ORIGINAL

C, EVERETT KOOP, M,D,, SCUD,
   SURGEON GENERAL
      OF THE

U, S, PLBLIC HEALTH SERVICE

PRESENTED TO THE WEST JERSEY HEALTH SYSTEM
    CHERRY HILL, NEW JERSEY
     NOVEMBER 17, 1987


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  WITH SO MUCH ATTENTION FOCUSED ON THE WORLD PANDEMIC OF AIDS
THESE DAYS -- AND IT CERTAINLY DESERVES OUR ATTENTION -- WE
NEVERTHELESS TEND TO LOSE SIGHT OF THE MANY OTHER MAJOR HEALTH
PROBLEMS IN THE WORLDmPROBLEMS WHICH, AT THE PRESENT TIME AT
LEASTwCLAIM MANY MORE LIVES AND EXHAUST MANY MORE OF THE FISCAL
AND HUMAN RESOURCES OF MOST COUNTRIES THAN AIDS DOES,

  BUT LET'S STICK TO AIDS, AND LET ME START WITH THE GLOBAL
PICTURE,

  AS OF AUGUST, THE REPORTED AIDS CASE-LOAD IN COUNTRIES OTHER
THAN THE UNITED STATES HAD REACHED 14,600,  IT'S FAIR TO SAY THAT
THIS FIGURE IS WELL BELOW WHAT THE TRUE FIGURE MIGHT BE, SINCE
AIDS IS VERY UNDER-REPORTED, FOR INSTANCE, ABOUT 17 COUNTRIES IN
AFRICA REPORT EITHER 1 CASE OR NO CASES AT ALL, WHILE OTHER
COUNTRIES -- SOME SHARING COMMON BORDERS -- REPORT
300,,,700,,,AND 1,100 CASES OF AIDS,


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  W,H,O, SAYS, HO\jEVER, THAT THE NUMBERS ARE CLIMBING STEEPLY
AND THAT, OVER THE NEXT 5 YEARS, THE WORLD COULD ADD ANY'w'HERE
FROM ANOTHER HALF-MILLION TO ANOTHER 3 MIU NEW CASES OF AIDS,

  I SHOULD ADD THAT THIS IS ONE MAJOR REASON WHY THE PRESIDENT
HAS ASKED THE CONGRESS TO APPROPRIATE THE FULL US, CONTRIBUTION
TO THE UNITED NATIONS, AND ESPECIALLY TO THE WORLD HEALTH

ORGANIZATION,

  DISEASE KNOWS NOT BORDERS, IN FACT, IT WOULD APPEAR THAT
THE DISEASE OF AIDS ITSELF MAY HAVE COME TO THESE SHORES FROM
AFRICA BY dkY OF THE CARIBBEAN,


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  WHETHER THAT'S THE WAY IT HAPPENED OR NOT, WE WILL NEVER
FULLY CONTAIN THIS DISEASE HERE IN THE UNITED STATES, AS LOrlG AS
IT IS NOT ALSO COyiTAINED ELSEWHERE IN THE WORLD, AND THAT TAKES
MONEY,

  IT WILL BE TERRIBLY SELF-DEFEATING, IF THE UNITED STATES
DOES NrJT PAY ITS FULL ASSESSMENT TO THE UNITED NATIONS AND THUS,
WILL NOT ENABLE THE WORLD HEALTH ORGANIZATION TO BE AN EFFECTIVE
WORLD LEADER IN THE FIGHT AGAINST AIDS,

  WE MUST STAND TgGETHER Ii4 THE FIGHT AGAINST AIDS ;/ITH ALL
OUR KEIGHBORS ON THI: TINY PLANET, AIDS IS CERTAINLY A PERSONAL
TRAGEDY FOR EVERYaNE WHO IS INFECTED, BUT IT'S ALSO A TRAGEDY
FOR HUMANITY ITSELF,


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  I BELIEVE THAT THE UNITED STATES MUST BE A FULL PARTNER WITH
ALL OTHER COUNTRIES, IN THIS FIGHT AGAINST AIDS, THAT'S A MORAL
CHOICE THAT WE MUST MAKE,  IT MUST NOT BE DECIDED BY EITHER
POLITICS OR ECONOMICS,

  AS OF NOW -- SINCE WE FIRST ENCOUNTERED AIDS IN JUNE 1981 --
43,000 HAVE BEEN DIAGNOSED, 26,000 HAVE DIED, AND THE REST '&ILL
PROBABLY DIE,

  BY 1991, WE ESTIMATE THAT 270,000 WILL BE DIAGNOSED, 170,000
WILL BE DEAD, AND 54,000 WILL DIE IN THAT YEAR,

  BETWEEN 1 AND 185 MILLION ARE HIV POSITIVE, THEY MAY NOT
KNOW THAT THEY ARE HIV POSITIVE, THEY ARE INFECTIOUS TO OTHERS
THROUGH SEX AND OR NEEDLE-SHARING AMONG I,V, DRUG ABUSERS,


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  AIDS IS A DEVASTATING DISEASE, BUT LET'S PUT IT IN THE
PROPER PERSPECTIVE,

  I SAID 26,000 PEOPLE HAVE DIED FROM AIDS IN 6 YEARS, 5

MONTHS,

THAT SAME NUMBER WILL DIE EVERY 28 DAYS FROM SMOKING,

  OR, WHILE 26,000 HAVE DIED FROM AIDS -- OVER 2,209,OOO HAVE
DIED FROM SMOKING,

  WITH THE NUMBER OF AIDS CASES DOUBLING IN A LITTLE MORE THAN
A YEAR, IT WON'T TAKE AIDS LONG TO CATCH UP,


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   I'D LIKE TO LOOK AT THIS PANDEMIC OF AIDS FROM A LITTLE

DIFFERENT POINT OF VIEW,  I WANT TO TALK ABOUT WHAT IT'S DOING TO
SOME OF OUR PEOPLE,, ,WHAT IT CAN DO TO &!= OF OUR PEOPLE,, aAND
WHAT j&. MUST DO TO HELP PEOPLE CONQUER AIDS, THE MOST VICIOUS OF
INFECTIOUS DISEASES IN THE HISTORY OF THE HUMAN RACE,

  LET ME CONFESS THAT, IN THE BATTLE AGAINST THIS DISEASE,
MEDICINE AND SCIENCE ARE MAKING VERY SMALL HEADWAY, RELATIVE TO
WHAT HAS YET TO BE ACCOMPLISHED,

  IN FACT, I'LL GO EVEN FURTHER AND SAY THAT THE FINAL VICTORY
OVER THIS DISEASE WILL NOT FOLLOW THE PATTERNS OF OTHER SUCH

VICTORIES -- THE ONE OVER SMALLPOX, FOR EXAMPLE, OR POLIO,


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  NO, THIS TIME, THE VICTORY WILL PROBABLY j.Ql BE THE
EXCLUSIVE VICTORY OF SCIENTIFIC RESEARCH AND CLINICAL PRACTICE,

  THE FINAL VICTORY OVER THE DISEASE OF AIDS WILL MUCH MORE
LIKELY SPRING FROM THE IMPELLING FORCE OF COMPASSIONATELY
COMMITTED, ETHICALLY MOTIVATED, AND COURAGEOUS MEN AND WOMEN WITH
LITTLE OR NO MEDICAL BACKGROUND AT ALL,

LET ME TAKE A LITTLE TIME TO EXPLAIN THAT OBSERVATION,

  EVERYTHING THE PUBLIC THINKS AND DOES ABOUT AIDS SEEMS TO BE
RELATED TO THE THREE BASIC ASPECTS OF THE DISEASE:


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  FIRST OF ALL, IN SPITE OF ALL WE'VE LEARNED ABOUT THIS VIRUS
IN THE PAST 6 YEARS, AIDS IS STILL PRETTY MUCH OF AJ+!YSTERY,
ESPECIALLY TO THE PUBLIC, WE KNOW HO'// IT'S TRANSMITTED, FOR
EXAMPLE, AND WE ALSO KNOW HO'd IT ATTACKS AND DESTROYS THE HUMAT
IMMUNE SYSTEM,  BUT WE DON'T KNOW WHY IT DOES THAT AND k/E STILL
CAN'T PREDICT WHEN THE AIDS VIRUS u -- OR WILL JOT -- PROCEED
ON ITS DESTRUCTIVE PATH, SO, FIRST ON OUR LIST IS MYSTERY,

  BUT MEDICAL SCIENCE DOES NOT THRIVE 014 MYSTERY, JT THRIVES
OF: DISCOVERY, AFiD DISCOVERY STILL SEEMS TO BE SOME DISTANCE AWAY
FROM US,

  AIDS IS A ffYSTERY,,,BUT IT'S NOT m A MYSTERY, IT'S AN
ENORMOUS HUMAN CATASTROPHE,


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  MANY PEOPLE DENY THAT THEY ARE NOW -- OR COULD EVER BE --
INFECTED WITH THE AIDS VIRUS, EVEN THOUGH THEY MAY ENGAGE IN
HIGH-RISK BEHAVIORmANAL INTERCOURSE, FOR EXAMPLE, OR NEEDLE-
SHARING AMONG IJ, DRUG ABUSERS,

  BUT MORE IMPORTANT, MANY PEOPLE WHO DO NOT ENGAGE IN ANY
HIGH-RISK BEHAVIOR AT ALL AND WILL PROBABLY NEVER CATCH AIDS, ARE
READY TO GIVE UP ON PEOPLE WHOJQ HAVE AIDS,

  BUT THAT'S EXACTLY WHAT WE CANNOT DO,, ,WE CANNOT GIVE UP ON
PEOPLEwWE HAVE NO MORAL RIGHT TO ABANDON ANOTHER PERSON,

  AND THAT'S THE THREAT FROM THIS ASPECT OF AIDS,,,THE THREAT
RAISED BY ITS MYSTERY, BECAUSE, IF WE RETREAT FROM THIS MYSTERY,
THEN WE WILL BE RETREATING FROM MAN HIMSELF,,,


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  WE WILL ACCEPT THE CONTINUING CATASTROPHE OF LOSS OF HUMAN
LIFE,,,

WE WILL DENY THAT MANKIND IS SUPERIOR TC) THIS DISEASE,,,

  BUT IN THIS TERRIBLE AND FEARSOME PERIOD, I MAINTAIN -- AS A
PHYSICIAN, AS A SCIENTIST, BUT ALSO AS A HUMAN BEING -- THAT MAN
CANNOT BE DENIED I

AIDS -- BY ITSM -- WOULD MAKE US DO THAT,

PEOPLE WHO LIVE IN TOTAL FEAR OF AIDS WOULD HAVE US DO THAT,

  AND SOME PEOPLE WEAKENED 3Y THE DESPAIR OF AIDS, SEEING
PATIENTS DIE OF IT, WOULD HAVE US DO THAT,


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BUT WE CANNOT,

  AND THAT'S WHY k/E MUST RECOGfJIZE THIS ASPECT OF MYSTERY FOR
WHAT IT ISwAND OVERCOME IT,

  THE SECOND FACT ABOUT AIDS THAT COLORS ALL WE SAY AfiD DO IS
THAT THE DISEASE IS V ;a

  I MENTIONED A MOMENT AGO THAT THE DISEASE HAS ATTACKED MORE
THAfJ 44,000 PEOPLE SINCE JUNE OF 1981 AND THAT ALMOST 26,000 OF
THOSE PEOPLE HAVE ALREADY DIED,

  THAT'S THE TRUTH,, ,BUT THERE'S MORE, THE TRUTH ALSO
INCLUDES THE FACT THAT, OF THOSE PEOPLE WHG HAD AIDS IN 1981, AT
LEAST 91 PFRCENT OF THEM HAVE ALREADY DIED,


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OF THOSE WHO HAD THE DISEASE IN 1982, SOME 87 PFRCENT HAVE
ALREADY DIED,

  OF THOSE IN 1983, 89 PERCENT OF THEM HAVE ALREADY DIED OF
AIDS,

AND SO Ok

AIDS IS THE CLOSEST THING IN OUR ENVIRONMENT TODAY TO BEIMG
A "VIRTUALLY 100 PERCENT FATAL DISEASE",

WE HAVE OfJLY A FEW DRUGS COMING INTO THE MARKETPLACE --
A,Z,T, MOST PROMINENT AMONG THEM -- AND THESE DRUGS HELP PROLONG
LIFE A LITTLE BIT,,,A FEW MONTHS,,,MAYBE A YEAR OR SO,

BUT WE HAVE NOTHING AT All,.,UOTHING,,,THAT WILL SAFELY AND
EFFECTIVELY STOP THE DISEASE OF AIDS IN ITS TRACKS,


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  WE HAVE NO DRUGS,,,NO VACCINES, ,,NO MAGIC BULLETS, a #NOTHING
THAT CAN ACCOMPLISH THAT LIFE-SAVING JOB,

WHAT m WE HAVE? ONLY EDUCATION,

  NOW, SOME PEOPLE CALL IT "EDUCATION," OTHERS CALL IT
"PUBLIC INFORMATION,"  AND STILL OTHERS CALL IT A "CONSCIOUSNESS-
RAISING,"

  ALL THOSE TERMS WILL DO, BECAUSE THEY ARE ALL ESSENTIALLY
THE SAME THING,

  IT IS IMPERATIVE THAT 'rJE TELL THE PUBLIC, WHOSE SYMPATHY AND
COOPERATION ARE SORELY NEEDED, THAT -- AT THE MOMENT -- DEATH IS
THE PARTNER OF PEOPLE WITH AIDS,


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  IT'S A GREAT MISTAKE TO UNDERESTIMATE THE SIGNIFICANCE OF
THIS SECOND ASPECT OF AIDS -- ITS VIRTUALLY 100 PERCENT MORTALITY

RATE -- BECAUSE THIS FACT IS ALREADY RAISING THE POSSIBILITY OF
ABANDONMENT IN THE MINDS OF OTHERHISE RESPONSIBLE PEOPLE,

  I'VE BEEN HEARING STORIES OF SOME PHYSICIANS AND NURSES --
VERY FE'& THANK GOODNESS, BUT EVEN m IS ONE TOO MANY --
PHYSICIANS AND NURSES idHO DON'T WANT TO TREAT AIDS PATIENTS
BECAUSE OF THE DANGER OF BECOMING INFECTED WITH THE VIRUS
THEMSELVES,

  YOU KNOCI,, , I KNOW,, ,Al';D THFY KNObi THAT SUCH A DANGER IS
MINUSCULE,, ,AT THE VERY JIOST,


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  YET WE ALL WATCHED THE TELEVISION NEWS COVERAGE OF THE
TRAGEDY CF THE RAY FAMILY IN ARCADIA, FLORIDA,,,REJECTED AND
EXPELLED NOT ONLY BY PLAIN TOWNSPEOPLE BUT ALSO BY EDUCATORS AND
COMMUNITY LEADERS,

  I THINK THEY MAY BE TRYING TO TELL US SOMETHING
ELSE, aSOMETHING SO CONTRARY TO WESTERN ETHICAL TRADITIONS THAT
THEY SIMPLY CANNOT BRING THEMSELVES TO SAY IT STRAIGHT OUT, BUT
I THINK THEY MIGHT BE TRYING TO SAY WHAT SOME HAVE ALRFADY SAID
TO ME,,,

  "WE DON'T CARE, BECAUSE THESE PEOPLE WITH AIDS ARE AS GOOD
AS DEAD ANYWAY",

  THAT'S A HORRIBLE STATEMENT, AND THE FIRST MOMENT IT IS SAID
IT MUST STIMULATE US TO EXTEND EVEN FURTHER OUR CALL FOR
COMPASSION FOR PEOPLE WITH AIDS,


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  THERE IS A MESSAGE THAT EACH OF US MUST DELIVER TO THE WORLD
EVERY DAY, THE INEVITABLY OF DEATH FROM THE DISEASE OF AIDS
SHOULD NOT -- BY ITSELF -- CAUSE THE VICTIMS OF AIDS TO BE
ABANDONED AND, IN THE WORDS OF THE PHILOSOPHER MARTIN BUBER,
GIVEN THE "FORETASTE OF DEATH",

WE HAVE NO REASON TO LET THAT HAPPEN,

SO THERE IS THE MYSTERY OF AIDS

AND THERE IS THE CERTAINTY OF DEATH FROM AIDS,


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  AND FINALLY, THERE IS THE THIRD ASPECT OF THE DISEASE OF
AIDS THAT IS ?OSED TO ME IN JUST ABOUT EVERY QUESTION-AND-ANS'dER
PERIOD WHEREVER I SPEAK, AND IT'S THAT PEOPtE GET AIDS BECAUSL
THEY DO THINGS MOST OTHER PEOPLE DON'T DO AND DON'T APPROVE OF
DOING1

  BUT THIS THIRD ASPECT OF THE ISSUE OF AIDS IS EVEN MORE
COMPLICATED THAN IT SEEMS,

  IN ADDITION TO THE 28,000 HOMOSEXUALS AND BISEXUAL MALES WHO
HAVE HAD AIDS, WE IlUST ADD THE 10,000 DRUG ADDICTS WHO HAVE
SHARED DIRTY NEEDLES AND OTHER PARAPHERNALIA AND, BY SUCH
ACTIONS, SPREAD THE DISEASE OF AIDS EVEN FURTHER,

  THE VAST MAJORITY OF AMERICANS DON'T "SHOOT" DRUGS, BELIEVE
ME, NOR DO THEY APPROVE OF PEOPLE WHO DO,


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  IN ADDITION, OF THOSE DRUG ADDICTS WITH AIDS, THERE ARE 4
BLACKS AND LATINOS FOR EACH WHITE PERSON, SO THERE IS YET
ANOTHER ELEMENT OF SOCIAL RANCOR AND DIVISION THAT FILLS OUT THIS
THIRD ASPECT OF AIDS,

  IN OTHER WORDS, 90 PERCENT OF THE PEOPLE WHO HAVE THE
DISEASE OF AIDS CONTRACTED IT WHILE THEY WERE ENGAGING IN HIGH-
RISK BEHAVIOR, OF WHICH THE MAJORITY OF THE PUBLIC DISAPPROVE,

  NOW THAT THEY HAVE THE DISEASE, IT IS A VIRTUAL CERTAINTY
THAT THEY WILL DIE,

  AND THE REST OF US WILL BE WITNESS TO THEIR DEATHS, YET WE
WILL HAVE NOTHING AT HAND TO PREVENT THOSE DEATHS,


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  SOME DAY, WE MAY WELL HAVE A BIOMEDICAL CURE FOR AIDS,, ,A
VACCINE THAT IS BOTH SAFE AND EFFECTIVE AND GENERALLY AVAILABLE,

  BUT WHO SHOULD BE THE FIRST PEOPLE TO GET IT? u GUESS
WOULD BE THOSE VERY SAFlE PEOPLE WHO PRACTICE HIGH-RISK BEHAVIOR,

  :/ILL THE AMERICAN PEOPLE BE ABLE TO UNDERSTAND THAT? I HOPE
SO,, #BUT I'M NOT REALLY SURE THEY'RE READY YET,

HOW TRAGIC FOR THT:h

AND HOW TRAGIC FOR AMERICA,


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  THE UNITED STATES IS ONLY NOW EMERGING FROM TWO DECADES OF
TURMOIL, DURING WHICH WE HAVE TRIED TO CORRECT THE SOCIAL
INJUSTICES OF THE PAST, WE HAVE FINALLY EXTENDED TO ALL
AMERICANS -- REGARDLESS OF RACE, COLOR, CREED, ETHNIC ORIGIN,
RELIGION, AGE, OR SEX -- THE BIRTHRIGHT OF FREEDOM THAT IS

THEIRS,

  WILL THE DISEASE OF AIDS -- ALL BY ITSELF -- REVERSE THIS
TREND IN OUR NATION'S HISTORY? WE HOPE AND PRAY THAT IT WILL

NOT,


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   BUT HOPES AND PRAYERS MAY NOT BE ENOUGH, WE WILL NEED

COURAGEOUS LEADERSHIP AT ALL LEVELS OF GOVERNMENT AND THROUGHOUT
OUR SOCIAL AND POLITICAL INSTITUTIONS TO REINFORCE THOSE HOPES

AND PRAYERS,

   IT'S APPROPRIATE TO ASK THAT QUESTION OF OUR GOVERNMENT,

BUT WE CANNOT STOP THERE,  WE NEED TO MAKE SURE THAT EVFRY
AMERICAN UNDERSTANDS JUST WHAT IS AT STAKE HERE AND THAT HE OR
SHE WILL DO WHATEVER IS NECESSARY TO MAKE SURE THAT OUR COUNTRY
NEVER RETURNS IN FEAR AND HATRED TO THE WAYS OF A SHAMEFUL PAST,

   AS THE PRESIDENT HAS SAID, WE MUST COME TOGETHER AND FIGHT
THIS DISEASE WITH EVERYTHING AT OUR COMMAND, BUT WE MUST m BE
THE ENEMIES OF THE PEOPLE WHO HAVE IT,


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   BUT ARE WE TRULY MATURE ENOUGH A SOCIETY TO REMAIN COLOR-
BLIND IN THIS WAR AGAINST AIDS? HOW DO WE KNOW?

   THESE AND OTHER ISSUES LIE ON THE HORIZON BEFORE US, BUT
THE HORIZON IS NOT THAT FAR AWAY,

   I HOPE WE WILL NOT STUMBLE ACROSS THAT TERRAIN, UNPREPARED
FOR THE CHALLENGES THAT LIE BEYOND, I HOPE WE WILL BEGIN TO TALK
ABOUT THESE ISSUES AS THE WISE, 2000YEAR-OLD SOCIETY WE PROFESS

TO BE,

   IF WE DO, WE MAY GIVE THE WORLD SOMETHING EVERY BIT AS
PRECIOUS AS THE MUCH-DESIRED AIDS VACCINE: WE WILL SHOti THE
WORLD HOW COMPASSION AND JUSTICE,, aNOT SCIENCE ALONE,, CAN
TRIUMPH OVER DISEASE,

ONCE AGAIN, a ,THANK YOU,