The impact of ‘It’s a Sin’: Lessons from the U.K.

The British drama series It’s a Sin recently premiered in Canada, telling the stories of young gay men in London in the 1980s and early 1990s, and the impact that HIV had on themselves, their friends, families and communities. The series has sparked a number of conversations in Canada and abroad.

To find out how the series started a national dialogue about HIV in the United Kingdom, and what Canadian HIV organizations can learn from that experience, former CATIE board chair John McCullagh spoke to Ian Green, chief executive officer of Terrence Higgins Trust, the largest HIV charity in the United Kingdom.

John McCullagh: For those of you who haven’t seen It’s a Sin or are not aware about it, it’s a television drama series about young people living and loving in London, the United Kingdom, in the 1980s at the dawn of the HIV epidemic and in those terrible days before there was effective treatment for HIV. It’s been described as heartwarming but with humanity and humour at its heart, and it’s also full of joy, life, and surviving. It’s available on Amazon Prime Video here in Canada, and all episodes are now streamed on that service.

So, maybe I could start by saying a little bit about myself. I’m a gay guy and I’m living with HIV. I’ve lived with HIV for a long time, but I don’t identify as a long-time survivor because I was diagnosed after the introduction of effective treatment in the mid-1990s. But I have been witness to the epidemic from the beginning. I’m a social worker by profession, and for the first decade of AIDS in the 80s and throughout the 90s I was a counsellor in an organization that worked with gay men and lesbians. So, of course, we saw a lot of people who were very anxious and frightened about HIV and AIDS, both for themselves and for their friends who were sick or dying. And it was a very difficult time for all of us.

So, Ian, can you tell us a bit about your relationship to HIV?

Ian Green: Sure. I was diagnosed with HIV in 1996 when antiretrovirals were just becoming available, so I consider myself to be very fortunate that I was able to access treatment very early on in my diagnosis. In the era that It’s a Sin portrayed, the early 1980s, I was 18 then. So a young gay man exploring my sexuality. And so the drama really resonates with me, but also goes back to the history of the organization that I now lead, and there are some scenes in It’s a Sin which have got characters from the Terrence Higgins Trust as part of the drama.

I have a personal connection with HIV as somebody who has lived with the virus for almost 25 years now. But also, as the chief executive of the U.K.’s leading HIV charity, obviously I have a professional responsibility, as well.

John: Those are two great responsibilities and experiences, and of course you’re a great friend of CATIE. You’ve worked with us to help us bring to Canada the basics of the Can’t Pass It On campaign that Terrence Higgins Trust initiated, and that was a great success here in Canada.

Tell me a little bit about how It’s a Sin has been received in the U.K.

Ian: It’s been phenomenal. I don’t normally use that word, but it’s absolutely incredible, the response, and it’s not just been within the LGBT community. It’s been much broader and wider and really encapsulated the whole of society, and that’s not an overstatement. It really has once again started or restarted a national conversation around HIV. Channel 4, one of the mainstream broadcasters here who purchased the drama, they were expecting maybe a million people to view it in the first weekend and there were six and a half million over that first weekend, and it’s been the largest ever drama on this streaming program, as well.

We’ve had conversations about it over the floor of the House of Commons, parliamentarians have engaged in the debate, every newspaper has covered it, every news channel has covered it, it’s been on all of the talk shows, our leaders have all been talking about It’s a Sin. And so it’s certainly surprised us, and we knew that it was coming because we’ve been working with the production company over the last 12 months or so. But it’s also, I think, taken creator Russell T. Davies and the rest of his colleagues by surprise, as well. So “phenomenal” is a word I’m going to stick to.

John: Excellent. I’m thrilled that the U.K. is now having a conversation about the realities of HIV today and how things have changed since the early days, but also the work that we still have to do. I’m kind of interested as to how. I imagine that didn’t happen organically that people started talking about it.

Ian: I think Channel 4 did a lot of good work in preparing the ground to ensure that there was a lot of interest around It’s a Sin in advance. I also think the organization, Terrence Higgins Trust, we worked with the producers to make sure that there was an appropriate level of understanding, particularly through our networks but also using some of our celebrity supporters, as well, to get the message out about how important this particular drama was going to be. It was aired in prime time Friday night at 9 p.m., so really the high profile slot on mainstream television. I think genuinely the building blocks were in place to promote the series, but then it suddenly had a life of its own, and so I think that lots of people, including us, have been really surprised by the traction that it’s had within wider society. So, a bit of planning, but an awful lot of luck.

John: Well, kudos to you for taking the initiative to talk with the producers, and I’m sure talking to the media, too, about the series. So, one of the things that I was wondering was whether you were concerned – because this series focuses on HIV or AIDS in the 1980s in the first decade –

Did you have any concerns that this might reinforce outdated stereotypes and maybe reinforce HIV-related stigma?

Ian: Yeah, that was a real concern for us, and I know it was also a concern for Russell T. Davies, as well, and the production company. Interestingly, I understand there was going to be a sixth episode. If people haven’t seen the whole series yet, I’m not going to give any spoilers, but the sixth episode was going to be one of the main characters, Jill, when she was 55 and going back to the Isle of Wight as a bit of a retrospective. I think that would have been very powerful to have explored in a bit more detail HIV today.

I think that, yes, it was a concern that it was portraying HIV in the late 1980s and 1990s, and it was very gloomy and very bleak and a very painful time. I think that this is where we come in and the sector comes in to actually talk when we go on to news programs. We did an awful lot of media activity over the course of the six-week period during which the series is broadcast to say that was AIDS in the 1980s and 1990s. We want to talk about HIV in 2021, and so we could then talk about effective treatment and that people on effective treatment today can have a normal life expectancy; we could talk about the fact that people on effective treatment who have an undetectable viral load can’t pass the virus on; and we can also talk about the fact that a third of people living with HIV in the U.K. today are women and people of colour disproportionately impacted by HIV, as well. So it gave us an opportunity through what is ultimately a drama to talk about the reality of HIV in 2021.

So absolutely, it was a concern for us, but I think how we and others have been able to develop that narrative has meant that that’s not been an impact in terms of how people are viewing the series.

John: I’ve seen some of the online interviews that you’ve done and the discussions you’ve had between yourself and others, and it’s been very impressive. What kind of struck me, though, somewhat disappointingly, has been the reaction of some people living with HIV working in the HIV sector, particularly in the United States, who have seen it as maybe reinforcing stereotypes of gay men being reckless and having sex even though they knew they were passing on the virus. I just wondered how you respond to those criticisms, even coming from some very prominent HIV activists in the States.

Ian: Yeah, so I’ve read and I’ve been in contact with some of the colleagues whom I respect and trust in the States. I think the starting point for me is that this is a drama. It’s not there as a factual demonstration. It’s not as a documentary. I think what Russell T. Davies was trying to do in five quite short episodes was to try and accurately portray what things were like for some people, not everybody, impacted by HIV and AIDS during the early days of the epidemic. Ultimately, he needed to make sure this was going to be a program that people wanted to watch and that commissioners were going to buy, and I think he did a remarkable job in doing that.

We want to talk about HIV in 2021, and so we could then talk about effective treatment and that people on effective treatment today can have a normal life expectancy; we could talk about the fact that people on effective treatment who have an undetectable viral load can’t pass the virus on.

I guess my reflection, John, on this whole issue around shame and issues around recklessness, I mean, I think that does come out at certain points in the drama, but that was reality for some people, certainly in some of my reality around shame in the 1980s and 1990s. So it’s a drama. Some people love it, some people hate it, but what we must make sure we do, whether we like it or not, is use it as an opportunity to talk about HIV and the narrative around HIV today. Not everyone’s going to like a drama, are they?

John: No, they’re not, and I must say, I was in Toronto in the 1980s, and when looking at the drama, it reflected my experience. I saw myself there, and I saw my friends and some of the issues we had to struggle with, and, yes, there were times when we did party too much and we did have too much to drink, but we were young and we were human.

You know, you’d have to be in your 50s at least to remember the 1980s as a sexually active person, and it resonates with those of us who lived through them, but I’m just wondering how well you think the series has worked for younger people or newly diagnosed people, for most of whom an HIV diagnosis will be a very different experience than it was for the young men portrayed in It’s a Sin.

Ian: It’s been another concern: will this resonate with young people, younger people, today? And they’re the group who have taken It’s a Sin to heart more passionately than some people of our generation, and I think partly because it’s become as a complete surprise to them that this is what it was like back in the 1980s and 1990s. They were shocked and horrified about Section 28, when the Thatcher government was putting restrictions on having the ability to talk about homosexuality in schools. They were horrified about how gay men were treated back in the 1980s and 1990s. So, for them, they saw this and they were amazed about the progress that’s happened, but also were really keen to make sure they had up-to-date information about the history and about the journey that we’ve all been on.

I think the other thing that’s highlighted is the really important need – and, again, it’s another campaigning point for us – for good quality relationships and sex education in the school, which is only just becoming mandatory and, COVID willing, will be actually introduced into the curriculum in all schools in England in this academic year.

So it’s a drama. Some people love it, some people hate it, but what we must make sure we do, whether we like it or not, is use it as an opportunity to talk about HIV and the narrative around HIV today.

I think the other thing that really surprised me, and this is what has really, really overwhelmed me, is the cast of It’s a Sin were all young gay guys mainly and they’ve all become activists. They’ve all become these amazing HIV activists. Kick-ass activists, I would say. They’ve all been going on to news programs to talk about HIV today. One of them, a guy called Nathaniel who plays a character in episode 3, a love interest of Ritchie, he’s a good friend of ours and he’s openly living with HIV, and so he’s used his story to talk about the realities of HIV today. I think it’s actually resonated far more strongly with a younger audience than I think Russell T. Davies or we would ever think would be possible.

John: That’s amazing. I had a couple of experiences talking recently with young people. One young person that I know said that he was just in tears just watching the series. And this is not a guy living with HIV, but just in tears learning that history. And another guy who thought that, you know, 1980s and AIDS was ancient history, and he said it really opened his eyes and it was really important to know what those of us who lived through that time went through. Luckily, we’re still alive. Many of our peers and friends are not.

Ian, you mentioned that one-third, I think, of people in the U.K. living with HIV are women and/or people of colour. So, this is a gay story, right, and

I’m just wondering if you have reached people who don’t identify as gay or who may not really be part of the gay community or understand it?

Ian: Yes, and I think that, again, in terms of the national conversation that’s taking place, it’s mainly the conversation taking place between straight people that have had that conversation, surprisingly, as well as, of course, LGBT communities who resonate much more closely with the story.

Interestingly, this all happened at the same time as national HIV testing week, which we are responsible for. We don’t have the up-to-date data yet, but what we do know is there was a fourfold increase in self-testing and home sampling during testing week this year. I think a lot of that was due to It’s a Sin, and that’s not just open to gay and bisexual men but also to every community that could potentially be impacted by HIV. So it will be really good when we have the data just to see how that’s resonated and whether there’s been an uplift, particularly amongst the Black African community who are, again, disproportionately impacted by HIV in the U.K. context. I think it’s mainly resonated more with the LGBT community, but not exclusively.

John: Interesting. So, here in Canada, this series has just been released, and it’s on a subscription-based service, Amazon Prime, which not everybody has access to. It wasn’t on one of the broadcast channels like Channel 4, where it would have had more access. I must confess, much to my disappointment, Amazon Prime, unlike Channel 4, has done very little to promote it. From my talking to people and colleagues and friends and what I see online, I think it’s been well received by those who have seen the show. The series is certainly growing. I think a lot of people, myself included, have found it painful to watch, but most have been, I think, emotionally impacted by the story.

Like the U.K., the populations at greater risk for HIV in Canada are not homogeneous. We actually probably have more than the U.K. in terms of non-gay people living with and impacted by HIV, like 50% of people probably are gay men and other men that have sex with men, but like in the U.K., the African, Caribbean and Black community here is disproportionately impacted, as of course are the Indigenous peoples of Canada. And in some provinces in Canada, the incidence of HIV is mostly among people who use injection drugs.

I think one of the challenges we’ve had here in Canada in getting the message out is that we don’t have the same infrastructures you have in the U.K. We don’t have a national health service. Health care in Canada is a provincial responsibility. Our HIV service organizations are very small and very local and often inadequately funded, and so they don’t have the capacity to be the national voice.

Having said all that, and I know this may not be an easy question for you to answer, but

Are there any any recommendations you might have in terms of what we can do in Canada similar to what you’ve done in the U.K.?

Ian: I certainly think the opportunity of using social media is really, really important. The other thing that we’ve found is really helpful for us is to have a hook: to say, “this is really an important series and actually HIV testing week is now here, so order an HIV test”. That was really important for us and just seeing it as a conversation starter.

Also, we didn’t forget local media, either. Really important, I think, in terms of not having a national organization like Terrence Higgins Trust. I know you’ve got some very good locally based HIV organizations, so you can use the networks that they have. The local media channels, I think, were just as important for us to make sure that we were doing that. We always use lots of case studies in terms of our media activity to give it a human flavour. The opportunity that It’s a Sin provides, I think, is really important, so I’d encourage that.

One of the strongest pieces of television was on the mainstream BBC Breakfast program, where they had the cast talking to Rupert Whitaker, who was Terry Higgins’ partner and the founder of Terrence Higgins Trust, as well as a woman who was an HIV buddy, back in the early days of the epidemic. It was incredibly powerful and incredibly moving, because it was talking about people’s personal stories and how they resonate with what the drama shows. Which, as you’ve said, John, is extraordinarily powerful and, for me, at times, very, very painful to watch. I’ve never watched a series so much where I’ve been in pain through laughing and in pain through crying during the course of one episode. It’s been incredibly powerful. So, I think those are just some tips. I don’t think you need to just say it can only be done on a national scale. Think about some of the local opportunities that exist with It’s a Sin, as well.

John: Thanks for those hints, Ian. We’ll take them to heart.

Do you have any kind of final thoughts you want to share with us?

Ian: So, I think the final thing I would say, John, is take this as an opportunity. We have really been overwhelmed by the response, and it’s had an impact for us as an organization. It certainly has created that dialogue. It’s also had a massive financial impact, as well. Our fundraising income has increased significantly. I think we’ve probably raised in excess of half a million pounds off the back of It’s a Sin just because people are saying, actually, HIV isn’t over, there are still things that need to be done, and actually we want to give in order to make sure that the stigma is tackled and do all that we can to finally bring an end to HIV transmissions. And that’s been a big focus of our work over the last couple of months. So, I think I would just encourage you to keep these conversations going and just to think of where the hooks might be to keep that narrative going.

John: Thanks, Ian, so much. That’s wonderful. Again, congratulations to you personally and also to your staff and your organization for the brilliant work you’ve done on this and everything else in terms of talking about HIV and hopefully reaching the end of new HIV transmissions in the U.K. and making sure that people living with HIV can continue to look forward to a long, healthy and productive life.

This interview had been edited for brevity and clarity. To see the full discussion between John and Ian, watch the video here.

John McCullagh is co-chair of the Ontario AIDS Network and former chair of CATIE’s board of directors.

Ian Green is chief executive officer of Terrence Higgins Trust, the U.K.’s largest HIV charity.