AaDREss
BY

C, EVERETT KOOP, MIDl, Sc,D,
   SURGEON GENERAL

        OF THE

    'u,S, PUBLIC HEALTH SERVICE
U& DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE NATIONAL P,T,A,
   SALT LAKE CITY, UTAH
     JUNE 19, 1988


1

(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETCJ

  THANK YOU FOR THIS OPPORTUNITY TO SPEAK AT YOUR ANNUAL

MEETING, AND THANK YOU FOR BEING TRUE AND EFFECTIVE ALLIES TO

THE OFFICE OF THE SURGEON GENERAL,

  THIS IS MY 7TH YEAR IN THAT OFFICE,  IT'S BEEN ONE OF THE

MOST EXCITING -- AND MOST REWARDING -- PERIODS OF MY LIFE, THE

PUBLIC HEALTH ISSUES I'VE HAD TO CONFRONT HAVE BEEN PROFOUNDLY

CHALLENGING,


2

BUT WITH THE HELP OF PRIVATE, GRASS-ROOTS ORGANIZATIONS SUCH

AS THE NATIONAL PmToAe AND THE THOUSANDS OF INDIVIDUAL, LOCAL

P,T,A,'s AROUND THE NATION, WE'VE BEEN ABLE TO "MAKE A

DIFFERENCE" -- A POSITIE DIFFERENCE -- IN THE LIVES OF AMERICA'S

CHILDREN AND THEIR FAMILIES,

  WE'VE DEALT WITH THE NEEDS OF OUR HANDICAPPED AND DISABLED

CHILDREN, THIS WAS AMONG THE FIRST ITEMS ON MY AGENDA, WHEN I

ASSUMED THIS OFFICE, AND WITH YOUR HELP, WE'VE BEEN ABLE TO

BRING TOGETHER EDUCATORS, PUBLIC HEALTH PERSONNEL, AND CONCERNED

LAYPEOPLE AND WE'VE MADE THEM FOCUS ON THE PROBLEMS OF THESE

CHILDREN AND THEIR FAMILIES AND COME UP WITH BETTER SUPPORT AND

MORE RELEVANT SERVICES FOR THEM,


3

TOGETHER WE'VE MET THE TOBACCO INDUSTRY HEAD-ON I  WE'VE

PROPERLY DENOUNCED THEM FOR DOING A TERRIBLE THING a,, FOR

SHAMELESS ADVERTISING DESIGNED TO CONVINCE OUR NATION'S CHILDREN

TO BECOME ADDICTED TO CIGARETTE SMOKING,

  AND THAT'S PRECISELY AND MEDICALLY WHAT SMOKING IS , , , AN

ADDICTION aa, ONE THAT WILL EXPOSE CHILDREN TO THE RAVAGES OF

MAJOR HEART AND LUNG DISEASES THROUGHOUT THEIR LIVES.

AND IT WILL SHORTFN THEIR LIVES AS WELL,


4

BUT THROUGH OUR SCHOOLS, WE'RE REACHING CHILDREN WITH THE

TRUTH AND, AS A RESULT, FEWER AND FEWER OF THEM ARE BUYING THE

TOBACCO INDUSTRY'S FLASHY BUT DEADLY FALSEHOODS,

  AND TOGETHER, ALL OF US -- PARENTS, TEACHERS, AND PUBLIC

HEALTH PERSONNEL -- WE'VE LINKED ARMS IN JHE BATTLE AGAINST

SUBSTANCE ABUSE, WHETHER IT'S JUVENILE ALCOHOLISM AND DRUNK

DRIVING OR MARIJUANA AND COCAINE,

  THAT BATTLE IS ALSO FAR FROM OVER, BUT AGAIN, WE HAVE EVERY

REASON TO BE ENCOURAGED BY THE RESPONSE BY THE OVERWHELMING

MAJORITY OF YOUNG PEOPLE, THEY UNDERSTAND THE DANGER. AND

THEY'RE NOT BUYING,


5

  AND RIGHT NOW, WE STAND TOGETHER ONCE AGAIN, A UNITED FORCE

FOR REASON 1,s AND HEALTH mm, AND FOR LIFE m,m A UNITED FORCE IN

A BATTLE AGAINST WHAT IS POTENTIALLY ONE OF THE MOST DEVASTATING

OF ALL THE DISEASES THAT EVER SCARRED THE HISTORY OF .THE HUMAN

RACE,

   AIDS mm, THE "ACQUIRED IMMUNE DEFICIENCY SYNDROME" ,,a A

DISEASE SPREAD BY A VIRUS,

  NO, THAT'S NOT QUITE RIGHT, IT'S A DISEASE CONDITION CAUSED

BY A VIRUS JHAT IS SPREAD,  IT DOESN'T GO ANYWHERE ON ITS OWN a,,

NOT THROUGH THE AIR , , , NOT IN OUR RIVERS AND RESERVOIRS m mm AND

NOT IN OUR FOOD,


6

PEOPLE TRANSMIT THIS DEADLY VIRUS THROUGH THEIR OWN

PERSONAL, HIGH-RISK BEHAVIOR: ANAL INTERCOURSE I,, SEXUAL

PROMISCUITY turn NEEDLE-SHARING AND DRUG ADDICTION a,, THE THINGS

THAT HAVE BEEN TALKED ABOUT ON RADIO AND TELEVISION AND DESCRIBED

IN NEWSPAPERS AND MAGAZINES.

  EVERY PUBLIC OPINION SURVEY I'VE SEEN RECENTLY INDICATES

THAT CLOSE TO 99 PERCENT OF THE AMERICAN PEOPLE KNOW ABOUT AIDS

AND ABOUT THE WAYS IT IS MOST COMMONLY TRANSMITTED,


7

  YOU DESCRIBE THE SITUATION VERY CANDIDLY IN YOUR PaTmAn

BROCHURE, HOW TO TAIK TO YOUR TENS AND CHILDRFN ABOUT AIDS,

I'VE ALSO WRITTEN ABOUT THIS EPIDEMIC IN TWO PAMPHLETS -- MY

FIRST SURGEON GENERAL'S REPORT ON AIDS, WHICH I RELEASED IN

OCTOBER OF 1986, AND THE ONE THAT IS NOW GOING INTO EVERY MAILBOX

IN AMERICA, CALLED UNDWING AIDS,

  AND AT THIS CONVENTION YOU CAN SEE FOR THE FIRST TIME A

SHORT VIDEO PRODUCED BY THE NATIONAL P,T,A, AND THE USa PUBLIC

HEALTH SERVICE IN WHICH I GIVE THE FACTS ABOUT AIDS AND ASK

LOCAL P,TtAe'S TO HELP GET THE MESSAGE ACROSS TO EVERYONE IN OUR

SCHOOLS: STUDENTS, TEACHERS, ADMINISTRATORS, BOARD MEMBERS, AND

PARENTS


8

WHY ALL THIS URGENCY? THE ANSWER IS SIMPLE am, AND VERY,

VERY WORRISOME,

  FIRST OF ALL, AIDS IS A FATAL DISEASE,  THE MORTAL I TY RATE,

FOR ALL INTENTS AND PURPOSES, IS 100 PERCENT, ALMOST A THIRD OF

THE PEOPLE WITH AIDS DIAGNOSED JUST LAST YEAR HAVE ALREADY DIED,

  SECONDLY, WE HAVE NO CURf FOR AIDS,
           NO VACCINE aa, NO PILL




I I I NO TABLET us, NO "MAGIC BULLET" s,m NOTHING,

  NO DOUBT YOU'VE READ NEWS REPORTS ABOUT SOME VACCINE TESTING

THAT'S JUST GETTING UNDERWAY, IT'S TRUE ,a, THE GOVERNMENT !j.&

ALLOWED SOME VACCINE TESTING TO BEGIN,


9

BUT THESE ARE ONLY THE VERY FIRST STEPS IN VACCINE

DEVELOPMENT, THE REMAINDER OF THE PROCESS WILL BE VERY LONG --

STRETCHING TO THE END OF THIS CENTURY AT THE LFAST,  AND THAT'S

PUTTING THE BEST FACE ON IT,

   SO I MUST SAY THAT IF YOU -- OR ANY OF YOUR TEACHERS OR ANY

PARENTS OR STUDENTS -- MINIMIZE THE SITUATION WE'RE IN, EXPECTING

A CURE TO BE DISCOVERED ANY DAY NOW a a a YOU -- AND THEY -- ARE

SADLY MISTAKEN.

"ANY DAY" COULD BE 12 TO 15 YEARS AWAY,


10

  WE QQ HAVE A,Z.T,, WHICH SEEMS TO SLOW DOWN THE DISEASE
PROCESS, ADDING MONTHS -- MAYBE EVEN YEARS -- TO THE LIFE OF

SOMEONE WITH AIDS

BUT A,Z,T, IS NOT A CURE EITHER,

AND FINALLY, AIDS IS SPREADING, THE NUMBERS ARE ALL GOING

UP, NOT DOWN,

  EXACTLY SEVEN YEARS AGO, IN JUNE OF 1981, WE HAD OUR FIRST

REPORTS OF THIS STRANGE DISEASE, A RARE TYPE OF PNEUMONIA HAD

STRUCK FIVE "OTHERWISE HEALTHY HOMOSEXUAL MALES" IN LOS ANGELES,

CALIFORNIA,


11

SINCE THOSE FIRST 5 CASES WERE RECORDED, LOS ANGELES HAS

REPORTED ANOTHER 5,000 CASFS  I I I AND THE COUNTRY AS A WHOLE HAS

TURNED UP MORE THAN 65,000 CASES OF AIDS,

FROM 5 CASES TO 65,000 CASES IN 7 YEARS, OVER HALF THOSE

PEOPLE HAVE SINCE DIED, AND THE REST PROBABLY WILL,

   YOU MUST TAKE SERIOUSLY AN!( DISEASE THAT EXPLODES UPON A

NATION -- AND UPON THE WORLD -- WITH SUCH SPEED AND SUCH

SEVERITY,


12

BUT THE AIDS EPIDEMIC IS MORE THAN JUST AN EXERCISE IN

NUMBERS THE FIRST REPORTS MAY HAVE COME FROM LOS ANGELES, BUT
TODAY [ HAS BEEN TOUCHED BY THIS

EPIDEMIC,

  INDIANA, OUT IN THE HEARTLAND OF AMERICA, HAS HAD 337 CASES

SO FAR a an KANSAS HAS HAD 149 a a e MAINE, 76 CASES am m NORTH

DAKOTA, 7 urna AND EVEN GUAM HAS HAD 5 CASES SO FAR,

  AND 20 CITIES IN 14 STATES HAVE EACH REPORTED OVER 500 CASES
OF AIDS SINCE 1981, CLEARLY, THE AIDS EPIDEMIC IS GROWING

NUMERICALLY AND SPREAD I NG GEOGRAPHICALLY,


-*-- THE VIRUS IS FOLLOWING A FAIRLY STABLE PATTERN, AS IT

   BUT

SPREADS,

FOR THE PAST SEVERAL YEARS ,a m

ABOUT TWO-THIRDS OF ALL PEOPLE WITH AIDS WERE

HOMOSEXUALS OR BISEXUAL MALES

ANOTHER ONE-FOURTH OF ALL AIDS VICTIMS HAVE BEEN DRUG

ADDICTS WHO SHARE THEIR NEEDLES

AND A VERY SMALL NUMBER -- 4 PERCENT OF THE TOTAL --

HAVE BEEN NONE OF THE ABOVE BUT ARE HETEROSEXUAL MEN

AND WOMEN AMONG WHOM THE VIRUS HAS BEEN SEXUALLY

TRANSMITTED,

13


14

THERE ARE, HOWEVER, SOME EARLY SIGNS OF POSSIBLE SHIFTS

TAKING PLACE, FOR EXAMPLE, THE NUMBER OF HOMOSEXUALS WITH AIDS

IS NOT CLIMBING AS RAPIDLY AS IT HAS IN THE PAST, WHILE THE RISE

IN THE NUMBER OF DRUG ADDICTS WITH AIDS Is BEGINNING .TO

ACCELERATE,

  NEVERTHELESS, THE BASIC AIDS POPULATION IS REMAINING THE

SAME: 90 PERCENT OF ALL AIDS CASES INVOLVE EITHER HOMOSEXUALS AND

BISEXUAL MALES OR INTRAVENOUS DRUG ABUSERS


15

  TO OUR BEST KNOWLEDGE, THIS IS STILL THE PATTERN SHOWING UP

IN ALL THOSE AREAS I MENTIONED BEFORE ,,a THE MIDWEST, NEW

ENGLAND, THE NORTHWEST, AND SO ON 11, THE AREAS WHICH, AT THIS

LATE DATE, ARE JUST BEGINNING TO REPORT THEIR FIRST CASES OF

AIDS,

  THEREFORE, IF WE HOPE TO PREVENT THE DISEASE FROM SPREADING

INTO THE GENERAL POPULATION -- AND DO THIS WITHOUT THE HELP OF

ANY BIOMFDICAC CURE -- WE MUST FIND A BIOBEHAVIORAL WAY,


16

AND THAT MEANS EDUCATION:
  EDUCATION TO CONVINCE HOMOSEXUALS AND DRUG ADDICTS TO

  CHANGE THEIR LIFESTYLES AND ABANDON THEIR HIGH-RISK

   BEHAVIOR am,

AND FDUCATION TO CONVINCE THE REST OF THE COUNTRY m

TO CHANGES

  ONE APPROACH WITHOUT THE OTHER WOULD BE DISASTROUS FOR US,

HENCE, WE'VE BEEN SENDING STRONG EDUCATIONAL MESSAGES TO THE

HOMOSEXUAL COMMUNITY -- AND WE BELIEVE THE VIRUS TRANSMISSION

RATE MAY BE GOING DOWN AS A RESULT -- AND WE'RE TRYING, AS

ALWAYS, TO MAKE SOME DENT IN THE SHADOWY UNDERGROUND SUB-CULTURE

OF DRUGS,


17

AT THE SAME TIME, HOWEVER, WE'RE MAINTAINING A STRONG AND

CONTINUOUS PROGRAM OF AIDS EDUCATION DIRECTED TO THE COUNTRY AT

LARGE men IN EFFECT, TO NON-ADDICTED HETEROSEXUALS

  AND THESE ARE OUR STUDENTS, OUR TEACHERS, OUR PARENTS, OUR

COMMUNITY LEADERS, AND THE GENERAL PUBLIC,

AND JUST WHAT ARE WE TELLING THESE DIFFERENT GROUPS?

TO THE DRUG ABUSERS, THE MESSAGE IS CLEAR ENOUGH:

  DON'T SHqRE DIRTY NFEDLES OR SYRINGFS,


18

TO THE HOMOSEXUAL COMMUNITY, ,I

DO NOT ENGAGF IN UNPROTECTED SEXUAL ACTIVITY I

TO HETEROSEXUAL ADULTS AND YOUNG ADULTS, WE'RE SENDING

ESSENTIALLY THAT SAME MESSAGE,

  BUT FOR CHILDREN AND ADOLESCENTS, WE NEED TO PRESENT

SOMETHING QUITE DIFFERENT,  IT'S LIKELY THAT THEY HAVE LITTLE OR

NO UNDERSTANDING OF HUMAN SEXUALITY, AND I MUST CONFESS THAT I

AM DEEPLY SADDENED BY THE IDEA THAT WE MUST EXPLAIN HUMAN

RELATIONSHIPS AND HUMAN SEXUALITY TO A NEW GENERATION OF GIRLS

AND BOYS -- SO THAT THEY MAY AVOID CONTRACTING A FATAL DISEASE,


19

AND YET , , , WE MUST,

AND OUR FIRST RECOMMENDATION OUGHT TO BE ABSTINFNCE FRO11

I GRANT THAT SEXUAL ABSTINENCE MAY NOT WORK FOR EVERYONE,

IF IT DID, THAT WOULD LITERALLY MEAN THE END OF THE HUMAN RACE,

  BUT SEXUAL ABSTINENCE IS A VFRY GOOD IDEA FOR YOUNGSTERS OF

SCHOOL AGE,


                   20

   TODAY -- IN THE PRESENCE OF THE DEADLY AIDS EPIDEMIC -- I

THINK WE, AS ADULTS, MUST STEP FORWARD AND HELP OUR CHILDREN

ADDRESS THE PHENOMENON OF THEIR OWN SEXUALITY IN A CARING,

DEVELOPMENTAL WAY,

  AND OUR MESSAGE OUGHT TO INCLUDE THE WISDOM OF CHOOSING TO

BE SEXUALLY ABSTINENT, WHILE STILL IN SCHOOL,

  FOR THE REST OF US -- THE ADULTS AND YOUNG ADULTS IN THE

COMMUNITY -- ABSTINENCE MAY NOT BE THE BEHAVIOR OF CHOICE, WHAT

THEN?


21

I BELIEVE THE NEXT BEST THING IS MONOGAMY , , , ONE PERSON,

ONE MATE: FIND SOMEONE TO WHOM YOU CAN GIVE YOUR LOVE AND

RESPECT AND TRUST 81, SOMEONE WHO WILL GIVE THE SAME IN RETURN




I I I AND STAY WITH THAT PERSON FOREVER,

SUCH A MONOGAMOUS RELATIONSHIP IS NOT LIKELY TO BE INFECTED

AND CONSUMED BY AIDS 11, OR BY ANY OTHER DISEASE EITHER,

  OF COURSE, A NUMBER OF PEOPLE ARE MONOGAMOUS -- BUT u
SEQUENCE: THAT IS, THROUGH DIVORCE AND RE-MARRIAGE, FOR EXAMPLE,

AN INDIVIDUAL MAY HAVE ONE 111 TWO mm1 OR MORE MONOGAMOUS

PARTNERS DURING HIS OR HER ADULT LIFETIME,   WHAT ABOUT THEM?


22

  AND WHAT ABOUT THE PEOPLE WHO, FOR WHATEVER REASONS, DO NOT

HAVE A LOVING, MONOGAMOUS RELATIONSHIP -- AND PERHAPS NEVER WILL

HAVE? YET, THEY, TOO, MAY WANT TO EXPRESS THEIR OWN SEXUALITY

FROM TIME TO TIME AND THAT'S A NORMAL ENOUGH DESIRE,

   FOR THEM WE MUST RECOMMEND THAT THEY PROTECT THEMSELVES,

AND, AT THE PRESENT TIME, THE ONLY EFFECTIVE PROTECTION AVAILABLE

IS THE LATEX CONDOM,

   CONDOMS ARE NOT ONE-HUNDRED-PERCENT-PERFECT, I'VE NEVER

CLAIMED THAT THEY WERE aan ALTHOUGH, FRANKLY, CONDOMS -- AS

GADGETS -- ARE MORE RELIABLE THAN THE PEOPLE WHO USE THEM,


23

  HOWEVER, WHEN USED CORRECTLY -- THAT IS, WHEN THE LATEX

CONDOM IS WORN FROM START TO FINISH DURING SEXUAL INTERCOURSE,

WITH A LITTLE SPERMICIDE ADDED IN THE TIP AND ON THE SIDES -- IT

DOES PROVIDE AN EFFECTIVE BARRIER AGAINST THE TRANSMKSION OF THE

AIDS VIRUS

  ABSTINENCE a ,m MONOGAMY a a, AND THE USE OF THE LATEX CONDOM

ARE AT THE CORE OF OUR EDUCATION PROGRAM TO HELP ADULTS AND YOUNG

ADULTS DEFEND THEMSELVES AGAINST THE TRANSMISSION OF THE AIDS

VIRUS THROUGH SEXUAL INTERCOURSE,


24

OF COURSE, IT IS EASIER TO DESCRIBE THAN TO DELIVER, AND

IT'S AN ESPECIALLY DIFFICULT MESSAGE TO DELIVER TO YOUNG PEOPLE,

ESPECIALLY CHILDREN IN ELEMENTARY AND MIDDLE SCHOOL,

  BUT IT 1s A LIFE-SAVING MESSAGE AND, THEREFORE, WE ARE

DUTY-BOUND TO DELIVER IT,

  THOSE OF US IN MEDICINE AND PUBLIC HEALTH MAY RELY TOO MUCH

ON THE CLINICAL ASPECTS OF THE MESSAGE, AND I THINK THAT'S A

MISTAKE,


25

A THOUGHTFUL EDUCATIONAL PROGRAM DEALING WITH SEXUALITY AND

AIDS PREVENTION SHOULD ALSO TOUCH UPON SOME NON-CLINICAL

CONCEPTS, SUCH AS SEX WITH RESPONSIBILITY ama SEX WITH CARING mnm

SEX WITH JUSTICE 1,s AND SEX WITH U-RESPECT AND WITH MUTUAL

RESPECT,

  FROM A PUBLIC HEALTH POINT OF VIEW, THEN, THIS IS ALL THERE

IS TO A BASIC INFORMATION PROGRAM ABOUT AIDS: WHAT IT IS, HOW

IT'S TRANSMITTED, AND HOW TO PROTECT ONE'S SELF AGAINST IT,


26

AND I BELIEVE THAT WE ADULTS ARE MORALLY OBLIGATED TO TELL

YOUNG PEOPLE THE FACTS ABOUT AIDS, BUT THOSE FACTS DO NOT EXIST

IN A VACUUM,

  MAHATMA GHANDI ONCE WROTE THAT "MORALITY IS THE BASIS OF ALL

THINGS AND TRUTH IS THE SUBSTANCE OF ALL MORALITY,"  WELL, THEN,

LET'S TELL OUR YOUNG PEOPLE THE TRUTH ABOUT AIDS, BUT LET US

ALSO TELL THEM THE TRUTH ABOUT HUMAN DECENCY AND LOVE.AND MUTUAL

RESPECT AND RESPONSIBILITY m

  AND WITH THESE FACTS AND THESE TRUTHS, LET US HELP THEM PUT

TOGETHER THE SUBSTANCE OF THEIR OWN MORAL LIVES AND, IN SO DOING,

HELP THEM TO DFFFND THOSE VERY LIVES AGAINST AIDS ,I, AND EVERY

OTHER HUMAN CALAMITY AS WELL,


27

THAT'S THE KIND OF ADULT OUR SOCIETY NEEDS TODAY,

AND TOMORROW mm, EVEN MORE SO.

   WITH YOUR HELP -- AND WITH THE HELP OF YOUR SCHOOLS AND YOUR

COMMUNITIES -- WE WILL HAVE THOSE ADULTS TOMORROW 1.1 ALIVE AND

WELL AND LIVING IN AMERICA,

THANK YOU,

#####