With Aids there came health warnings on TV and talk of divine retribution: a health holocaust was on its way. Horrified contemplation of half-remembered flings became a national pastime. We whipped ourselves into the same panic over BSE, and billions of pounds were spent on research into both.
But all that may soon seem like a storm in a teacup. There is a much bigger, seriously underestimated killer around, which has already infected 170m people worldwide - hepatitis C. Unlike Aids, it is just as likely to hit nice little Middle Englanders as prostitutes, drug addicts and homosexual men. Yet there are no signs of the health campaigns or government inquiries we might expect.
Maybe it's all just too confusing. Hepatitis ranges through types A to E, all with varying degrees of severity - and there could be up to a dozen more types still unidentified. Maybe it is because the disease can take up to 30 years to have any obvious effect on health. Whatever the reason, the ignorance is astounding, even in the medical profession. Britain is ill-prepared to deal with what experts are calling a "viral timebomb".
A survey of 5,000 women at a London ante-natal clinic gives a hint of what could lie in store: almost one in 100 were found to be infected with hepatitis C, which, extrapolated, would suggest up to 500,000 people across the country are carrying the virus. The report's authors, from St Mary's Hospital, London, are now calling for routine screening.
Dr Graham Foster, a leading liver specialist at the hospital, says: "There is no question there will be a huge epidemic of deaths - we're looking at anything up to 200,000 cases within the next decade. In the United States there are targeted screening campaigns. The French plan to identify 85% of sufferers by 2002. Here it seems we are all just hoping it will go away."
Foster says most people developing hepatitis C today are in their 40s and caught it 20 years ago, when it was fashionable for students to dabble with intravenous drugs. Most people only tried them once - but that was enough. "What makes it worse is that at that time we were short of blood and going round universities to get donations," says Foster.
The disease is caused by a virus (called the hepatitis C virus, or HCV) which was not identified until 1989. It is thought to have existed for at least 4,000 years in Asia before jumping to the west after the second world war.
Possible routes of infection are legion, including acupuncture, tattooing, ear piercing, sharing razors or dental treatment - some surveys suggest only a fifth of dentists use sterilisation techniques adequate to wipe out HCV. Occasionally it is passed on during childbirth and sex, but most of those at risk will have used intravenous drugs or had blood transfusions or clotting treatment before the early 90s.
Unlike HIV, which can survive for less than a minute outside the body, HCV can survive for hours or even weeks. Patients can live for decades with no obvious symptoms, and tens of thousands of people in the first, acute, stages are probably being misdiagnosed - up to 40% of those diagnosed with chronic fatigue syndrome could actually have hepatitis C. Later on, however, 60% will develop severe liver disease, at least half of them cirrhosis or liver cancer. Once the liver starts to fail, it does so quickly. If a transplant liver cannot be found, the patient will usually die within six to 12 months.
Although a combination of the drugs interferon and ribavirin can cure up to 40% of patients, many are denied the £7,000 therapy by their local authority, often ending up with a choice between transplant or death. Transplants may cost more than £30,000 plus £7,000 per year in anti-rejection drugs, but - crucially - are centrally-funded. William Rosenberg, of the liver group at the University of Southampton, says the cost of treating hepatitis C over the next 20 years could reach £9bn. "We can make a huge dent in that by spending something now. We can do a huge amount more about hepatitis C than we can about heart disease or hypertension or diabetes."
In the past, some patients have moved to different health authority areas to get treatment and beat the "postcode lottery". The loophole which allowed this has now been closed, however. Dr Foster says: "It beggars belief that anyone can possibly justify depriving a patient of a life-saving treatment, which will also reduce the long-term burden of care and cost to the NHS - but it is happening. We're also going to run out of organs for transplant very quickly at the rate cases are increasing."
The side effects of the drugs are so harsh that 20% of patients give up taking them, but John Bexon, 45, from Allestree, Derby, is one of the thousands who has been refused the chance even to try them. "I had to give up my work in construction because I got so ill," he says. "I've already cost the state a huge amount in terms of benefits and free prescriptions - never mind if I have a transplant." Bexon, who has tattoos and pierced ears, had several operations and was once an intravenous drug user, does not know how he caught the virus. It was detected in 1990 when he went to donate blood - worryingly, his 18th pint.
Hepatitis C has taken a heavy toll on him. "You get massive fatigue attacks which leave you unable to get out of bed for days. Sometimes you're too tired to even eat. I feel like an old man. I get headaches, I'm apathetic and depressed - in fact the psychological effects are as much torture as the physical ones. It's hard to explain how it feels to know that when your liver packs up there may very well be no liver available for transplant - and that you'll end up in a box."
Therese Cronje, 51, who also found out she was infected after giving blood in 1992, has been free of the disease for almost three years after receiving the combination drugs.
An employee of Barnet council in north London, she was offered treatment as part of an experimental programme at St Mary's Hospital, starting with interferon in 1995 and the combined drugs in 1997. She feels "guilty and privileged" to be cured.
Like Bexon, she still has no idea how she became infected, although she grew up in West Africa and had two miscarriages and blood transfusions in the 70s. It could also have been something as innocuous as dental work or electrolysis. "The fear when I found I was infected was incredible," she says. "My GP had never even heard of hepatitis C. I bought a book about it for information, which basically told you to prepare for death. It wasn't exactly helpful to be reading about 'end stages'."
The National Institute for Clinical Effectiveness (Nice) is reviewing the prescription of interferon and ribavirin, with a view to making them uniformly available - which it will probably do in November. "But the real question is what will happen next?" asks Dr Foster. "Where will the money come from to pay for treating all the patients? Who will do the sophisticated virological testing? Most importantly, where is the strategy?
"We need central funding as we had with Aids, because if decision-making remains at local level, the health authorities still won't have the budget for the drugs, and patients will go on suffering."
A guide to the hepatitis viruses
Hepatitis is an inflammation of the liver which causes slow, long-term damage. It is generally caused by viruses, occasionally by other infections such as mononucleosis, yellow fever and herpes simplex.
A, B and C are the most serious forms, and between them account for 75% of all chronic cases.
Anyone with hepatitis should drink plenty of water and avoid alcohol, processed foods, saccharin, wild mushrooms, iron and excessive amounts of vitamins such as Aand B3. This will stop your liver working too hard, and give you some control over the progress of the disease and speed of recovery.
Hepatitis A
Spread by consuming food or water contaminated with the stools of an infected person.
The virus can survive for four hours at room temperature in a speck of faeces on a nappy, hand or hard surface, and is most common in Latin America, Africa and parts of Asia.
Risks include eating infected food, such as shellfish contaminated with untreated sewage, oral or anal sex, poor hygiene, intravenous drug use and eating vegetables fertilised with human manure (a common practice in China).
Hepatitis A can worsen liver damage or even kill patients suffering from hepatitis B or C.
Hepatitis B
Spread by contact with blood and bodily fluids such as semen, vaginal secretions, saliva and open wounds.
Risks include intravenous drug use, unprotected sex, sharing razors or toothbrushes, and problems during childbirth. Cancer patients and those on dialysis are at increased risk, as are people living in closed communities such as prisons, or those exposed to blood at work.
95% of people fight the disease off themselves, but in America it kills 5,000 people a year, and one million are chronic sufferers who may go on to develop cirrhosis or cancer. In some states a child must be vaccinated before being allowed into elementary school.
In experiments, woodchucks vaccinated against hepatitis B were also apparently immune to liver cancer.
Hepatitis B is most common in the Pacific Islands and Asia.
Hepatitis C
Men, or anyone who contracts the virus over the age of 40, are most likely to develop serious damage.
Hepatitis C is twice as common in southern, as compared to northern Europe, three times as common in the Middle East, and 13 times more common in North Africa. In Egypt 15-20% of the adult population is infected.
Hepatitis D
Cannot take hold in anyone not already suffering from hepatitis B. Transmitted in the same way, although less commonly through sex or childbirth.
Hepatitis E
There are occasional epidemics in the developing world, but it does not become chronic.
Non A-E hepatitis
There could be up to a dozen other unidentified strains among those which currently do not respond to treatment. However, these are very rare. It is not yet known whether any go on to cause severe liver damage.
