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,
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