Mp ADDRESS 70 PARTICIPANTS OF THE FIRST NATIONAL CONFERENCE ON HEALTH PROMOTION / DISEASE PREVENTION FOR AERICAN INDIANS AND ALASKA NATIVES "BEYOND SURVIVAL" HEALTH CHALLENGES IN AMERICAN INDIAN AND ALASKA NATIVE COMMUNLTIES FRIDAY, JUNE 19, 1987 10:00 A.M, DHHS BUILDING, NORTH HALL C. EVERETT KOOP, H.D., SC.D. SURGEON GENERAL U.S. PUBLIC HEALTH SERVICE ADDRESS TO PARTICIPANTS OF THE FIRST NATIONAL CONFERENCE ON HEALTH PROMOTION / DISEASE PREVENTION FOR AMERICAN INDIANS AND ALASKA NATIVES “BEYOND SURVIVAL" HEALTH CHALLENGES IN AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES FRIDAY, JUNE 19, 1987 10:00 A.M., DHHS BUILDING, NORTH HALL C. EVERETT KOOP, M.D., SC.D. SURGEON GENERAL U.S. PUBLIC HEALTH SERVICE ADDRESS TO PARTICIPANTS OF THE FIRST NATIONAL CONFERENCE ON HEALTH PROMOTION / DISEASE PREVENTION FOR AMERICAN INDIANS AND ALASKA NATIVES "BEYOND SURVIVAL" HEALTH CHALLENGES IN AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES FRIDAY, JUNE 19, 1987 10:00 A.M. , DHHS BUILDING, NORTH HALL C. EVERETT KOOP, H.D., S¢.D. SURGEON GENERAL U.S. PUBLIC HEALTH SERVICE THANK YOU GOVERNOR JAMES, DR. SUNDWALL, DR. RHOADES, DR. WAUNEKA, AND HONORED GUESTS ... GOOD MORNING TO YOU ALL. T AM MOST PLEASED 10 BE HERE TODAY SINCE THIS CONFERENCE I$ THE FIRST PUBLIC EVENT THAT 1 AM AWARE OF WHICH EXPOSES ONE OF THE BEST KEPT SECRETS IN THE PUBLIC HEALTH SERVICE: THE INDIAN HEALTH SERVICE. | SAY BEST KEPT SECRET BECAUSE THE INDIAN HEALTH SERVICE HAS QUIETLY AND NITHOUT MUCH FANFARE ESTABLISHED ITSELF AS A LEADER IN HEALTH SERVICES PLANNING AND DELIVERY. MOST SIGNIFICANTLY, THE INDIAN HEALTH SERVICE HAS CLEARLY DEMONSTRATED UNIQUE AND INNOVATIVE TALENT IN THE DEVELOPMENT AND IMPLEMENTATION OF HEALTH PROMOTION AND DISEASE PREVENTION ACTIVITIES. LET HE GIVE YOU BUT A FEW EXAMPLES OF THIS INNOVATION AND ITS QUTCOMES, CONSIDER FOR A MOMENT INFANT MORTALITY, AN INTERNATIONALLY ACCEPTED MEASURE OF EFFECTIVENESS IN PREVENTING DISEASE. THE INDIAN HEALTH SERVICE BEGAN ITS EFFORTS IN 1955 FACING AN AMERICAN INDIAN AND ALASKA NATIVE INFANT MORTALITY 3 TIMES THE NATIONAL AVERAGE. TODAY, AMERICAN INDIAN AND ALASKA NATIVE INFANT MORTALITY I$ BELOW THE NATIONAL AVERAGE, AND NEONATAL DEATHS ARE ONLY 60% OF THE NATIONAL RATE. THIS HAS BEEN ACHIEVED THROUGH A SOLID COMMUNITY BASED EFFORT IN SANITATION, HEALTH EDUCATION, OUTREACH EFFORTS BY COMMUNITY HEALTH REPRESENTATIVES AND COMMUNITY HEALTH NURSES, AS WELL AS ENHANCED OBSTETRICAL CAPABILITIES. THIS ACHIEVEMENT I$ ALSO ATTRIBUTABLE TO THE OUTSTANDING COMPREHENSIVE PRIMARY CARE PROGRAM DEVELOPED BY THE INDIAN HEALTH SERVICE, THIS PROGRAM IS CHARACTERIZED BY THE COORDINATED USE OF EPIDEMIOLOGIC TOOLS 10 ANALYZE HEALTH NEEDS, THE DEPLOYMENT OF COMMUNITY BASED SERVICES TO PREVENT DISEASE AND IDENTIFY EARLY MANIFESTATIONS OF DISEASE, AND THE PROVISION OF THE HIGHEST QUALITY PRIMARY MEDICAL SERVICES 10 TREAT AND CURE DISEASE WHEN IT OCCURS. LASTLY, AND MOST IMPORTANTLY, THIS SUCCESS I$ ATTRIBUTABLE TO THE AMERICAN INDIAN AND ALASKA NATIVE PEOPLE THEMSELVES. WITHOUT THE COMMITMENT OF INDIAN LEADERSHIP 10 THE FUTURE OF THEIR PEOPLE, THESE EXCEPTIONAL PROGRAS HOULD HAVE BEEN ONLY MODESTLY SUCCESSFUL. THAT COMMITMENT IS THE CORNERSTONE 10 FUTURE HEALTH SUCCESSES. A MORE RECENT EXAMPLE OF INDIAN HEALTH SERVICE LEADERSHIP IS DEMONSTRATED IK THE DEVELOPMENT OF SMOKE-FREE ENVIRONMENTS. IT HAS BEEN MOST GRATIFYING 10 SEE AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES BECOME INCREASINGLY COMMITTED TO SMOKE-FREE HEALTH FACILITIES, TRIBAL OFFICES, SCHOOLS, AND OTHER PUBLIC BUILDINGS IN INDIAN COUNTRY, BEGINNING IN DECEMBER 1983, WITH THE ANNOUNCEMENT THAT THE KEAMS CANYON HOSPITAL WOULD BE THE FIRST SMOKE-FREE HOSPITAL IN ARIZONA. THE IHS HOSPITALS AND CLINICS HAVE LED THE WAY IN MANY STATES IN ESTABLISHING SMOKE-FREE HEALTH FACILITIES. TRIBAL GOVERNNENTS HAVE SHON LEADERSHIP IN ESTABLISHING SMOKE-FREE POLICIES IN TRIBAL OFFICES AND OTHER TRIBAL CONTROLLED FACILITIES. THESE STEPS HAVE BEEN UNDERTAKEN DESPITE PRESSURE 10 MAINTAIN THE STATUS-QUO. THE MEMBERS OF AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES HAVE PERSISTED 10 WORK AT THESE PROBLEMS IN SPITE OF ALL KINDS OF ADVERSITY. NATIONAL RECOGNITION FOR THIS COMMITMENT TO GOOD HEALTH HAS CONE FROM A VARIETY OF ENTITIES INCLUDING: NATIONAL LUNG ASSOCIATION, VARIOUS STATE LEGISLATURES, AND THE AMERICAN PUBLIC HEALTH ASSOCIATION. I WOULD LIKE 10 ADD MY PERSONAL CONGRATULATIONS 10 THE MANY PEOPLE WHO HAVE CONTRIBUTED 10 THE SUCCESS OF THIS EFFORT ESPECIALLY EVERETT RHOADES, AND HIS AREA AND ASSOCIATE DIRECTORS, THE NURSING AND COMMUNITY HEALTH PERSONNEL OF INDIAN HEALTH SERVICE NAO HAVE BEEN MAJOR SUPPORTERS OF THIS EFFORT, AND THE MANY TRIBAL LEADERS WHO HAVE SHOWN THE WAY 10 THEIR COMMUNITIES, YOU KNOW THAT 1 TALK 10 LARGE AUDIENCES ALL OVER THE COUNTRY AND ABROAD - AND I NEVER MISS A CHANCE 10 SPEAK OF THIS IHS ACHIEVEMENT KITH CONSIDERABLE PRIDE. QUR PROBLEMS DO NOT STOP WITH MAINSTREAM AND SIDESTREAM SMOKE, HONEVER, SMOKELESS TOBACCO PRESENTS ADDITIONAL, SIGNIFICANT HEALTH RISKS. USE OF SMOKELESS TOBACCO HAS BEEN HEAVILY PROMOTED AND, AS A RESULT, NE'RE SEEING IT BECOME FAIRLY POPULAR ANONG SUSCEPTIBLE MALE ADOLESCENTS, WHO USE IT EVERY DAY, AND DAILY USAGE CAN LEAD 10 NICOTINE ADDICTION AND DEPENDENCE. SMOKELESS TOBACCO I$ HERE AND WE WILL HAVE A TOUGH TIME GETTING RID OF IT, HENCE, WE CAN EXPECT 10 SEE A RISE IN THE INCIDENCE OF CERTAIN CANCERS IN AMERICAN INDIAN AND ALASKA NATIVE POPULATIONS AS WELL AS AN INCREASE IN MANY NONCANCEROUS ORAL CONDITIONS. THE COMMUNITIES REPRESENTED HERE ARE ALREADY SHOKING LEADERSHIP IN THIS AREA AS HELL. LET ME TURN NOW TO THO PRESSING ISSUES CONFRONTING US IN THE PUBLIC HEALTH SERVICE TODAY TODAY. THE FIRST IS THE REVITALIZATION OF THE COMMISSIONED CORPS OF THE UNITED STATES PUBLIC HEALTH SERVICE AND THE SECOND 1S THE GROWING THREAT OF AIDS. I MILL ADDRESS REVITALIZATION FIRST. AS SURGEON GENERAL, I AM ACUTELY ANARE OF THE HEALTH ISSUES AND DIFFICULTIES HHICH CONFRONT US AS A NATION AND THE VITAL ROLES PLAYED BY BOTH CLVIL SERVICE AND COMMISSIONED CORPS EMPLOYEES IN QUR CONTINUING BATTLE AGAINST ILLNESS AND DISEASE. 1 SEE THE VITALITY OF THE MEN AND WOMEN OF THE PHS AS ESSENTIAL 10 THE PHYSICAL AND MENTAL HEALTH AND WELL BEING OF THE PEOPLE OF AMERICA, AND ] AN PROUD OF THEIR CONTRIBUTIONS 10 THE MISSION OF THE PUBLIC HEALTH SERVICE. THE MISSION OF THE UNITED STATES PUBLIC HEALTH SERVICE 15 10 PROMOTE THE PROTECTION AND ADVANCEMENT OF BOTH THE PHYSICAL AND THE MENTAL HEALTH OF THE ANERICAN PEOPLE. A VERY SIGNIFICANT PART OF THIS MISSION IS TO PROVIDE HEALTH CARE 10 THE FIRST AMERICANS, THE AMERICAN INDIAN AND ALASKA NATIVE PEOPLES. IF THE PHS 15 TO CONTINUE TO CARRY QUT ITS MISSION, AND AS THE THEME OF TRIS CONFERENCE SUGGESTS, WE ARE 70 GO "BEYOND SURVIVAL", IT MUST MAINTAIN A CRITICAL MASS OF HIGHLY QUALIFIED, EXPERZENCED HEALTH PROFESSIONALS, CIVIL SERVICE AS WELL AS COMMISSIONED CORPS. THE ROLE OF THE PHS COMMISSIONED CORPS IN CARRYING QUT THIS MISSION IS 10 ATTRACT AND RETAIN AN EFFECTIVE CADRE OF HIGHLY TRAINED, MULTI-SKILLED, MOBILE, FLEXIBLE HEALTH PROFESSIONALS WHO ARE COMMITTED 10 HUMAN SERVICE AND NO CAN ASSIST THE DEPARTMENT 10 RAPIDLY AND EFFECTIVELY PURSUE ITS POLICY INITIATIVES AND PROGRAM EFFORTS. IF THE HISTORIC MISSION OF THE PUBLIC HEALTH SERVICE 1S GOING TO CONTINUE TO BE SUCCESSFUL AND FULFILLED AND IF WE ARE GOING 10 BE ABLE TO RESPOND APPROPRIATELY TO NEN CHALLENGES, SUCH AS AIDS, NATIONAL EMERGENCY PREPAREDNESS, AND SUBSTANCE ABUSE, THE CORPS MUST BE MAXIMALLY FIT AND CAPABLE, TQ ACCOMPLISH THIS I HAVE INITIATED A MAJOR REVITALIZATION EFFORT WITHIN THE COMMISSIONED CORPS. MANY OF THE IMPROVEMENTS FROM THE REVITALIZATION PROCESS WILL BE ESPECIALLY BENEFICIAL 10 THE INDIAN HEALTH SERVICE AND WILL PROVIDE ADDITIONAL CAPABILITIES TO FURTHER ASSURE THE DELIVERY OF HIGHEST QUALITY SERVICE T0 THE INDIAN PEOPLE. MANY OF THE HEALTH PROVIDERS WORKING IN INDIAN COMMUNITIES ARE MEMBERS OF THE COMMISSIONED CORPS. THIS GROUP OF DEDICATED PUBLIC HEALTH PROFESSIONALS HAS SERVED THE AMERICAN INDIAN AND ALASKA NATIVE PEOPLE WELL OVER THE LAST 30 YEARS. IN FACT, I FEEL THAT THE COMMITMENT AND SKILL EXEMPLIFIED BY THESE PROFESSIONALS WORKING WITHIN THE INDIAN HEALTH SERVICE EPITOMIZE ThE VERY HIGHEST OF QUALITIES I IDENTIFY WITH COMMISSIONED OFFICERS. IT 1S MY GOAL AND INTENTION THAT THE KHOLE OF THE COMMISSIONED CORPS REFLECT AND LIVE BY THOSE VALUES OF COMPASSION, STEADFASTNESS, COMPETENCY, AND UNDERSTANDING THAT I HAVE OBSERVED IN SO MANY OF THE COMMISSIONED OFFICERS WITHIN THE IKS. NHILE I WOULD LIKE 10 PROCEED WITH THE REVITALIZATION INITIATIVE AS RAPIDLY AS POSSIBLE, I ALSO RECOGNIZE THE UNIQUE MISSION, THE SPECIAL SERVICE ENVIRONMENT, AND THE UNIQUE RELATIONSHIP THAT EXISTS BETWEEN THE INDIAN TRIBES AND THE PUBLIC HEALTH SERVICE. I ALSO RECOGNIZE THE IMPORTANCE OF TRIBAL CONSULTATION AS AN INTEGRAL PART OF THE REVITALIZATION EFFORT AND I FULLY SUPPORT AND ENCOURAGE DR. RHOADES" EFFORTS IN THIS AREA. | APPRECIATE THE STRONG SUPPORT THAT HAS BEEN GIVEN BY DR. RHOADES IN TRIS INITIATIVE. I WOULD LIKE TO RE-EMPHASIZE MY FIRM COMMITMENT 10 THE MISSION OF THE INDIAN HEALTH SERVICE AS ONE OF THE PRINCIPAL OBJECTIVES OF THE PUBLIC HEALTH SERVICE AND 70 DR. RHOADES’ LEADERSHIP OF THIS PROGRAM. I NILL CONTINUE TO WORK CLOSELY WITH HIM TO INSURE THAT THE REVITALIZATION EFFORT MAINTAINS THE FLEXIBILITY 70 BE SENSITIVE AND RESPECTFUL OF THE UNIQUE RELATIONSHIP THAT EXISTS WITH THE INDIAN PEOPLE AND THEIR HEALTH CARE NEEDS. THE LAST ISSUE I WISH 10 BRING BEFORE YOU IS THE CURRENT STATUS OF AIDS SPREAD, TREATMENT, AND PREVENTION. AS YOU MAY BE ANARE, AN INTERNATIONAL CONFERENCE ON THIS TOPIC WAS HELD IN WASHINGTON 2 WEEKS AGO. LET ME SHARE NITH YOU THE MOST RECENT INSIGHTS REGARDING THIS DEVASTATING DISEASE. MEDICINE HAD NEVER COME UPON A SYNDROME QUITE LIKE IT BEFORE. NE GAVE IT A LONG TITLE: THE "ACQUIRED IMMUNE DEFICIENCY SYNDROME." BUT WE SOON SETTLED JUST FOR THE INITIALS...A.1.D.9. ...0R “AIDS.” AND IT'S BEEN AIDS EVER SINCE. ELL JUST TOUCH ON A FEW KEY POINTS: FIRST OF ALL, WE'RE TALKING ABOUT A DISEASE THAT 15 SPREADING AND [5 FATAL. IT NOW TAKES ABOUT A YEAR 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 VICTIMS 15 CLOSE 10 36,000. OVER HALF 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 THE 1990 THE CUMULATIVE TOTAL WILL BE OVER A QUARTER OF A MILLION, SECOND POINT: EVEN THOUGH SCIENTISTS HAVE RAD A LOOK AT THE AIDS VIRUS, WE STILL DON'T KNOW PRECISELY WHAT IT IS. ONCE YOU KNOW WHERE THE AIDS VIRUS 1S, YOU CAN THEN RECOGNIZE THE PRESENCE OF ANTIBODIES SPECIFIC 10 IT, 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 NERE TURNING UP IN ABOUT 4 OR 5 UNITS OF BLOOD PER 10,000 UNITS. NOW, SINCE BLOOD SCREENING WAS BEGUN, THAT FIGURE HAS COME DOWN TO ABOUT 4 UNITS PER | MILLION UNITS OF TRANSFUSED BLOOD. AND, AS YOU KNOW, I'M SURE, THAT'S AS CLOSE 10 PERFECT AS YOU CAN GET IN THIS KIND OF SERVICE. THERE ARE BETWEEN A MILLION AND A MILLION~AND-A~RALF AMERICANS WALKING AROUND WITH THE AIDS VIRUS IN THEIR SYSTEMS. THEY HAVE THE VIRUS...BUT THEY AREN'T YET SICK WITH AN AIDS~RELATED DISEASE, SUCH AS PNEUMOCYSTIS CARINII PNEUMONIA OR KAPOSI'S SARCOMA OR ANY OF THE THE VIRULENT MEGALOVIRAL DISEASES. THE INCUBATION PERIOD, APPARENTLY CAN BE ANYWHERE FROM A YEAR OR SO. N° SOME PEOPLE 70 10 YEARS IN OTHERS. SO WE STILL CAN'T PREDICT WHICH PERSON CARRYING THE AIDS VIRUS WILL OR WELL NOT GET AN AIDS-RELATED DISEASE. SQ THE POSSIBILITY OF BEING OVERCOME BY AN INFECTIOUS DISEASE OF SOME KIND IS VERY, VERY HIGH. | THERE'S OTHER RESEARCH GOING ON AS WELL, IN THE AREA OF DRUG THERAPY AND VACCINE DEVELOPMENT. IN FACT, RESEARCH NOW COMMANDS ABOUT $300 MILLION IN FEDERAL FUNDS THIS YEAR, PLUS MANY MILLIONS MORE IN STATE AND PRIVATE SECTOR FUNDS. AND EVERYBODY WANTS TO KNON WHEN AN EFFECTIVE VACCINE MIGHT BE AVAILABLE. I HAVE TO TELL THEM THAT I DON'T SEE ONE IN THE NEAR FUTURE. NATURALLY, WE'RE MOVING AHEAD ON THIS FRONT AS QUICKLY AS WE CAN. BUT, AS YOU KNON, VACCINE DEVELOPMENT IS ONE THING THAT CANNOT BE RUSHED WITHOUT CREATING MORE PROBLEMS THAT NE ALREADY HAVE. NOK, FOR HY THIRD POINT: HE DON'T KNOW VERY MUCH ABOUT AIDS...BUT NE DO KNON -~ NITH COMPLETE CERTAINTY ~~ THAT THE AIDS VIRUS TENDS 10 CONCENTRATE IN BODY FLUIDS NhICH 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. THE INITIAL ALARM ABOUT AIDS MAS SOUNDED AMONG ROMOSEXUALS AND BISEXUAL MEN BECAUSE SOME SEX PRACTICES AMONG THESE MEN NOT ONLY PRODUCE SEMEN BUT MANY ALSO CAUSE SOME BLEEDING. AND, AGAIN, BLOOD AND SEMEN ARE THE ONLY THO BODY FLUIDS THAT CARRY -- AND TRANSMIT -- HIGH ENOUGH CONCENTRATIONS OF ThE LIVE AIDS VIRUS. THE BIOPHYSICAL PECULIARITIES OF THE AIDS VIRUS ALSO EXPLAIN NAY 25 PERCENT OF ALL AIDS CASES ARE INTRAVENOUS DRUG ABUSERS NHO USE CONTAMINATED NEEDLES AND OTHER PARAPHERNALIA THEY'VE BORROWED FROM OTHER ADDICTS WHO HAVE AIDS. THIS GROUP INCLUDES DRUG ABUSERS WHO ARE HOMOSEXUALS, ALSO. WHEN WE FIRST BEGAN THE 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 ANONG HETEROSEXUAL MEN AND WOMEN WHO ARE NOT I.V. DRUG ABUSERS. IN FACT, THEIR HETEROSEXUAL ACTIVITY SEEMS TO BE THEIR ONLY RISK FACTOR. ANOTHER CONCERN IS THE RISE IN AIDS AMONG BLACKS AND HISPANICS. BLACKS ACCOUNT FOR 12 PERCENT OF THE 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. 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. OVER THE PAST 5 YEARS, NE'VE BEAMED INFORMATION ALMOST EXCLUSIVELY 10 HOMOSEXUALS AND BISEXUAL MEN AND, NHEREVER POSSIBLE, 10 DRUG ABUSERS. BUT NOW NE NEED TO DIRECT OUR INFORMATION AND EDUCATION EFFORTS QUT 10 HETEROSEXUAL MEN AND WOMEN, .HHICH IS 10 SAY, 10 SOCIETY AT LARGE. THAT WAS THE BASIS FOR THE SURGEON GENERAL'S REPORT ON AIDS, WHICH I RELEASED LAST OCTOBER, THERE TS MUCH SCIENTIFIC AND PUBLIC HEALTH INFORMATION IN THAT REPORT, BUT ON THE BERAVIORAL SIDE, THERE ARE JUST THREE MESSAGES THAT ARE VITALLY IMPORTANT: THE FIRST MESSAGE 1S SIMPLE ENOUGH. IT SAYS THAT THE BEST DEFENSE AGAINST AIDS 15 TOTAL ABSTINENCE FROM SEAUAL RELATIONS. ] THINK THAT'S PRECISELY THE RIGHT MESSAGE 10 GIVE TO OUR CHILDREN -- AIDS OR NO AIDS. BUT ADULTS ARE AT RISK ALSO, AND A RECOMMENDATION OF TOTAL ABSTINENCE FRO THE ENTIRE POPULATION 15, 10 SAY THE LEAST, UNREALISTIC. HENCE, MY SECOND MESSAGE IS THIS: FIND SOMEONE HO TS WORTHY OF YOUR RESPECT AND YOUR LOVE...GIVE THAT PERSON BOTH...AND STAY FAITHFUL TO HIM OR HER. QN OTHER WORDS, SHORT OF TOTAL ABSTINENCE, THE BEST DEFENSE AGAINST AIDS IS 10 MAINTAIN A FAITHFUL, MONOGAMOUS RELATIONSHIP IN WHICH YOU HAVE ONLY ONE CONTINUING SEXUAL PARTNER, ..AND THAT PERSON I$ AS FAITHFUL AS YOU ARE. NY THIRD MESSAGE 1S FOR PEOPLE WHO AREN'T ABSTINENT BUT DON'T YET HAVE A FAITHFUL MONOGAMOUS RELATIONSHIP. ..FOR WHATEVER REASON. UNLESS YOU KNOW WITH ABSOLUTE CERTAINTY THAT NEITHER YOU NOR YOUR PARTNER IS CARRYING THE AIDS VIRUS, YOU MUST USE CAUTION, FROM THE VIENPOINT OF EPIDEMIOLOGY, NHEN YOU HAVE SEX WITH SOMEONE, YOU'RE ALSO RAVING SEX MITH EVERYONE ELSE WITH HHOM THAT PERSON HAS HAD SEX FOR AT LEAST 5 YEARS. IF YOU 00 DECIDE 10 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 10 FINISH, IF YOU'RE A NOMEN, MAKE SURE YOUR MALE PARTNER USES A CONDOM. AGAIN, FROM START 10 FINISH. A CONDOM WON'T PROVIDE 100 PERCENT PROTECTION -- FEW THINGS IN LIFE DO -- BUT SQ FAR IT SEEMS 10 BE THE BEST PROTECTION AVAILABLE. | APOLOGIZE FOR TRYING 10 PACK SO MUCH INTO A FEW MINUTES, BUT I FELT I MUST SHARE THESE ACCOLADES AND PROBLEMS WITH YOU. TN SUMMARY, SIGNIFICANT PUBLIC HEALTH CHALLENGES HAVE BEEN IDENTIFIED IN AMERICAN INDTAN AND ALASKA NATIVE COMMUNITIES IN THE PAST. THESE CHALLENGES WAVE BEEN MET WITH GREAT SUCCESS AND THERE MILL BE MANY MORE AHEAD, 1 AN CERTAIN THAT THEY WILL BE ADDRESSED WITH THE SANE VIGOR, INNOVATION, AND COMPETENCY BY THE MANY INDIVIDUALS HHO PROVIDE HEALTH SERVICES 10) ANERICAN TNDTAN AND ALASKA NATIVE PEOPLE, THEIR EFFORTS, MHEN COMBINED NITH Th COOPERATION OF TRIBAL COMMUNITIES AND GOVERNMENTS, WILL MOST CERTAINLY PROVIDE THE CRITICAL INGREDIENTS FOR WANY MORE SUCCESSES AND CARRY THE NATIVE ANERICAR PEOPLE WELL “BEYOND SURVIVAL."