Reiko Kanazawa reflects on a workshop series about Scotland and AIDS crisis during the COVID-19 pandemic.
Organising a workshop during a pandemic is daunting. So also is talking about AIDS while each country is going through COVID-19. AIDS was forty years ago. Is it still a problem? Aren’t there more pressing issues? These thoughts ran through my mind, as COVID made in-person seminars impossible, taking us all online. Yet the UK was in a mood of AIDS reflection. Documentaries such as BBC Scotland’s Choose Life: Edinburgh’s Battle Against AIDS (2020) and Channel 4 dramas like It’s a Sin (2021) indicated that there was still a lot left to process about AIDS. The ambiguities of substances as painkiller medicines and sources of dependence continued in Netflix documentaries such as The Pharmacist (2020). In terms of current events, Glasgow had been experiencing a resurgence of HIV, to which former drug users/activists initiated their own responses by operating safe injection vans notwithstanding COVID and resistance from politicians (see UNAIDS 2019 and McCann 2020). Current events and contemporary memory would not let AIDS, drugs and Scotland’s experiences with both fade.
In April and May 2021, I organised a workshop series ‘Scotland in the Global’ for the Centre for Biomedicine, Self and Society (CBSS-Wellcome Trust) at the University of Edinburgh. As part of a ‘Beyond Global’ thematic research strand, the workshops illuminated how exchanges within and across national borders – of individuals, institutions, products, information and finance – create new spatial and temporal landscapes of health and illness. A particular question the researchers engaged was how the ‘global North’ is part of global health. To this end, the workshop gathered five speakers, a mix of former practitioners and historians, each contributing new perspectives on the inter linkages between HIV/AIDS, drugs, Scotland and global health.
‘Scotland in the Global’ Workshops
On 7 April Ray Brettle, an infectious disease physician with a particular interest in immunology, spoke about his experiences encountering Edinburgh’s explosive epidemic in 1983. He discussed how he developed a model for the city’s HIV response drawing inspiration from needle-syringe programmes in New York, Amsterdam and San Francisco – despite not being originally trained in psychiatry or an addiction specialisation. His exploration was based on personal reflection as well as retrospective research he had conducted throughout the 1990s of blood sample analyses and collating new research publications. Ray’s reflections reminded me of the importance of tailoring epidemiological categories to the context and the vital role medical professionals play in doing so, oftentimes without the support of policymakers.
Ray’s talk was followed by Alex Mold’s overview of the similarities and differences between Scottish and English drug education campaigns in the 1980s. A policy historian at LSHTM working on the idea of ‘the public’ in public health, Alex’s visual analysis illuminated the vast differences in tone across educational campaigns. While the Scottish campaign highlighted ‘choose life’ and promoted healthy lifestyles, the English campaign used language like ‘heroin screws you up,’ which was darker and more punitive in its messaging. Despite the different attitudes each campaign had towards their respective ‘publics’, Alex carefully considered why all the campaigns explored had little effects on drug-consumption in the two locations.
On 14 April, the workshop series hosted Jim Mills, an early modernist, and Hannah Elizabeth, a contemporary historian. Jim, a historian of drugs and narcotics at the University of Strathclyde, gave participants a snapshot of his most recent work on cultures of medicinal opium use in early modern Scotland, drawing from local Scottish archives. Jim’s presentation closely analysed fascinating recipes for smallpox cures to the uses of red (local) or white (foreign) poppies in an era of growing global trade. His presentation also reminded the audience that substances have been used for centuries for pain relief and other health conditions, often without public outcry or need for policing and certainly preceding the modern healthcare system.
Hannah’s paper took us forward to HIV and Edinburgh in the 1980s, examining how families with HIV affected children interacted with healthcare services. A contemporary policy historian focusing on childhood and the family at LSHTM, Hannah’s research examined Scottish Health Department and Lothian Health Service archives. Her presentation carefully drew out how ideas about confidentiality, empowerment and normalisation were negotiated by doctors and social workers in communicating children’s serostatus to HIV-positive mothers: a push and pull between protecting children and empowering mothers. This was not limited to Edinburgh, as healthcare workers faced similar experiences in the US and Canada.
Our final session on 21 April foregrounded Kirsten Horsburgh’s work with the Scottish Drugs Forum. Kirsten drew from her experiences as strategy coordinator for the Scottish National Naloxone Programme, launched in 2011 as a world’s first programme of its kind, and she has experienced the global drug policy-side by consulting for WHO and UNODC. Like HIV in the 1980s and 90s, drug use continues to be criminalised, stigmatised and marginalised in the language and the policies of politicians, health services and the public. Kirsten illuminated her travel fellowships to research safe drug consumption spaces in Australia (Sydney) and gave insights into the more progressive but still hesitant current state of Scottish and UK policies on harm reduction, right to life and preventable drug deaths. Kirsten’s insights as a practitioner highlighted the importance of harm reduction in a context of slow policy-responses to preventable drug deaths (in contrast to COVID-19), as well as transnational cross-learning in designing tailored health programmes.
Enacting Effective Public Health Policies?
From visual to textual, historical to practice-oriented, past to present, the papers had different approaches to the relationship between AIDS, drugs, Scotland and the global. Nevertheless, they each considered the uses of substances and societal responses to prevent disease and promote health. How then does Edinburgh’s health experience show that the global North is part of global health? Three key themes emerged: (1) the trade of substances, whether in pharmaceutical supply chains or illicit trafficking; (2) the exchange of technical expertise and knowhow; and (3) the formation of patient and expert communities advocating for right to health, at times against their own policymakers. Most importantly, health crises can occur in any context of deprivation and social, economic vulnerability. The presence of sophisticated medical infrastructure or an advanced pharmaceutical sector is not a guarantee of deaths prevented; in fact, it can sometimes be a contributing factor.
This workshop bookended my own postdoctoral research project examining the intersection of post-war international drug control and global health. The UN drug regime initially had utopian ideals about ‘addiction’ (the term used then) as a problem of circumstance and to be resolved primarily through social rehabilitation, with limited reliance on substitution medicines. Bringing together experts from Taiwan, Switzerland, Denmark, Iran and the United States, the World Health Organization announced in 1956 that treatment should be tailored upon ‘a study of the individual personality’, and ‘[s]uch treatment should aim at giving the patient more insight into his problems, some understanding of the unrealistic character of his neurotic fears and wishes and a better judgement of situations, thus enabling him better to respond to the unavoidable stress of life’ (WHO 1957, p. 7).
But both the UN and the WHO soon discovered the complexities of governing substances in which many agendas were embedded: global geopolitics, pharmaceuticals, country government unwilling to acknowledge drug issues, illicit trafficking, among others. Most countries and regions, global North or South, pursued other priorities and left coordinated and coherent domestic policies on drugs and health to the wayside. It struck me that through Edinburgh’s (and other countries’) HIV experience in the 1980s, the global community had re-discovered through a devastating disease the core ideas WHO had articulated in the late 1950s: that social reintegration was a critical determinant of successful substance use rehabilitation. While careful not to apply a presentist frame, as a global health historian I am left wondering if it takes major catastrophes like HIV or deaths due to overdose in order to enact effective and humane policies.
Re-visiting AIDS in reference to our collective witnessing of COVID pandemic responses, Scotland’s experience reminds us of what has been successful and what is still yet to learn. Public health emergencies get pushed under the rug and lives are lost often because of a simple lack of consensus. Each individual, whether policymaker, healthcare worker or member of the public, has a role to play in effective and humane crisis responses.
The ‘Scotland in the Global’ Workshop recordings are available here via the Centre for Biomedicine, Self and Society at the University of Edinburgh.
Reiko Kanazawa is a Research Fellow in Global Health Governance at the University of Edinburgh’s Centre for Biomedicine, Self and Society (CBSS). Her postdoctoral project examines the intersection of international drug control and global health and will be published as a book titled Boundaries of Addiction, Treatment and Disease: Global Drugs Governance from Post-war to AIDS in 2022. Her most recent paper, currently under peer review by the ISIS-Current Bibliography pandemics special issue, reviews global AIDS historiography and its significance for COVID-19 (access here).
Allison McCann. (2020). ‘How a Man with a Van is Challenging U.K. Drug Policy’, The New York Times. 21 Nov. Available from: https://www.nytimes.com/2020/11/21/world/europe/scotland-glasgow-drugs-van.html
UNAIDS. (2019). ‘Unwavering care for people who inject drugs on the streets of Glasgow’, UNAIDS. 18 Sept. Available from: https://www.unaids.org/en/resources/presscentre/featurestories/2019/september/20190919_Glasgow
WHO. (1957). ‘Treatment and Care of Drug Addicts: Report of a Study Group’, World Health Organization: Geneva, p. 7. Available from: https://apps.who.int/iris/bitstream/handle/10665/40389/WHO_TRS_131.pdf?sequence=1