ORIGINAL

CURRENT Issues IN AIDS
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

ae

PRESENTED AT THE ANNUAL MEETING OF THE
FEDERATION OF AMERICAN HEALTH SYSTEMS
New ORLEANS, LOUISIANA
MarcH 17, 1988
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I'M DELIGHTED TO JOIN YOU THIS AFTERNOON AND BE COUNTED
AMONG THE SEVERAL SPEAKERS YOU’RE HEARING TODAY. YOU‘RE
RECEIVING A GREAT DEAL OF INFORMATION, I KNOW. BUT YOU NEED IT
TO CARRY OUT YOUR DUAL ROLES AS MEMBERS OF THE WORLD’S BEST
SYSTEM OF HEALTH CARE ... AND AS CITIZENS OF THE WORLD’S GREATEST
DEMOCRACY.

AND IT 1S WITH BOTH THOSE ROLES IN MIND THAT I WOULD SPEAK
WITH YOU THIS AFTERNOON,
2
I WANT TO SPEND A FEW MOMENTS AND EXPLORE WITH YOU A

COUPLE OF QUESTIONS THAT I KNOW TROUBLE A GREAT MANY OF OUR
COLLEAGUES IN HEALTH CARE AND WHICH TROUBLE A GREAT MANY OF OUR
FELLOW AMERICANS AS WELL.

THE QUESTIONS HAVE TO DO WITH THE AIDS EPIDEMIC ... WHOM IT
TS AFFECTING AND HOW WE ARE RESPONDING. AND WHAT IS THE
PROGNOSIS FOR THOSE AT RISK ... AND FOR SOCIETY ITSELF.

I’M NOT GOING TO DWELL ON THE PARTICULARS OF THE DISEASE.
THE DAILY PRESS -- AND OUR PROFESSIONAL JOURNALS -- DO A VERY
GOOD JOB OF THAT,
3
INSTEAD, I WOULD LIKE TO SHARE WITH YOU MY PERCEPTION OF

WHAT EFFECT THE EPIDEMIC OF AIDS IS HAVING UPON THE WAY AMERICANS
THINK ABOUT DISEASE ... ABOUT EACH OTHER ... AND ABOUT
RESPONSIBILITY: PROFESSIONAL, SOCIAL, AND PERSONAL
RESPONSIBILITY.

“MAKE NO MISTAKE ABOUT IT. AIDS IS NOT JUST A DISEASE
AFFECTING THE BODIES AND MINDS OF A FEW THOUSAND PEOPLE.

THIS DISEASE ALSO THREATENS OUR COUNTRY’S SOCIAL COHESION
AND NATIONAL PURPOSE.
4
WHY IS THIS SO? WHAT MAKES AIDS SO THREATENING?

AS A BEGINNING, WE NEED TO ISOLATE THOSE THREE ASPECTS OF
THE AIDS EPIDEMIC THAT COLOR EVERYTHING DONE AND SAID ABOUT IT.

FIRST, AIDS 1S STILE A MYSTERY. WE KNOW SOME THINGS ABOUT
TT. BUT UNFORTUNATELY WE DON’T YET KNOW ENOUGH TO PRODUCE A
VACCINE TO PREVENT ITS SPREAD OR A DRUG TO STOP IT IN ITS TRACKS.

I] SHOULD ADD THAT THE WORLD’S MOST TALENTED VIROLOGISTS AND
IMMUNOLOGISTS HAVE BEEN WORKING ON THIS DISEASE FOR ONLY A HALF-
DOZEN YEARS AND THEY’VE MANAGED IN THAT SHORT A TIME TO PRODUCE
AN IMPRESSIVE BODY OF KNOWLEDGE.
5
BUT THE AVERAGE PERSON WANTS A CLEAR-CUT “YES” OR “NO” TO

THE MOST PRESSING PERSONAL QUESTIONS. SCIENTISTS SHY AWAY FROM
CLEAR-CUT ANSWERS. WE ALL KNOW THAT. BUT IN THE CASE OF AIDS,
WE SHY AWAY ... BECAUSE THERE SIMPLY AREN’T ANY.

AND, REMEMBER, WE‘RE TRYING TO EXPLAIN THIS TO A GENERATION
OF AMERICANS WHO HAVE BEEN USED TO READING ABOUT THE CONQUESTS OF
SCIENCE -- NOT ITS DEFEATS.

DESPITE ALL THE THINGS WE KNOW ABOUT THIS VIRUS, AIDS IS
STILL A MYSTERY. IT MAY TAKE A FEW MORE YEARS -- AT THE LEAST --
BEFORE WE UNRAVEL ALL ITS RIDDLES. BUT WE WILL.
6
I HAVE ABSOLUTELY FAITH IN THE PERSISTENT GENIUS OF OUR

BIOMEDICAL RESEARCH COMMUNITY.

OUR SCIENTISTS ARE CONQUERING BALDNESS ... OBVIOUSLY THEY’LL
CONQUER AIDS.

IT’S NOT “WHETHER” -- IT’S “WHEN.” WE DON’T KNOW WHEN. AND
THAT’S WHAT IS SO UNNERVING FOR THE AMERICAN PEOPLE.

AIDS IS A MYSTERY. BUT AIDS IS ALSO FATAL. IN FACT, AIDS
SEEMS TO HAVE ONE OF THE HIGHEST FATALITY RATES OF ANY INFECTIOUS
DISEASE WE'VE EVER COME ACROSS,
7
WHEN YOU LOOK AT ALL THE REPORTED CASES OF AIDS SINCE 1981,

AND THE REPORTED DEATHS AS WELL, THE MORTALITY RATE IS ABOUT 56
PERCENT ... WHICH IS BAD ENOUGH,

BUT WHEN YOU LOOK BACK TO THOSE PERSONS WHO HAD AIDS IN
1981, YOU DISCOVER THAT 93 PERCENT OF THEM HAVE SINCE DIED OF THE
DISEASE.

AND IN MY BOOK, A MORTALITY RATE OF 93 PERCENT IS AS BAD AS
A RATE OF 100 PERCENT.
8
SO, THE DISEASE IS A MYSTERY ... IT'S FATAL ... AND, THREE,

THE AIDS VIRUS IS TRANSMITTED BY THE KIND OF BEHAVIOR THAT MOST
PEOPLE DON’T ENGAGE IN -- OR APPROVE OF,

AS I’M SURE YOU KNOW BY NOW, THE HIGHEST CONCENTRATIONS OF
THE AIDS VIRUS ARE FOUND IN BLOOD AND SEMEN. HENCE, THE SPECIFIC
PERSONAL BEHAVIORS THAT PRODUCE THE HIGHEST RISK OF TRANSMISSION
ARE UNPROTECTED ANAL INTERCOURSE -- PARTICULARLY AS PRACTICED BY
HOMOSEXUALS AND BISEXUAL MALES -- AND THE SHARING OF NEEDLES BY
INTRAVENOUS DRUG ABUSERS.
9
UNFORTUNATELY, THERE'S A GREAT DEAL OF UNINFORMED AND WRONG-

HEADED TALK ABOUT OTHER MODES OF TRANSMISSION: TEARS AND
MOSQUITOS AND WATER GLASSES AND KISSING AND SO ON,

IF ANY OF THESE REALLY DID TRANSMIT THE AIDS VIRUS, THE
EPIDEMIC OF AIDS WOULD BY NOW HAVE WIPED OUT MANY MILLIONS OF
AMERICANS -- AND TENS OF MILLIONS OF PEOPLE AROUND THE GLOBE.

BUT IT HASN'T. AND THE REASON IS SIMPLY THAT THE VIRUS
THRIVES BEST IN THOSE TWO BODY FLUIDS -- BLOOD AND SEMEN -- AND
TO PASS THOSE TWO FLUIDS FROM ONE PERSON TO ANOTHER IS HARDLY A
CASUAL ACT.
10
BUT THE OVERWHELMING MAJORITY OF AMERICANS -- AND I WOULD

ADD, AMERICANS OF EVERY RACE, COLOR, CREED, OR ETHNIC GROUP --
THE OVERWHELMING MAJORITY OF AMERICANS DO NOT ENGAGE IN ANAL SEX
AND I.¥. DRUG ABUSE. YOU DON’T HAVE TO BE A BOARD-CERTIFIED
PROCTOLOGIST TO KNOW THAT THIS IS TRUE,

AND THIS TS THE RESULT OF CONSCIOUS CHOICE. THE AMERICAN
PEOPLE -- BY AND LARGE -- DON’T LIKE AND DON’T APPROVE OF THESE
TWO BEHAVIORS ... THE TWO THAT ACCOUNT FOR THE OVERWHELMING
MAJORITY OF AIDS CASES THUS FAR.
11
THESE THREE KEY ASPECTS OF THE DISEASE MAKE THE AMERICAN

PEOPLE VERY EDGY ABOUT AIDS -- AND FRANKLY, WHO CAN BLAME THEM?
I THINK WE WOULD BE EVEN MORE UPSET IF PEOPLE WERE NOT CONCERNED
ABOUT THE THREAT OF A DISEASE WITH THESE THREE DISTURBING
CHARACTERISTICS.

YES, THE AMERICAN PEOPLE HAVE EVERY REASON TO BE EDGY ABOUT
AIDS. BUT THEY HAVE NO REASON TO BECOME PARALYZED BY IT.
12
YET, SOME AMERICANS ARE PARALYZED. AND I‘M SORRY TO REPORT

THAT THE WORST EXAMPLES ARE OF PROFESSIONAL PEOPLE WHOSE
JUDGMENT IS OBSCURED BY IRRATIONAL FEARS:

* SCHOOL OFFICIALS, FOR EXAMPLE, WHO BAR CHILDREN WITH
AIDS FROM PUBLIC CLASSROOMS. THAT KIND OF ACTION STIGMATIZES A
CHILD AND SETS HIM OR HER APART FROM THE COMMUNITY -- AND FOR NO
GOOD REASON, IT IS TRAGIC FOR THE CHILD ... AND A DISGRACE FOR
THAT SCHOOL AND COMMUNITY.
13
* AN EMPLOYER WHO SUMMARILY DISMISSES A WORKER WITH AIDS

IS PLAIN WRONG. I HAVE TOLD MANY AUDIENCES OF BUSINESS PEOPLE
THAT THE ONLY REASON THEY HAVE FOR DISMISSING SOMEONE WITH AIDS
IS IF THE ROUTINE WORK OF THEIR COMPANIES INVOLVE ANAL
INTERCOURSE OR “SHOOTING” DRUGS. IF THAT’S THE CASE, THEN BY ALL
MEANS, THEY SHOULD DISMISS THE OFFENDING EMPLOYEE. BUT THEY
OUGHT TO TAKE A LOOK AT THE REST OF THE PLACE, T00, BECAUSE
THEY’VE GOT MUCH MORE TROUBLE THAN JUST AIDS.

* AND PHYSICIANS AND HOSPITAL ADMINISTRATORS WHO TURN
AWAY AIDS PATIENTS ARE ALSO WORTHY OF OUR CONTEMPT AND
CONDEMNATION,
14
FOR THREE MILLENNIA, THE HEALING ARTS AND SCIENCES HAVE

REACHED OUT TO ALL WHO HAVE NEEDED ATTENTION, THIS IS HARDLY THE
TIME -- AND AIDS IS HARDLY THE REASON -- FOR ANYONE TO REVERSE
THE COURSE OF THIS NOBLE HISTORY.

ALL THESE ACTIONS ARE IRRATIONAL AND WRONG, THEY RUN
COUNTER TO THE FUNDAMENTAL INSTINCTS OF AMERICAN SOCIETY. MOST
AMERICANS WOULD CONDEMN THEM. BUT I MUST SADLY REPORT THAT NOT
EVERYONE FEELS THIS WAY,

JUST RECENTLY I SAW THE RESULTS OF A SURVEY OF EMPLOYEES
CONDUCTED BY THE CENTER FOR WORK PERFORMANCE PROBLEMS AT GEORGIA
TECH, HERE’S WHAT THEY HAD TO SAY:
15
* TWO-THIRDS OF THE WORKERS SURVEYED SAID THEY WOULD BE

“CONCERNED” ABOUT SHARING A RESTROOM AT WORK WITH A
COLLEAGUE WHO HAD AIDS. YOU CANNOT CATCH AIDS FROM TOILET
SEATS OR WASH-BASINS, A FACT THAT HAS BEEN REPEATED IN THE
PRESS A HUNDRED TIMES, YET, THIS IRRATIONAL FEAR STILL

_ PERSISTS,

* FORTY PERCENT OF THE WORKERS WEREN'T SURE ABOUT THE
WISDOM OF EATING IN THE SAME CAFETERIA WITH PERSONS WITH
AIDS. WE KNOW THE AIDS VIRUS CANNOT BE TRANSMITTED IN FOOD
OR ON CROCKERY OR CUTLERY. YET, THIS FEAR PERSISTS, ALSO,

* AND 37 PERCENT WOULD NOT SHARE TOOLS OR EQUIPMENT WITH
PEOPLE WHO HAD THE AIDS VIRUS. AGAIN, A TOTALLY GROUNDLESS
FEAR,
16
THESE ARE IRRATIONAL AND DISCRIMINATORY RESPONSES. WE NEED

TO RECOGNIZE THEM AS SUCH AND DO WHATEVER WE CAN -- IN OUR OWN
HOMES, OFFICES, AND INSTITUTIONS -- TO REPLACE THESE FEARFUL
MISCONCEPTIONS WITH THE TRUTH.

_ ARE THERE NO RISKS AT ALL FOR HEALTH PERSONNEL? NO, THAT’S
NOT TRUE. THERE ARE RISKS AND TWO YEARS AGO THE PUBLIC HEALTH
SERVICE RELEASED A SET OF PRACTICAL GUIDELINES WHICH, IF
FOLLOWED, WILL PROTECT ANY HEALTH WORKER FROM BECOMING
CONTAMINATED OR INFECTED WITH THE AIDS VIRUS,
17
I HOPE YOU AND YOUR PERSONNEL ARE COMPLETELY FAMILIAR WITH

THOSE C.D.C. GUIDELINES, SQ FAR, OUT OF A TOTAL HEALTH WORKFORCE
OF NEARLY 7 MILLION PERSONS, FEWER THAN A DOZEN HAVE BECOME

INFECTED WITH THE AIDS VIRUS BECAUSE OF SOME MISADVENTURE ON THE
JOB,

AND IN EACH OF THOSE CASES, THERE WAS A MOMENT WHEN THE
PERSON’S VIGILANCE WAS RELAXED AND THE VIRUS FOUND A WAY IN,

DESPITE THIS EXTRAORDINARY RECORD OF SAFETY, WE STILL HEAR
OF STORIES INVOLVING HEALTH PROFESSIONALS -- OR GROUPS OF
PROFESSIONALS -- WHO REFUSE TO TREAT SOMEONE WITH AIDS ... OR
REFUSE TO TREAT SOMEONE WHOM THEY SUSPECT OF HAVING AIDS,
18
THIS IS NOT CHARACTERISTIC OF THE OVERWHELMING MAJORITY OF

OUR COLLEAGUES, WHO CONTINUE TO PROVIDE QUALITY, COMPASSIONATE
CARE TO EVERY PATIENT -- INCLUDING PERSONS DYING OF AIDS.

BUT THE GOOD CONDUCT OF THE MAJORITY SHOULD NOT IN ANY WAY
SHIELD THE POOR CONDUCT OF A FEARFUL AND IRRATIONAL MINORITY,

IN THIS CONNECTION I SHOULD LIKE TO RECOGNIZE THREE LEADING
NATIONAL ORGANIZATIONS OF HEALTH PROFESSIONALS FOR THE STRONG
STAND THEY HAVE TAKEN TO REINFORCE THE ETHICAL CONDUCT OF THEIR
MEMBERS,
19
JUST THIS PAST DECEMBER THE AMERICAN MEDICAL ASSOCIATION

ADOPTED A POLICY THAT STATES UNEQUIVOCALLY...

“A PHYSICIAN MAY NOT ETHICALLY REFUSE TO TREAT A PATIENT
WHOSE CONDITION IS WITHIN THE PHYSICIAN’S CURRENT REALM OF
COMPETENCE SOLELY BECAUSE THE PATIENT IS SEROPOSITIVE,
PERSONS WHO ARE SEROPOSITIVE SHOULD NOT BE SUBJECTED TO
DISCRIMINATION BASED ON FEAR OR PREJUDICE.”

THE POLICY ALSO DEALS WITH THE POSSIBILITY OF THE PHYSICIAN --
NOT THE PATIENT -- BEING SEROPOSITIVE FOR AIDS. THE A.M.A,
POLICY PAPER SAYS THAT...
20
“A PHYSICIAN WHO KNOWS THAT HE OR SHE IS SEROPOSITIVE SHOULD

NOT ENGAGE IN ANY ACTIVITY THAT CREATES A RISK OF TRANSMIS-
SION OF THE DISEASE TO OTHERS,” BUT “SHOULD CONSULT
COLLEAGUES AS TO WHICH ACTIVITIES (10) PURSUE WITHOUT
CREATING A RISK TO PATIENTS.”

SIMILARLY THE AMERICAN COLLEGE OF PHYSICIANS AND THE
INFECTIOUS DISEASES SOCIETY OF AMERICA ADOPTED A JOINT “POSITION
PAPER” ON AIDS THIS PAST JANUARY. ITS FIRST “POSITION” SAYS
THAT...
21
"4+sPHYSICIANS, OTHER HEALTH CARE PROFESSIONALS, AND

HOSPITALS ARE OBLIGATED TO PROVIDE COMPETENT AND HUMANE CARE
TO ALL PATIENTS, INCLUDING PATIENTS WITH AIDS AND AIDS-
RELATED CONDITIONS, AS WELL AS HIV-INFECTED PATIENTS WITH
UNRELATED MEDICAL PROBLEMS. THE DENIAL OF APPROPRIATE CARE
TO PATIENTS FOR ANY REASON IS UNETHICAL.”

FURTHER ALONG IN THE DOCUMENT, SUCH BEHAVIOR BY A PHYSICIAN
IS CALLED “MORALLY AND ETHICALLY INDEFENSIBLE.”

AND FINALLY, THE AMERICAN NURSES’ ASSOCIATION LAST JUNE
REAFFIRMED ITS ...
22
"yas COMMITMENT TO PROTECTING THE CIVIL AND HUMAN RIGHTS OF

PERSONS AFFECTED WITH AIDS AS WELL AS THOSE OF THE
CAREGIVERS.” IN THE SAME CONTEXT, THE A.N.A. HOUSE OF
DELEGATES ALSO REAFFIRMED “THE COMMITMENT OF THE NURSING
PROFESSION TO ALL PEOPLE IN NEED OF NURSING SERVICES,
REGARDLESS OF THE ILLNESS OR THE SEVERITY OF THAT ILLNESS.”

T BELIEVE THE RESPONSIBLE LEADERS IN MEDICINE AND NURSING
HAVE CORRECTLY GAUGED THE NEED TO REASSERT THE PRIMACY OF
ETHICAL CONDUCT IN HEALTH CARE. AND THEY HAVE DONE SO.
23
I THINK MOST PEOPLE WANT TO DO THE RIGHT THING. AND SUCH

STATEMENTS AS THESE MAKE IT POSSIBLE FOR INDIVIDUAL HEALTH
PROFESSIONALS TO DO THE RIGHT THING AND TO FEEL THE STRENGTH OF
NUMBERS AS THEY DO SO.

I AM PERSUADED THAT THE OVERWHELMING MAJORITY OF AMERICAN
HEALTH PROFESSIONALS ARE LIVING UP TO THE HIGHEST IDEALS OF THEIR
CALLING. AND, THEREFORE, I BELIEVE THAT MOST PATIENTS WITH AIDS
WILL GET THE HEALTH AND MEDICAL CARE THEY NEED.
24
BUT I AM NOT NAIVE. AND NEITHER ARE YOU. THERE IS STILL A

GREAT DEAL OF UNEASINESS IN THE COUNTRY AND IN THE HEALTH CARE
PROFESSIONS THEMSELVES, AND YOU CAN TRACE THOSE FEELINGS BACK TO
THOSE THREE ASPECTS OF THE DISEASE I MENTIONED EARLIER: ITS
MYSTERY, ITS HIGH MORTALITY RATE, AND THE PARTICULAR WAYS IN
WHICH THE DISEASE IS TRANSMITTED,

AS A FINAL WORD, LET ME RETURN FOR A MOMENT TO THAT THIRD
ASPECT OF THE DISEASE, THE WAYS IN WHICH IT IS TRANSMITTED ...
AND THE PEOPLE WHO DO THOSE THINGS.

* I.V. DRUG ABUSERS COMPRISE ONE MAJOR GROUP ... A FOURTH
OF ALL AIDS VICTIMS SO FAR. AND IT APPEARS THAT THIS GROUP IS
GROWING THE FASTEST,
25
DRUG ADDICTS HAVE NEVER BEEN WITHIN EASY REACH OF THE HEALTH

CARE SYSTEM. AND INDEED ONLY A FEW HAVE COME FORWARD TO SHAKE
THEIR HABIT AND ESCAPE THE RISK OF AIDS.

ON THE OTHER HAND, THE HEALTH SYSTEM ITSELF HAS NOT BEEN
ESPECIALLY INNOVATIVE IN REACHING OUT TO FIND THEM. ONE OF
ADMIRAL WATKINS’ KEY POINTS IN HIS STATEMENT EARLIER THIS MONTH,
WAS THAT WE HAD FAR TOO FEW DRUG TREATMENT CENTERS, RELATIVE TO
THE NEED.

BY THE WAY, THIS IS NOT A PROBLEM THAT MONEY ALONE CAN
SOLVE. FOR EXAMPLE, SOME COMMUNITIES WITH THE MONEY TO OPEN
MORE AIDS-RELATED DRUG TREATMENT CENTERS HAVE NOT DONE SO BECAUSE
THEIR CITIZENS OBJECT TO HAVING SUCH CENTERS IN THEIR MIDST --
DESPITE THE EPIDEMIOLOGICAL EVIDENCE THAT THEY MAY BE NEEDED,
26
FOR DRUG ABUSERS, THEN, THE STATEMENTS OF ETHICAL CONDUCT I

READ EARLIER -- EXCELLENT STATEMENTS THAT THEY ARE -- MAY BE
IRRELEVANT. HENCE, I AM CONCERNED THAT THE PEOPLE NOW BURIED
ALIVE IN THE WORLD OF AIDS AND DRUG ADDICTION -- AND THE AMERICAN
SYSTEM OF HEALTH CARE -- WILL FAIL TO CONNECT IN THE FUTURE, AS
THEY HAVE IN THE PAST. AND WITH TRAGIC CONSEQUENCES FOR
THEMSELVES ... AND FOR SOCIETY,

* THE SECOND MAJOR HIGH-RISK POPULATION IS COMPRISED OF
HOMOSEXUALS AND BISEXUAL MALES WHO ARE NOT MONOGAMOUS AND WHO
ENGAGE IN UNPROTECTED ANAL INTERCOURSE. THEY ACCOUNT FOR TWO-
THIRDS OF ALL AIDS CASES SO FAR.
2/
SEVERAL YEARS AGO, IN THE EARLY STAGES OF THE AIDS EPIDEMIC,

IT WAS CLEAR THAT A GREAT MANY MEN IN THIS GROUP USED A VARIETY
OF “ALTERNATIVE” HEALTH SERVICES -- CLINICS AND HEALTH PROVIDERS
WHO WERE MORE KNOWLEDGEABLE AND MORE TOLERANT OF THE HOMOSEXUAL
LIFESTYLE. BUT THOSE SERVICES WERE OUTSIDE THE MAINSTREAM OF
AMERICAN HEALTH CARE ... AND, AS A RESULT, OUTSIDE THE MAIN
SOURCES OF THERAPY, INFORMATION, AND MONEY.

WHILE SOME MAY ARGUE THE POINT, I NEVERTHELESS AM INCLINED
TO THINK THAT THE STAND-OFF WAS MUTUAL. BUT IT HURT BOTH SIDES,
28
IT HURT THE MEN WHO HAD BECOME INFECTED WITH THE AIDS VIRUS

AND WHO NEEDED ACCESS TO THE BEST CARE AVAILABLE ... AND IT HURT
THE HEALTH CARE SYSTEM BECAUSE THE CHALLENGE OF UNDERSTANDING THE
AIDS EPIDEMIC AND LEARNING HOW TO RESPOND TO IT -- ALREADY A VERY
DIFFICULT CHALLENGE -- BECAME EVEN MORE SO.

ANOTHER RESULT OF THIS STAND-OFF WAS THE LOSS OF BOTH TIME
AND INFORMATION BY THE BIOMEDICAL AND BIOBEHAVIORAL RESEARCH
COMMUNITIES.
29
* THERE ARE ALSO ABOUT A THOUSAND WOMEN -- MOSTLY BUT NOT

EXCLUSIVELY PROSTITUTES -- WHO HAVE BECOME INFECTED BECAUSE THEY
HAVE BEEN THE SEXUAL PARTNERS OF DRUG ABUSERS OR BISEXUAL MEN WHO
HAD AIDS. THESE WOMEN KNOW -- AND ARE KNOWN BY -- THE EMERGENCY
ROOM PERSONNEL AND THE CLOSEST CLINIC TREATING SEXUALLY
TRANSMITTED DISEASES. BUT THE REST OF THE HEALTH CARE SYSTEM IS,
FOR MANY OF THEM, ALIEN TERRITORY,

* AT OUR LAST COUNT, THERE WERE SOME 700 BABIES WHO WERE
GIVEN NOT ONLY THE GIFT OF LIFE -~ BUT ALSO OF AIDS -- FROM THEIR
AIDS-INFECTED MOTHERS.
30
A GREAT MANY OF THESE NEONATES HAVE BEEN ABANDONED BY THEIR

MOTHERS AND HAVE BECOME BOTH PATIENTS AND WARDS OF THE NURSING
STAFFS IN THE HOSPITALS WHERE THEY WERE BORN. THIS IS AN
UNFAMILTAR AND INTOLERABLE BURDEN FOR THOSE INSTITUTIONS, AS YOU
CAN WELL IMAGINE,

* AND FINALLY, YOUNG BLACK AND HISPANIC AMERICANS APPEAR
AMONG THE AIDS CASE REPORTS TWICE AS OFTEN AS THEY APPEAR IN THE
POPULATION GENERALLY. THE MINORITIES WITH AIDS TEND TO BE POOR,
UNINSURED OR UNDERINSURED, AND URBAN, LIVING IN THOSE SAME MAJOR
METROPOLITAN AREAS WHERE THE HEALTH DELIVERY SYSTEMS ARE ALREADY
STRAINED TO THE LIMIT,
31
THIS IS A QUICK BUT ACCURATE SKETCH OF THE AIDS CASELOAD,

AND SO I MUST WONDER TO WHAT EXTENT THESE CITIZENS MAY HAVE
ACCESS TO OUR SYSTEM OF HEALTH CARE, AS THEY BECOME ENVELOPED BY
THE AIDS VIRUS AND BY ONE OR MORE AIDS-RELATED CONDITIONS,

ARE THEY STILL ON THE PERIMETER OF OUR SOCIETY’S MAINSTREAM
HEALTH DELIVERY SYSTEM? OR HAVE THE RECENT STATEMENTS OF
ETHICAL CONDUCT STIMULATED A NEW OPENNESS ... A NEW ACCEPTANCE
»e+ MAYBE A NEW DESIRE TO BRING THEM IN?

STATEMENTS OF ETHICAL CONDUCT ARE GOOD, PLEASE DON’T
MISUNDERSTAND ME. WE NEED THEM AND THEY ARE WELCOME,
32
BUT THEY'RE NOT ENOUGH.

THEY MUST BE ACCOMPANIED BY THE WILL TO PUT THOSE STATEMENTS
TO WORK.

IT’S DIFFICULT FOR MANY INSTITUTIONS AND MANY PRACTITIONERS
TO DO THAT, I KNOW, SINCE, AS I INDICATED A MOMENT AGO, MOST
PEOPLE CARRYING THE VIRUS --TENS OF THOUSANDS OF THEM ... MAYBE A
MILLION OR MORE -- DO NOT KNOW THE HEALTH SYSTEM VERY WELL ...
NOR DOES THE HEALTH SYSTEM KNOW THEM,
33
THESE, THEN, ARE SOME OF THE QUESTIONS THAT CONFRONT

MEDICINE AND HEALTH CARE IN A FREE SOCIETY SUCH AS OURS. THEY
ARE NOT MEDICAL, BUT THE AIDS EPIDEMIC IS A THREAT NOT ONLY TO
INDIVIDUAL AMERICANS BUT ALSO TO THE SOCIAL COMPACT THAT HAS HELD
OUR NATION TOGETHER THROUGH PERIODS OF GREAT TURMOIL AS WELL AS
TRANQUILITY.

HISTORICALLY, AMERICANS HAVE HAD A NATIONAL TEMPERAMENT OF
CHARITY AND TOLERANCE ... OF RESPONSIVENESS AND AFFIRMATION,
WE'VE EXTENDED OUR GENEROSITY TO EACH OTHER IN EVERY TIME OF
NEED.
34
AND THIS IS SURELY ONE OF THOSE TIMES.

NOW, WHAT CAN YOU DO? OBVIOUSLY, YOU CAN INFLUENCE THE
HEALTH CARE SYSTEM TO REMAIN OPEN TO EVERYONE WHO CONTRACTS THE
DISEASE OF AIDS. THIS IS ESSENTIAL.

SECOND, YOU CAN HELP REINFORCE -- THROUGH PATIENT AND
COMMUNITY EDUCATION PROGRAMS -- THE KIND OF LOW-RISK OR NO-RISK
BEHAVIOR THAT WILL PROTECT PEOPLE FROM AIDS, IN THE ABSENCE OF A
VACCINE: STAYING FREE OF DRUGS, FOR EXAMPLE, AND BEING SENSIBLE
ABOUT ONE’S OWN SEXUALITY.
35
AND FINALLY, MAKING SURE THAT YOUR OWN COLLEAGUES AND YOUR

STAFFS HAVE THE FACTS ABOUT AIDS ... UNDERSTAND THEM ... AND
CARRY ON THEIR PROFESSIONAL LIVES WITH A HEALTHY RESPECT FOR THE
VIRUS, OBSERVING ALL THE GUIDELINES FOR PERSONAL SAFETY.

SOCIETY IS BEING TESTED, THERE’S NO QUESTION ABOUT THAT.
THE EPIDEMIC OF AIDS IS PROVIDING ONE OF THE MOST SERIOUS TESTS
OF SOCIAL AND POLITICAL WILL THAT WE’VE EVER EXPERIENCED,

I TRULY BELIEVE WE WILL COME THROUGH SUCH A TEST WITH OUR

IDEALS AND OUR INSTITUTIONS INTACT. THE NEXT FEW YEARS WILL NOT

BE EASY, THAT'S FOR SURE.

BUT WE’LL MAKE IT... AND WE’LL MAKE IT TOGETHER.

THANK YOU,
HH # #