AIDS first appeared in Europe in the early 1980s, and prisons were soon identified as sites that would face particular challenges. Injecting drug use was one of the primary modes of HIV transmission, and the large numbers of drug users passing through prisons meant that the prevalence of HIV was feared to be high.¹ Added to this were suspicions about the frequency of risky sexual activity and injecting drug use within prisons. Prisoners were not only thought to be at a higher risk of already having HIV or AIDS, but prisons themselves were seen as an ideal environment for the spread of infection amongst inmates, potentially also from inmates to staff, and ultimately from released prisoners to the wider population. For Her Majesty’s Prison Service of England & Wales [HMPS], the situation first became pressing in early 1985. In Chelmsford, the death from an AIDS-related illness of the prison chaplain Gregory Richards saw the Prison Officers’ Association banning all movement of prisoners in and out of the prison, accompanied by lurid headlines and widely publicised concerns over contagion via the communion cup. Urgent decisions had to be made about how to minimise disruptions of this kind, how to reduce the risks of HIV transmission, and how to look after prisoners with HIV or AIDS.

This Witness Seminar, held at the London School of Hygiene and Tropical Medicine in May 2017, brings together some of those involved in influencing and implementing prison policy decisions surrounding HIV and AIDS in the 1980s and 1990s. The Witness Seminar is a means of creating material for recent history. The technique is essentially group oral history, though the participation of eminent individuals sets it apart from mainstream oral history practice. The strengths and limitations of the method reflect those of oral history more broadly: participants may have good or inaccurate recall, may be candid or rehearse the received wisdom, and inevitably some witnesses are absent. The group setting carries additional pitfalls, in that some aspects of the story may not be considered suitable for public discussion or participants may be unwilling to interact. Nonetheless, when carefully triangulated with other sources it has significant virtues. The direct testimony of influential actors can generate valuable new insights, and can illuminate issues such as individual motivation, interpersonal dynamics and intellectual and cultural influences. Group interaction cannot aspire to generate a perfect collective memory, but it has other attributes, prompting recollection and exposing areas of consensus or dissent.² With this in mind, a lack of representativeness and collusive construction of historical narrative may also be viewed as strengths. A transcript reveals how participants make their vision of history, replete with their ideological and theoretical assumptions; the point is not simply to look for the facts, important as these may be, but also to think of witnesses as ‘bearers of culture’ who can reveal much about these assumptions.

As this transcript shows, despite some shared impressions of a prison service that was often slow-moving and reluctant to change, many of our witnesses were at pains to emphasise the fears surrounding HIV and AIDS, the lack of firm information, and the lack of evidence regarding best practice, not only in prisons but in the wider community as well. Over three decades have now passed since those early days. With HIV now a manageable condition in the West, thanks to treatments that enable most people with the virus to live a long and healthy life, many of those who remember HIV and AIDS in the 1980s are keen to convey just how different the situation was then. As several witnesses mention, prison service staff and prisoners were not immune to the views and anxieties circulating in wider society. Problems and paranoia may then have been exacerbated by the closed environment of the prison. The Prison Officers’ Association [POA] had an influential voice in the 1980s, and called for staff to be made aware of the identities of prisoners with HIV or AIDS, in breach of national policies that followed principles of medical confidentiality.³ As the recollections here of Sir Richard Tilt and John Dring indicate, POA branches were not always problematic at the local level, although it may be that their anxieties were lessened when staff had knowledge as to who in the prison had HIV or AIDS. At a time of considerable fear, this provided some sense – albeit a false one – of security.

The question of segregation was much debated in these early years, including within the AIDS & Prisons Forum, convened by the National AIDS Trust [NAT] and the National Association for the Care and Resettlement of Offenders [NACRO]. As Dame Ruth Runciman explains, the Prison Service initially allowed individual prisons to implement Viral Infectivity Regulations to prisoners with HIV or AIDS. This could involve housing prisoners separately from the general population and restricting their work or sports activities, at the discretion of the prison doctor. It was a means of segregation to prevent the spread of HIV, although at the time its merits for people with HIV and AIDS were also considered. Some prisons, such as Wandsworth in London, created separate wings for prisoners with HIV or AIDS and this persisted into the 1990s, while others did not introduce any special measures at all. In the uncertain 1980s, HMPS prepared for cases of AIDS amongst prisoners by designating sections of Risley, Brixton, and Gartree prisons as AIDS hospital units.⁴ As we hear in the witness seminar, in the end, these were barely used: more information and improved treatments were emerging, and the numbers and needs of prisoners were less than expected. Prisoners requiring specialist treatment were transferred to external hospitals. On the clinical side, the most significant problem was remembered as the interruptions to drug regimens that could occur once people with HIV or AIDS entered the criminal justice system.

In general terms, though, there were concerns throughout the 1990s about the quality of healthcare provided to prisoners, and the transfer of prison medicine to the NHS in 2006 was significant. Dr Mary Piper remembers vividly just how little funding the prison medical service had when she first joined, and describes her sense of a health service that had been abandoned. Prison doctors themselves receive a mixed report card, reflecting wide variations across a large prison estate. Such variations were evident in the approach to drug addiction, where doctors were very much left to their own devices. Drug addiction services in the UK had changed significantly in response to HIV and AIDS, to favour harm minimisation efforts including needle exchanges, the provision of information about sterilising needles, and the long-term prescribing of methadone as a heroin substitute. As Dr Hilary Pickles confirms, the drug treatment community was not initially enthusiastic about this, but even after most had been won over, the prison service maintained its resistance. Our witnesses agree that the prison service was in denial until the mid-1990s that drug addiction amongst prisoners and drug use in prison was a problem. Some felt that there was relatively little injecting taking place within prisons, but Mike Trace outlined a shift in prison and crime cultures over the 1980s that saw drugs beginning to feature much more prominently within the environment of the prison. Paolo Pertica describes the particular needs of prisoners from overseas, and this in part prompted the establishment of European networks to share best practice in relation to HIV and prisons. Ultimately, official recognition of the extent of addiction problems and drugs in prisons brought an element of unwelcome political attention, but eventually also new strategies and all-important funding.

This new attention re-energised previous debates over allowing disinfecting tablets or bleach within prisons for inmates to clean injecting equipment to prevent infection, an issue that remained contentious well into the 2000s. Disinfecting tablets were first introduced very briefly in 1995, and efforts to reintroduce them in the decades since have met with many obstacles. Drug services in other forms also failed to receive the support of prison staff at times, including early services such as the Parole Release Scheme and later initiatives such as dedicated and medically supervised detoxification units. In her recollections below, Jan Palmer describes a key turning point for her in gaining the trust of staff, before which she was viewed with some suspicion as both an ‘outsider’, on secondment from the NHS, and a substance misuse specialist delivering services of uncertain value to addicted women.

Although the issues of addiction and drug use feature particularly prominently in discussions of prison responses to HIV and AIDS, the matter of sex amongst prisoners was not entirely ignored. As charities, health authorities, and gay community groups worked to spread information about safer sex in the 1980s and 1990s, there were calls at national and international levels for prisons to play their part and to provide condoms to inmates.⁵ This was vetoed in the 1980s, and we hear about several of the concerns that was raised with the Department of Health AIDS Unit. It was much debated whether prisons were private places for the purposes of the Sexual Offences Act 1967, and whether therefore the provision of condoms could be viewed as encouragement to commit a sexual crime. It was also feared that condoms could be used in constructing weapons. The provision of condoms was vetoed again in the 1990s, this time by the Home Secretary Michael Howard, contrary to the recommendations of the Prison Board. This time, the director of the prison medical service Dr Rosemary Wool found something of a workaround, and doctors in some prisons began to prescribe condoms and dental dams. Nevertheless, witnesses including John Podmore maintain that the prison service consistently failed to address sexual violence within prisons, and its policy on condoms has also been the subject of criticism from the mid-1990s to the present day.⁶

The emergence of HIV and AIDS highlighted many of the existing tensions and problems surrounding healthcare for prisoners. It exposed what Andrea Kelmanson describes as something ‘doggedly resistant’ about the service, in its apparent reluctance to acknowledge and tackle difficult issues. Fears of bad headlines, pressures of a political nature, and a focus upon the day-to-day demands of running a prison all played a role, and there could be a significant gulf between policy and practice. Ultimately, and despite some heightened fears and tensions in the 1980s, HIV and AIDS were not at any time a top priority for the prison service, although many individuals, particularly Len Curran and Rosemary Wool, worked extremely hard behind the scenes to bring about whatever changes they could. Our witnesses also observed that, for whatever reasons, there did not seem to have been an HIV or AIDS epidemic within prisons, despite the many problems that were identified. What also emerged was a sense of some of the ongoing difficulties facing the prison service, in terms of lost gains in healthcare services, mounting overcrowding, and a failure to learn the lessons of the past.

Footnotes

1

Gary P. Wormser, ‘Acquired Immunodeficiency Syndrome in Male Prisoners: New Insights into an Emerging Syndrome’, Annals of Internal Medicine, 98.3 (1983), 297 [PubMed: 6338788].

2

Virginia Berridge, ‘Hidden from History? Oral History and the History of Health Policy’, Oral History, 2010, 91–100.

3

The POA passed a resolution to this effect in 1987. See Prison Reform Trust, HIV, AIDS and Prisons (London: Prison Reform Trust, 1988), p. 11.

4

Only the Gartree unit is discussed in the Witness Seminar. For more on these units, see House of Commons Social Services Committee, Third Report from the Social Services Committee: Prison Medical Service (London: HMSO, 1986); Prison Reform Trust, HIV, AIDS and Prisons: Update, (London: Prison Reform Trust, January 1991).

5

For example, Council of Europe, Parliamentary Assembly, ‘Recommendation 1080 on a Coordinated European Policy to Prevent the Spread of AIDS in Prisons’, 1988, available from <http://hrlibrary​.umn​.edu/instree/recommendation1080.html>; Advisory Council on the Misuse of Drugs, AIDS and Drug Misuse: Part One (London: Advisory Council on the Misuse of Drugs, 1988).

6

Critiques have come from the Advisory Council on the Misuse of Drugs, Drug Misusers and the Criminal Justice System, Part Three: Drug Misusers and the Prison System: An Integrated Approach (London: HMSO, 1996); the British Medical Association’s Foundation for AIDS, in Prescribing of Condoms in Prison: Survey Report (London: BMA Foundation for AIDS, 1997); and the Howard League, in Ailsa Stevens, Sex in Prison (Howard League for Penal Reform, 2015).