Richard Smith: Remembering the early days of AIDS

I started as the BBC Breakfast Time doctor in January 1983, six months after a new disease was given the name AIDS (Acquired Immune Deficiency Syndrome). When the producers asked me what we should talk about in the first broadcast I suggested AIDS, the big medical story of the time. They told me that it was impossible to talk about it on a family show broadcast at breakfast. It was another four years before Terry Madeley, a friend of ours, in March 1987 became the first person to say on British television that he had AIDS. After he died the BBC broadcast a film about him, Remembering Terry.

Two things have taken me back to that time: It’s a Sin, a drama series about young gay men in London in the early days of the AIDS pandemic; and a radio broadcast by Dame Anne Johnson, who is now the president of the Academy of Medical Sciences, but who did much of the early research on AIDS and created the National Survey on Sexual Attitudes and Lifestyles. Johnson also created the ward for patients with AIDS that was opened by Princess Diana in April 1987. It was then that the famous photo of her shaking hands with a patient with AIDS was taken. The handshake marked a turning point when the broader population began to realise that you couldn’t catch AIDS simply from contact with somebody with the disease—or, indeed, as many people thought from any gay man. Princess Diana’s handshake came six weeks before President Reagan first made a speech about AIDS.

It’s hard now to understand the fear that surrounded AIDS in the first half of the 80s. People feared that you could get AIDS from drinking in a gay pub or by taking holy communion when a gay man had taken it before you. Homosexual acts among men had become legal only in 1968 in England, and there was still huge stigma attached to homosexuality. The young men in It’s a Sin have not dared tell their parents that they are gay, and their families might learn of their sexuality only when they were sick with AIDS. The hostility towards gay people makes some in the drama, as happened at the time, believe that AIDS is not a real disease, but a conspiracy. Young men—like the author, Bruce Chatwin, who died in 1989 aged 48—did not want to say that they were gay, or had AIDS, and were reported to have died of strange diseases that were only later declared to be AIDS.

It was the heterosexual spread of AIDS in sub-Saharan Africa that created a “grande peur” among politicians fearful that the same would happen in Britain. Margaret Thatcher was the prime minister at the time, and her initial reaction was likely to have been a punitive one, to lock up those infected, but Donald Acheson, the chief medical officer, and Norman Fowler, the Secretary of State for Health, prevailed and encouraged a public health campaign on the disease and on safe sex. Politicians became obliged to speak about sex, anal intercourse, condoms, and needles for drug users. As one columnist wrote: “I never supposed that at one of my occasional lunches with a very senior government official we would be discussing the politics of condoms. Anal sex was mentioned during the avocado, buggery in Her Majesty’s prisons as we ate our beef.” The campaigns, including the slogan “Don’t die of ignorance,” caused great discomfort among senior Tories, and Thatcher was even worried that the advertisements might be prosecuted for obscenity.

I worked on BBC Breakfast Time until 1987 and then moved to TV-AM before leaving for America in 1989. I suppose that once the campaigns began we must have talked about AIDS and HIV on the programme, but I can’t clearly remember. I do remember, however, that I was stopped once from talking about testicular cancer. But later the jockey Bob Champion was on the programme talking about his cancer, and, although the producers wanted us to talk about cancer generally rather than his testicular cancer, we inevitably had to become more specific. I remember sharing my censorship with the medical correspondent of the Guardian, who told me that he had similar problems—the Guardian editors wouldn’t allow the phrase “anal intercourse.”

We came to know Terry Madeley in the early 80s before he was ill. He lived next door. We met him first when he interrupted a dinner party we were having to ask if he could climb out of our first floor window to his house as he was locked out. Watching him inch along a tiny ledge was the highlight of the dinner party. 

Terry was tall, beautiful, and a natural entertainer, loud and funny, the centre of every party and every conversation. His acting career had not gone well, and ironically AIDS was the making of him. He had a chance to star, and star he did in the film, funny to the end. The plan, as I remember it, was to make six programmes, but he died before much filming had been done—so instead there is the one-hour film.  AZT, the first treatment for AIDS became available in 1987. Terry may have had some, but it was too late. Another gay friend lost two partners from AIDS and was infected himself, but he is alive and well now thanks to the effective drugs that became available.

The film of Terry shows me with my two sons, who were then 5 and 3, because Terry used to babysit for us. The point was to show that a doctor was completely comfortable with a man with AIDS looking after his children. Unfortunately, Terry died before we could film him with the boys, so the point that he babysat had to be made in a voiceover rather than visually.

I hadn’t seen the film since it was shown in December 1988, but in my search of the past I found it on Youtube. I find it poignant to watch Terry fade, although beside my desk I have a picture of him in the hospital smoking a cigarette while seated on the toilet. I also think of Terry every time I walk past a tree at the end of the road where his ashes were scattered. The film ends with his partner, also a friend of ours, walking beside the tree. I’m also delighted to see pictures of my sons and amused by the cocky, cockney 35-year-old me pontificating.

AIDS was my first pandemic. Covid-19 is my second. Will there be a third before I die?

Richard Smith was the editor of The BMJ until 2004.