On World AIDS Day 2020, we're fortunate enough to be hosting a guest blog from Dr Hannah J Elizabeth. Hannah's a great champion of LHSA, having first worked with us in 2018 during their research on the impact of HIV on women, children and young people in Edinburgh.
Currently, Hannah is a Research Fellow for the Wellcome Trust Senior Investigator Award 'The Cultural History of the NHS' in the Centre for the History of Medicine at the University of Warwick, researching late twentieth century lesbian health activism in the Midlands. Alongside their research on lesbian health, they are writing a monograph based on their PhD research on representations of HIV to children and adolescents. In January, they will begin a Wellcome Research Fellowship based at the London School of Hygiene and Tropical Medicine and the University of Edinburgh titled: ‘What’s love got to do with it? Building and maintaining HIV-affected families through love, care, and activism in Edinburgh 1981-2016’.
‘Enjoy your sexuality - safely’ – learning caution and hope from 1990s lesbian HIV materials
This World AIDS Day there are reasons to be cautiously hopeful. Rates of new HIV infections are dropping across the UK, with testing, PreP and successful treatment regimens lowering transmission risks and improving clinical outcomes. This trend, as has been widely reported, has been accelerated by the social distancing measures required to combat Covid. If we dig down into the statistics though, we come across reasons for caution.
Access to PreP is by no means universal. While improving, many people who are vulnerable still find access to PreP difficult. Successful treatment for those already living with HIV remains dependant on testing and sticking with treatment, something which isn’t always easy. Indeed, the proportion of people diagnosed late remains stubbornly high at 42% according to latest figures. Globally Covid may cause serious disruption to treatment regimes. So evidently, more needs to be done to continue to combat HIV and to lessen health inequalities nationally and globally. We need more money for HIV prevention, testing, treatment, and education!
HIV education has taken many forms over the years. Here I’m focusing on information targeted at lesbians (a fairly rare primary source) because the hopeful-but-cautious tone adopted mirrors how I feel about HIV in the UK today. We shouldn’t be complacent, but we should be optimistic!
This leaflet, created by Lesbian Line, part of Lothian Gay and Lesbian Switchboard, captures an interesting moment in HIV’s history. In its pages we can see a turn in messaging from describing people as ‘at risk’ towards describing activities – rather than identities – as risky. It addresses women who have sex with women, telling them: ‘Like anybody else, it’s what we do that determines how much we place ourselves at risk.’ Women who had sex with women played an important role in the history of AIDS activism: advocating for change, working to produce education materials, and supporting people who became sick. But they also produced material like this to address their own needs directly in the face of government silence and ongoing stigma.
Overall the leaflet is frank, admitting when the medical research was unclear and risks uncertain, while offering practical solutions on how to have sex as safely as possible. Indeed, on the final page of the leaflet it explains:
‘We want you to be aware of the facts, not the scare stories: our sexual activities are generally low risk, so enjoy your sexuality – safely!’
This message, about enjoying ourselves, still resonates today. Much of the sexual health messaging we are used to seeing still insists on a risk first, pleasure second (or not at all) narrative, but in the 1990s this kind of intervention was even more powerful. When we think about public health messaging around HIV it is usually the ‘tombstone campaign’ that we think of. We remember John Hurt’s sombre voice telling us that ‘if you ignore AIDS it could be the death of you: So don’t die of ignorance!’ A scary campaign is a memorable campaign, but as I’ve argued elsewhere, that doesn’t mean it worked brilliantly. As the leaflet above explains, not all sexual acts are as risky as one another, and there are many ways to make sex safer without forgetting about pleasure in the process!
Another important element of the leaflet is its emphasis on personal choice and communication around risk. While the methods available in the 1990s were fewer, and perhaps less technologically advanced than those available to us today, there were always more ways to have safer-sex than using condoms. While PreP is game changer, and condoms, lube, and sex toys have also increased in variety and type, safer-sex has always meant different things to different people.
People found ways to have fun safely in the 1990s. By leaving space for different activities while emphasising communication, the Lesbian Line leaflet strikes an inclusive tone. Indeed, part of this leaflet’s important intervention was debunking the myth that lesbians as a group were not at risk of HIV, while carefully leaving space for pleasure in the process of managing that risk. Which I suppose brings us back to World AIDS Day 2020. Today we still need to know the facts so we can, as far as possible, manage our risk. We also should work hard not to lose sight of pleasure. But we also need to acknowledge that the burden of risk is not distributed equally. And so we must fight on for better education, funding, and treatment for all.
You can find out more about Dr Hannah J Elizabeth's work here:
Selected LHSA material relevant to lesbian health and well-being includes:
Acc09/021, Acc09/027: Lothian Gay and Lesbian Switchboard. Includes information on the Lesbian Line service, and publications for and by lesbian communities, including Dykenosis, and newsletters from the International Lesbian Information Service. The collection features runs of the magazine Gay Scotland. Until January 2022, students and staff from the University of Edinburgh can access Gay Scotland (along with 24 other LGBT publications) online through the LGBT Magazine Archive through a link in this list.
LHB45/2/5/1: Lothian Health Board HIV/AIDS Team and Health Promotion Department. Information produced by lesbian, gay and transgender groups.
LHB45/1/2/2/5: Lothian Health Board HIV/AIDS Team and Health Promotion Department. Terrance Higgins Trust. THT leaflet on lesbian safe sex.