AIDS lecture Vol. 13 tab 17:- Cover

      Remarks
By C. Everett Koop, MD, ScD.

   Surgeon General of the
   U.S. Public Health service
Presented to the Institute of Medicine
    Washington, DC
     November 16.1987

It had been four days since I last had spoken to the public on AIDS

In this collection of lectures and talks on the subject of AIDS in various venues here and
abroad, it is difficult to assign priority in reference to importance to any of them.
However, it should be clear to those who know the United States and its institutions that
anything the Surgeon General would say to the Institute of Medicine at that body's
annual meeting in the midst of an epidemic like AIDS had to ring of the truth.

The Institutes of Medicine itself had made its own publication on the subject of the
epidemic entitled, "Confronting AIDS". Their document and this document compared
and adjusted for time and style would give the user of this archive the status of the
epidemic of AIDS as of mid-November 1987.

The user will find attached to this lecture two additional documents. One, is an editorial
that appeared in the New York Times the day before this report was given and it sums up
not only what the New York Times thought, but what in general the public health
community thought about one aspect of the way the AIDS epidemic was being handled -
namely voluntary vs. compulsory testing. The user is urged to remember that AIDS was
treated as a political disease and up until the time of this report, had never been treated as
if it were an epidemic like typhoid fever, cholera, or the plague. The view of the New
York Times is, for the era in which it was written, correct, as do I believe, was the attitude
of the public health community. Nevertheless, in retrospect, I do think we would have
made better progress against the epidemic and made the people of the country more
aware that we were dealing with an infectious disease, if we had faced the fact that
compulsory testing was essentially impossible, not necessary, a program that would drive
underground intravenous drug abusers and gay men, most in need of being reached - but
- there should have been a different attitude toward compulsory testing of known
contacts of HIV positive individuals. Even as of this writing, December 2003, the
Centers for Disease Control estimates that there are a million people in America that are
HIV positive and do not know it. These individuals, therefore, do not warn their sexual
partners, nor unfortunately, do they protect their sexual partners.

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The other document explains something about the history of AIDS that puzzles people to
this day, but which I think I understand now in retrospect. If one reviews the history of
AIDS from June of 1981 until - let's arbitrarily say - the middle of the year 1988, it is
evident that the media, both print and television, did a magnificent job of educating the
American public about a disease process difficult to understand and fraught with so many
special circumstances that it wasn't treated as the infectious disease that it was, because
of the related problems of driving patients away from diagnosis and treatment, as well as
encouraging discrimination against patients who were HIV positive. Also, in retrospect,
one could say that for some reason after six years of such magnificent performance the
press seemed to have lost interest or at least thought AIDS was not as important as it had
been before. Some how or other the media must have had a reason for slackening their
constant drumbeat about the disease, how it is acquired, and how it is not acquired. I
think this second document explains it all. I have chosen to include the Chicago
Tribune's version of a report issued by the Centers for Disease Control.

By way of explanation, at the Coolfont Retreat, the Centers for Disease Control and other
public health officials laid out what they thought the future of the epidemic might be
early on and everyone concerned used those figures projected for approximately eight
years into the future. What this report actually, released by the White House on the 15th
of November 1987, says that, "The estimate of the scope and progress of the epidemic is
likely to have been overstated and the numbers are now falling off'. The report no way
said the disease was over. It in no way said that we had issued a false alarm. It in no way
said that we could lower our guard. But as someone who lived through those days, in the
midst of the epidemic, as the Surgeon General, as the chief spokesperson for the
government about AIDS, I can attest to the fact that the attitude of the press was, "Hey,
it's not nearly as important as we thought it was."

As a result, the teaching dropped off, the awareness fell, the knowledge as well as the
fear of infection was no longer the powerful preventive it had been, and in my opinion, it
was the turning point in the AIDS epidemic not downward as the report predicts, but
upward as time proved to be true.

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