ORIGINAL Vast 7 eee : p To KNow BY C. Everett Koop. M.D., Sc.D, SURGEON GENERAL OF THE U.S. PuBLic HEALTH SERVICE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PRESENTED TO NATIONAL ASSOCIATION OF SECONDARY SCHOOL PRINCIPALS ANAHEIM, CALIFORNIA MarcH 6, 1988 1 (GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.) I WANT TO THANK DR. SCOTT THOMSON, GEORGE MELTON, AND JOHN KOURMADAS FOR MAKING THIS PLATFORM AVAILABLE TO ME THIS MORNING, WE'VE GOT TO TALK ABOUT SOME DIFFICULT TIMES THAT LIE AHEAD OF US ... AND WE’VE GOT TO TALK ABOUT SOME DIFFICULT SITUATIONS THAT I KNOW MANY OF YOU -- MAYBE EVEN MOST OF YOU -- WILL BE FACING, AS LEADERS BOTH IN EDUCATION AND IN CIVIC AFFAIRS ... IF, IN FACT, YOU AREN’T FACING THEM ALREADY. 2 MANY NEW ISSUES ARE PRESSING IN ON US -- EDUCATIONAL, MORAL, ETHICAL, POLITICAL -- ALL STIMULATED, OF COURSE, BY THE AIDS EPIDEMIC, WHICH IS POTENTIALLY ONE OF THE WORST INFECTIOUS DISEASES EVER TO HIT THE HUMAN RACE. YES, I SAID “POTENTIALLY” BECAUSE I AM HOPEFUL THAT WE WILL SOMEHOW ESCAPE THE FULL FORCE OF THE EPIDEMIC, THANKS TO SCIENCE AND MEDICINE ... AND THANKS TO THE COMMON SENSE OF THE AMERICAN PEOPLE. I’M HOPEFUL THAT AMERICANS -- AND PEOPLE EVERYWHERE ON THIS PLANET -- WILL HAVE THE GOOD SENSE TO LEARN THE FACTS ABOUT AIDS AND TO BEHAVE THEMSELVES IN WAYS THAT PREVENT THE SPREAD OF AIDS, 3 BUT JUST WHAT ARE THE FACTS AT THIS TIME? AND -- AS DR, THOMSON ASKED, WHEN HE PHONED MY OFFICE A WHILE BACK ~- “WHAT DO YOU REALLY HAVE TO KNOW ABOUT THIS DISEASE IN ORDER TO PROTECT YOURSELF, YOUR FAMILY AND LOVED ONES, AND YOUR SCHOOL.” THE FIRST THING TO KNOW -- AND THIS, DESPITE MY NOTE OF HOPEFULNESS OF A MOMENT AGO -- IS THAT THE AIDS VIRUS IS SPREADING. WE CAN DEDUCE THIS FROM THE REPORTS COMING IN TO THE U.S. PUBLIC HEALTH SERVICE EVERY WEEK. 4 FOR EXAMPLE, FROM FEBRUARY 1986 TO FEBRUARY OF ‘87, WE LOGGED IN 13,500 NEW CASES OF AIDS. BUT OVER THE MOST RECENT 12- MONTH PERIOD ~- FROM FEBRUARY ‘87 TO FEBRUARY 188 -- WE LOGGED IN 23,000 NEW CASES. YOU MAY REMEMBER THAT OUR FIRST CLUE ABOUT THIS DISEASE APPEARED BACK IN JUNE 1981, WITH A REPORT OF 5 CASES OF A RARE TYPE OF PNEUMONIA FOUND AMONG “OTHERWISE HEALTHY HOMOSEXUAL MALES” IN LOS ANGELES, CALIFORNIA, 5 SINCE THOSE FIRST 5 CASES WERE RECORDED, LOS ANGELES HAS REPORTED ANOTHER 4,370 CASES ... AND THE COUNTRY AS A WHOLE HAS HAD TURNED UP 54,000 CASES OF AIDS. YOU MAY RECALL THAT LINE FROM VOLTAIRE THAT SAYS, “HISTORY IS ONLY THE PATTER OF SILKEN SLIPPERS DESCENDING THE STAIRS ... TO THE THUNDER OF HOBNAILED BOOTS CLIMBING UPWARD FROM BELOW.” THOSE FIRST 5 CASES QUIETLY TIP-TOED IN ON US BACK IN 1981, BUT SINCE THEN, HISTORY HAS BEEN MADE TO THE ACCOMPANYING THUNDER OF AN ARMY OF PERSONS WITH AIDS, 6 FROM 5 CASES TO 54,000 CASES IN LESS THAN 7 YEARS ... YOU MUST TAKE SERIOUSLY ANY DISEASE THAT EXPLODES UPON A NATION WITH SUCH SPEED AND SUCH SEVERITY, BUT IT’S MORE THAN JUST NUMBERS. THE FIRST REPORTS MAY HAVE COME FROM LOS ANGELES, BUT TODAY EVERY STATE AND TERRITORY HAS BEEN TOUCHED BY THIS EPIDEMIC. I GRANT YOU THAT HALF OF ALL CASES REPORTED SO FAR HAVE BEEN IN EITHER NEW YORK OR CALIFORNIA. BUT THE REST OF US CAN‘T BE SMUG ABOUT THAT INFORMATION, 7 INDIANA, OUT IN THE HEARTLAND OF AMERICA, HAS HAD 270 CASES SO FAR ... KANSAS HAS HAD 119 ... MAINE, 65 CASES ... NORTH DAKOTA, 6 ... AND EVEN GUAM HAS HAD 4 CASES SO FAR. AND EACH ONE OF 20 CITIES IN 14 STATES HAVE REPORTED OVER 450 CASES OF AIDS SINCE 1981, SO THIS EPIDEMIC IS GROWING NUMERICALLY AND SPREADING GEOGRAPHICALLY. 8 HOWEVER, THE EXPANSION OF THE AIDS EPIDEMIC IS ONLY PART OF THE STORY, THE OTHER PART IS AN EVEN GRIMMER STORY, AIDS IS VIRTUALLY 100 PERCENT FATAL. OF THOSE 54,000 PERSONS WHO WERE REPORTED AS HAVING AIDS SO FAR, 30,000 HAVE DIED. THAT'S AN OVERALL MORTALITY RATE OF 56 PERCENT. BUT WAIT A MINUTE. OF THE PEOPLE WHO HAD AIDS IN 1981, SOME 93 PERCENT HAVE ALREADY DIED. OF THOSE IN 1982, CLOSE TO 90 PERCENT HAVE DIED, 9 AND ALMOST A THIRD OF THE PEOPLE WHO WERE REPORTED WITH AIDS JUST LAST YEAR HAVE ALREADY DIED. WE DO NOT KNOW EVERYTHING ABOUT THIS DISEASE. BUT ONE THING WE CAN SAY WITH SOME ASSURANCE: 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. 10 OF COURSE, WE HAVE A DRUG CALLED A.Z.T. WHICH SEEMS ABLE TO PROLONG THE LIVES OF MANY PERSONS WITH AIDS. AND SEVERAL OTHER DRUGS WITH THE SAME KIND OF PROMISE ARE IN THE DEVELOPMENTAL PIPELINE. BUT ALL THESE DRUGS WILL DO -- IF AND WHEN THEY WORK -- IS TO PROLONG A PERSON’S LIFE FOR A FEW MONTHS ... MAYBE A YEAR OR SO. THEY DO NOT CURE AIDS ... OR ANY CONDITION BROUGHT ON BY AIDS, THE HARD TRUTH IS THAT WE HAVE NO DRUG ... NO VACCINE ... NO "MAGIC BULLET” OF ANY KIND THAT PREVENTS AIDS OR STOPS IT IN ITS TRACKS. 11 NO DOUBT YOU’VE READ NEWS REPORTS ABOUT SOME VACCINE TESTING THAT'S JUST GETTING UNDERWAY. IT'S TRUE ... WE HAVE ALLOWED SOME VACCINE TESTING TO BEGIN, 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 LEAST. AND THAT’S PUTTING THE BEST FACE ON IT. SO I MUST SAY THAT IF YOU -- OR ANY OF YOUR TEACHERS OR YOUR STUDENTS -- MINIMIZE THE SITUATION WE’RE IN, EXPECTING A CURE TO BE DISCOVERED ANY DAY NOW... YOU -- AND THEY -- ARE SADLY MISTAKEN, 12 "ANY DAY” COULD BE ABOUT 12 TO 15 YEARS AWAY. WHAT ELSE DO YOU NEED TO KNOW ABOUT AIDS? HOW THE BUG REALLY OPERATES, FOR ONE THING. AT LEAST, AS FAR AS WE UNDERSTAND IT. REMEMBER, THE AIDS VIRUS IS STILL A MYSTERY, SO, WHILE WE KNOW QUITE A BIT ABOUT IT, AIDS COULD STILL SPRING SOME SURPRISES ON US LATER DOWN THE ROAD. GENERALLY SPEAKING, THE AIDS VIRUS -- TECHNICALLY, THE HUMAN IMMUNODEFICIENCY VIRUS, OR H.1.¥. -- GOES AFTER TWO TARGETS, ONCE IT INVADES THE HUMAN BODY. | 13 ONE TARGET IS THE BRAIN AND THE CENTRAL NERVOUS SYSTEM. HERE, THE AIDS VIRUS ITSELF APPARENTLY BRINGS ON A DETERIORATION OF THE CENTRAL NERVOUS SYSTEM. HENCE, TO THE ALREADY LONG LIST OF DISEASES AND CONDITIONS CAUSED BY AIDS, WE’VE RECENTLY ADDED DEMENTIA. BUT THE CENTRAL NERVOUS SYSTEM IS NOT WHERE THE AIDS VIRUS HAS BEEN DOING ITS WORST DAMAGE FOR THE PAST 6 YEARS, THE AIDS VIRUS MOST COMMONLY FEEDS ON -- AND DESTROYS -- ITS OTHER TARGET: THOSE WHITE BLOOD CELLS THAT ARE THE BASIS OF OUR HUMAN IMMUNE SYSTEM, 14 ONCE THE VIRUS FINDS THAT TARGET AND ATTACKS, THE PERSON WITH THE VIRUS BECOMES AN EASY MARK FOR THE NEXT INFECTIOUS DISEASE OR CANCER THAT COMES ALONG. AND THOSE DISEASES ARE WHAT ATTACK AND KILL AIDS PATIENTS oes DISEASES SUCH AS PNEUMOCYSTIS CARINII PNEUMONIA, KAPOSI‘S SARCOMA, CYTOMEGALOVIRAL INFECTIONS, “VALLEY FEVER” OR PROGRESSIVE COCCIDIOMYCOSIS, HISTOPLASMOSIS, ATYPICAL TUBERCULOSIS, CANDIDIASIS OF THE ESOPHAGUS AND THE RESPIRATORY TRACT, ULCERATIVE HERPES, AND SO ON, 15 SINCE THE AIDS VIRUS FEEDS ON WHITE BLOOD CELLS, THE VIRUS APPEARS WHERE THERE ARE HIGH CONCENTRATIONS OF SUCH CELLS. AND THOSE CELLS ARE FOUND MAINLY IN TWO BODY FLUIDS: BLOOD AND SEMEN, THAT INFORMATION ALSO HELPS US UNDERSTAND HOW THE AIDS VIRUS IS SPREAD FORM PERSON TO PERSON: THIS DISEASE IS SPREAD WHEN ANY AIDS-INFECTED BLOOD AND/OR SEMEN FROM ONE PERSON ENTERS INTO ANOTHER PERSON’S BODY AND TS ABSORBED INTO HIS OR HER BLOODSTREAM, 16 NEEDLESS TO SAY, THE TRANSMISSION OF THE AIDS VIRUS DOESN'T HAPPEN IN ANY CASUAL WAY. YOU TRANSMIT -- OR CATCH -- AIDS ONLY IF YOU DO SOMETHING THAT WILL PASS AIDS-INFECTED BLOOD AND/OR SEMEN BETWEEN YOU AND SOMEONE ELSE. AND THIS TRANSMISSION TAKES PLACE IN FOUR DIFFERENT MAYS. ONE WAY WAS THROUGH BLOOD TRANSFUSIONS. MOST CHILDREN WITH AIDS OR CARRYING THE VIRUS RECEIVED THE VIRUS THROUGH A CONTAMINATED BLOOD TRANSFUSION OR THROUGH THE CLOTTING FACTORS, MADE FROM BLOOD, THAT ARE USED FOR THE TREATMENT OF. HEMOPHILIA, SO, ONE WAY WAS THROUGH BLOOD TRANSFUSIONS. I SAY “WAS” BECAUSE IN 1985 WE DEVELOPED A VERY GOOD BLOOD TEST THAT DETECTS THE PRESENCE OF ANTIBODIES TO THE AIDS VIRUS IN A SAMPLE OF A PERSON’S BLOOD. 17 THAT SOUNDS SORT OF ROUNDABOUT -- AND IT IS, BECAUSE, REMEMBER, THERE’S STILL MORE ABOUT THE AIDS VIRUS THAT WE DON'T KNOW THEN WHAT WE DO KNOW, THEREFORE, WE HAVE TO LOOK FOR A CONCENTRATION OF ANTIBODIES TO THE AIDS VIRUS TO TELL US THAT THE VIRUS ITSELF IS PRESENT. IT’S LIKE KNOWING THERE’S A KILLER NEARBY BECAUSE YOU SEE HIS SHADOW ON THE WALL. IN ANY CASE, THANKS TO TWO TESTS -- A SCREENING TEST AND A CONFIRMATION TEST -- OUR BLOOD SUPPLY IS JUST ABOUT AS SAFE AS WE CAN MAKE IT. AND THAT GOES FOR CLOTTING FACTORS AS WELL. 18 THE ODDS TODAY OF GETTING A CONTAMINATED UNIT OF TRANSFUSED BLOOD ARE BETWEEN 1 IN 40,000 AND 1 IN 250,000. COMPARE THOSE ODDS WITH, SAY, DEATH ON THE HIGHWAY: THAT’S 1 IN 5,900. OR BEING KILLED PLAYING SOCCER: YOUR CHANCES ARE 1 IN 25,000 FOR THAT, SO EVEN THE VERY CONSERVATIVE ESTIMATE OF 1 CHANCE IN 40,000 THAT YOU'LL GET A TRANSFUSION OF AIDS-CONTAMINATED BLOOD MEANS THAT SUCH A POSSIBILITY IS EXTREMELY REMOTE. AND THAT WAS SOMETHING WE COULDN’T SAY JUST A COUPLE OF YEARS AGO. THAT LEAVES THREE WAYS TO CATCH AIDS, AND THESE ARE MUCH MORE SIGNIFICANT FOR SOCIETY TODAY. 19 THE MOST COMMON OF THESE THREE IS THROUGH SEXUAL INTER- COURSE. A MAN WITH AIDS CAN PASS THE VIRUS TO HIS SEXUAL PARTNER THROUGH HIS SEMEN, UNFORTUNATELY, THE PROCESS CAN BE THAT SIMPLE. AND, AGAIN UNFORTUNATELY, THE VIRUS CAN BE PASSED THE OTHER WAY, TOO: FEMALE-TO-MALE. AS A RESULT, A GREAT MANY PROSTITUTES HAVE CONTRACTED AIDS THROUGH HAVING VAGINAL INTERCOURSE WITH A MAN WHO WAS INFECTED WITH THE AIDS VIRUS. UNFORTUNATELY, SOME UNSUSPECTING WIVES AND SWEETHEARTS HAVE BEEN GIVEN THE VIRUS AS WELL. BUT CERTAIN SEX PRACTICES NOT ONLY PRODUCE SEMEN, THEY ALSO CAUSE BLEEDING. THIS IS PARTICULARLY TRUE DURING ANAL INTER- COURSE, WHEN TISSUES TEND TO BE RUPTURED, BLEEDING OCCURS, AND A MAN’S AIDS-INFECTED SEMEN THEN DIRECTLY ENTERS HIS PARTNER’S BLOODSTREAM, 20 ANAL INTERCOURSE IS MOST OFTEN PRACTICED BY HOMOSEXUALS AND BISEXUAL MALES. TODAY, LOOKING BACK TO 1981, IT’S NO LONGER SURPRISING THAT THOSE FIRST 5 CASES OF AIDS INVOLVED “OTHERWISE HEALTHY HOMOSEXUALS. ” INDEED, OVER THE PAST 7 YEARS, 2 OUT OF EVERY 3 PERSONS WITH AIDS HAVE BEEN EITHER HOMOSEXUALS OR BISEXUAL MALES. BUT PLEASE REMEMBER THAT HOMOSEXUALITY ... BY ITSELF ... DOES NOT CAUSE AIDS. 21 THERE ARE, AFTER ALL, AN ESTIMATED 12 MILLION HOMOSEXUALS IN THE U.S, POPULATION AND IT IS APPEARS THAT MOST OF THEM -- LIKE MOST AMERICANS IN GENERAL -- ARE MONOGAMOUS ... THEY ARE NOT SEXUALLY PROMISCUOUS ... AND THEY DO NOT ENGAGE IN THE ROUGHER KINDS OF SEXUAL INTERCOURSE, AND SO... THOSE HOMOSEXUALS DO NOT HAVE AIDS AND THEY‘LL PROBABLY NEVER GET IT. IN FACT, THEY’RE JUST AS FRIGHTENED OF THE DISEASE AS THE REST OF US ARE, 22 WHAT IT COMES DOWN TO IS THIS: WE’RE FIGHTING A DEADLY DISEASE ... WE'RE NOT FIGHTING THE PEOPLE WHO HAVE IT... OR THE PEOPLE WHO WE THINK MIGHT HAVE IT. THAT’S ALWAYS BEEN AN IMPORTANT PUBLIC HEALTH PRINCIPLE IN THIS COUNTRY. AMERICA HAS TAKEN ON SOME PRETTY DIFFICULT DISEASES OVER THE YEARS -~ SMALLPOX, POLIO, LEPROSY, MEASLES, SYPHILIS -- BUT IN NOT ONE OF THOSE CASES DID WE ATTACK THE PEOPLE WHO WERE SICK ... JUST THE SICKNESS ITSELF. 23 AND I CAN ASSURE YOU, AS YOUR SURGEON GENERAL, WE’RE NOT GOING TO CHANGE NOW ... AIDS OR NO AIDS. I SAID THERE WERE FOUR WAYS TO GET AIDS. ONE WAS THROUGH TRANSFUSED BLOOD, WHICH IS NO LONGER A PROBLEM. THE SECOND WAY IS THROUGH SEXUAL INTERCOURSE ... ESPECIALLY -- BUT NOT EXCLUSIVELY -- ANAL INTERCOURSE, AND NOW THE THIRD WAY IS TO SHARE NEEDLES AND SYRINGES ALREADY USED BY AN AIDS-INFECTED DRUG ADDICT. 24 I’M TOLD THAT THIS IS A VERY COMMON PRACTICE AMONG INTRA- VENOUS DRUG ABUSERS ... IT’S AN EXPRESSION OF CAMARADERIE, AMONG OTHER THINGS, AND DOESN’T SEEM RELATED TO THE COST OR AVAILABILITY OF THIS PARAPHERNALIA, BUT EXACTLY HOW IS THE VIRUS TRANSMITTED BY THIS MEANS? AGAIN, IT’S UNFORTUNATELY QUITE SIMPLE. AFTER A PERSON INJECTS THE DRUG INTO HIS OR HER ARM, A TINY DROP OF BLOOD OFTEN REMAINS BEHIND IN THE NEEDLE OR EVEN FURTHER UP, IN THE SYRINGE ITSELF. 25 IF THE USER IS INFECTED WITH AIDS, SOME OF THAT VIRUS WILL BE IN THAT DROP OF BLOOD, ALSO. AND FROM WHAT WE CAN GATHER SO FAR, IT APPEARS THAT THE AIDS VIRUS CAN REMAIN ALIVE IN SUCH A SITUATION FOR SEVERAL HOURS AT THE VERY LEAST AND POSSIBLY A DAY OR TWO AT THE MOST, THE NEXT PERSON USING THAT NEEDLE AND SYRINGE TO “SHOOT UP” WILL GET THAT DROP OF BLOOD ALONG WITH HIS OR HER “FIX.” AND THE AIDS VIRUS WILL BE RIGHT THERE WITH IT. Q,E,D, 26 AT THE LAST COUNT, 1 OUT OF EVERY 4 PERSONS WITH AIDS -- OVER 13,000 PEOPLE SO FAR -- HAS BEEN AN INTRAVENOUS DRUG ABUSER. THE FOURTH AND FINAL WAY TO GET AIDS IS TO BE BORN OF A MOTHER WHO HAS AIDS. SO FAR, OVER 660 CHILDREN IN THIS COUNTRY HAVE BEEN BORN WITH AIDS. IN THOSE CASES, THE AIDS VIRUS -- ALREADY IN THE MOTHER’S BLOODSTREAM ~~ SIMPLY MIGRATES INTO THE CHILD'S BLOODSTREAM SOMETIME DURING PREGNANCY OR DURING CHILDBIRTH ITSELF. 27 THOSE, THEN, ARE THE FOUR WAYS BY WHICH A PERSON CAN BECOME INFECTED WITH THE AIDS VIRUS. NOTICE, PLEASE, THAT NONE OF THEM INVOLVES A CASUAL ACT ON ANYONE’S PART. NOW, YOU CAN ARGUE THAT A BABY BORN WITH AIDS IS A PASSIVE, INNOCENT VICTIM OF CIRCUMSTANCE. AND I’D AGREE, BUT THERE IS NOTHING PASSIVE ABOUT THE BABY’S PARENTS ... ALMOST ALWAYS ONE OR BOTH OF THEM ARE I.V. DRUG ABUSERS. 28 I HOPE ALL THIS INFORMATION HELPS YOU UNDERSTAND THAT A PERSON CAN SHARE OTHER PEOPLE'S WATER GLASSES, BATH TOWELS, TOILET SEATS, CAFETERIA UTENSILS, SWEATSHIRTS, PENS, PENCILS, AND COMPUTER KEYBOARDS ... AND NOT GET AIDS. YOU MIGHT CATCH A COLD. OR YOU MIGHT CATCH THE ELU. BUT YOU WON’T CATCH AIDS, SO, WHEN WE TALK ABOUT “AIDS EDUCATION” IN THE SCHOOLS ... THESE ARE THE FACTS THAT OUGHT TO BE DISCUSSED. BUT NOT JUST THESE FACTS ALONE. 29 I BELIEVE WE ARE MORALLY OBLIGATED TO INFORM YOUNG PEOPLE ABOUT THE FACTS OF AIDS, AS I‘VE JUST RELAYED THEM TO YOU. BUT WE’RE ALSO OBLIGATED TO TELL THEM HOW TO AVOID AIDS, I DON’T THINK YOU CAN LEAVE THIS UP TO THEIR IMAGINATION OR THEIR POWERS OF DEDUCTION. AND THE PEOPLE WHO KNOW THAT BEST ARE YOU ... AND PARENTS. BUT HERE IS WHERE THE PROBLEMS ARISE. IT’S NOT POSSIBLE -- AND IT CERTAINLY ISN'T EASY -- TO DISCUSS AIDS WITHOUT ALSO DISCUSSING SEXUAL INTERCOURSE ... AND SEVERAL VARIETIES AT THAT. 30 T’LL BE HONEST WITH YOU. IN MY OWN OPINION, THIS HAS BEEN THE MOST DIFFICULT PART OF THE AIDS EPIDEMIC: HAVING TO TELL YOUNG PEOPLE THE FACTS ABOUT PERSONAL AND SEXUAL RELATIONSHIPS IN THE CONTEXT OF A HORRIBLE, FATAL DISEASE. THE JOINING OF TWO PEOPLE IN AN EMBRACE OF LOVE AND MUTUAL RESPECT IS ONE OF THE GREAT MIRACLES OF THE HUMAN RACE. INDEED, THERE DOESN‘T SEEM TO BE ANY EMOTIONAL EQUIVALENT ANYWHERE ELSE IN CREATION. 31 HENCE, THE VERY IDEA THAT WE MUST INTRODUCE A NEW GENERATION OF YOUNG MEN AND WOMEN TO THE SUBJECT OF HUMAN RELATIONSHIPS AND HUMAN SEXUALITY -- SO THAT THEY MAY AVOID CONTRACTING A FATAL DISEASE -- IS ITSELF A HORROR, AND YET ... WE MUST. YES, WE HAVE A DIFFICULT MESSAGE TO DELIVER -- BUT IT'S A LIFE-SAVING MESSAGE AND, THEREFORE, WE ARE DUTY-BOUND TO DELIVER IT, 32 BUT WHILE IT MAY HAVE A NASTY CLINICAL SIDE TO IT, | BELIEVE A THOUGHTFUL EDUCATIONAL PROGRAM CONCERNING AIDS WOULD ALSO DEAL WITH SOME NON-CLINICAL CONCEPTS THAT YOUNG PEOPLE OUGHT TO LEARN ANYWAY, 1 SAID EARLIER THAT WE HAVE NO VACCINE YET. SO, ANYONE WHO CATCHES THE AIDS VIRUS, GETS NO SECOND CHANCE TO BE MORE CAREFUL. BUT WE DO HAVE SOME OTHER DEFENSES AGAINST THE VIRUS. ONE IS ABSTINENCE FROM SEX. THAT MAY NOT WORK FOR ALL ADULTS -- IN FACT, IT WOULD SPELL THE END OF THE HUMAN RACE IF ABSTINENCE REALLY CAUGHT ON. BUT IT’S NOT A BAD IDEA AT ALL FOR YOUNG PEOPLE STILL IN SCHOOL. 33 IF THE ADOLESCENT’S ALTERNATIVE IS SEX WITHOUT CARING ... SEX WITHOUT RESPONSIBILITY ... SEX WITHOUT JUSTICE ... OR SEX WITHOUT RESPECT ... THEN I, FOR ONE, WOULD WHOLEHEARTEDLY RECOMMEND AND ENDORSE ABSTINENCE. BUT NOT EVERYONE WILL SEE THE LOGIC OF THAT POSITION, SO THE NEXT BEST THING IS THE CONCEPT OF MONOGAMY ... ONE PERSON, ONE MATE. FIND SOMEONE TO WHOM YOU CAN GIVE YOUR LOVE AND RESPECT AND. TRUST ... SOMEHOW WHO FAVORS YOU WITH THE SAME ... AND STAY WITH THAT PERSON FOREVER. THAT KIND OF A MONOGAMOUS RELATIONSHIP IS NOT LIKELY TO BE INFECTED BY AIDS. 34 BUT HERE, AGAIN, THE REAL WORLD TELLS US THAT, WHILE MANY PEOPLE ARE MONOGAMOUS -- THEY MAY CHANGE PARTNERS ONCE OR TWICE, AND THEN THERE ARE THE MANY MILLIONS OF PEOPLE WHO, FOR WHATEVER REASONS, DO NOT HAVE A LOVING, MONOGAMOUS RELATIONSHIP - - AND NEVER WILL HAVE -- BUT WHO MAY NEVERTHELESS HAVE THE PERFECTLY NORMAL DESIRE TO EXPRESS THEIR OWN SEXUALITY FROM TIME TO TIME. FOR THESE PEOPLE, WE MUST RECOMMEND THAT THEY PROTECT THEMSELVES AGAINST THE UNKNOWN. THE “UNKNOWN” IN SUCH CASES IS THE SEXUAL HISTORY OF EVERY NEW PERSON YOU ENCOUNTER. AND THE ONLY PROTECTION THAT IS CURRENTLY AVAILABLE IS THE CONDOM, 35 THE CONDOM IS NOT ONE-HUNDRED-PERCENT-PERFECT. AND I HAVE NEVER CLAIMED IT WAS, HOWEVER, WHEN THE CONDOM IS USED CORRECTLY -- THAT IS, WHEN IT IS WORN FROM START TO FINISH DURING SEXUAL INTERCOURSE -- THE CONDOM IS MORE RELIABLE THAN THE PEOPLE WHO USE IT. IN THE ABSENCE OF A SAFE AND EFFECTIVE VACCINE, THE CONDOM IS THE ONLY DEVICE WE HAVE THAT IS LITERALLY A BARRIER AGAINST THE TRANSMISSION OF THE AIDS VIRUS. WE ALSO KNOW FROM THE LABORATORY THAT THE ADDITION OF A SPERMACIDE IN THE TIP OR ON THE OUTSIDE OF THE CONDOM PROBABLY ADDS ANOTHER MEASURE OF PROTECTION FROM THE VIRUS, 36 FROM A PUBLIC HEALTH POINT OF VIEW, THIS IS REALLY ALL THERE IS TO THE BASIC INFORMATION PACKAGE YOU NEED CONCERNING AIDS. NOTICE, THERE IS NOTHING IN IT ABOUT EXCLUDING FROM SCHOOL ANY STUDENT OR TEACHER WITH AIDS. FROM A PUBLIC HEALTH POINT OF VIEW, THERE LS NO REASON TO EXCLUDE SUCH A PERSON, YOU MAY WISH TO DO SO FOR OTHER REASONS ... REASONS WHICH MAY OR MAY NOT BE FAIR TO THE PEOPLE INVOLVED ... BUT IT WOULD NOT BE FOR PUBLIC HEALTH REASONS, 37 SIMILARLY, IN THE MATTER OF TESTING, I HAVE ARGUED AGAINST ANY KIND OF UNIVERSAL COMPULSORY TEST FOR AIDS. EVEN THE MOST GENEROUS ESTIMATE OF THE NUMBER OF PEOPLE WALKING AROUND WITH THE VIRUS TODAY -- AND IT’S CURRENTLY 1.5 MILLION AT THE OUTSIDE -- EVEN THAT ESTIMATE IS AN EXTREMELY SMALL FRACTION OF THE TOTAL U.S. POPULATION. AND, IN ANY CASE, WE ALREADY KNOW THAT 90 PERCENT OF ALL PERSONS WITH AIDS THUS FAR HAVE EITHER BEEN 1.V, DRUG ABUSERS OR HOMOSEXUALS OR BISEXUAL MEN. AND THESE TWO GROUPS ARE THEMSELVES NOT LARGE. 38 IN ADDITION, THE OVERWHELMING MAJORITY OF HOMOSEXUALS AND BISEXUAL MEN HAVE BEEN UNTOUCHED BY THE EPIDEMIC. APPARENTLY ONLY A MINORITY OF THESE INDIVIDUALS HAVE ENGAGED IN THE KIND OF SPECIFIC HIGH-RISK BEHAVIOR THAT SPREADS THE AIDS VIRUS, AND WE GATHER FROM SURVEYS DONE HERE AND THERE THAT THIS COMMUNITY OF MEN HAS UNDERGONE A VERY SERIOUS AND POSITIVE CHANGE IN BEHAVIOR. WE MIGHT EVEN EXPECT A DECLINE IN THE RATE OF AIDS REPORTING FROM THIS GROUP IN A YEAR OR SO, IF 17 SEEMED UNLIKELY BEFORE THE PUBLIC EDUCATION PROGRAMS THAT ALL HOMOSEXUALS WOULD BE STRICKEN WITH AIDS, IT SEEMS EVEN LESS SO TODAY, 39 THE I.V, DRUG ABUSER PRESENTS US WITH A DIFFERENT PROBLEM, THE PEOPLE OF THE UNITED STATES SEE THE DRUG HABIT ITSELF AS THE ISSUE. THE APPEARANCE OF AIDS WITHIN THE DRUG CULTURE IS JUST ANOTHER POTENTIAL CATASTROPHE FOR THE DRUG ADDICT -- ALONG WITH HEPATITIS, 1T.B., DEMENTIA, STARVATION, SUICIDE, AND SO ON, IT'S TRUE THAT MANY DRUG ADDICTS HAVE VOLUNTARILY PRESENTED THEMSELVES FOR AIDS TESTING ... BUT WE SUSPECT THAT THE MAJORITY OF THEM HAVE NOT ... AND WILL NOT. 40 OVER THE YEARS WE‘VE BEEN SINGULARLY UNSUCCESSFUL IN PENETRATING THE DRUG-ADDICTED CULTURE WITH EVERY OTHER PUBLIC HEALTH MESSAGE WE'VE EVER HAD -- INCLUDING THE ONE THAT SAYS "STOP!" IN ADDITION, THE SHEER VOLUME OF NON-AIDS DRUG-RELATED DEATHS -- THROUGH DRUG OVERDOSES OR DRUG-INDUCED VIOLENCE -- IS STILL VERY HIGH: ABOUT 5,000, ACCORDING TO THE F.B.1. AND OUR OWN NATIONAL INSTITUTE OF DRUG ABUSE, HENCE, THE HEART OF THE PROBLEM -- AND THE URGENT NEED FOR A SOLUTION -- MAY WELL BE THE ADDICTION ITSELF AND NOT THE SPECIFIC ACT OF NEEDLE-SHARING AMONG ADDICTS. 41 T BELIEVE THIS 1S IMPORTANT INFORMATION FOR YOU TO KNOW BECAUSE THE SECONDARY SCHOOLS OF THIS NATION HAVE BEEN, FOR YEARS, AMERICA’S FRONT LINE OF DEFENSE AGAINST THE SCOURGE OF DRUGS. YOU’VE DONE OUR SOCIETY A TREMENDOUS SERVICE SO FAR. WE’D BE IN REALLY TERRIBLE SHAPE, WERE IT NOT FOR YOUR CONSTANT ATTENTION TO THIS MAJOR PUBLIC HEALTH PROBLEM. I] WANT TO ENCOURAGE YOU TO KEEP ON DOING JUST WHAT YOU’RE DOING IN THAT REGARD -- EXCEPT MORE SO. TO SUM UP: AIDS [S SPREADING, THOUGH IT STILL SEEMS TO BE CONFINED AMONG HOMOSEXUALS, BISEXUAL MALES, AND DRUG ABUSERS, WITH AN ADDITIONAL 2,200 OR SO BECOMING INFECTED THROUGH HETEROSEXUAL INTERCOURSE. AIDS IS VIRTUALLY FATAL, AND WE ARE A LONG WAY FROM HAVING A SAFE AND EFFECTIVE VACCINE TO PREVENT ITS SPREAD ANY FURTHER, 42 AIDS IS CARRIED PRIMARILY BY BLOOD AND SEMEN, WHATEVER ACTIVITY PROMOTES THE EXCHANGE OF THESE FLUIDS FROM ONE PERSON TO ANOTHER IS AN ACTIVITY THAT CAN TRANSMIT AIDS. SEX IS ONE ... INTRAVENOUS DRUG ABUSE IS ANOTHER. YOUNG PEOPLE NEED TO BE TOLD ABOUT AIDS ... BUT THEY PROBABLY NEED TO BE TOLD ABOUT THE WAYS OF DECENCY AND LOVE AND MUTUAL RESPECT AND RESPONSIBILITY EVEN MORE. DRUG ADDICTS NEED TO BE TOLD ABOUT AIDS. BUT THE REAL MESSAGE TO THEM IS ... “GET OFF DRUGS ALTOGETHER.” 43 AND NOW, I MUST GIVE UP THE PODIUM SO THAT THIS IMPORTANT MEETING MAY CONTINUE. LET ME END ON A NOTE OF OPTIMISM. I DO BELIEVE WE WILL OVERCOME THE DISEASE OF AIDS AND WE WILL EMERGE FROM THIS TERRIBLE EXPERIENCE WITH OUR AMERICAN ETHOS INTACT, BERNARD DE VOTO, IN A LITTLE ESSAY ON THE AMERICAN PEOPLE, ONCE WROTE THAT... “NO ESTIMATE OF WHAT THE UNITED STATES COULD ACHIEVE IN POPULATION, POWER, COMFORT, WEALTH, OR LIVING STANDARD HAS EVER PROVED ADEQUATE. WHEN TOMORROW CAME, THE EXPECTATION PROVED TO HAVE BEEN TOO MODERATE, THE ACHIEVEMENT INVARIABLY OUTRAN THE PROPHECY.” Hy WELL, I PREDICT WE WILL FIGHT THIS DISEASE -- AND WE WILL WIN. AND I CERTAINLY HOPE THAT SUCH AN ACHIEVEMENT WILL OUTRUN MY PROPHECY AS WELL. THANK YOU, HHH # #