of face masks during the prime minister’s 23 March address to the nation in which the lockdown was announced. When masks were introduced, it happened in instalments. Public transport in June, shops in July (though not for staff) and schools in August (but only some schools).
Fowler knew that effective behavioural change requires clarity and unambiguous calls to action. “I was fortunate in a way that it was absolutely certain that acquiring HIV caused Aids and Aids caused death. It was a reasonably clear message and we could put out clear advice.” The government’s piecemeal approach on masks has fallen some way short of this.
It is not only clarity of advice that is critical, but also who is giving that advice. What made Aids awareness and condom campaigns successful was not just the message, but the messenger. Some of the most impactful messaging came from within the LGBT community – a community that was beleaguered, oppressed and fighting back.
“If medical experts were the sole bearers of the message, it wouldn’t go as far,” explains Nina Hasen of PSI, a global health charity. “When people from the inside told you to wear condoms, it became an act of solidarity and your right to get laid.” Whereas the message from a sometimes hostile outside world could redound to “stop having sex, you perverts.” This was less effective in containing the virus.
The power of in-group messaging can perhaps be best illustrated by a poster produced by the Aids charity ACT UP, which declared that “Safe Sex is Hot Sex” over an image of two muscular young men embracing. The message was that sex with a condom was something to be enjoyed and even revered. The challenge of Covid-19 is to find similarly impactful messaging where the sense of one community under siege is less obvious.
What does not work is shaming. In a paper entitled “Gay Men, Aids, and the Code of the Condom”, Professor David L. Chambers of the University of Michigan writes that “Casting unprotected sex in moral terms may most harm those who not only engage in unprotected sex but also learn later that they have become infected.”
It can be frustrating to see people in shops or on public transport not wearing a face mask and tempting to react with anger or guilting. But the response to the Aids pandemic demonstrates that it is clarity, credibility and empathy that is most likely to produce prompt and widespread behavioural change. “Pragmatic health advice is by far the most helpful thing to do,” says Fowler. “A moral message gets you into all kinds of difficulties.”
If the government wants its message on masks to cut through, it needs to follow the lessons of the Aids and condoms campaign: be clear and consistent, and not rely on patchy guidance or so-called British common sense. Masks can be the new condoms, but only if we replicate what worked last time.
Fowler laments that some of the lessons from that pandemic were not carried forward to this one. “We talk now about an inquiry into Covid-19. It’s a great pity we didn't have one on the lessons of Aids. That was a successful campaign, but there’s nothing that says you can’t have an inquiry into a success story.”
