ADDRESS

BY

C, EVERETT KOOP, MID,, Sc,D,

    SURGEON GENERAL

         OF THE

     U,SI PUBLIC HEALTH SERVICE
IJA DEPARTMENT OF HEALTH AFilD HUMAN SERVICES

PRESENTED TO THE NATIONAL CAPITAL AREA CHAPTER OF THE
   AMERICAN SOCIETY OF PUBLIC ADMINISTRATION
          WASHINGTON, DL
          DECEMBER 12, 1988


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,)

  I APPRECIATE THIS OPPORTUNITY TO TALK TO THE WASHINGTON

CHAPTER OF THE A,S,P,A, YOU ARE THE PEOPLE THAT MAKE GOVERNMENT

WORK, YEAR IN AND YEAR OUT , . , AND YOU KEEP IT HONEST , me AND YOU

KEEP IT FAIR,

  AND THAT'S WHAT OUR GOVERNMENT IS , , , BECAUSE THAT'S WHAT

THE OVERWHELMING MAJORITY OF GOVERNMENT PERSONNEL ARE, THEY'RE

HONEST n 8 m AND THEY'RE FAIR,


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  UNFORTUNATELY, ROUTINE DAY-TO-DAY HONESTY AND FAIR PLAY

WON'T MAKE A HEADLINE OR A "SOUND BITE" ON THE EVENING TJ'm NEWS,

INSTEAD D&HONESTY AND UNFAIRNESS WILL GET THE HEADLINES,

  AND I GUESS, FOR OUR KIND OF OPEN DEMOCRACY, THAT'S AS IT

SHOULD BE, WRONGDOERS SHOULD BE EXPOSED AND THE AMERICAN PEOPLE

SHOULD GET A LOOK AT THEM AND KNOW THEIR NAMES,

AS RESPONSIBLE ADMINISTRATORS AND DECISION-MAKERS IN

GOVERNMENT, WE SHOULD BE ON OUR GUARD, BECAUSE SOME VERY STRONG

FORCES ARE LINED UP AGAINST US,


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   "GREED" IS ONE am, EVERYONE TALKS ABOUT GREED, WHICH IS THE

FIRST DEADLY SIN TO MAKE THE COVER OF NEWSWEEK,

  BUT THERE'S MORE THAN GREED OUT THERE, THERE'S ALSO

PREJUDICE AND INTOLERANCE a a n INATTENTION , , , BOREDOM AND

IGNORANCE au m AND INDOLENCE,

THEY ARE AMONG THE BASER INSTINCTS OF THE HUMAN RACE, I'M

SORRY TO SAY, I WISH IT WERE NOT SO, BUT IT'S TRUE.


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  BUT THE HUMAN RACE HAS ANOTHER AND A MUCH GRANDER INSTINCT,

IT'S THE INSTINCT TO RECOVER AND TO SURVIVE 11, TO GET UP AND

KEEP GOING a,, THE INSTINCT FOR RENEWAL 11, THE INSTINCT FOR

SELF-PRESERVATION AND THE NEED TO FEEL GOOD ABOUT ONE'S SELF,

  AND, IF YOU THINK ABOUT IT FOR A MOMENT, YOU MIGHT AGREE

WITH ME THAT A GREAT DEAL OF OUR WORK IN GOVERNMENT SEEMS TO BE

IN THE SERVICE OF THIS PARTICULAR HUMAN INSTINCT,

  IT'S AN OPTIMISTIC INSTINCT, AND I THINK GOVERNMENT IS AT

ITS BEST, WHEN IT SUPPORTS AND NOURISHES THIS MOST HOPEFUL OF

HUMANITY'S MANY ATTRIBUTES: OUR BASIC INSTINCT TO WANT TO LIVE A

DECENT LIFE,


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  BUT THIS OBSERVATION ISN'T LIMITED TO GOVERNMENT, I THINK A
GOOD ADMINISTRATOR ANYWHERE WILL RESPECT THIS BASIC INSTINCT AND
WILL SUPPORT IT AND NURTURE IT AMONG HIS OR HER PERSONNEL,

  I THINK THAT'S WHAT WE MEAN THESE DAYS BY "OCCUPATIONAL

HEALTH" OR "EMPLOYEE HEALTH,"  WE'RE CONCERNED WITH MORE THAN AN
EMPLOYEE'S SPECIFIC HEALTH NEEDS TO GET A PARTICULAR JOB DONE an,
WE'RE CONCERNED WITH THAT EMPLOYEE'S HEALTH NEEDS IN GENERAL,

  AS A RESULT, WE'RE BRINGING THE CONCEPTS OF DISEASE
PREVENTION AND HEALTH PROMOTION INTO THE WORKPLACE AND ONTO THE

WORKSITE, ENLIGHTENED ADMINISTRATORS HAVE a.1


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3   MADE TIME FOR EXERCISE on, AND EVEN A PLACE FOR

      EXERCISE,



*   THEY'VE BANNED SMOKING ,a, MAKING THE WORKPLACE

      "SMOKE-FREE,"



*   THEY'VE PROVIDED ADVICE AND COUNSEL FOR EMPLOYEES

     ADDICTED TO CERTAIN DRUGS , , , ALCOHOL, FOR

     INSTANCE am, OR COCAINE ia, OR NICOTINE,



*   AND IF THERE'S AN EMPLOYEE CAFETERIA, GOOD ADMINI-

     STRATORS HAVE TRIED TO MAKE SURE THAT IT SERVES

HEALTHFUL, NUTRITIONAL MEALS


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  THESE ELEMENTS HAVE BECOME PART AND PARCEL OF WHAT WE WOULD

CALL "ENLIGHTENED MANAGEMENT AND ADMINISTRATION/' THEY ARE THE

HALLMARKS OF A PROGRESSIVE, OPTIMISTIC, SUCCESSFUL, "PEOPLE-

CENTERED" ORGANIZATION,

  THAT'S THE KIND OF ORGANIZATION THAT FULFILLS ITS MISSION

AND GETS THE JOB DONE BECAUSE ITS EMPLOYEES WORK HARD AND ARE

LOYAL afin AND ITS MANAGERS SET REALISTIC GOALS AND CONSISTENTLY

ACHIEVE THEM,


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   THIS APPROACH TO EMPLOYEE HEALTH HAS MANY GOOD OUTCOMES,

IT'S POSSIBLE, FOR EXAMPLE, FOR ENLIGHTENED MANAGERS TO SEE

PROGRESS AMONG THEIR EMPLOYEES WHO, WITH A LITTLE HELP, TRY TO

COPE WITH STRESS AND PRE-MENSTRUAL SYNDROME OR TRY TO REVERSE THE

DAMAGE DONE BY ALCOHOLISM OR OBESITY,

THOSE ARE POSITIVE EXPERIENCES AND THEY REFLECT, AGAIN, THE

TRIUMPH OF THAT BASIC HUMAN INSTINCT FOR SURVIVAL AND RENEWAL,

   AND BECAUSE SUCH EXPERIENCES DO OCCUR AMONG EMPLOYEES WITH

THOSE KINDS OF HEALTH PROBLEMS, MANY ADMINISTRATORS AND MANAGERS

GO THROUGH AN INITIAL PHASE OF UNCERTAINTY AND CONFUSION AS TO

THEIR ROLE IN REGARD TO EMPLOYEES WITH AIDS,


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LET ME SPEND THE NEXT FEW MOMENTS ON THIS PARTICULAR ISSUE:

THAT IS, AIDS IN THE WORKPLACE,

WHY TALK ABOUT IT AT ALL? FIRST, BECAUSE THE AIDS VIRUS IS

STILL SPREADING, BOTH IN THIS COUNTRY AND AROUND THE WORLD,

FOR EXAMPLE, IN THE 12 MONTHS THAT ENDED ON NOVEMBER 28, WE

LOGGED IN 32,000 NEW CASES RIGHT HERE IN THE UNITED STATES,

   SINCE THE FIRST 5 CASES OF AIDS WERE RECORDED IN LOS ANGELES

BACK IN 1981, WE'VE HAD A TOTAL OF 79,400 CASES REPORTED ACROSS

THE COUNTRY.


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  AT LEAST 5 CASES HAVE THUS FAR BEEN REPORTED FROM EVERY

STATE AND TERRITORY IN THE COUNTRY -- EXCEPT FOR THE PACIFIC

TRUST TERRITORY, WHICH HAS HAD ONLY ONE,

  AND OVER 700 CASES OF AIDS HAVE BEEN REPORTED FROM EACH OF

THE COUNTRY'S TOP 20 CITIES, FROM BOSTON TO SAN DIEGO n,, FROM

SEATTLE TO TAMPA,

SO WE NEED TO FOCUS ON THIS EPIDEMIC BECAUSE IT'S NOT

LETTING UP -- AND IT'S EVERYWHERE,


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  BUT THAT'S ONLY PART OF THE STORY,
          THE OTHER PART IS EVEN

MORE GRIM: AIDS IS VIRTUALLY 100 PERCENT FATAL, OF THOSE 79,000

AMERICANS WHO WERE REPORTED AS HAVING AIDS SINCE 1981, NEARLY

45,000 HAVE ALREADY DIED,

THAT'S AN OVERALL MORTALITY RATE OF 57 PERCENT,

BUT LET'S LOOK AT THOSE FIGURES MORE CLOSELY, OF THE NUMBER

OF PEOPLE WITH AIDS IN 1981, SOME 92 PERCENT HAVE ALREADY DIED,

OF THOSE IN 1982, CLOSE TO 90 PERCENT HAVE DIED,


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AND ALMOST HALF THE NUMBER OF PEOPLE WHO WERE REPORTED WITH

AIDS JUST LAST YEAR HAVE ALREADY DIED,

SO, EVEN THOUGH WE DON'T KNOW EVERYTHING ABOUT THIS DISEASE,

WE DO KNOW ONE THING FOR CERTAIN:

IF YOU HAVE AIDS, YOUR CHANCES OF SURVIVING THE NEXT TWO OR

THREE YEARS ARE NOT VERY GOOD, BUT YOUR CHANCES OF

SURVIVING ANY LONGER THAN THAT ARE ALMOST NIL,


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  AIDS IS SPREAD BY A VIRUS, BUT WE HAVE NO ANTI-VIRAL VACCINE

YET, WE'RE WORKING ON IT a mm IN FACT, WE'RE IN THE FIRST STAGES

OF VACCINE DEVELOPMENT RIGHT NOW, BUT THE FULL DEVELOPMENT

PROCESS CAN TAKE THE REST OF THIS CENTURY u nm EVEN ON AN

ACCELERATED TRACK,

  AND THE DRUGS THAT WE'RE LOOKING AT OR THAT WE' RE USING FOR

TREATMENT -- SUCH AS AmZ,T, -- ONLY PROLONG A PERSON'S LIFE FOR A

FEW MONTHS ma, MAYBE A YEAR ,nn E THEY WORK, THEY DO NOT CURE

ANYONE OF AIDS aam NOR DO THEY CURE ANYONE OF ANY CONDITION

BROUGHT ON BY AIDS,


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THE HARD TRUTH IS STILL THIS: WE HAVE NO "MAGIC BULLET" OF

ANY KIND TO PREVENT AIDS OR STOP IT IN ITS TRACKS,

  WHAT WE HAVE INSTEAD IS PUBLIC EDUCATION ABOUT THE DISEASE

AND THE WAY IT'S SPREAD, THROUGH PUBLIC EDUCATION, WE STAND A

CHANCE OF SLOWING DOWN AND ONE DAY EVEN REVERSING THE TREND OF

THIS EPIDEMIC

  WE CAN CARRY ON AN EDUCATION PROGRAM BECAUSE WE KNOW HOW

THE AIDS VIRUS IS TRANSMITTED, IT'S TRANSMITTED IN FOUR WAYS .,a

AND ONLY FOUR WAYS:


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*

  FIRST, THE MOST COMMON ROUTE OF TRANSMISSION IS SEXUAL

INTERCOURSE a, n MOSTLY BUT NOT EXCLUSIVELY ANAL INTERCOURSE,

WHICH OCCURS MOST FREQUENTLY AMONG HOMOSEXUALS AND BISEXUAL

MALES, THIS ACCOUNTS FOR ABOUT TWO-THIRDS OF ALL CASES OF

AIDS,

BUT PLEASE REMEMBER THAT HOMOSEXUALITY a an BY ITSELF mm,

DOES NOT CAUSE AIDS, JUST AS HETEROSEXUALITY ,,n BY ITSELF




I I I DOES NOT CAUSE SYPHILIS.

8

  SECOND, THE AIDS VIRUS IS ALSO TRANSMITTED WHEN

INTRAVENOUS DRUG ADDICTS USE THE NEEDLES AND SYRINGES OF

OTHER ADDICTS ALREADY INFECTED WITH AIDS VIRUS,


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THE VIRUS IS ALSO SPREAD WHEN INFECTED DRUG ADDICTS ENGAGE

IN HETEROSEXUAL ACTIVITIES, IN SOME OVERSEAS AREAS, FOR

EXAMPLE, ABOUT 90 PERCENT OF THE PROSTITUTES ARE AIDS-

POSITIVE, IN SOME AMERICAN CITIES, THE PREVALENCE RATE IS

ABOUT 20 PERCENT n,, BUT RISING,

+   THE VIRUS CAN ALSO BE TRANSMITTED FROM AN AIDS-INFECTED

MOTHER TO HER INFANT DURING PREGNANCY OR AT THE TIME OF

DELIVERY,


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RIGHT NOW, THIS COUNTRY HAS ABOUT A THOUSAND BABIES

NATIONWIDE WHO WERE BORN SEROPOSITIVE ,a, THAT IS, TESTS

MADE AT THE TIME OF BIRTH HAVE CONFIRMED THE PRESENCE OF

AIDS VIRUS ANTIBODIES IN THEIR BLOODSTREAMS,

*   AND FINALLY, AIDS CAN BE TRANSMITTED THROUGH TRANS-

FUSED BLOOD OR BLOOD PRODUCTS, BUT THIS DANGER IS NOW

ALMOST STATISTICALLY INSIGNIFICANT,

THE ODDS TODAY OF ANYONE GETTING A CONTAMINATED UNIT OF

TRANSFUSED BLOOD ARE BETWEEN 1 IN 40,000 AND 1 IN 250,000,

COMPARE THAT WITH, SAY, DEATH ON THE HIGHWAY, WHERE THE ODDS

AGAINST YOU ARE AS BAD AS 1 IN ONLY 5,900,


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  THESE, THEN, ARE THE FOUR ASPECTS OF THE AIDS EPIDEMIC THAT

WE ALL SHOULD KEEP IN MIND:

  ONE, THAT IT'S SPREADING 11,

  TWO, THAT IT'S FATAL, a 8

THREE, THAT WE DON'T HAVE A CURE YET 11,
AND FOUR, THAT IT'S SPREAD MAINLY BY CERTAIN SPECIFIC HIGH-

  RISK BEHAVIORS INVOLVING SEX AND/OR DRUGS,

  THESE FOUR ASPECTS MAKE THE AMERICAN PEOPLE VERY EDGY ABOUT
AIDS, AFTER ALL, THE OVERWHELMING MAJORITY OF AMERICANS DO NOT
ENGAGE IN ANAL SEX NOR DO THEY "SHOOT" DANGEROUS DRUGS, NOR DO

THEY APPROVE OF OTHERS WHO DO THESE THINGS,


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AND THAT'S WHERE THINGS CAN GET OFF TRACK, SO WE MUST

CONSTANTLY MAKE SURE THAT WHAT WE'RE DOING IS FIGHTING A DISEASE,

NOT THE PEOPLE WHO HAVE IT,

   I DON'T BELIEVE THAT MEANS WE HAVE TO COMPROMISE OUR

FEELINGS ABOUT THE KIND OF BEHAVIOR THAT MAKES AIDS POSSIBLEn  IN

FACT, OUR BASIC WEAPON AGAINST AIDS -- EDUCATION -- IS DIRECTED

RIGHT AT THOSE HIGH-RISK PATTERNS OF BEHAVIOR AND RIGHT AT THE

PEOPLE WHO PRACTICE THAT BEHAVIOR SO THAT THEY'LL CHANGE.

BUT EDUCATION IS NOT WHOLESALE CONDEMNATION 1.. AND IT'S NOT

HATE 11, AND IT'S NOT FEAR,


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   ONCE WE INDISCRIMINATELY ATTACK WHOLE GROUPS OF PEOPLE AMONG

WHOM THERE MAY BE SOME HIGH-RISK INDIVIDUALS -- CONDEMNING ALL

HOMOSEXUALS, FOR EXAMPLE, BECAUSE OF THE HIGH-RISK LIFESTYLES

PRACTICED BY 1 PERCENT OF THEM  -- OR ONCE WE ATTACK THOSE HIGH-

RISK PEOPLE THEMSELVES THROUGH DISCRIMINATORY PRACTICES OF ONE

KIND OR ANOTHER, THEN WE'LL LOSE THIS BATTLE FOR SURE.

  WE'LL LOSE THE WAR AGAINST AIDS a.1 AND WE'LL LOSE THE GOOD

SENSE THAT HAS PRESERVED OUR SOCIETY AND KEPT AMERICANS UNITED

THROUGHOUT MANY OTHER THREATS TO OUR PUBLIC HEALTH.


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  HENCE, I WOULD ENCOURAGE ALL OF You, AS ADMINISTRATORS AND

MANAGERS IN THE PUBLIC SECTOR, TO LEARN ABOUT THIS DISEASE AND

KNOW HOW TO AVOID THE EFFECTS NOT JUST AS THEY AFFECT OUR BODIES,

BUT ALSO AS THEY AFFECT OUR THOUGHTS AND OUR FEELINGS AS

COMPASSIONATE AND FAIR-MINDED CITIZENSm

  YOU MUST NOT USE YOUR IRRATIONAL FEAR OF AIDS AS A SHIELD

BEHIND WHICH TO VIOLATE THE ETHICS OF THE AMERICAN WORKPLACE,

OVER THE YEARS WE'VE TRIED TO ESTABLISH THE RULES OF FAIRNESS IN

ALL OUR WORK ENVIRONMENTS, WE CAN'T ALLOW THE AIDS VIRUS TO

INFECT AND DESTROY THAT ASPECT OF THE AMERICAN WAY,


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  WE'VE SENT THAT MESSAGE TO EDUCATORS m,, DOCTORS 11, AND
HOSPITAL ADMINISTRATORS WHO ARE TEMPTED TO TURN AWAY PEOPLE

WITH AIDS, WE'VE TOLD THEM: "DON'T DO IT."

  AND WE'RE SENDING IT TO ADMINISTRATORS, EMPLOYERS, AND
MANAGERS WHO ARE TEMPTED TO DISMISS ANY EMPLOYEE WITH AIDS, WE

SAY, "DON'T DO IT,  IT'S AGAINST THE LAW AND IT'S AGAINST THE

AMERICAN ETHIC OF COMPASSION AND FAIR PLAY,"

THE SUPREME COURT, THE PRESIDENT, AND THE ATTORNEY GENERAL

HAVE ALSO SENT THAT MESSAGE,


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   THEY'VE ALSO SAID THAT AIDS IS A "HANDICAPPING DISEASE/'

HOWEVER, A PERSON INFECTED WITH THE AIDS VIRUS MAY NOT SHOW ANY

CLINICAL SIGNS OR SYMPTOMS AND, HENCE, BE ABLE TO FUNCTION

NORMALLY AND ADEQUATELY ON THE JOB,

  THEREFORE, CURRENT LAW AND REGULATION SAYS THAT "HIV-

INFECTED EMPLOYEES SHOULD BE ALLOWED TO CONTINUE WORKING AS LONG

AS THEY ARE ABLE TO MAINTAIN ACCEPTABLE PERFORMANCE AND DO NOT

POSE A SAFETY OR HEALTH THREAT TO THEMSELVES OR OTHERS IN THE

WORKPLACE,"  THAT'S NOW FEDERAL POLICY,


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  AS I INDICATED EARLIER, A PERSON WITH AIDS HAS TO KNOWINGLY

DO CERTAIN THINGS TO POSE A SPECIFIC "SAFETY OR HEALTH THREAT" TO

OTHERS, SUCH AS PASSING ON THE VIRUS   THE TWO KEY THINGS WOULD

BE SEXUAL INTERCOURSE -- ESPECIALLY ANAL INTERCOURSE -- AND THE

SHARING OF NEEDLES WHILE "SHOOTING" DANGEROUS DRUGS,

  BELIEVE ME, IF THOSE KINDS OF THINGS ARE GOING ON IN YOUR

ORGANIZATION DURING THE NORMAL WORKDAY , mm THEN, MY FRIENDS,

AIDS IS THE LEAST OF YOUR PROBLEMS


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  OF COURSE, I'M USED TO TALKING IN THIS MANNER, AS A

PHYSICIAN AND AS YOUR SURGEON GENERAL, I'M PART OF A TRADITION OF

CARE THAT WILL NOT ABANDON THE SICK AND THE DISABLED, WHOEVER

THEY ARE AND WHATEVER THEY MAY HAVE DONE TO HAVE ENDED UP IN SUCH

A FIX,

AND I HAVE TAKEN AN OATH TO DO WHATEVER I CAN FOR SUCH

PEOPLE Enm

  THAT'S THE TRADITION OF MEDICINE, BUT IT ALSO HAPPENS TO BE

A FUNDAMENTAL TRADITION OF OUR COUNTRY, AND THIS IS WHERE I HOPE

YOU AND I STAND ON COMMON GROUND,


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  1JE CAN BE PROUD OF THE WAY THE UNITED STATES HAS SUCCESS-

FULLY FACED THE CHALLENGE OF FAIRNESS AND HAS GUARANTEED ALL OUR

CITIZENS EQUAL ACCESS TO ALL HEALTH AND SOCIAL SERVICES,

REGARDLESS OF THEIR RACE, COLOR, CREED, AGE, SEX, NATIONAL ORIGIN

I a I OR HANDICAP,

   IT'S NOT AN EASY TRADITION AND k/E HAVEN'T BEEN PERFECT AT IT

EITHER, BUT OUR RECORD IS STILL VERY GOOD, AND IT'S A RECORD TO

BUILD ON ma, NOT A RECORD TO IGNORE,


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SO THE QUESTION BEFORE US IS SIMPLY THIS:

8

WILL WE LET THE DISEASE OF AIDS -- ALL BY ITSELF --

REVERSE THIS SPECIAL AMERICAN CONTRIBUTION TO HUMAN HISTORY?

WE HOPE AND PRAY THAT THAT WON'T HAPPEN,

  BUT HOPES AND PRAYERS MAY NOT BE ENOUGH, WE NEED TO

REINFORCE THOSE HOPES AND PRAYERS WITH COURAGE AND COMPASSION AT

EVERY LEVEL OF GOVERNMENT nm,  IN EVERY OFFICE AND MEETING-ROOM




I I I AND AT EVERY WORK STATION,


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  WE MUST FIGHT THIS DISEASE WITH GOOD SCIENCE 1.1 AND WITH

GOOD SENSE,  IF WE DO, WE MAY YET GIVE THE WORLD SOMETHING EVERY
BIT AS PRECIOUS AS THE MUCH-DESIRED AIDS VACCINE:

WE COULD GIVE THE WORLD A GENUINE DEMONSTRATION OF THE POWER
OF COMPASSION AND JUSTICE IN THE BATTLE AGAINST THIS DREAD

DISEASE OF AIDS

THAT'S MY HOPE, MAYBE IT CAN BE YOURS AS WELL,

ONCE AGAIN, m BTHANK YOU,

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