Tale of one city: a history of HIV/AIDS policy-making in Edinburgh, 1982-1994

Abstract

The historiography surrounding the policy response to AIDS/HIV has largely focussed on the national or international picture. This thesis seeks to provide a muchneeded local perspective by examining the dynamics of policy-making in Edinburgh - the so-called `AIDS Capital of Europe' - during the period 1982-94. The thesis is primarily based on a wide range of hitherto unexplored primary sources generated by the Scottish Office and health authorities north of the Border. These sources have furnished new insights into the policy-making process and the interaction between the local and central state. In particular, it has enabled the author to compare and contrast the Edinburgh experience with that of other parts of the UK.

An introductory section locates the study within both the broader literature on the social response to disease and the more specific historiography of AIDS/HIV, while Chapter 2 provides a pre-AIDS history of the policy response to disease in Edinburgh. The main body of the thesis comprises four parts. The first two parts address the response to AIDS/HIV between 1982-1987, concentrating on the early role in policymaking of a medico-gay alliance, debates on the problem of haemophiliacs and AIDS as a `disease of the blood', the increasing association of AIDS as a drug-related disease with associated debates on the uses of screening, needle exchange and methadone therapy, and health education. The last two parts analyse the policy responses between 1987-1994, especially the formulation of new care and treatment strategies, the relationship between voluntary and statutory groups and the establishment of a new health education campaign in Edinburgh.

While acknowledging that much of policy-making followed a UK pattern, the conclusion seeks to tease out what was distinctive about the experience of AIDS/HIV policy-making in Edinburgh, using specifically the findings of Professor Virginia Berridge as a comparator. The evidence would suggest that Edinburgh's response to AIDS/HIV was shaped by local factors such as the legacy of previous responses to diseases, the distinctive drug-related epidemiology of HIV in the City, and the particular configuration of local pressure groups and civic authority. It was also heavily influenced by a number of distinctively Scottish factors, including Scotland's legal and health education structures, its blood transfusion service and clinical input.