For a year Surgeon General C. Everett
Koop has campaigned for an all-out
war against acquired immune deficien-
cy syndrome. The 70-year-old head of
the Public Health Service believes that
massive research and public educa-
tion programs are essential if a cata-
strophic epidemic is to be averted. Ris-
ing concern was underlined at a
conference in Atlanta two weeks ago
when widespread mandatory testing
was discussed as a way of identifying
AIDS carriers. Koop gave Correspon-
dent Marsha Dubrow an update on
the disease.

How much worse do you think the AIDS
problem will get?

In the U.S. we think that by the end of
1990 there will be about 170,000 dead,
with 54,000 dying in that year, and an-
other quarter of a million people will
have been diagnosed. We expect be-
tween 50 and 100 million deaths world-
wide by the early years of the next
century. Ninety-one countries have al-
ready reported AIDS. Many nations are
loath to do so because of the stigma,
so I think all the statisticswe get from
abroad are on the low side. Even in the
U.S. there is underreporting by some
states due to incorrect diagnosis and
the wish to avoid stigmatizing.victims.

Is there any chanoethat the AIDS threat
might be exaggerated?
I don't think so. Everything I see
scares me more than I was before.

And yet the Administration's 1988 bud-
get request of $534 million is only half of
what some experts recommend. Do you
think the Administration has requested
sufficient funding?

I think so. For thls year. I'm very'
pleased that there'sa 28 percent in-
crease In the AIDS budget and that 25
percent of that whole budget goes to
public education. I'm sure there will be
more next year and more the year af-
ter that. There'sno doubt that it has to
go up because we are facing a prob-
lem that we can fight only with educa-
tion and information. In research, peo-
ple are naive in thinking that just
money will produce the answer. How-
ever, we have some excellent people
workingon the thing we're most con-
cerned about, a vaccine.

-what is the threat to the heteKeexual
.oonimunity,whiohnowaooountsforonty
4 peroertt of the AIDS sufferers?

AIDS is going to increase ninefold
in the U.S. between now and 1990.
But among heterosexuals there are
going to be twenty times as many
cases, so that perhaps 10 percent of
the patients will be heterosexual. The
curve for heterosexuals contracting
AIDS is going up more than twice as
fast because they are not taking the
precautions homosexuals have
learned are essential. I don't think
people realize this: It isn!t just the
possibility that your prospective sexu-
al partner might have been promiscu-
ous; you are in a sense having sex
with all the people that your partner
had sex with in the past five to 10
years. That's a huge bunch of people,
enough to give anybody pause.

You have said that blacks make up 12
percent of the U.S. population but 25 per-
cent of AIDS viotims. Hllpanios, who rep-
resent 7 percent of the U.S. population,
make up 14 percent of the AlDS cases.
Why is this?

We don't know all the answers yet.
Obviously if blacks and Hispanics have
a disproportionately high percentage,
they are indulging In high-risk behav-
ior. Many are intravenous drug use.rs.
It does point out that we have to de-
vise different public information pro-
grams to reach the black and Hispanic
communities.

`Howcanpeopleprotectth0lnsehres
against AIDS?

Let me make this clear. If you go to
yaur partner and say, "I Want you to
come and have a blood test today,"
and you stick with him for the next
three months,that doesn't help you
one bit. He could have been contami-
nated as long as six months ago. But
his test might not show up yet, and that
false negative creates a feeling of
complete security. The test could turn
positlve as early as two we'eks-un-
Ilkely; by three months-unusually; by
six months-usually. You've got to
keep your eye on hlm all the time.
That's why it's so important to stick
to a mutually faithful monogamous
relationship.

-When should people take t~lood   .
test3

if I thought I had been contaminat-
ed wlth the AIDS virus I would want to
get a test right now. But I would want
one in six months, and another six
months later, so I WQUld be absolutely
certain I wasn't one of those strange
people that didn't turn positive for as
                   GONTlNlJED


much as a year. This is what makes
the blood supply still not totally safe.
AIDS-infected blood is undetected
about once in 100,000 donations. Peo-
ple who have indulged in high-risk be-
havior-including homosexual activi-
ty, intravenous drug abuse and.
heterosexual promiscuity-would do
well to be tested.

So abstinence is the only guarantee of
safety?
Abstinence is the only sure method
of preventing AIDS. But abstinence, I  .

think we all know, is not a realistic goal.
However, it certainly is a realistic goal
for very young people. Then they could
look forward to finding a mutually faith-
ful monogamous relationship. But If
you have failed at both of those en-
deavors, you've got to protect yourself
with a condom.

How safe are they?

Studies on the use of condoms for
contraception most frequently find a
10 percent failure rate. But if you study
groups of intelligent people who were
taught how to use a condom correctly,
that failure rate drops to 2 or 3 percent.
The average person who uses a con-
dom for birth control goes through a
period of foreplay, puts on the con-
dom, ejaculates, then may not disen-
gage himself early enough from his

Once targeted at homosexuals (above), ex-
plklt posters advlsing safe sex are now be-
ing directed at the heterosexual community.

partneri he loses his erection and the
condom comes off. That's what the
failure rate stems from. You should
use a condom from start to finish:
That means before you have any
genital contact at all, the condom
is on.

But even then won't there be some failure
rate in AIDS prevention?

It should be about the same as con-
traception. The same 2 to 3 percent
risk. Think of it the other way-97 to.98
percent safe.

Why doesn't the government require
that partners of AIDS patients be noti-
fied, as it does in cases of venereal
disease?

We have,not followed the usual
practice that goes with a sexually
transmitted disease because we don't
think it would stay the epidemic. With
AIDS you don't have any treatment to
offer, just more stigma. If we try to fol-
low the contacts of someone who is
known to harbor the virus, we could
drive underground those very people
we're trying to reach.

Milht the country eventually quarantine
known,AlDS carriers?

How are you going to find the peo-
ple to quarantine? You would have to
test the entire population, 240 million
people. Suppose you found three mil-
lion carriers of the AIDS antibodies,
what are you going to do to them?
And why? And is it fair? Suppose in
that group of three million you have
1,000 irresponsible people whq are
spreading the virus; should all the oth-
ers be locked up for the rest of their
lives?

'

How soon do you expect a vaccine?

It took 17 years to develop a vaccine
against hepatitis B, and my virology
friends tell me that was an easy virus
to understand in comparison to this
one. I don't see a vaccine in the fore-
seeable future. O