ADDRESS
"EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT AIDS”

BY
C, EVERETT KOOP, M.D., SC.D,
SURGEON GENERAL
OF THE
U. S. PUBLIC HEALTH SERVICE —

PRESENTED TO THE COA AUXILIARY
LAS VEGAS, NEVADA
NOVEMBER 11, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

1 APPRECIATE THIS OPPORTUNITY TO SPEAK WITH

YOU ABOUT A RELATIVELY NEW AND VERY SERIOUS

PUBLIC HEALTH MATTER WHICH AFFECTS @OUR COUNTRY

mpi -- AND INDEED THE REST OF THE WORLD.

I'M TALKING ABOUT AIDS..

LET ME TAKE JUST A MOMENT TO BRING YOU UP
TO DATE ON THIS ISSUE. AND THEN | WANT TO
EXPLORE SOME OF THE KEY QUESTIONS THAT AIDS

POSES TO OUR SOCIETIVS TODAY...AND TOMORROW.

FIRST...A LITTLE HISTORY #gReRiiaRiMiGiGizias

ALMOST SIX YEARS AGO, IN JUNE 1981, THE
PUBLIC HEALTH SERVICE PUBLISHED THE FIRST
REPORTS OF FIVE CASES OF PNEUM YSTI ARINI

PNEUMONIA IN LOS ANGELES.
NOW, FIVE CASES AREN'T MUCH...BUT THIS

LETHAL DISEASE IS SO RARE THAT A HANDFUL OF

  
     

AT THE TIME...

"THE OCCURRENCE:!
4

<Ay INDIVIDUALS WITHOUT A

 

LATER,
17 was
REPORRoTHAT 26 YOUNG MEN HAD BEEN Bewawetry

DIAGNOSED AS HAVING KAPOS!'S SARCOMA, "AN

UNCOMMONLY REPORTED MALIGNANCY” USUALLY FOUND -

IE AT ALL -- AMONG ELDERLY MEN.

 

5 IN LOS ANGELES WITH PNEUMOCYSTIS, WERE YOUNG

THEY

 

HOMOSEXUALS. A
THERE wERre

 

10 NEW REPORTS OF

PNEUMOCYSTIS...AND ALL OF THEM INVOLVED YOUNG
HOMOSEXUALS, ALSO.
PUBLIC HEALTH INVESTIGATORS THEN REPORTED

THAT PEOPLE WERE NOT ONLY SICK WITH THESE VERY

DANGEROUS DISEASES...THEY WERE DYING OF THEM.
FOR SOME MYSTERIOUS REASON, THEIR BODIES

WERE NOT FIGHTING BACK.

APPARENTLY THESE VICTIMS HAD ACQUIRED SOME
KIND OF "BUG" -- A VIRUS, MOST LIKELY -- THAT

ATTACKED AND DESTROYED THEIR NATURAL IMMUNE

SYSTEMS.

MEDICINE HAD NEVER COME UPON A SYNDROME
QUITE LIKE IT BEFORE. WE GAVE IT A LONG
TITLE: THE "ACQUIRED IMMUNE DEFICIENCY

SYNDROME." BUT WE SOON SETTLED JUST FOR THE

INITIALS...A.LD.S. ..OR "AIDS."

AND IT’S BEEN AIDS EVER SINCE.
YOU'VE READ THE STORIES AND HAVE SEEN IT ON
TELEVISION, I’M SURE, SO | WON'T GO THROUGH THE
WHOLE HISTORY ALL OVER AGAIN. INSTEAD, VEL

jUST TOUCH ON A FEW KEY POINTS:

FIRST OF ALL, WE’RE TALKING ABOUT A DISEASE

THAT IS SPREADING AND tS EATAL. IT NOW TAKES
1Ls77es Mowe THAN.

eee A YEAR IN THE U.S. FOR THE NUMBER OF
VICTIMS TO DOUBLE. FOR EXAMPLE, AT THE END OF
1985, WE HAD A CUMULATIVE TOTAL OF ABOUT 19,000

REPORTED CASES. TODAY THE TOTAL NUMBER OF AIDS
. Yioe
VICTIMS IS CLOSE TO abe.
mo ceeE THAN
ayato
Q@lenmemesr OF THEM HAVE ALREADY DIED OF THE

DISEASE...AND THE REST PROBABLY WILL.
THIS YEAR WE EXPECT TO ADD ANOTHER

23,000. AND BY THE END OF 1990 THE CUMULATIVE

TOTAL WILL BE OVER A QUARTER OF A MILLION.

SECOND POINT: EVEN THOUGH SCIENTISTS HAVE
HAD A LOOK AT THE AIDS VIRUS, WE STILL DON'T

KNOW PRECISELY WHAT IT 1S.

IN 1984 THE SEARCH WAS NARROWED DOWN TO
SOMETHING CALLED A “HUMAN RETROVIRUS.” THE
SCIENTISTS AT THE NATIONAL CANCER INSTITUTE WERE
EVEN ABLE TO PIN-POINT A SPECIFIC ONE. THEY

CALLED IT THE "HUMAN T-CELL LYMPHOTROPIC VIRUS

TYPE 111," OR SIMPLY "HTLV-II."
THE SAME VIRUS SHOWED UP IN THE WORK OF THE
PASTEUR INSTITUTE, WHERE IT BECAME KNOWN AS THE
“LYMPHADENOPATHY-ASSOCIATED VIRUS,” OR "LAV."
SCIENTISTS NOW AGREE TO CALL IT BY THE SINGLE

COMMON NAME OF "HUMAN IMMUNODEFICIENCY VIRUS,”

OR “H.I.V."

THE ABILITY TO RECOGNIZE THE VIRUS WAS A
VERY IMPORTANT DEVELOPMENT. ONCE YOU KNOW WHERE
THE AIDS VIRUS IS, YOU CAN THEN RECOGNIZE THE

PRESENCE OF ANTIBODIES SPECIFIC TO IT.

OF COURSE, THOSE ANTIBODIES AREN'T VERY

EFFECTIVE, BUT THEY'RE PRESENT NEVERTHELESS.
 

AS OF 1985 WE'VE HAD A TEST THAT CAN DETECT
THE PRESENCE OF THESE ANTIBODIES IN A PERSON'S
BLOODSTREAM. BEFORE THE TEST WAS DEVELOPED, THE
AIDS ANTIBODIES WERE TURNING UP IN ABOUT 4 OR 5
UNITS OF BLOOD PER 10,000 UNITS. NOW, SINCE

SEPFEED
BLOOD SCREENING WAS BEGUN, THAT FIGURE HAS Ga
SErvll Y avd 10
neomees UNITS PER 1 MILLION UNITS OF
TRANSFUSED BLOOD. AND, AS YOU KNOW, I'M SURE,
THAT'S AS CLOSE TO PERFECT AS YOU CAN GET IN

THIS KIND OF SERVICE.

ON THE BASIS OF SUCH TESTING, PLUS OTHER
EPIDEMIOLOGICAL DATA, WE THINK THERE ARE BETWEEN
A MILLION AND A MILLION-AND-A-HALF AMERICANS.

WALKING AROUND WITH THE AIDS. VIRUS IN THEIR
SYSTEMS. ALTHOUGH, HONESTLY, IT COULD BE

400,000 TO 4 MILLION.

THEY HAVE THE VIRUS...BUT THEY AREN'T YET
SICK WITH AN AIDS-RELATED DISEASE, SUCH AS

PNEUMOCYSTIS CARINIT PNEUMONIA OR KAPOSI’S
opp AVY OTHER GPE TIAN © [MEECHO

SARCOMA OR Gaara

   

 

ONE MAJOR COMPLICATION FOR MAKING ESTIMATES
FOR THE FUTURE IS THE LENGTH OF THE INCUBATION
PERIOD. IT CHANGES. APPARENTLY IT CAN BE
ANYWHERE FROM A YEAR OR SO IN SOME PEOPLE TO 10
YEARS IN OTHERS. SO WE STILL CAN'T PREDICT
WHICH PERSON CARRYING THE AIDS VIRUS WILL OR

WILL NOT GET AN AIDS-RELATED DISEASE.
- 10 -

BUT IT'S NOT A 50-50 RISK. THE ODDS ARE
WORSE THAN THAT. THE POSSIBILITY OF BEING
OVERCOME BY AN INFECTIOUS DISEASE OF SOME KIND
IS VERY, VERY HIGH. IN FACT, SOME RESEARCHERS
NOW FEEL THAT ANYONE WITH THE AIDS VIRUS WILL
EVENTUALLY CONTRACT AN AIDS-RELATED DISEASE IF

HE LIVES LONG ENOUGH...AND WILL DIE FROM IT.

THERE’S OTHER RESEARCH GOING ON AS WELL, IN

THE AREA OF DRUG THERAPY AND VACCINE

DEVELOPMENT. IN FACT, RESEARCH NOW COMMANDS

2/7
sepmipmeses, MILLION IN U.S. FEDERAL FUNDS THIS

YEAR, PLUS MANY MILLIONS MORE IN STATE AND
FEDERRO&

PRIVATE SECTOR FUNDS. WE#? Y Et oy ef bet felt

Fuwnmve wite RE Gz miuug v7

oF A MTR Feaeane Wo EXP EAD =

IiFyle oF 7 ? Bicetow .
-ii1-

ONE NEW EXPERIMENTAL DRUG --
AZIDOTHYMIDINE, OR A.Z.T. -- HAS GONE THROUGH A
SO-CALLED “EAST-TRACK" APPROVAL PROCESS AND IS
NOW BEING USED TO PROLONG THE LIVES OF AIDS

VICTIMS DYING OF PNEUMOCYSTIS CARINII PNEUMONIA.

BUT I'M AFRAID THAT'S ALL A.Z.T. DOES...IT
PROLONGS SOME LIVES, IT DOES NOT SAVE THEM. FOR

SAVING LIVES, WE NEED A VACCINE.

AND EVERYBODY WANTS TO KNOW WHEN AN
EFFECTIVE VACCINE MIGHT BE AVAILABLE. | HAVE TO

TELL THEM THAT ! DON’T SEE ONE IN THE NEAR

FUTURE.
-12-

 

DEVELOPMENT IS ONE THING THAT CANNOT BE RUSHED
WITHOUT CREATING MORE PROBLEMS THAN WE ALREADY

HAVE.

WE NEED TO REMEMBER, FOR EXAMPLE, THAT IT
TOOK 17 YEARS TO DEVELOP THE HEPATITIS B
VACCINE...AND THAT WAS A COMPARATIVELY EASY

VIRUS TO UNDERSTAND.

NOW FOR MY THIRD POINT:

WE DON'T KNOW VERY MUCH ABOUT AIDS...BUT WE
DO KNOW --WITH COMPLETE CERTAINTY -- THAT THE.

AIDS VIRUS TENDS TO CONCENTRATE IN BODY FLUIDS
- 13 -

WHICH ALSO CARRY LARGE CONCENTRATIONS OF

INFECTED LYMPHOCYTES.

IN MOST BODY FLUIDS -- SUCH AS TEARS,
SALIVA, AND PERSPIRATION, FOR EXAMPLE -- THE
VIRUS PARTICLE COUNT IS VERY LOW OR ABSENT
ALTOGETHER. ON THE OTHER HAND, LARGE NUMBERS OF

VIRUS PARTICLES ARE FOUND IN BLOOD AND SEMEN.

THIS 1S ONE OF THE MOST IMPORTANT PIECES OF
INFORMATION WE HAVE SO FAR. IT EXPLAINS, FOR
EXAMPLE, WHY THE INITIAL ALARM ABOUT AIDS WAS

SOUNDED AMONG HOMOSEXUALS AND BISEXUAL MEN.
- 14 -

RECTAL SVIPEACOGCAIE ¢h Sodomy

OQIPRTSRNNINEES AMONG THESE MEN NOT ONLY

PRODUCE SEMEN BUT MAY ALSO CAUSE SOME
BLEEDING. AND, AGAIN, BLOOD AND SEMEN ARE THE
ONLY TWO BODY FLUIDS THAT CARRY -- AND TRANSMIT

-- HIGH ENOUGH CONCENTRATIONS OF THE LIVE AIDS

VIRUS.

THE BIOPHYSICAL PECULIARITIES OF THE AIDS
VIRUS ALSO EXPLAIN WHY 25 PERCENT OF ALL AIDS
CASES ARE INTRAVENOUS DRUG ABUSERS WHO USE
CONTAMINATED NEEDLES AND OTHER PARAPHERNALIA
THEY'VE BORROWED FROM OTHER ADDICTS WHO HAVE

AIDS. THIS GROUP INCLUDES DRUG ABUSERS WHO ARE

HOMOSEXUALS, ALSO.
- 15 -

WHEN WE FIRST BEGAN TO CONFRONT THE AIDS
EPIDEMIC, THE PEOPLE AT HIGHEST RISK WERE EITHER
HOMOSEXUALS AND BISEXUAL MEN AND I.V. DRUG
ABUSERS, MALE AND FEMALE. I'M AFRAID THEY STILL

ARE: 9 OF EVERY 10 CASES INVOLVE THESE KINDS OF

INDIVIDUALS.

BUT NOWADAYS WE'RE RECEIVING MORE AND MORE
REPORTS OF THE AIDS VIRUS OCCURRING AMONG
HETER X MEN AND WOMEN WHO ARE NOT 1.V. DRUG

ABUSERS. IN FACT, THEIR HETEROSEXUAL ACTIVITY

SEEMS TO BE THEIR ONLY RISK FACTOR.

ibeiiminbleeeE SK , 4 PERCENT OF ALL REPORTED
wmCLE

AIDS CASES IN THE.U.S. SP OF SUCH HETEROSEXUAL

MEN AND WOMEN...A PERCENTAGE, BY THE WAY, THAT'S .

CLIMBING. Stowe ”
- 16 -

ANOTHER CONCERN IS THE RISE IN AIDS AMONG
BLACKS AND HISPANICS. BLACKS ACCOUNT FOR 12
PERCENT OF THE U.S. POPULATION, BUT THEY ACCOUNT
FOR 25 PERCENT OF ALL AIDS CASES. SIMILARLY,
| HISPANICS ACCOUNT FOR 6 PERCENT OF THE U.S.
POPULATION, BUT THEY ACCOUNT FOR 14 PERCENT OF

ALL AIDS CASES. 9S % oe Gute Rares Sond
¢ Ard FRE Renee et PAPAL

SO THE DEMOGRAPHY OF THIS DISEASE !S

BECOMING AS COMPLEX AS THE DISEASE ITSELF.

AND THAT LEADS ME TO MY FOURTH POINT: OUR
SINGLE DEFENSE AGAINST THIS DISEASE FROM THE
VERY BEGINNING HAS BEEN INFORMATION AND

EDUCATION. AND IT STILL IS.
- 17 -

OVER THE PAST 5 YEARS, WE'VE BEAMED
INFORMATION ALMOST EXCLUSIVELY TO HOMOSEXUALS
AND BISEXUAL MEN AND, WHEREVER POSSIBLE, TO DRUG
ABUSERS. AMONG HOMOSEXUALS, THIS CAMPAIGN SEEMS
TO HAVE BEEN EFFECTIVE...THEIR SEXUAL BEHAVIOR

HAS APPARENTLY CHANGED.

 

IN THE INCIDENCE OF OTHER SEXUALLY TRANSMITTED

DISEASES AMONG HOMOSEXUAL MEN, SUCH AS

GONORRHEA, HEPATITIS B., AND SYPHILIS.

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- 18 -

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GaR7vEAS

THAT WAS THE BASIS FOR THE SURGEON
ENERAL'S REPORT IDS, WHICH | RELEASED LAST
OCTOBER. LET ME TAKE JUST A MINUTE HERE TO

EXPLAIN HOW THAT REPORT CAME ABOUT.

EARLY IN FEBRUARY 1986, PRESIDENT REAGAN

INSTRUCTED ME TO PULL TOGETHER EVERYTHING WE
KNEW ABOUT AIDS AND PUT IT INTO A PLAIN-ENGLISH

REPORT TO THE AMERICAN PEOPLE.
-19-

THE PRESIDENT WAS CONCERNED THAT THERE WAS
STILL TOO MUCH CONFUSION AMONG THE AMERICAN
PEOPLE ABOUT THE NATURE OF THIS THREAT TO PUBLIC

HEALTH. HE ASKED ME TO DO WHAT |! COULD TO SET

THE RECORD STRAIGHT.

FOR THE NEXT 8 MONTHS |! MET WITH CONCERNED
INDIVIDUALS AND GROUPS FROM ACROSS THE SPECTRUM

OF SOCIETY...HEALTH, EDUCATION, THE CHURCHES,

CIVIL RIGHTS GROUPS.

THEY WERE ALL EXTRAORDINARILY CANDID AND

HELPFUL.
- 20 -

AFTER 8 MONTHS OF LISTENING AND WRITING, |
DELIVERED BY REPORT TO THE CABINET AND TO THE
PRESIDENT. IT WAS ACCEPTED...AND | RELEASED IT

TO THE AMERICAN PEOPLE ON OCTOBER 22, 1986.
/F foo 20 WOT wAVEe Pe coh) B00 - BY APS

1 WANT TO ASSURE YOU THAT AT NO TIME HAVE |

HAD ANY MISGIVINGS ABOUT ANYTHING 1! WROTE.

THERE IS MUCH SCIENTIFIC AND PUBLIC HEALTH
INFORMATION IN THAT REPORT, BUT ON THE

BEHAVIORAL SIDE, THERE WERE JUST THREE MESSAGES

THAT ARE VITALLY IMPORTANT:

THE FIRST MESSAGE iS SIMPLE ENOUGH. IT

SAYS THAT THE BEST DEFENSE AGAINST AIDS IS TOTAL

ABSTINENCE FROM SEXUAL RELATIONS.
- 21 -

1 THINK THAT'S PRECISELY THE RIGHT MESSAGE
TO GIVE TO OUR CHILDREN -- AIDS OR NO AIDS. BUT
ADULTS ARE AT RISK, ALSO, AND A RECOMMENDATION
OF TOTAL ABSTINENCE FOR THE ENTIRE POPULATION

iS, TO SAY THE LEAST, UNREALISTIC.

HENCE, MY SECOND MESSAGE IS THIS:

FIND SOMEONE WHO IS WORTHY OF YOUR RESPECT

AND YOUR LOVE...GIVE THAT PERSON BOTH...AND STAY

FAITHFUL TO HIM OR HER,

IN OTHER WORDS. SHORT OF TOTAL ABSTINENCE,

THE BEST DEFENSE AGAINST AIDS IS TO MAINTAIN A

FAITHFUL M RELATI IN WHICH YOU

HAVE ONLY ONE CONTINUING SEXUAL PARTNER...AND

THAT PERSON IS AS FAITHFUL AS YOU ARE.
MUToan co Farmfee MARRIA CES nave MAaT
More PesiTrb € 7Arals Fe EMI AEE owes

LiFe , 7tAaw PAE MERE Patvenw Mow @F
A §$.7T, o.* cévtinw A j%k&§$“_?EVAHAA: on é &016F Aros
. MY THIRD MESSAGE iS FOR PEOPLE WHO AREN'T

ABSTINENT BUT DON'T YET HAVE A FAITHFUL

MONOGAMOUS RELATIONSHIP...FOR WHATEVER REASON.
| Awe How CHW pou ic Won

UNLESS YOU KNOW WITH ABSOLUTE ERTAINTY, THAT

NEITHER YOU NOR YOUR PARTNER !S CARRYING THE

AIDS VIRUS, YOU MUST USE CAUTION.

FROM THE VIEWPOINT OF EPIDEMIOLOGY, WHEN
YOU HAVE SEX WITH SOMEONE, YOU'RE ALSO HAVING
SEX WITH EVERYONE ELSE WITH WHOM THAT PERSON HAS

HAD SEX.
- 23 -

AND, WHEN YOU CONSIDER THE LONG INCUBATION
PERIOD FOR THE AIDS VIRUS, WE'RE TALKING ABOUT
THAT PERSON’S HISTORY OF SEXUAL RELATIONS GOING

BACK 5 YEARS OR PERHAPS LONGER. ~ JE ter V7
prwPtw Fo FE 2 Coon speete ae Mellacé s

fed IF YOU DO DECIDE TO HAVE SEX WITH SOMEONE
AND YOU ARE NOT ABSOLUTELY CERTAIN ABOUT HIS OR
HER SEXUAL HISTORY, THEN -- IF YOU'RE A MAN --
USE A CONDOM FROM START TO FINISH. IF YOU'RE A
WOMEN, MAKE SURE YOUR MALE PARTNER USES A

CONDOM...AGAIN, FROM START TO FINISH.

A CONDOM WON'T PROVIDE 100 PERCENT
PROTECTION -- FEW THINGS IN LIFE DO -- BUT SO

FAR IT SEEMS TO BE THE BEST PROTECTION

Cc
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- 24 -

     

HE DIFFER

   
  

ES OF OPINI THE U.S.
SWIRL AROUND:
O X EDUCATION FOR THE YOU D

O HOW TO BEST PROTECT INDIVIDUALS WHO ARE
HIV POSITIVE, OR HAVE AIDS, FROM
UNWARRANTED DISCLOSURE AND
DISCRIMINATION, WHILE PROTECTING THE

PUBLIC FROM INFECTION. }
257

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Pre MALTA TESTING
CURRENT CONTROVERSY @eeEEESS 1S
BETWEEN THOSE WHO FAVOR MANDATORY TESTING AND
THOSE WHO DO NOT. THE MOTIVATION OF THE FORMER
GROUP IS MIXED, MOST OF THE PUBLIC HEALTH PEOPLE

ADHERE TO THE LATTER STANCE.

THE TWO AREAS OF MOST HEATED CONTROVERSY
ARE PREMARITAL TESTING AND THE TESTING OF

HOSPITAL ADMISSIONS.

HIGH RISK PEOPLE ARE USUALLY NOT GETTING
MARRIED IN THE UNITED STATES. THE OLD LAWS
PERTAINING TO MARRIAGE LICENSES AND TESTING FOR
SYPHILIS ARE NOT APPLICABLE BECAUSE FOR SYPHILIS

THERE WAS A CURE; THERE IS NO SUCH THING
a7

AVAILABLE FOR AIDS. SEVENTY-FIVE PERCENT OF |
THOSE GETTING MARRIED HAVE ALREADY BEEN LIVING
TOGETHER. THE COSTS OF SUCH TESTING iS
EXORBITANT IN REFERENCE TO THE NUMBER OF CASES
FOUND, AFTER WHICH THERE iS NO PROGRAM AVAILABLE
EXCEPT EDUCATION. IT iS ESTIMATED THAT IN THE |

were Suen A

STATE OF NEW HAMPSHIRE, Aaaeet
meT PASSEP FHAT 17

WOULD COST $100,000 TO FIND A SINGLE HIV

 

INFECTED PERSON IN PREMARITAL SCREENING.

  
 

ie

MANDATORY FASHION IS OPPOSED-8Y MOST PUBLIC
HEALTH AUTHORITIES >A COMPROMISE PLAN IS UNDER
gt

piscusslO yen HERE ONLY SURGICAL ADMISSIONS WOULD

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tuo, eg, ow
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E TITLE OF MY REMARKS TODAY WOULD INDICATE, |
EVIEWING FOR YOU -- ALBEIT IN A BRIEF
HOICES THAT LIE AHEAD OF US,

  

AND NOW,
WANT TO SPEND A FEW MO
MANNER -~ SOME OF THE OTHER DIFFI
RELTAIVE TO THE PANDEMIC OF AIDS.

FIRST, LET ME REMIND YOU THAT THE THREE ASPECTS OF AIDS THAT
COLOR EVERYTHING DONE AND SAID ABOUT THE DISEASE ARE, ONE, THAT IT

IS STILL A MYSTERY...TWO, THAT IT IS FATAL...AND THREE, THAT PEOPLE
GET AIDS BY DOING THINGS THAT THE MAJORITY OF PEOPLE DON’T DO AND

WE NEED TO KEEP THESE THREE ASPECTS OF THE DISEASE IN MIND,
BECAUSE THEY. IN COMBINATION, TRULY OBSCURE THE MANY SCIENTIFIC
ISSUES SURROUNDING AIDS AND, INSTEAD, SWING OUR AJTENTION TO THE
MORE SENSITIVE AND VOLATILE ISSUES OF LAW, ETHICS, ECONOMICS,
MORALITY, AND SOCIAL COHESION THAT SURROUND AIDS.
/ 2

FOR EXAMPLE. WE ARE ALREADY WITNESSING THE ASSAULT BY THIS
DISEASE UPON THE ETHICAL FOUNDATION OF HEALTH CARE ITSELF.

DESPITE THE SENSIBLE AND RATHER ELEMENTARY GUIDELINES ISSUED TO
THE HEALTH PROFESSIONS BY OUR CENTERS FOR DISEASE CONTROL. WE STILL
HEAR -- EVERY DAY -- OF PHYSICIANS, DENTISTS, NURSES, AND OTHER
HEALTH PERSONNEL WHO REFUSE TO TREAT PERSONS WITH AIDS...OR EVEN TO
TREAT PERSONS WHOM THEY SUSPECT OF HAVING AIDS,

LET ME QUICKLY ADD THAT THIS IS NOT CHARACTERISTIC OF HEALTH
PROFESSIONALS BY ANY MEANS. ON THE CONTRARY, THE OVERWHELMING
MAJORITY OF MY COLLEAGUES HAVE PROVIDED -- AND WILL CERTAINLY
CONTINUE TO PROVIDE -- QUALITY, COMPASSIONATE CARE TO PERSONS DYING

OF AIDS.
/13

BUT THE GOOD CONDUCT OF THE MAJORITY SHOULD NOT IN ANY WAY
SHIELD THE UN-PROFESSIONAL CONDUCT OF A FEARFUL AND IRRATIONAL

MINORITY,
WELL, WHAT SHOULD WE DO ABOUT THAT?

I THINK THAT’S AN IMPORTANT QUESTION, BECAUSE HEALTH CARE IN
THIS COUNTRY HAS ALWAYS BEEN PREDICATED ON THE ASSUMPTION THAT --
SOMEHOW -- EVERYONE WHO NEEDS HEALTH CARE WILL RECEIVE HEALTH CARE.
AND NO ONE WILL BE TURNED AWAY,

AS A PHYSICIAN -- S ER -- I’M PROUD TO BE PART OF
A TRADITION OF CARE THAT WILL NOT ABANDON THE SIEK AND THE DISABLED
J 14

HENCE, I REGARD AS EXTREMELY SERIOUS THE REPORTS OF A FEW
PHYSICIANS AND OTHERS WHO ARE WITHHOLDING CARE FROM PERSONS WITH
AIDS. THEIR CONDUCT THREATENS THE VERY FABRIC OF HEALTH CARE IN
THIS COUNTRY,

ONE DAY SOON, WE WILL HAVE TO CONFRONT THAT ISSUE AND COME UP
WITH SOME GOOD ANSWERS. OTHERWISE THE VIRUS OF AIDS WILL FURTHER
WEAKEN THE ETHICS OF MEDICAL PRACTICE IN THE UNITED STATES. AND
THAT WOULD BE ANOTHER AND JUST AS DEADLY A KIND OF EPIDEMIC FOR OUR
SOCIETY.

A RELATED ISSUE CONCERNS THE COST OF CARE FOR AIDS PATIENTS:
WHO SHOULD PAY THOSE THAT COSTS?
Vs

AS YOU KNOW. WE HAVE A MIXED SYSTEM OF SUPPORT FOR HEALTH CARE
IN THIS COUNTRY: PRIVATE METHODS OF PAYMENT EXIST SIDE-BY-SIDE WITH
PUBLICLY SUPPORTED SYSTEMS OF REIMBURSEMENT FOR CARE.

THE AMERICAN TAXPAYER SUPPORTS MATERNAL AND CHILD HEALTH |
PROGRAMS, FOR EXAMPLE, AND DIABETES CONTROL AND HYPERTENSION
SCREENING PROGRAMS, TAXPAYERS ALSO SUPPORT PROGRAMS FOR ALCOHOLICS.
DRUG ADDICTS, AND SYPHILITICS.

ALL SUCH PROGRAMS ARE PART OF OUR GOVERNMENT’S TOTAL COMMIT-
MENT TO PROVIDE FOR "THE GENERAL WELFARE OF THE UNITED STATES.” AS
THE CONSTITUTION INSTRUCTS IN ARTICLE 1, SECTION 8. THAT

_ Ttes€ witw wheT€ (7. --

INSTRUCTION, BY THE WAY, IS 200 YEARS OLD. GOOD FOR £E...AND GOOD
FOR US.
ar

THOSE PROGRAMS THAT MORE OR LESS CLEAN UP AFTER PEOPLE WHO
BEHAVE POORLY ARE NOT REALLY EXPENSIVE PROGRAMS. IN ADDITION. THEY
ARE. GEARED TO BRING -- OR TO BRING BACK -- MEN, WOMEN, AND CHILDREN
TO A STATE OF GOOD HEALTH.

BUT AIDS 1S ESPECIALLY DIFFICULT. IT ALSO IS A DISEASE THAT A
PERSON CONTRACTS USUALLY AS A RESULT OF HIGH-RISK BEHAVIOR. LET'S -
FOR THE MOMENT DISREGARD THE FEW REMAINING CASES INVOLVING TRANS-
FUSED BLOOD OR BLOOD PRODUCTS OR THE SMALL NUMBER OF BABIES BORN

WITH AIDS,
WHA? MOS OF out Ctt2E0s CACL

AIDS 1S LINKED TO, QUESTIONABLE BEHAVIOR. THE WAY DRUG
ADDICTION, LIVER FAILURE. AND LUNG CANCER ARE CAUSALLY LINKED TO
POOR INDIVIDUAL JUDGMENTS,
V 17

BUT THE TREATMENT OF AIDS PATIENTS IS PROVING TO BE VERY
EXPENSIVE. IT IS BOTH TECHNOLOGY- AND LABOR-INTENSIVE .AND CAN BE AS
MUCH AS $50,000 PER YEAR -- AND MORE -- FOR SOME PATIENTS,

BUT, AFTER CONSUMING TENS OF THOUSANDS OF DOLLARS WORTH OF
MEDICAL CARE AND SOCIAL SERVICES...THE AIDS PATIENT DIES.

THE AIDS CASE-LOAD IS CLIMBING. BETWEEN AUGUST OF 1986 AND
THIS PAST AUGUST, THERE WERE SOME 14,000 NEW CASES OF AIDS REPORTED.

BY THIS TIME NEXT YEAR, WE EXPECT THERE WILL BE AN ADDITIONAL
15-16,000 NEW CASES.
Vig

WILL THE AMERICAN PEOPLE CONTINUE TO SUPPORT HIGH-COST PATIENT
CARE FOR PEOPLE WITH AIDS? OR WILL THEY ASK FOR RELIEF AND SUPPORT
A KIND OF "SECOND-CLASS CARE” FOR AIDS PATIENTS?

HOW SHOULD WE RESPOND TO SUCH A DEVELOPMENT? IT’S A VERY.
TROUBLING POSSIBILITY BECAUSE IT WOULD DRIVE THE FIRST SMALL WEDGE
INTO THE FOUNDATIONS OF HEALTH CARE POLICY IN THIS COUNTRY. WE’ VE
NEVER ACCEPTED THAT BEFORE. WOULD WE ACCEPT IT NOW?

THEN THERE 1S THE ISSUE OF “INDIVIDUAL PRIVACY versus THE NEED
TO PROTECT THE COMMUNITY FROM DANGER.”
pean Rew ©
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No WNE7TE4 Sexvae Lu Pee TOM
- 38 -

 
  

   

AREAS, as ate

Ca
CANE PATIENTS

BECAUSE OF FEAR OF yy SSITIVITY AND IT IS

OUR ONLY HOPE AS A NATION -- INDEED AS A
CIVILIZATION -- IS THAT WE ALL DO OUR PART TO
STOP THE SPREAD OF AIDS...THAT WE WILL PROTECT

AND SAVE THE LIVES OF PEOPLE AT RISK.

THAT'S A TALL ORDER -- AND THERE ARE MANY

SAYING IT CAN'T BE DONE.

BUT, THEY'RE WRONG.
- 39 -

1 THINK WE WILL EVENTUALLY AGREE ON THE

TASKS THAT REALLY MATTER -- AND GET THEM DONE.

MY PERSONAL HOPE IS THAT I'LL STILL BE

AVAILABLE TO HELP!

THANK YOU.