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

1
(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,

2
  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,

                    3
   "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.

4
  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,

5
  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

                 6
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

7
  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,

8
   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,

9
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.

10
  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,

11
  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,

12
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,

13
  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,

14
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:

                15
*
  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,

16
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,

17
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,

18
  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,

19
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,

20
   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.

21
  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,

22
  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,

23
   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,

24
  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

25
  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,

26
  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,

27
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,

28
  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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