Flirting with death: The UK's first Aids 'cluster'

After 20 years of public-health campaigns about Aids, it seems that complacency is setting in. And nowhere more so than among heterosexuals, many of whom still believe that Aids is something that should concern gays, drug-users and Africans, but not them. They are wrong. In 1999, heterosexually acquired, new cases of HIV overtook homosexually acquired infection for the first time in the UK. In the last six years, there has been an alarming three-fold increase in HIV cases resulting from sex between men and women.

If you are young, heterosexual and out clubbing on a Saturday night – or any night, come to that – the disease could be closer than you think. The residents of Doncaster discovered just how close when the town was at the centre of one of Britain's biggest Aids scares. Five women, who were all found to be HIV-positive, named the same man among their sexual partners – a tall, dark and, presumably, charismatic nightclub bouncer called Steve Robson, whose exploits earned him the title of the "Doncaster bonker".

Doncaster's wild nightlife is indistinguishable from that of many northern towns. Young people come to drink in its bars, dance in its clubs, and carouse in its streets. But when Mr Robson told the public-health officials who contacted him that he had had sex with up to 1,000 women, most of whose names and faces he could not remember, they feared that the town was facing a disaster.

Up to that point, doctors had identified 11 women who'd had sex with Mr Robson, of whom five were infected with HIV. One had died. That suggested a near 50 per cent transmission rate. If his claims to have had sex with 1,000 women were even half-true, it was possible that scores of people were carrying the virus. Since most would be ignorant that they were infected, they in turn could pass the disease on to scores more.

The possibility brought Ken Allen, the regional specialist in communicable-disease control, out in a cold sweat. As the consultant in charge, it was his responsibility to tackle, and to curb, any public-health threat. The full story of how he and his colleagues dealt with the UK's first Aids cluster, in 1998, is told in the current volume of the Communicable Disease and Public Health journal. As heterosexually transmitted cases of Aids now outnumber those contracted from gay sex (although most have a connection with Africa), it serves as a warning to carefree clubbers of how unlucky those who fail to take precautions can be. One woman who caught HIV from Mr Robson had sex with him just three times.

The scare was triggered when the health authority identified 10 cases of HIV in Doncaster, twice the national average rate, five of which were linked with Mr Robson. In order to protect his identity, they decided to launch a campaign highlighting the rise in local heterosexual HIV infections, and linking it with the dangers of unprotected sex on the Doncaster nightclub scene. However, the real aim was to identify Mr Robson's other sexual contacts.

Mr Robson, 40, was offered sanctuary in another town before the press release was issued because it was thought likely that he could be identified as the source of the outbreak. Health officials feared for his safety in the furore that was bound to follow. His name had been mentioned frequently by women attending the genito-urinary clinic, and it was known to the police, so they believed his cover could be blown. Dr Allen said: "Of his known contacts, nearly 50 per cent had acquired the disease. There he was, boasting of how many women he'd had. It could have been very serious."

He was thought to have acquired the infection more than a decade earlier while living in Amsterdam, where he had been injecting drugs. He didn't discover that he was infected until he was admitted to hospital in 1996 with a lung infection, Pneumocystis carinii, typical of Aids. Since then, he was believed to have "behaved well" and taken care to wear a condom when having sex. The five women with HIV linked to him had all been infected prior to 1996.

When the press release was issued on 28 July 1998, helplines set up by the health authority were besieged by callers, some desperately worried. Many admitted to having sex with several people on the same night without using condoms. Dr Allen said: "A lot of people don't know whom they have sex with on a Saturday night. That's what came out. I took a call one night from a woman who had been going into town and having sex with anybody and everybody. She became quite hysterical when she realised what she had been doing. It was distressing and difficult to deal with." Some volunteers hired to counsel callers found the emotional pressure too hard to take. Others needed help to recover at the end of a shift. The town experienced a collective trauma.

Two days after the launch of the campaign, there was an unexpected development. Mr Robson, whose identity was still unknown to the public, discarded the cloak of anonymity that the health authority had thrown around him, and identified himself to the press. "He told me that he was going to sell his story, but whether he did or not, I don't know," said Dr Allen.

It seems unlikely that any news organisation paid him for his story as it appeared in several papers at the same time. But it revealed just how little notice young people were taking of the safe-sex messages that had been pumped out by government organisations for a decade.

Mr Robson told The Sun: "I can't give the doctors a list of all the women I've had. I can't remember the names or even the faces. I'd never wear a condom. We'd have sex in doorways or down alleys. Sometimes, we'd go back to their place. Aids was the last thing on my mind. It was wham bam and on to the next one."

The next day, it emerged that he had been married, briefly, to a woman half his age in 1996, four months after learning that he was HIV-positive. She said that they had only had sex a few times during their 20- month relationship, always with a condom, adding: "I know people won't understand, but I loved him and wanted us to be man and wife. But now I am appalled by him. The only sympathy I have is for the women he condemned to death by his lifestyle."

By the time the helplines closed a month later, 1,600 people had called for advice, of whom more than 1,000 were thought to be at risk. Of these, 772 had an HIV test, which revealed two more women with the virus, one from Doncaster and one from London, who later admitted having had sex with Mr Robson. That brought his tally of women infected to seven.

Among almost 250 people who declined an HIV test, doctors considered four to be at especially high risk on account of their sexual history. Dr Allen said: "If you think you might be infected with HIV, there are two things you can do. You can either go for a test, which may have repercussions on your ability to get life insurance or a mortgage, or you can assume that you are infected and modify your behaviour. A small number of women chose the latter course."

It was another year before public-health officials learnt what impact the HIV cluster linked to the nightclub bouncer had had on the local population. It was zero. Every Saturday night, the town buzzed with clubbers as before, and a survey conducted in September 1999 found condom use had actually declined. Eight out of 10 young people questioned said that they did not consider themselves to be at risk.

Four years on, the situation is much the same, according to Dr Allen. "The potential for another cluster is still there because behaviour hasn't changed," he said. Except for one factor – the town is at least safe from Mr Robson. He died two years ago.