ORIGINAL

Dou
; &.

Shibes

Appress

By
C. Everett Koop, MD, ScD
SURGEON GENERAL
OF THE
U, S, Pupiic HEALTH SERVICE
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

SS

PRESENTED TO THE NATIONAL COUNCIL OF STATE LEGISLATURES

INDIANAPOLIS, INDIANA
Jucy 30, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

1 APPRECIATE VERY MUCH THIS OPPORTUNITY TO SPEND A FEW MOMENTS
WITH YOU REGARDING A MAJOR EVENT IN PUBLIC HEALTH TODAY, AND THAT 1S
THE CONTINUING SPREAD OF THE DISEASE OF AIDS,

BUT WHILE 1 HAVE YOUR ATTENTION, 1 WANT TO PASS ALONG SOME OTHER
INFORMATION THAT I HAVE, AS YOUR SURGEON GENERAL, FRANKLY, IT’S THE
KIND OF INFORMATION THAT WILL SIT BETTER AFTER THIS NICE LUNCH,

FIRST OF ALL, I WANT TO TELL YOU THAT THE LIFE EXPECTANCY FOR
AMERICANS IS NOW AT AN ALL-TIME HIGH, THE AVERAGE CHILD BORN IN THE
UNITED STATES TODAY CAN EXPECT TO LIVE UNTIL HE OR SHE IS 75 YEARS
OLD.
MY COLLEAGUES IN THE SOCIAL SECURITY ADMINISTRATION ARE
SPEECHLESS, WHEN YOU TELL THEM THIS, BUT AS FOR ME, THAT'S PROGRESS
AND I’M DELIGHTED, |

IN ADDITION, I SHOULD TELL YOU THAT OUR INFANT MORTALITY RATE IS
NOW THE LOWEST IN OUR HISTORY AND -- I’M HAPPY TO SAY -- IS ONE OF THE
LOWEST INEANT MORTALITY RATES OF ANY MODERN, INDUSTRIALIZED COUNTRY IN
THE WORLD,

MORE CHILDREN BORN HERE ARE STARTING OUT HEALTHY...AND THEY TEND
TO STAY THAT WAY, ABOUT 10, 000 CHILDREN WILL BE BORN TODAY -- OVER
200 WHILE I’M UP HERE TALKING TO YOU THIS AFTERNOON, BUT LESS THAN 1
PERCENT OF THOSE CHILDREN -- 2 NEW BABIES -- WILL DIE WITHIN THE
MONTH, THAT'S 2 TOO MANY.,.STILL, IT IS A RECORD LOW FOR OUR COUNTRY,
I WON’T GIVE YOU ALL THE NUMBERS, BUT I THINK YOU SHOULD KNOW
THAT THE DEATH RATE FROM HEART DISEASE IS CONTINUING TO GO DOWN, AND
SQ ARE THE DEATH RATES FOR STROKE AND FOR MOST CANCERS, WHAT’S SO
IMPORTANT ABOUT THIS IS THAT THE NUMBERS ARE LOOKING BETTER, ESPECIALLY
AMONG PEOPLE IN THEIR 30's, 40's, anp 50’s, IN THEIR PEAK YEARS OF
EARNING POWER.

WHAT’S BEHIND ALL THIS GOOD NEWS? WITHOUT HESITATION, I’D HAVE
TO SAY THAT A VERY BIG FACTOR IS THE EXCELLENT PUBLIC HEALTH LEADER-
SHIP WE HAVE TODAY AT THE STATE AND LOCAL LEVELS,

IT ALWAYS WAS GOOD,..BUT TODAY IT’S OUTSTANDING, RIGHT ACROSS THE
COUNTRY.
IF 1 HAD SPENT THE PAST 6 YEARS CLINGING TO MY DESK BACK IN
WASHINGTON, I COULDN’T SAY THAT, BUT 1’VE BEEN ON THE ROAD A GREAT
DEAL -- AS MRS. KOOP REMINDS ME -- AND I’VE SPOKEN WITH AND I’VE
WORKED WITH MANY DOZENS OF PUBLIC HEALTH PERSONNEL FROM ALL 50 STATES
-- COMMISSIONERS..,THE CHAIRS OF BOARDS OF PUBLIC HEALTH ..,.EPIDEMI-
OLOGISTS...HEALTH ECONOMISTS,..PEOPLE FROM ALL DISCIPLINES,

OF COURSE, MY FAVORITES FOR MANY YEARS ARE THE PEOPLE WHO CARRY
OUT STATE MATERNAL AND CHILD HEALTH PROGRAMS,

1 THINK I KNOW WHO THEY ARE...AND HOW THEY WORK,,.AND I KNOW THE
KIND OF MAGNIFICENT JOB THEY’RE DOING FOR THE AMERICAN PEOPLE,
AND THAT’S WHY 1 BELIEVE THEY'RE A MAJOR FACTOR IN THE CONTINUING
IMPROVEMENT OF THE HEALTH STATUS OF THE AMERICAN PEOPLE.

BUT I ALSO KNOW THAT THESE FINE PUBLIC SERVANTS COULD ONLY
ACCOMPLISH THE THINGS THEY HAVE ACCOMPLISHED IN REGARD 10 CHRONIC
DISEASE, IMMUNIZATION. DENTAL HEALTH, WASTE MANAGEMENT, AND SO ON,
BECAUSE THEY’VE HAD THE UNDERSTANDING AND THE SUPPORT OF THEIR STATE
LEGISLATURES.

I SUSPECT THAT MANY OF YOU HERE TODAY ARE NOT PRIMARILY CONCERNED
WITH PUBLIC HEALTH ISSUES AND SO, LIKE MOST AMERICANS, WHEN YOU READ
SOMETHING IN THE NEWSPAPERS ABOUT THE NATION’S HEALTH, IT’S USUALLY
BAD NEWS,
BUT, DESPITE A HANDFUL OF TRULY SERIOUS PROBLEMS -- AND I’LL BE
TALKING ABOUT ONE OF THEM IN A MOMENT -- I WANT TO ASSURE YOU THAT THE
HEALTH STATUS OF THE AMERICAN PEOPLE CONTINUES TO IMPROVE.

AMERICANS ARE GOOD PEOPLE...AND THEY‘’RE A HEALTHY PEOPLE, 100,
YOU CAN TAKE MY WORD FOR THAT.

AND NOW 1 WANT TO SPEND A FEW MINUTES TALKING ABOUT ONE OF THOSE
PIECES OF BAD NEWS: THE DISEASE OF AIDS,

THE DISEASE HAS BEEN AROUND FOR ONLY 6 YEARS, YET, IN THAT SHORT
SPAN OF TIME, THE TOTAL CASE-LOAD HAS GROWN FROM 5 CASES TO 39,000
CASES,
BUT THEY’RE MORE THAN CASES, THEY’RE PEOPLE...HUMAN BEINGS... AND
ALREADY MORE THAN HALF OF THEM HAVE DIED -- SOME 22,000 -- AND THE
REST PROBABLY WILL,

IN FACT, ONE OF THE FEW THINGS WE KNOW WITH ANY CERTAINTY ABOUT
THIS DISEASE IS THAT IT IS GENERALLY FATAL,

YOU HAVE TO REACH VERY FAR BACK IN HUMAN HISTORY TO FIND A
CONTAGIOUS DISEASE THAT IS AS LETHAL AS THAT.

WE HAVE NO VACCINE FOR IT...AND WE PROBABLY WON'T HAVE ONE UNTIL
THE END OF THIS CENTURY.
THE FEDERAL BUDGET FOR VACCINE RESEARCH WAS $31 MILLION THIS
YEAR, AND WE EXPECT TO DOUBLE THAT FIGURE NEXT YEAR,

BUT SPENDING MORE MONEY WILL NOT NECESSARILY BRING A VACCINE TO
THE MARKETPLACE ANY FASTER. VACCINE DEVELOPMENT IS A HIGHLY COMPLEX
PROCESS... TIME-CONSUMING...WITH MANY DIFFICULT QUESTIONS OF PATIENT
CONSENT AND OTHER ETHICAL ISSUES THAT NEED TO BE ANSWERED ALONG THE
WAY,

MONEY IS NEEDED, BUT WITH AIDS AS WITH NEARLY EVERYTHING ELSE,
MONEY ISN’T EVERYTHING.
{oO

IN FACT, NOTHING ELSE RIGHT NOW CAN HELP STOP THE SPREAD OF AIDS
MORE EFFECTIVELY THAN A STRONG PROGRAM OF PUBLIC EDUCATION AND
INFORMATION, COMBINED WITH COUNSELING AND TESTING,

THE AIDS VIRUS, AS I’M SURE YOU KNOW BY NOW, 1S CHARACTERISTIC-
ALLY PASSED FROM PERSON TO PERSON ONLY IN BLOOD AND SEMEN. ALTHOUGH
THE VIRUS 1S SOMETIMES FOUND IN OTHER BODY FLUIDS, IT DOESN’T SHOW UP
IN SUFFICIENT CONCENTRATION IN TEARS OR SALIVA, FOR EXAMPLE, TO BE
TRANSMITTED TO ANOTHER PERSON,

THEREFORE, YOU DO NOT GET AIDS FROM SHAKING HANDS, HUGGING,
KISSING, SNEEZING, OR EATING,
10

YOU DON’T GET IT FROM TOILET SEATS, DRINKING FOUNTAINS, SUITCASE
HANDLES, OR DOORKNOBS,

YOU DON’T GET IT FROM DRINKING GLASSES, SWEATSHIRTS, LIPSTICK, OR
BATH TOWELS,

YOU DON’T GET AIDS FROM MOSQUITOS, FLEAS, OR PETS,

BARRING A CHILD WITH AIDS FROM GOING TO GRADE SCHOOL OR DENYING
ANYONE WITH AIDS ANY MEDICAL OR DENTAL SERVICE IS THE WORST KIND OF
NONSENSE. IN MOST SOCIAL SITUATIONS THERE 1S NO DANGER WHATSOEVER OF
BEING INFECTED,
ll

BUT YOU AREN’T ANY OF THOSE THINGS, YOU‘RE HERE, AND I'D GUESS
THAT THE WORST HEALTH PROBLEM MOST OF YOU HAVE HAD TODAY IS A TEMPO-
RARY DISAGREEMENT WITH YOUR LUNCH,

THAT'S NOT VERY ROMANTIC,..AND YOU CAN‘T GET A NICKEL FOR THE
MOVIE RIGHTS TO A CASE OF INDIGESTION,

BUT THERE IT IS,

OUR EPIDEMIOLOGISTS ESTIMATE THAT ABOUT A MILLION AND A HALF
AMERICANS ARE NOW INFECTED WITH THE AIDS VIRUS...BUT, FOR ONE REASON
OR ANOTHER, THEY HAVE NOT YET CONTRACTED AN AIDS-RELATED DISEASE.
THEREFORE. WE DON’T KNOW WHO THEY ARE...AND THEY DON’T KNOW EITHER,
12

IN ADDITION, 1 OF EVERY 4 AIDS VICTIMS HAS BEEN AN INTRAVENOUS
DRUG ABUSER. AND ONE-THIRD OF THESE PEOPLE ARE ALSO HOMOSEXUAL AND
BISEXUAL MEN.

IN OTHER WORDS, IN OVER 90 PERCENT OF THE AIDS CASES THUS FAR THE
AIDS VIRUS HAS BEEN TRANSMITTED THROUGH SPECIFIC SEXUAL OR DRUG-TAKING
ACTIVITIES THAT PEOPLE DO VOLUNTARILY,

IF WE COULD CHANGE THE BEHAVIOR OF JUST THESE TWO POPULATION
GROUPS -- HOMOSEXUALS AND 1,V. DRUG ABUSERS -- THEN THIS COUNTRY WOULD
NOT HAVE THE AIDS EPIDEMIC IT NOW HAS,

BUT AIDS IS NOW IN THE HETEROSEXUAL COMMUNITY AS WELL. FOUR
PERCENT OF PEOPLE WITH AIDS ARE NEITHER DRUG ABUSERS NOR HOMOSEXUALS
OR BISEXUAL MALES. IN OTHER WORDS, THEY BECAME INFECTED ONLY THROUGH
THEIR HETEROSEXUAL BEHAVIOR. BUT MORE OF THAT LATER,
13

AND IF YOU'RE A WOMAN THAT AGE,,.LIVING IN THOSE SAME LOW-
INCIDENCE AREAS,..YOUR CHANCES OF BEING AN AIDS CARRIER ARE 1 IN
14,000,

BUT IF YOU DON’T ENGAGE IN HIGH-RISK SEXUAL BEHAVIOR AND YOU
DON’T “SHOOT” DRUGS.,.REGARDLESS OF WHERE YOU LIVE AND REGARDLESS OF
HOW OLD YOU ARE... YOUR CHANCES OF BEING AN AIDS CARRIER ARE...ZERO.

NOW, BEFORE YOU BREATHE A BIG SIGH OF RELIEF. LET ME TELL YOU A
SECRET: THOSE ARE MARVELOUS ODDS.,.BUT WHETHER OR NOT THEY STAY THAT
WAY DEPENDS ON YOU,

AND THAT'S MY GREATEST CONCERN, AS YOUR SURGEON GENERAL.
14

A NUMBER OF SURVEYS HAVE BEEN CONDUCTED RECENTLY AND THEY SHOW
SHARP REDUCTIONS IN THE NUMBER OF HOMOSEXUAL AND BISEXUAL MEN WHO
STILL ENGAGE IN HIGH-RISK SEX PRACTICES...IN SOME CASES IT’S GONE FROM
A HIGH OF CLOSE TO 70 PERCENT TO A LOW, 18 MONTHS LATER, OF 41 PERCENT
OF THE MEN SURVEYED,

SO I WOULD SAY, YES, EDUCATION DOES WORK,

BUT EDUCATION, PLUS COUNSELING AND TESTING, WORKS EVEN BETTER,
FOR EXAMPLE, ONE RESEARCHER, PSYCHOLOGIST THOMAS COATES OF SAN

FRANCISCO, FOUND THAT MEN WHO TESTED POSITIVE FOR THE AIDS VIRUS AND
RECEIVED SOME COUNSELING WERE MUCH MORE LIKELY TO REDUCE THEIR HIGH-
RISK SEX BEHAVIOR THAN MEN WHO WERE NOT TESTED AND COUNSELED,
15

OTHER RESEARCHERS ARE FINDING THE SAME THING,

THAT'S IMPORTANT INFORMATION, AND MANY STATES SEEM TO KNOW IT AND
SEEM TO BE ACTING ON IT, A NUMBER OF STATES HAVE ESTABLISHED JUST
SUCH A COMBINATION OF PUBLIC EDUCATION WITH A NETWORK OF COMMUNITY-
BASED COUNSELING AND TESTING CENTERS, SOME HAVE DONE THIS
ADMINISTRATIVELY, WHILE OTHERS HAVE MANDATED SUCH PROGRAMS BY LAW,

OUR HOST STATE OF INDIANA IS A GOOD CASE IN POINT. THE INDIANA
STATE BOARD OF HEALTH HAS PROFESSIONAL PEOPLE WORKING FULL-TIME ON
AIDS EDUCATION AND RISK REDUCTION PROGRAMS, THESE PROGRAMS HAVE BEEN
DEVELOPED AND CARRIED OUT BY A NETWORK OF 14 “COMMUNITY ACTION GROUPS”
ALL AROUND THE STATE.
16

TRAINED PERSONNEL ARE ALSO DOING PRE-TEST COUNSELING IN A VARIETY
OF SETTINGS, SUCH AS DRUG ABUSE TREATMENT CENTERS AND CLINICS FOR
SEXUALLY TRANSMITTED DISEASES, THEY’RE GIVING THE FACTS T0 1.V, DRUG
ABUSERS AND TO PROSTITUTES AND OTHERS WHO HAVE MULTIPLE SEX PARTNERS
OR WHO ENGAGE IN A VARIETY OF HIGH-RISK SEX BEHAVIOR,

INDIANA HAS A MODEL PROGRAM, AND I'M DELIGHTED THAT PRESIDENT
REAGAN INVITED THE INDIANA HEALTH COMMISSIONER, WOODROW A, MYERS, JR.
-- "WOODY" TO EVERYONE WHO KNOWS HIM -- TO BE ONE OF THE 13 MEMBERS ON
THE NEW AIDS COMMISSION, HE HAS A GREAT DEAL TO OFFER,
17

THE DISEASE OF AIDS HAS BEEN WITH US ONLY 6 YEARS, BUT IT’S TRUE
IMPACT HAS BEEN UNDERSTOOD ONLY FOR THE PAST 2 OR 3 YEARS, NEVERTHE-
LESS, THERE’S BEEN EXTRAORDINARY PROGRESS ACROSS THE COUNTRY, IN STATE
AFTER STATE, IN REGARD TO THIS DISEASE,

AND MANY LEGISLATURES ARE LEADING THE WAY, I UNDERSTAND THAT, SO
FAR THIS YEAR. SOMETHING LIKE 500 BILLS DEALING WITH ALL ASPECTS OF
THE AIDS PROBLEM HAVE BEEN INTRODUCED IN STATE LEGISLATURES. THAT'S
ABOUT TWICE THE NUMBER INTRODUCED IN ALL OF LAST YEAR,

SO THE INTEREST IN THIS MATTER IS CLEARLY VERY HIGH AND THE
PUBLIC DIALOGUE HAS BEGUN IN EARNEST.
18

MORE MONEY IS BEING APPROPRIATED NOT ONLY FOR EDUCATION AND
COUNSELING AND TESTING, BUT ALSO FOR SURVEILLANCE, RESEARCH, PATIENT
CARE, AND ADMINISTRATION, AND YOU’RE PUTTING INTO PLACE NEW SYSTEMS
OF MAINTAINING ACCURATE AND CONFIDENTIAL RECORDS OF PERSONS WHO ARE
TESTED FOR AIDS,

AND RIGHT HERE WE HAVE SOME SERIOUS THINKING TO DO, IN REFERENCE
TO TESTING AND CONFIDENTIALITY,

MOST OF YOU ARE PROBABLY FAMILIAR WITH PUBLIC HEALTH PROGRAMS TQ
CONTROL VENEREAL DISEASE, THE INFECTIOUS DISEASES OF CHILDHOOD, AND
GENETIC SCREENING PROGRAMS, FOR EXAMPLE,
19

AND SO YOU KNOW THAT CONFIDENTIALITY DOES NOT PREVENT VITAL
HEALTH INFORMATION FROM BEING GIVEN TO PERSONS WHO HAVE A NEED OR A
RIGHT TO KNOW. AMONG SUCH PERSONS WOULD BE A SPOUSE, A CHILD.
HOSPITAL PERSONNEL, CORRECTIONAL STAFF, OR AN ENTIRE SCHOOL SYSTEM,

WITH AIDS, THIS "NEED TO KNOW” CONCEPT 1S EVEN MORE SIGNIFICANT,
SINCE, UNLIKE MOST OTHER PUBLIC HEALTH PROBLEMS, AIDS 1S STILL A
MYSTERY -- WE HAVE NO CURE FOR IT -- AND IT IS VIRTUALLY 100 PERCENT

FATAL.

IT SEEMS TO ME THAT THOSE ARE TWO VERY COMPELLING REASONS FOR
STRENGTHENING CONFIDENTIALITY TO THE POINT THAT PEOPLE AT RISK WILL

VOLUNTEER TO BE TESTED AND FOR INSURING THAT CERTAIN NARROWLY DEFINED
PERSONS IN THE COMMUNITY -- WITH A CLEAR “NEED TO KNOW” FOR THEIR OWN

PROTECTION -- ARE GIVEN THAT INFORMATION,
20

THIS IS NOT NEW PUBLIC HEALTH DOCTRINE BY ANY MEANS, WE’RE
ALWAYS BALANCING ONE PERSON’S NEED FOR PRIVACY AGAINST ANOTHER’S -- OR
THE COMMUNITY'S -- NEED FOR PROTECTION,

WE SHOULD ENCOURAGE PEOPLE, ESPECIALLY THOSE WHO PRACTICE HIGH-
RISK BEHAVIOR, TO COME IN, TO GET TESTED, AND TO GET HELP FOR THE NEXT
STEP IN THEIR LIVES,

WE DON’T WANT THEM TO AVOID THE TEST FOR FEAR THAT KNOWLEDGE OF
THE FACT MAY JEOPARDIZE THEIR JOBS, THEIR HOUSING, OR THEIR FAMILY
LIFE,
21

BUT THERE ARE OCCASIONS WHEN AIDS TESTING OUGHT TO BE DONE
ROUTINELY AND THE INFORMATION ROUTINELY SHARED WITH THOSE WHO NEED TO
KNOW,

FOR EXAMPLE, WE’RE ALL FAMILIAR WITH THE PROBLEM OF MALE RAPE IN
PRISONS, CLEARLY THE AIDS VIRUS IN A PRISONER’S BLOODSTREAM CAN BE
JUST AS DEADLY AS A PISTOL IN HIS BELT.

THEREFORE, I BELIEVE -- ALONG WITH PRESIDENT REAGAN -- THAT ALL
FEDERAL PRISONERS OUGHT TO BE TESTED FOR AIDS, AND THE TEST RESULTS
OUGHT TO BE GIVEN TO WIVES OR OTHERS WHO WILL BE WITH THAT PRISONER
DURING CONJUGAL VISITS OR AFTER HE’S RELEASED BACK INTO THE
COMMUNITY,
22

IF THAT'S GOOD LAW FOR FEDERAL PRISONS, THEN I THINK IT IS
EQUALLY GOOD LAW FOR OTHER PRISONS AS WELL.

I AM NOT SO NAIVE, HOWEVER, AS TO THINK THAT A NEW LAW -- ALL BY
ITSELF -- WILL CHANGE PEOPLE’S BEHAVIOR OR WILL CHANGE THE ENVIRONMENT
FOR ENFORCEMENT,

FOR EXAMPLE, MANY PRISON AUTHORITIES HAVE TOLD US, YES, THEY
WOULD LIKE TO KNOW WHICH PRISONERS ARE CARRYING THE VIRUS, BUT
THEY/RE NOT SURE THEY CAN DO MUCH WITH THAT INFORMATION, SINCE THEIR
FACILITIES ARE ALREADY CROWDED TO THE LEGAL MAXIMUM -- OR WORSE, THEY

DON’T HAVE EXTRA SPACE OR STAFF TO DEAL WITH PRISONERS WITH AIDS,
23

AND SOME HAVE ALSO EXPRESSED THE FEAR OF ADDITIONAL VIOLENCE, IF
THE CONFIDENTIALITY OF THE TEST RESULTS WERE SOMEHOW BREACHED,

SO 1 THINK THE MOVE TO TEST PRISONERS IS THE RIGHT MOVE,,.EVEN
THOUGH IT COULD RAISE MORE NEW ISSUES FOR PRISON ADMINISTRATION,

THERE IS ANOTHER ISSUE, SORT OF RELATED TO THIS ONE, WHICH IS
BEGINNING TO CAUSE US SERIOUS CONCERN, IT INVOLVES PATIENTS
UNDERGOING SURGERY,

BEFORE I DONNED THE UNIFORM OF THE PUBLIC HEALTH SERVICE, I HAD
SPENT NEARLY 40 YEARS IN PEDIATRIC SURGERY SO 1 AM QUITE FAMILIAR WITH
THE HUNDREDS OF OPPORTUNITIES IN THE OPERATING ROOM FOR AN AIDS VIRUS
TO BE TRANSMITTED. BUT I ALSO KNOW THAT THE MEMBERS OF A SURGICAL
TEAM CAN TAKE RATHER SIMPLE AND ROUTINE PRECAUTIONS TO PROTECT
THEMSELVES,
24

THIS IS ANOTHER MANAGEMENT PROBLEM, TO BE SURt, AND YOU DON’T
WANT TOO MANY OF THOSE IN THE OPERATING ROOM. BUT IT CAN BE DONE AND
IT OUGHT TO BE DONE,

INSTEAD, HOWEVER, WE’RE HEARING STORIES OF A DOCTOR HERE AND
THERE REFUSING TO OPERATE ON PATIENTS KNOWN TO BE AIDS CARRIERS. AND
SOME NURSES HAVE REPORTEDLY LEFT THEIR ASSIGNMENTS IN THE O.R. AS
WELL,

NECDLESS TO SAY, THAT KIND OF THING COULD DEVELOP INTO A SERIOUS
PUBLIC HEALTH PROBLEM.
25

FOR THAT REASON, THE SECRETARY OF HEALTH AND HUMAN SERVICES, DR,
OTIS BOWEN. AND 1 AGREE THAT AIDS TESTING OUGHT TO BE CONSIDERED FOR
NON-EMERGENCY SURGICAL PATIENTS WHEN IT IS DECMED TO BE NECESSARY BY
THE PHYSICIAN.

WE DON’T KNOW AS MUCH ABOUT AIDS AS WE'D LIKE TO. BUT WE DO KNOW
THAT IT KILLS PEOPLE,

1 THINK THOSE ARE THE TWO BIG REASONS WHY AT LEAST 9 STATES NOW
REQUIRE THAT POSITIVE TEST RESULTS BE REPORTED. AND MOST STATES WANT
TO KNOW THE NAMES OR OTHER IDENTIFIERS OF THE PERSONS WHO TEST
SEROPOSITIVE,
26

1 BELIEVE COLORADO -- WHICH HAS ABOUT 400 CASES OF AIDS ALL
TOGETHER -- WAS THE FIRST STATE TO REQUIRE THE REPORTING -- BY NAME --
OF PEOPLE WHO TEST POSITIVE FOR AIDS. AND THE CITIZENS OF COLORADO
KNOW THIS,

YET, COLORADO CONTINUES TO HAVE A VERY HIGH NUMBER OF PEOPLE WHO
VOLUNTARILY COME IN TO BE TESTED, RECORDS ARE CONFIDENTIAL AND NO ONE
HAS BEEN ADVERSELY AFFECTED BY THE TEST SO FAR, THAT, TO ME. IS THE
KEY REASON THAT COLORADO HAS BEEN SUCCESSFUL, |

IN MINNESOTA THE NAMES OF PERSONS WITH AIDS ARE NOW BEING
REPORTED TO THE DEPARTMENT OF HEALTH, IN TURN, THE DEPARTMENT IS
OFFERING “PARTNER NOTIFICATION” SERVICES, ON REQUEST, TO ANYONE WITH
AIDS WHO WANTS TO BE FAIR TO HIS OR HER SEX PARTNER, BUT CAN’T DO IT
ALONE AND NEEDS A THIRD PARTY TO BREAK THE NEWS,
2/7

THE STATE OF MINNESOTA RECOGNIZES THE COMPELLING PUBLIC INTEREST
FOR IT TO STEP FORWARD AND PROVIDE THAT VERY DIFFICULT PERSONAL
SERVICE,

IN 7 STATES, POLICE, FIRE, AND RESCUE WORKERS MUST BE TOLD IF
THEY'VE BEEN EXPOSED TO A PERSON WITH AN INFECTIOUS DISEASE .. ATDS IN
PARTICULAR, AND 1 THINK THAT’S A GOOD IDEA, 100.

WE'RE JUST BEGINNING TO FACE THESE KINDS OF PROBLEMS. BUT 1
BELTEVE we'RE NOW IN BETTER SHAPE TO COME UP WITH WORKABLE, FAIR
SOLUTIONS THAN WE WERE A COUPLE OF YEARS AGO,
23

AT THAT TIME, WE HAD AN UNCLEAR PICTURE OF THIS DISEASE...WE
STILL DID NOT KNOW HOW MUCH OF A THREAT IT REALLY WAS, OUR
EPIDEMIOLOGICAL RECORD WAS STILL BEING BUILT. AND THE BEST WE COULD DO
WAS TO MAKE SOME EDUCATED GUESSES ABOUT THE NATURE AND PROGRESS OF THE
DISEASE, WHERE WAS IT GOING? WHAT WAS IT DOING?

BUT TODAY WE HAVE A GOOD STATISTICAL BASIS FOR ESTIMATING THE
FUTURE COURSE OF THIS DISEASE, EXCEPT IN ONE AREA,

WE ARESTILL NOT SURE HOW TO PREDICT THE SPREAD OF AIDS IN
HETEROSEXUALS, AS I MENTIONED EARLIER, SOME 4 PERCENT OF PEOPLE WIOTH
AIDS BECAME INFECTED THROUGH HETEROSEXUAL RELATIONS, WE DON'T YET
KNOW HOW SIGNIFICANCE THIS IS...1F, FOR EXAMPLE, THIS WILL REMAIN A
MINOR PHENOMENON OR IF WE ARE ACTUALLY ON THE THRESHHOLD OF OF A
RAPIDLY EXPANDING EPIDEMIC AMONG HETEROSEXUALS, AS WE‘VE ALREADY
EXPERIENCED AMONG HOMOSEXUALS.,

CLEARLY, STATISTICS -- WHILE VALUABLE -- DON’T GIVE US THE WHOLE
STORY,
29

I MENTIONED BEFORE THE FACT THAT AIDS ATTACKS PRIMARILY HOMO-
SEXUAL AND BISEXUAL MALES AND INTRAVENOUS DRUG ABUSERS, THOSE ARE
POPULATION CATEGORIES BY HIGH-RISK ACTIVITY,

BUT REPORTS FROM STATE AGENCIES STIMULATED US TO BREAK OUT THE
AIDS FIGURES IN ANOTHER WAY: THAT IS, BY RACE AND BY ETHNIC
BACKGROUND, AND WHEN WE DID THAT, WE COULD CLEARLY SEE THAT A
POPULATION GROUP VERY HARD HIT BY THIS DISEASE IS MADE UP OF YOUNG
BLACKS AND HISPANICS.

AT THE PRESENT TIME, 46 PERCENT -- NEARLY HALF -- OF ALL AIDS
VICTIMS UP TO THE AGE OF 29 ARE BLACK OR HISPANIC,
30

BUT IN THE U.S, POPULATION AT LARGE, ONLY 23 PERCENT OF ALL
PERSONS UP TO THE AGE OF 29 ARE BLACKS AND HISPANICS. IN OTHER WORDS,
THESE YOUNG PEOPLE ARE APPEARING AS AIDS VICTIMS TWICE AS FREQUENTLY
AS THEY APPEAR IN THE POPULATION IN GENERAL,

 

1 CONSIDER THAT TO BE A VERY. VERY IMPORTANT PIECE OF
INFORMATION, IT MEANS THAT THE MINORITY COMMUNITY IN AMERICA HAS 10
CONFRONT AND CONTAIN A LIFE-THREATENING DISEASE THAT'S HITTING THEM
WITH TWICE THE EFFECT THAT IT’S HAVING ANYWHERE ELSE,

AND THAT'S PROBABLY AN UNDERSTATEMENT, BECAUSE -- AND I’M NOT
VERY PROUD OF THIS -- BECAUSE WE KNOW FROM VIRTUALLY EVERY OTHER
HEALTH INDICATOR WE HAVE THAT MINORITY AMERICANS ARE NOT MAKING AS
MUCH PROGRESS IN HEALTH STATUS AS THE REST OF THE COUNTRY DOES.
3]

1 BEGAN MY REMARKS TODAY WITH A LIST OF THE INDICATORS WE HAVE
THAT SHOWS AMERICA’S PHYSICAL AND MENTAL HEALTH AS BEING REALLY QUITE

GOOD. ..IN GENERAL.

BUT IN EVERY ONE OF THOSE CATEGORIES I MENTIONED -- INFANT
MORTALITY, HEART DISEASE, STROKE, CANCER, AND SO ON -- OUR FELLOW
CITIZENS WHO ARE BLACK, HISPANIC, OR NATIVE AMERICAN TEND TO FARE LESS
WELL THAN THE REST OF AMERICA,

THERE ARE REASONS FOR THIS, BUT, AS A SOCIETY. WE HAVE NOT YET
FOCUSED ON THIS PROBLEM INTENSELY ENOUGH TO FIGURE OUT WHAT THEY ARE.

YES, THERE ARE REASONS. BUT THERE ARE NO GOOD REASONS.. .WHAT-
EVER THEY ARE.
32

AND TODAY, WITH THE SPECTRE OF AIDS CASTING SUCH A LARGE SHADOW
OVER THE HOMES OF AMERICANS WHO ARE BLACK OR HISPANIC, WE MUST COME
FACE-TO-FACE WITH THIS SERIOUS DEFICIENCY IN THE AMERICAN SYSTEM OF
FAIR AND COMPASSIONATE HEALTH CARE FOR ALL.

EARLY NEXT MONTH, THE PUBLIC HEALTH SERVICE WILL HAVE A TWO-DAY
MEETING IN ATLANTA,,.SOME 600 PEOPLE WILL BE THERE FROM NATIONAL,
STATE, AND COMMUNITYWIDE ORGANIZATIONS REPRESENTING BLACK AND HISPANIC
AMERICANS,

WE’RE GOING TO CONFRONT THIS AIDS INVASION OF THEIR COMMUNITIES
AND SEE WHAT WE CAN DO -- TOGETHER -- TO BRING IT TO A HALT.
33

BUT IN SEPTEMBER, WE WILL CONVENE ANOTHER MEETING, WHICH HAS BEEN
IN THE PLANNING STAGES FOR A LONG TIME, THAT WILL BE A NATIONAL
CONFERENCE FOR STATE AND LOCAL PERSONNEL, THE OBJECTIVE OF THAT
CONFERENCE 1S TO COME UP WITH A STRATEGY FOR DEALING WITH MINORITY
HEALTH CONCERNS THAT'S BETTER THAN THE NON-STRATEGY WE’VE GOT NOW,

AND I'M TRUISTING THAT THAT CONFERENCE WILL SOMEHOW MARK A NEW
BEGINNING FOR ALL OF US -- BLACK AND WHITE, HISPANIC, ASIAN AND ANGLO
-- AS WE BEGIN TO FOCUS WITH MORE CLARITY AND MORE COMMITMENT UPON THE
HEALTH NEEDS OF OUR MINORITY CITIZENS,

AIDS IS A TERRIBLE DISEASE, BUT IT HAS DONE ONE THING OF SOME
VALUE. IT HAS SHAKEN US OUT OF OUR COMPLACENCY ABOUT THE DELIVERY OF
HEALTH CARE IN AMERICA,
34

AIDS ATTACKS PEOPLE WHO HAVE BEEN ON THE PERIPHERY OF HEALTH
CARE. WE’VE PROVIDED THEM WITH SPECIAL CLINICS AND SPECIAL PROGRAMS
OF ONE KIND OR ANOTHER, BUT THEY REMAIN OUTSIDE THE NAINSTREAM OF
AMERICAN HEALTH CARE,

AND NOW, WHEN WE DESPARATELY NEED TO REACH THEM AND HELP THEM...
WE DISCOVER THAT WE DON’T REALLY KNOW HOW TO DO IT,

AND THAT'S A TERRIBLE FIX FOR THIS COUNTRY TO BE IN,

I KNOW THAT YOU SHARE WITH ME THE PAIN OF KNOWING THAT MANY OF
OUR CITIZENS NEED OUR HELP.
35

BUT I ALSO KNOW THAT YOU SHARE WITH ME THE COMMITMENT TO NEVER
GIVE UP...NEVER GIVE IN,..AND NEVER GIVE WAY TO FEAR OR PREJUDICE.

LIVES ARE AT STAKE. AND I MAINTAIN THAT LIVING IS WHAT GOVERN-
MENT IS ALL ABOUT.

THANK YOU,

Hag HH