I’ve been following my left-liberal friends’ reaction to Margaret Thatcher’s death. I take it they’re not huge fans of her historical legacy. I’m not such a big fan myself. But one aspect of her legacy deserves some notice. The Thatcher government responded rather effectively and humanely to the HIV/AIDS crisis. Embracing harm reduction measures such as syringe exchange and methadone maintenance, it saved thousands of lives. Indeed the words “harm reduction,” anathema to American drug control policy until the Obama administration, were official watchwords of British drug policy. As Alex Wodak and Leah McLeod summarize this history:
By 1986 the Scottish Home and Health Department concluded that ‘the gravity of the problem is such that on balance the containment of the spread of the virus is a higher priority in management than the prevention of drug misuse.’ and recommended accordingly that ‘on balance, the prevention of spread should take priority over any perceived risk of increased drug use.’ This approach was strengthened by the influential UK Advisory Committee on the Misuse of Drugs asserting in 1988 that ‘the spread of HIV is a greater danger to individual and public health than drug misuse…accordingly, services that aim to minimize HIV risk behaviour by all available means should take precedence in development plans.’
Thatcher-era British policies provided a damning contrast to the Reagan and George H. W. Bush administrations, which so disfigured their legacies by allowing HIV policy to become yet another front in the culture wars. More than 600,000 Americans have died after being diagnosed with AIDS. An unknowable number of these deaths would not have occurred had our government moved with greater speed, resources, and humanity to contain a deadly epidemic.
The HIV epidemic struck at the weakest points of American society and our political life. The centrality of homosexuality and drug use guaranteed that HIV prevention would spark bitter ideological and moral fights. Within the British system, these fights occurred in a context in which experts at the National Health Service and related public health bodies commanded real legitimacy and respect within the political process.
Things played out rather differently here. In September 1985, President Reagan prepared to make his first, very-late public comments on AIDS. Responding to unfounded fears, health authorities proposed to include the following words in his speech: “As far as our best scientists have been able to determine, AIDS virus is not spread through casual or routine contact.”
These words were never spoken. A young White House aide redacted them. This story is telling, not because that young aide—now Chief Justice of the United States—got the science wrong. It’s telling because the medical and public health consensus was casually over-ruled by a young lawyer who knew little about AIDS. Public policy is not only about making the right decision. It is also about creating the right organizational capacities and the right norms of decision-making so that judicious analysis is performed and is then given a proper hearing. That didn’t happen.
The Reagan presidency ended twenty-five years ago. That was a different time. Public attitudes have changed—not least because of what we all witnessed in the HIV epidemic itself. Maybe it’s unfair to judge American public policy of the 1980s by our values three decades later.
Still, it’s still worth remembering that one of the English-speaking world’s greatest conservative politicians faced the same crisis, at the same moment, just across the Pond. And the Iron Lady did much better.