Aids has always been laden with political and emotional volatilities. The possibility of blood- or sex-based transmission combined with its first emergence among marginalised and criminalised populations created a potent mix of primal terror and terrifying prejudice.

It can sometimes be difficult to remember just how potently misinformation, fear and outright hostility framed the knowledge and experience of Aids in the first decade or so of the pandemic. In this period, a positive result on an HIV test was a terminal diagnosis and medical knowledge about transmission and treatment was still cloudy.

In Australia in the 1980s it was an easy slide from epidemiological concentration among gay men, sex workers and IV drug users to moralising approbation and discrimination. Some parliamentarians and church leaders in Australia even suggested the forced imprisonment of anyone who tested positive for HIV.

Today in Africa shame and morality combine in a different way. More than half the global population of those living with HIV and Aids are found in southern and central Africa, where prevalence among adults in some countries is more than 10%. Here, transmission is primarily heterosexual, and it is the gap between assumptions of monogamy and the gendered realities of sexual practice that pose the biggest public health challenge. It is the most sexually vulnerable, then, in whom rates of transmission are growing most troublingly – namely among younger women.

Public health experts across the world knew it would be difficult to overcome the potent forces of shame, stigma and fear that textured the response to Aids. That is why public information officers at the World Health Organization invented World Aids Day on 1 December in 1988. They hoped it would become a powerful........

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