Trigger warning: Mentions of homophobia and discrimination

The 1980s and 90s were a period marked by fear, stigma and misinformation, but also courage, compassion and community response. While public understanding lagged and prejudice was widespread, often spurned on by national media outlets and the UK government, frontline organisations like St John Ambulance played a crucial role in offering practical support and lifesaving care.

I also want to take one moment to examine the terminology I am going to use throughout the blog. Today we know that HIV (human immunodeficiency virus) is a virus that weakens your immune system and increases your risk of serious illness. There is no cure currently, but with treatment people with HIV can live long and healthy lives. AIDS (acquired immune deficiency syndrome) is the name for a collection of serious illnesses caused by the HIV virus and is often now called late-stage or advanced HIV. In the UK today, most people being treated for HIV do not develop AIDS. Where I am referring to modern terminology, I will differentiate between the terms. The term HIV was not formally adopted until 1986, so where sources that I am going to talk about say a particular word, I will use that word. If it is generally referring to the epidemic, I will mention both.

While researching for this blog, I consulted a number of resources, including chatting to volunteers who were active in St John in the 80s, but I primarily explored the St John Review. The Review was the monthly organisational magazine for the Order of St John and was published between 1950 and 1988. It featured news, reports, photographs, articles and information about the work and activities of the Order and St John Ambulance nationally and internationally, and you an access digitised edition here. I chose this resource primarily because it tells volunteer first aider stories, and these are the people I want to consider. There was a lot of misinformation being spread at the time from media outlets with an agenda to cause distrust and fear of the gay population, and I wanted to consider if this had an impact on delivery of first aid.

Something that struck me in my research at first was that there was no mention of AIDS in the 1982 or 83 editions. To provide a background timeline, the first cases of AIDS in the UK were identified in December 1981, and Terry Higgins, amongst the first known people to die of AIDS-related illness in the UK died on 4 July 1982 at 37 years old. Cases began to increase markedly between 1984 and 85, and this is when we start to see mention in the sources, albeit briefly at first.

In the 1985 St John Review, in an article about the SJA Medical Conference in April 1985, it is noted that there was a talk on AIDS by a Dr Sutherland, but the article writer missed it to attend a session on SJA homemade videos. At the height of the crisis, the illness was still not been given the due attention it deserved, at least not by this writer.

Later in the same edition, you can see that people are really beginning to panic about the epidemic. Mr S Nicholson, an Area Superintendent writes in to say, ‘Can we please all stop worrying about AIDS and concentrate on performing basic, lifesaving first aid without facemasks, airways and rubber gloves?’.

He goes on to say that by the end of August 1985, there were only 206 recorded cases of AIDS, with the population of the UK reaching 50 million. He makes the case that the likelihood of treating someone with AIDS is very low. He works out that for someone to have AIDS, have an open wound and to require ventilation and be treated by a member of St John is 400,000 to one. He also suggests that to position a mouthguard each time for mouth-to-mouth is far too long of a process and puts the patient at an increased risk, which could be fatal.

This kind of story has been corroborated by conversations I’ve had with volunteers at the time – mouth covers were flimsy back then and caused blockages and stuck to your mouth instead of the patients. Even touching made people wary, putting people into the recovery position was a worry to some first aiders.

The concern in this section is very much for the average person who might require resuscitation rather than anyone who actually has AIDS. This, I believe, is partly to do with the wider dissemination of misinformation and scare mongering around the epidemic in popular culture more widely.

There was an immense amount of prejudice, intolerance and discrimination perpetuated in British newspaper coverage at the start of the epidemic. As young, primarily gay, men started dying, British newspapers harshly condemned them and blamed them for the spread of the deadly illness. There are lots of resources on how the British press sensationalised the crisis and fostered a moral panic surrounding HIV/AIDS, and were consistently putting out incredibly homophobic articles, similar in style to the media portrayal of trans people that we’re seeing today. Tabloid newspapers in particular used fear-inducing images and headlines to capture public attention – this often included quoting extreme views such as a vicar who reportedly said ‘I’d shoot my son if he had Aids’. There is little to no positive mention of the people who had HIV/AIDS, and instead gay men and drug user communities were heavily stigmatised, fostering the belief that the disease was a form of punishment brought on by their ‘sinful’ lives. Terms like ‘gay plague’ were used, reinforcing discriminatory attitudes and pushing the gay community back into the shadows after LGBTQ+ culture was starting to become more visible. This constant bombardment of homophobic scaremongering obviously impacted the public; if what you think it a reliable source is constantly saying that gay men are a threat, you’re going to start to believe their agenda. And we get into a bit of a back and forth here – newspaper’s approaches to reporting on HIV/AIDS both reflected and influenced public perceptions of the illness.

St John Ambulance is made up of the general public, of paid staff and volunteers, who have since inception had the main aim of providing first aid and care to other members of the public. I’m unable to, and absolutely not attempting to say anything negative about the St John family, but it is likely a proportion of St John Ambulance first aiders had read and were influenced by these newspaper articles, hence the story from Mr Nicholson where he mathematically breaks down the likelihood of treating someone with Aids, presumably to reassure those who might be scared.

But there was something that St John had on its side to combat this homophobic rhetoric – fantastic medical knowledge. In October 1985, county surgeon Dr John Windebank and consultant microbiologist Dr David Bullock gave a talk to 180 delegates in Derbyshire about resuscitation and the possibility of infection if delivering to somebody who has AIDS. They conclude that ‘transmission through mouth-to-mouth ventilation was extremely unlikely’, not only to those 180 people in the room, but to every person who reads the St John Review too.

At the start of the epidemic, little was known about transmission, but right from the point of discovery, St John Ambulance were informing their people of the facts. I would argue ‘extremely unlikely’ doesn’t fill you with 100% confidence, and we now know that HIV is only spread through blood, semen, vaginal fluids and mucus from inside the anus, and you cannot get HIV from kissing, hugging, shaking hands, sharing food or toilet seats. But as soon as senior internal medical officers are finding out information about AIDS, they are making sure that on the ground first aiders are informed as well.

By 1987, there is a front-page article about the significance of HIV/AIDS to first-aiders. Written by the chief medical officer, it starts off by very clearly reiterating that they now know that HIV is carried in the bloodstream and not transmitted unless large quantities of infected blood come into contact with broken skin. They go on in the article to say that alongside medical advisers from St Andrew’s Ambulance Association and the British Red Cross Society, they saw no grounds for recommending changes in resuscitation techniques or procedures for stopping bleeding because of AIDS or the virus associated with it. To conclude the article, they Director General asks that the contents of this letter be read or passed on to all members of St John Ambulance. This tells me two things, that there is still a level of panic enough that this information is reiterated in the Review and to be read aloud to all members performing first aid, and that I can see that this may not alleviate all worry, especially as it is relatively likely that a first aider may come in to contact with someone bleeding profusely.

You can tell that members were not entirely satisfied with this response as a few months later a follow up article is published. This orders first aiders to always cover exposed cuts or abrasions with a waterproof dressing and that if blood, semen of other bodily fluids need to be mopped up, disposable plastic gloves and an apron should be worn and then disposed of ‘preferably by burning’. However, as fantastic as this advice is in protecting first aiders on their duty, one sentence caught me – this should all be done ‘whether or not any infection is suspected’. How would someone suspect HIV/AIDS? Is this still based on harmful stereotypes perpetuated by the British media that gay men are spreading and dying from this disease, and are first aiders making those judgements themselves when treating patients? In an article a bit further on in the 1987 edition, it’s reported that a senior member at a conference ‘welcomed back his flock with a humorous and succinct presentation on AIDS’. Is it appropriate to be humorous when by the end of January 1987, at least 355 people had died, not including those who may have died but not even been reported. Is it quelling fears amongst people who are on the front line of medical delivery or is it making fun of harmful stereotypes.

This is absolutely not to say that the wonderful St John family did not provide fantastic care for people with HIV/AIDS, just that during the 80s, it was hard to avoid harmful rhetoric about gay men in the public sphere, and this clearly had an impact on people. Chats with volunteers at the time report incredible doctors in their units reassuring people that you were more likely to give an immune compromised person with HIV/AIDS an illness than pick one up from them in return.

I want to end this blog with a fantastic story that was shared about the Regency Community Care Division, a unit in Brighton dedicated to caring for people with HIV and AIDS. Set up in the 90s, the division was founded by 12 volunteers, young gay men struggling to come out. The division worked with people in their community, doing shopping for them or providing transport between hospitals. At the time, ambulance service would ‘gown up’ when transporting HIV and AIDS patients, but the Regency Division didn’t. Darren Owens, one of the people who set up the division, explained that they did this to treat people with respect during a difficult and scary time in their lives. He also spoke about fundraising. At one particular event, every drag artist in the UK came to support the division, allowing them to raise funds to buy an ambulance. It could hold 5 wheelchairs, meaning the division could take their patients on days out. The Regency Division became an integral part of the Brighton community, and they were involved with the first Brighton Pride: Darren said, “There were two first aiders, Terry and I, sat watching 40 people have a picnic in the park”. St John still provides first aid at the event today.

To conclude, it’s fantastic to see how St John has continuously developed and proven to be a charity dedicated to providing first aid to all, and despite continuous bombardment from the press in the 80s and 90s, lifesaving care was delivered to those in need. I’d like to end by remembering those we have lost to HIV and AIDS-related illnesses, and by celebrating equal and fair first aid and medical provisions to all.