Are ministers serious?

Observations on Aids

On World Aids Day (1 December), figures were released showing that infection rates in the UK had nearly doubled since 1997. There are now 33,500 people with HIV in the UK, about 30 per cent of them undiagnosed. Simultaneously, the Department of Health launched a campaign to raise awareness of sexual diseases in general among young adults.

It has been five years since there was any significant mainstream advertising on HIV and Aids. Now it is to be lumped in with gonorrhoea and herpes as just another thing you might catch if you don't use a condom.

Aids advertising got off to a memorable, but disastrous, start in the late 1980s with commercials full of icebergs and tombstones. The population was duly terrified (nuns rang the Aids helpline to see if they'd caught it). Everyone had heard of Aids, but after a few months of seeing none of their friends looking ill, people wrote off any further "scaremongering" on the subject and carried on as before.

The advertising agency that I then ran was called in at this stage. As it was by then impossible to get anyone to listen to anything about Aids, we started over again, on HIV - the infection that you can't tell if someone has. We did commercials with serious-looking doctors and true tales of people who had contracted HIV but whose behaviour was pretty average. Having established the risk, we moved on to the delicate issue of how to negotiate the use of a condom with a new partner, with- out implying that you think he or she is diseased. It was a large-budget, single-focus, long-term and successful campaign. From around the average, UK infection rates fell to 54 per cent of those in Europe.

Then in 1997 the government changed and the advertising stopped. Ministers pondered and consulted on a general sexual health strategy but did next to nothing to keep the Aids message in front of people - though it could have been broadened at that stage to other sexual diseases such as the virtually unknown infection chlamydia.

But you need to keep reminding people of risk. That's why, for instance, the government keeps up the advertising on seat belts and drink driving year in and year out. The failure to remind people, plus the discovery of drugs that contain (but don't cure) Aids, has led to a decline in condom use. But Aids will still cost the NHS £556m in the next two years alone.

Now we are to have the "sex lottery" campaign, addressed to the young in pubs and clubs and on lavatory doors, at around a third of the budget in real terms for the Aids campaign of the 1990s. But this campaign lumps together all sexual infection, implying that gonorrhoea can be equated with Aids. It is as though the government, instead of the drink-drive advertising campaign, were to substitute one to restrain drinking, pointing out that it could cause obnoxious behaviour, make you feel sick, give you liver damage or lead you to kill someone while driving. It wouldn't do much to prevent drink driving. Advertising doesn't work like that; it works by a single focus and persistent repetition.

Some money still goes to the Terence Higgins Trust to reach the gay community; the rest has been dispersed to the new primary care trusts, which are ill equipped to deliver any broad campaign. If the mounting infection rates of HIV are to be contained there must be a return to a single, focused, well-budgeted campaign. Where the new heterosexual cases come from - newspapers report that many are from abroad - is irrelevant. There is a risk to the UK population; the government should play its proper role in containing what remains a potential epidemic.

Chris Powell is honorary adviser to International Family Health and chair of the Institute for Public Policy Research