21 September 2022: Scottish Govt Decision Making 1970s to 1990s (Presentation) - B

The next theme of the presentation related to HIV/AIDS as an emerging issue in Scotland. It didn’t take long for the line to take of there being “no conclusive proof” of AIDS being transmitted by blood routes to rear its ugly head in the interactions between officials. While the SHHD received scientific and policy material from various sources, most came from the DHSS in London. Scottish briefings included the usual tropes, but also added localised factors such as Scotland being “self-sufficient” in sourcing blood. Again, it also didn’t take long for the discussions at the time to revolve around reassuring people of blood safety, designing leaflets, keeping the gay community informally involved, and seeking to specifically avoid donation sourcing from high risk locations such as prisons. The Chair picked out the stated aim to prepare a “neutral” leaflet. (Neutral as opposed to what opinionated stances?)

Westminster was taking the lead on messaging, and SHHD sought to be involved in the design of public information materials. The main aim was to “discourage practicing male homosexuals from donating their blood”, while not causing concerns in the public realm. (That went well, didn’t it.) The Chair noted the assumptions and virtue-signalling as contained in briefings that domestically produced blood was somehow automatically better than the imported stuff. (It was noted by this writer that the drafting of the briefings was by one Geoff Pearson, who was recalled to be an openly gay man; not that that fact was more significant than the fact of his reputation in SHHD as being a budget-slasher.) The Chair again intervened to mention his noting of the AIDS virus being “new to Britain” and that there was no “known” case in Scotland of an AIDS transmission by a blood route. The wording was seen to have been carefully chosen (which was typical of Geoff P).

A document was displayed from 1984 noting how a Scottish resident (from Wishaw, very near to Law Hospital) had contracted AIDS. To avoid accusations in the press of the previous statements being challenged, the briefing highlighted how that man had recently moved into the area from Newcastle. (That got Scotland off the hook, right?)

Counsel shifted attention to the issue of the “Edinburgh Cohort”, which became a known issue (known, that is, to a very small number of people) in 1984. The 16 patients (haemophiliacs) were infected by Scottish blood. The implicated batch from Liberton was withdrawn but the problem was highlighted of checking through individual donations involved due to the large numbers in the pool. The decision was made not to go public with the information. The Minister, Mr McKay, noted in handwriting on a memo that he appreciated the need not to cause concern, but he was aware of the possibility of an accusation of a “cover-up” being made. He also asked when heat treatment would be available. The Chair pointed out how the memo did not mention the prospect of a screening test, even though he knew from other evidence that there was at least one pre-dated memo circulating in England which did make mention of emerging screening options. He wondered if there was insufficient sharing of information between Scottish and English officials. Counsel advanced the matter by demonstrating how discussions about the safety of Scottish blood from later in the year did not benefit from the information about the 16  patients. The possibility existed of a hair-splitting distinction being made that the Edinburgh group had tested positive for HTLV-III antibodies but had not yet developed AIDS itself – so no confirmed cases of AIDS in Scotland could still be said (with a straight face).

The debate in the intervening months concentrated on the problem of when to disclose the exposure. It was noted that of the 400 haemophilia patients in Scotland, “only 10%” had shown the presence of HTLV-III antibodies. This was mentioned in the context of other places, including England and the US, where the ratio of infectees was higher. The line was still being peddled that only a small proportion of those with antibodies would go on to develop AIDS. (How does it feel to be nothing more than a stat in a spin-document?)

The emergence of the Yorkshire Post journalist who had the story obviously spoiled the party. The SHHD negotiated with the journalist to delay publication until after the 19 December 1984 meeting where clinicians met with patients and their families. At the same time a press release was drafted. The text began by highlighting how all Scottish produced supplies were heat treated. Clearly, this was an attempt to pre-empt any reactions.

The next topic in the presentation was the matter of screening for HTLV-III. Scottish officials advocated that there ought to be established a UK-wide group on screening. Again, the Chair wanted to explore the level of knowledge of the Scottish officials and also what they passed on to Ministers. It was in the context of communications between officials as well as the Galbraith development on the cause of AIDS. Counsel presented that there appeared to be a high level of knowledge among Scottish officials, particularly the medical civil servants, including the specific contemporaneous source of an article in the Lancet.

Displayed documents from 1985, showed how Scottish officials seemed more than just a little reluctant to spend money and have lots of extra work to ensure screening was carried out when there had apparently only been one implicated donor out of the more than a quarter of a million donations in Scotland each year. They blamed the hysteria over AIDS for such an irrational move. They felt there was an inevitability in Scotland following what was happening in England (oh, boo-hoo) (This writer speculates over the conversation between officials and clinicians in the tea-room that, “This work where we get to run the NHS would be a great job … if it wasn’t for the patients”.). They did not like the “high rate” of 4% false positives from the tests. (This writer recalls how “only 10%” of haemophiliacs being exposed to HTLV-III was not described as “high” because it was less than in other places. Lesson: follow the science, trust the data, but filter the spin.)