ADDRESS

BY

C, EVERETT Yoop, M.D,, ScA
   SURGEON GENERAL

         OF THE

    ILS, PLJBLIC HEALTH SERVICE
UA DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE REGIONAL CONFERENCE ON
  ADOLESCENTS AND HIV INFECTION
      BETHESDA, MARYLAND
      APRIL 28, 1989

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

  I'M VERY PLEASED TO BE YOUR GUEST THIS MORNING TO HELP GET

THIS IMPORTANT MEETING UNDER WAY,

  YOU HAVE A VERY FULL AGENDA, AND FOR THAT I WANT TO
CONGRATULATE THE PLANNERS OF THIS MEETING, MY COLLEAGUES WITHIN
THE U,Se PUBLIC HEALTH SERVICE AND THE LEADERSHIP OF THE SOCIETY

FOR ADOLESCENT MEDICINE, I THINK THEY DID AN EXCELLENT JOB,


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  AND I'M ALSO VERY IMPRESSED BY THE QUALITY OF THE INVITA-

TION LIST, THE PEOPLE WHO ARE ACTUALLY GOING TO WORK THEIR WAY

THROUGH THE AGENDA FOR THE REST OF TODAY,

  MINDFUL OF THE WORK AHEAD OF YOU, I WILL TAKE JUST A FE\1

MINUTES THIS MORNING TO SHARE WITH YOU MY OWN FEELINGS ABOUT THE
SIGNIFICANCE OF THIS MEETING ,,, WHY I'M GLAD IT'S TAKING PLACE

AND WHY I'M DELIGHTED THAT YOU COULD ALL MAKE IT.

FIRST OF ALL, THE FOCUS ON HIGH-RISK ADOLESCENTS IS NEW,

THE.ALARM WE ARE SOUNDING IS ALSO FAIRLY NEW TO THE EARS OF

THE GENERAL PUBL!C,


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AND THE NEED TO BUILD STRONG, WORKING COALITIONS OF YOUTH-

CENTERED AGENCIES IS CERTAINLY NEII AS WELL,

  AS A VETERAN OF 8 YEARS IN THE FEDERAL BUREAUCRACY, I CAN

TELL YOU THAT STARTING ANYTHING NEll IS A MAJOR ENTERPRISE IN

ITSELF, CONSIDER, THEN, HOW DIFFICULT IT OUGHT TO HAVE BEEN TO

GET THIS PARTICULAR INITIATIVE ROLLING,

  NEVERTHELESS, IT Is ROLLING, AND THAT'S BECAUSE THE CONCEPT

BEH IMD THESE MEET I NGS, ONCE HEARD, IS IMMEDIATELY UNDERSTOOD,


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  IT HAS BUILT INTO IT WHAT WE CALL THE "AH-M!" FACTOR, YOU

TELL PEOPLE WHAT YOUR IDEA IS , , , THEY THINK ABOUT IT n a a AND

THEN AFTER A MOMENT THEIR EYES LIGHT UP AND THEY SAY, "AH-M!"

  THAT'S THE "AH-H/J!" FACTOR ,,, AND IT'S ON OUR SIDE THIS

MORNING,

  AND NOT A MOMENT TOO SOON, EITHER, A SIGNIFICANT NUMBER OF

PERSONS WITH AIDS -- THOSE IN THEIR TWENTIES -- MAY VERY WELL

HAVE BECOME INFECTED AS ADOLESCENTS,


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  YOU ALL KNOW THAT, SO I WON'T DWELL ON WHY IT IS THAT WE'RE

PAYING ATTENTION TO THE ISSUE OF ADOLESCENTS AND AIDS, RATHER,

WHAT I m WANT TO EMPHASIZE IS THE PRESSING NEED FOR US TO START

ADDRESSING THIS ISSUE -- NOT JUST RECOGNIZE IT,  WE'VE DONE THAT

ALREADY,

NOW WE HAVE TO ADDRESS THE ISSUE IN A COMPREHENSIVE,

COORDINATED MANNER, THAT MAKES OUR JOB A LITTLE. HARDER, BUT

THERE'S NO OTHER ROUTE TO TAKE,


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  ADOLESCENT HIV INFECTION IS A PUBLIC HEALTH PROBLEM 11, BUT

IT'S ALSO MORE THAN THAT,

  IT'S A PROBLEM FOR OUR EDUCATIONAL SYSTEM, 'THAT'S TRUE n,,
BUT IT'S ALSO MORE THAN JUST ANOTHER PROBLEM FOR OUR SCHOOLS TO

SOLVE,

  AND, YES, THIS IS A PROBLEM FOR OUR SOCIAL SERVICE SYSTEM,

TOO 1,. BUT IT'S GOING TO TAKE MUCH MORE THAN JUST SOCIAL

SERVICES TO SOLVE THIS ONE,


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  IN OTHER WORDS, IF WE'RE GOING TO SOLVE THIS PROBLEM I)F

ADOLESCENT HIV INFECTION, THEN EVERY PROFESSIONAL IN EVERY

ASPECT OF HUMAN SERVICES -- EVERYONE WHO MAY HAVE AN INTEREST IN

SERVING ADOLESCENTS -- EVERYONE OF US MUST BEGIN WORKIFIG TOGETHER

IN NEW MULTI-DISCIPLINARY RELATIONSHIPS CLEAR DOWN TO THE

INSTITUTIONAL AND NEIGHBORHOOD LEVELS,

  THE SUB-TITLE OF THIS CONFERENCE REFERS TO THE BUJLDING OF

CONSORTIA , , a OF NEW ORGANIZATIONS AND NEW RELATIONSHIPS THAT

BRING TOGETHER DIFFERENT YET COMPLEMENTARY SERVICES am, THE KINDS

OF SERVICES THAT HELP INDIVIDUALS WHO ARE GOING THROUGH ONE OF

THE MOST DIFFICULT PERIODS OF HUMAN GROWTH -& AND WHO ARE DOING

SO IN A HIGH-RISKY, LIFE-THREATENJNG MANNER,


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  AND, MY FRIENDS, EVEN THOUGH THE HUMAN RACE HAS GONE THROUGH

ADOLESCENCE EVER SINCE THE HUMAN RACE BEGAN maa WE STILL DON'T
                

KNOW VERY MUCH ABOUT IT, NOR DO WE KNOW VERY MUCH ABOUT HOW TO

HELP YOUNGSTERS GET THROUGH IT,

  WE PHYSICIANS, FOR EXAMPLE, CAN ADVISE THE SCHOOLS TO TELL

YOUNG PEOPLE ABOUT THE WAY THE AIDS VJRUS GETS INTO THE BLOOD-

STREAM  BUT THAT ASSUMES THAT EDUCATORS ALREADY KNOW EVERYTHING

THERE Is TO KNOW ABOUT TEACHING HUMAN BIOLOGY TO ADOLESCENTS,

BUT THEY DON'T,


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  IF THEY DID, THEY WOULDN'T STILL NEED THE "BIOLOGICAL

SCIENCES CURRICULUM STUDY,"  WE'D CLOSE UP THAT SHOP AND SEND ALL

THOSE NICE PEOPLE HOME,

BUT WE WON'T,

  ON THE OTHER HAND, EDUCATORS CAN ASK PHYSICIANS TO BE MORE

FORTHRIGHT WITH YOUNG PEOPLE ABOUT SEXUAL TTY AND THE HEALTH

CONSEQUENCES OF HIGH-R I SK SEXUAL BEHAVIOR.


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    BUT IF PHYSICIANS COULD REALLY DO THAT EFFECTIVELY, WE

WOULDN'T HAVE ANY TEENAGE PREGNANCY PROBLEM IN THIS COUNTRY, FOR
EXAMPLE, AND THE ENTIRE MEMBERSHIP OF THE SilCIETY FOR ADOLESCENT

MEDICINE couLD HOLD ITS ANNUAL BANQUET IN ANY NEIGHBORHOOD

McDONALD'Sm

BUT OBVIOUSLY THAT'S NOT THE CASE EJTHER,

  AND MEDIC1 NE AND EDUCATION CAN'T HAND OVER THE PROBLEM OF

ADOLESCENT HIV INFECTION TO OUR FRIENDS IN SOCJAL SERVICES TO

SOLVE, BECAUSE THEY'RE IN THE SAME BOAT THE REST OF US ARE Ill,


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  THE SOCIAL SERVICES PEOPLE DON'T HAVE ANY COOK-BOOK RECIPES

FOR STOPPING TEENAGE VIOLENCE ,,a PREVENTING UNWANTED TEEN

PREGNANCIES , , . REDUCING SEXUAL PROMJSCUITY 1,s ELIMINATING

SUBSTANCE ABUSE AND EXPERIMENTATION ,a, OR ANY OTHER PROBLEM

COMMON AMONG TEENAGERS,

  THERE IS NO COOK-BOOK , ,a THERE ARE NO SIMPLE, MIX-AND-SERVE

RECIPES THAT PRODUCE PALATABLE, WORKABLE ANSWERS TO THE SOCIAL,

EDUCATIONAL, OR PUBLJC HEALTH PROBLEMS OF ADOLESCENT GROWTH,


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I'M OVER-STATING THE CASE, OF COURSE am n BUT PROBABLY NOT BY

MUCH,

BY NOW I HOPE MY POINT IS CLEAR TO YOU,  IT'S SIMPLY THIS:

*

OUR SOCIETY IS FACED WITH A VIRULENT AND FATAL DISEASE

CALLED AIDS ,,a

*

AMONG THE MOST VULNERABLE POPULATIONS TO BE HIT BY AIDS IS

THE ADOLESCENT POPULATION aa,

*

  YET, DESPITE OUR TOTAL HUMAN EXPERIENCE WITH ADOLESCENCE,

     WE'RE STILL TRYING UNDERSTAND IT AND TRULY HELP

     YOUNGSTERS GET THROUGH IT SAFELY AND HAPPILY It,



*

BECAUSE WE DON'T WANT YOUNG PEOPLE TO BE LIFE-THREATENING

TO THEMSELVES -- OR TO OTHERS


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THAT'S MY POINT THIS MORNING,

  I DO NOT FOR A MINUTE THINK IT'S A SIMPLE ONEa AND I DON'T

THINK FOR A MINUTE THAT YOUR MEETING HERE TODAY WILL BE ANYTHING

LIKE THE PROVERBIAL "DAY AT THE BEACH," IT WON'T BE LIKE THAT

AT ALL,

  FOR ONE THING, WE'VE GOT TO LOWER THE FENCES AROUND OUR

RESPECTIVE PROFESSIONAL TERRITORIES, AND THAT'S NEVER EASY,

  WE'VE GOT TO RID OURSELVES OF THE "TURF MENTALITY? WE CAN

DO SOME OF THAT TODAY,


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  WE'VE ALSO GOT TO SHARE WITH EACH OTHER OUR POSITIVE AND
OUR NEGATIVE EXPERIENCES WITH YOUNG PEOPLE, WHAT WORKS ,nm AND

WHAT DOESN'T WORK,

  PLEASE, LET'S NOT STAND BY AND WATCH EACH OTHER RE-DISCOVER

SOME WELL-KNOWN WHEELS -- SfllJARc ONES AS WELL AS ROUND ONES,
WITH YOUNG LIVES AT STAKE EVERY DAY, WE DON'T HAVE TIME FOR THAT

SORT OF THING,

LET'S SHARE OUR INFORMATION AND OUR EXPERIENCE TODAY Barn AND

WORRY ABOUT OUR EGOS TOMORROW, IF AT ALL,


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  AND LET'S THINK ABOUT COMPREHENSIVE CARE, LET'S THINK IN

TERMS OF A SEAMLES WEB OF SOCIAL, EDUCATIONAL, AND PUBLIC HEALTH'

SERVICES,

  LET'S NOT NIBBLE THIS PROBLEM TO DEATH OR REDUCE OUR VISJON

TO PIECEMEAL GLIMPSES OF THE TRAGEDY THAT IS BUILDING IN OUR

SOCIETY. LET'S NOT DO THAT

  AND WHILE THE PROBLEM OF ADOLESCENT AIDS IS IMMEDIATE .I m

\JHJiE IT'S DEFINITELY PART OF THE AMERICAN EXPERIENCE TODAY 11,

LET'S NOT BE CONTENT TO DEAL WITH IT ONLY IN TERMS OF WHAT CAN BE

DONE RIGHT AWAY TODAY,


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LET'S PLAN FOR A LONG-TERM EFFORT THAT WILL BE EFFECTIVE

WELL INTO THE FUTURE,

  FOR WE.MUST ALWAYS KEEP IN MIND THAT AIDS IS GOING TO BE

WITH US FOR A LONG TIME, WE'RE STILL YEARS AWAY FROM HAVING A

SAFE, EFFECTIVE, AND GENERALLY AVAILABLE AIDS VACCINE,

  I KNObi THE GENERAL PUBLIC IS IMPATIENT WITH THIS IDEA ana

THEY'RE FRUSTRATED BY THE SLOW PACE OF VACCINE DEVELOPMENT, AND

I CAN'T BLAME THEM,


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  YET, I KNOW -- AS WE u KNOW -- THAT VACCINE DEVELOPMENT IS

A VERY SLOW PROCESS, AND WE KNOW THAT THERE'S NO "QUICK FIX" TO

THE SPREAD OF THE AIDS VIRUS,

  THEREFORE, WE MUST PURSUE OUR DELIBERATIONS WITH THE

THOUGHT ALWAYS IN MIND THAT THE PROBLEM WE'RE GRAPPLING WITH

TODAY IS A PROBLEM WE'LL BE GRAPPLING WITH TOMORROlJ 11, AND NEXT

YEAR #me AND THE YEAR AFTER a,, AND, I'M AFRAID, MANY YEARS AFTER

THAT AS WELL mm, RIGHT INTO THE NEXT CENTURY,

THAT'S NOT PESSIMISM, THAT'S REALISM,


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  IN ANY CASE, I DIDN'T COME HERE THIS MORNING AS A

PESSIMIST, TO TELL YOU THE TRUTH, DESPITE THE SIZE OF THE TASK

BEFORE YOU, I HONESTLY BELIEVE YOU CAN MAKE A DIFFERENCE -- A BIG

DIFFERENCE -- IN THE LIVES OF YOUNG PEOPLE TODAY AND TOMORROW,

  I THINK THE CONSORTIUM IDEA IS A GOOD ONE Be a AND IT MAY

WELL BE THE ONLY ONE THAT WILL WORK, FOR ALL THOSE REASONS I

MENTIONED A MOMENT AGO,

AND NOW, A FINAL WORD,


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  I'VE BEEN TALKING ABOUT YOUNGSTERS ata YOU WILL SOON BE

TALKING ABOUT THEM AS WELL me, AND IT'S EASY TO ASSUME FROM OUR

REMARKS THAT WE'RE TALKING ABOUT AN ENTIRE GENERATION,

BUT WE AREN'T,

  WE DON'T KNOW EVERYTHING ABOUT ADOLESCENCE, BUT WE w KNOW

THAT YOUNG PEOPLE  -- FOR ALL THEIR WILD BEHAVIOR AND EXPERI-

MENTATION -- TEND TO BE VERY CONSERVATIVE IN ATTITUDE AND

THOUGHT,


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YOU CAN ALWAYS TELL WHICH TEEN-AGERS BELONG TO THE MAN IN

THE LOUD PLAID JACKET, THEY'RE THE ONES WHOSE CHEEKS ARE RED AND

WHO ARE SLUMPED ALL THE WAY DOWN IN THEIR CHAIRS, HOPING NOT TO

BE SEEN,

  A SUBSTANTIAL NUMBER FAVOR THE DEATH PENALTY am. THEY OPPOSE

ABORTION-ON-DEMAND a,, THEY MAY TRY ALCOHOL AND TOBACCO, BUT A

CLEAR AND LARGE MAJORITY FROWN ON BOTH THESE SUBSTANCES ma, AND

DRUGS ARE AN EVER-PRESENT DANGER, BUT MOST YOUNG PEOPLE SEEM TO

REJECT DRUGS ON INTUITION AND INSTINCT, AS WELL AS ON THE SCRAPS

OF INFORMATION THAT WE ADULTS FLOAT THEIR WAY,


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  MOST YOUNG PEOPLE IN AMERICA ARE JUST WONDERFUL, AND THANK

GOODNESS FOR THAT, OTHERWISE WE WOULD REALLY BE IN TERRIBLE

SHAPE,

  SI) LET'S FOCUS OUR ATTENTION WHERE IT IS NEEDED MOST ,, , ON

THOSE SMALLER, SUB-POPULATIONS OF YOUNG PEOPLE WHO TRULY NEED OUR

HELP -- IN SOME CASES, WHO DESPERATELY NEED IT,

  BUT AT THE SAME TIME, LET'S REMEMBER THAT OUR GREATEST
ALLIES IN THIS BATTLE TO SAVE THE LIVES OF SEVERAL MILLION AT-
RISK ADOLESCENT BOYS AND GIRLS ,,, ARE ALL THE OTHER ADOLESCENT

BOYS AND GIRLS WHO ARE rm AT RISK,

THANK YOU , m a AND BEST WISHES FOR A MOST SUCCESSFUL MEETING,

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