The Channel 4 series, It’s a Sin, aired on British television for the first time in January 2021. It depicted the lives of a group of gay men and their friends who lived during the HIV/AIDS crisis in the 1980s. Here, Dr Olwen Williams, RCP vice president for Wales and a consultant in sexual health and HIV medicine, discusses medical advances over the last 40 years and the stigma that remains.
People who make a difference have passion. It’s about having a drive and a vision to deliver on what’s important to you and what’s important to your patients. I never saw myself as a leader. I graduated from Liverpool University in 1984 and my passion was health inequalities. Deprivation, inequality, and this new virus floating around called HIV. I was encouraged into a 2-week placement in sexual health and I was totally smitten.
After my training, I came home to north Wales. People told me it was career suicide – it was only me, 200 patients and a filing cabinet. That was it. There was no service and there was no recognition that there was a problem – yet within 2 weeks of being there, I had 15 HIV-positive patients. Within a year, I’d gone from 200 sexual health attendees to 2,000, and 10 years later, there were 25,000 patient attendances in a year. Now we have about 250 HIV-positive patients. If someone ever tells you there isn’t a demand for something, just provide the service – the demand will always be there.
When I first started in my career, I wanted to understand how Cinderella specialties were treated. They were never given any funding, never developed and the patients were made to feel like third-class citizens. As a new consultant, I wanted to raise the profile of these overlooked services and got myself onto various committees. Then I started campaigning for a sexual health strategy for Wales. The Welsh government agreed, and a couple of years later, I won Welsh Woman of the Year. This award gave me a much bigger platform to talk about HIV and sexual health, which had a big impact for my patients – their voice was finally being heard.
‘You have to challenge things to see change – calling out negative attitudes, improving education and raising awareness is crucial.’
In 1996, it became apparent that a new combination of HIV drugs would dramatically improve patient wellbeing and survival. Instead of recruiting a consultant colleague, I used the available resource to fund highly active antiretroviral therapy (HAART) in my area – it became a game changer. Individuals living with HIV no longer developed opportunistic infections, or AIDS.
My inpatient workload dropped dramatically. Today, I manage everyone as outpatients, with 6-month follow ups if they have a well-preserved CD4 count and undetectable viral load. People with an undetectable viral load cannot transmit the virus to their sexual partner. I look after several individuals who were diagnosed in the 1980s – we reflect on how things have changed and lament for those we have lost. It’s a Sin made me both angry and sad.
While improved care and treatment have improved survival, many individuals are diagnosed late into their disease – stigma, fear and discrimination still play a big part in people visiting their doctor at a late stage. Sadly, these factors are as influential in 2021 as they were in the 1980s, and if we are aiming for zero new infections by 2030, we have our work cut out to achieve this.
Dr Olwen Williams OBE
Consultant physician in HIV medicine and sexual health
RCP vice president for Wales
Former president, British Association for Sexual Health and HIV