HE CURRENT Crisis IN AIDS

BY
C, Everett Koop. MD. ScD
SURGEON GENERAL
OF THE
U. S. Pupric HEALTH SERVICE
AND
DEPUTY ASSISTANT SECRETARY OF HEALTH
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

BC

<¢™=

PRESENTED AJ THE PASQUARIELLO LECTURE
CHILDREN’S HOSPITAL OF PHILADELPHIA

PHILADELPHIA, PENNSYLVANIA
Aprit 8, 1987

1G.
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I APPRECIATE THIS OPPORTUNITY TO SPEAK WITH YOU ABOUT A
RELATIVELY NEW AND VERY SERIOUS PUBLIC HEALTH MATTER.

I’M TALKING ABOUT AIDS.

LET ME TAKE JUST A MOMENT TO BRING YOU UP TO DATE ON THIS
ISSUE. AND THEN I WANT TO EXPLORE SOME OF THE KEY QUESTIONS THAT
AIDS POSES TO OUR SOCIETY TODAY...AND TOMORROW.

FIRST...A LITTLE HISTORY.

ALMOST SIX YEARS AGO, IN JUNE 1981, THE PUBLIC HEALTH SERVICE
PUBLISHED THE FIRST REPORTS OF 5 CASES OF PNEUMOCYSTIS CARINIL]
PNEUMONIA IN LOS ANGELES,
NOW, FIVE CASES AREN’T MUCH,..BUT THIS LETHAL DISEASE IS SO
RARE THAT A HANDFUL OF CASES IN A SINGLE YEAR IS LIKE AN
EPIDEMIC. ALSO, AS THE EDITOR OF THE MORBIDITY AND MORTALITY
WEEKLY REPORT, OR M.M.W.R., OBSERVED...

THE OCCURRENCE OF PNEUMOCYSTOSIS IN THESE 5 PREVIOUSLY
HEALTHY INDIVIDUALS WITHOUT A CLINICALLY APPARENT UNDERLYING
IMMUNODEFICIENCY IS UNUSUAL.”

SOON, THERE WERE SIMILAR REPORTS TRICKLING IN FROM OTHER
CITIES AS WELL. THEN, A MONTH LATER, THE EDITOR OF THE MMWR,
PUBLISHED A REPORT THAT 26 YOUNG MEN HAD BEEN RECENTLY DIAGNOSED
AS HAVING KAPOSI‘S SARCOMA, “AN UNCOMMONLY REPORTED MALIGNANCY”
USUALLY FOUND -- IF AT ALL -- AMONG ELDERLY MEN.
AS THE M.M.W.R, EDITOR NOTED IN THE JULY 1981 ISSUE, THESE 26
YOUNG MEN, LIKE THOSE FIRST 5 IN LOS ANGELES WITH PNEUMOCYSTOSIS,
WERE YOUNG HOMOSEXUALS. AND. IN THAT SAME JULY ISSUE. THE EDITOR
PUBLIBSHED 10 NEW REPORTS OF PNEUMOCYSTOSIS...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.1.D.5S.
»OR “AIDS.”

AND IT’S BEEN AIDS EVER SINCE.

YOU’VE READ THE STORIES AND HAVE SEEN IT ON TELEVISION, I’M
SURE, SO I WON'T GO THROUGH THE WHOLE HISTORY ALL OVER AGAIN,
INSTEAD, I’LL JUST TOUCH ON A FEW KEY POINTS:
FIRST OF ALL, WE’RE TALKING ABOUT A DISEASE THAT IS SPREADING
AND IS 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 IS JUST SHY OF 34,000,

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
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 IS.
IN 1984 THE SEARCH WAS NARROWED DOWN TO SOMETHING CALLED A -
“HUMAN RETROVIRUS.” OUR 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 III,” OR SIMPLY
“HTLV- LIL."

THE SAME VIRUS SHOWED UP IN THE WORK OF THE PASTEUR
INSTITUTE. WHERE IT BECANE KNOWN AS THE “LYMPHADENOPATHY-
ASSOCIATED VIRUS.” OR “LAV.” SCIENTISTS NOW AGREE TO CALL IT BY
THE SINGLE COMMON NAME OF “HUMAN IMMUNODEFICIENCY VIRUS.” OR
"HIV."

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 BLOOD SCREENING WAS
- BEGUN, THAT FIGURE HAS COME DOWN TO ABOUT 4 UNITS PER 1 MILLION
UNITS OF TRANSFUSED BLOOD. AND, AS YOU KNOW, I’M SURE, THAT IS AS
CLOSE TO PERFECT AS YOU CAN GET IN THIS KIND OF SERVICE.
ON THE BASIS OF SUCH TESTING. PLUS OTHER EPIDEMIOLOGICAL
DATA. WE BELIEVE THERE ARE BETWEEN A MILLION AND A MILLION-AND-A-
HALF AMERICANS WALKING AROUND WITH THE AIDS VIRUS -NEGBAFERS IN
THEIR SYSTEMS.

THEY HAVE AIDS,..BUT THEY AREN’T YET SICK WITH AN AIDS-
RELATED DISEASE, SUCH AS PNEUMOCYSTIS CARINII PNEUMONIA OR
KAPOSI’S SARCOMA OR ANY OF THE VIRULENT MEGALOVIRAL DISEASES.

ONE MAJOR COMPLICATION FOR MAKING ESTIMATES AND
"GUESSTIMATES” FOR THE FUTURE 1S 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,
BUT IT’S NOT A 50-50 RISK. THE POSSIBILITY OF BEING OVERCOME
BY AN INFECTIOUS DISEASE OF SOME KIND IS STILL VERY, VERY HIGH,
IN FACT, SOME RESEARCHERS NOW FEEL THAT ANYONE WITH THE AIDS VIRUS
WILL EVENTUALLY CONTRACT AN AIDS-RELATED DISEASE,..AND WILL DIE,

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,

ONE NEW EXPERIMENTAL DRUG -- AZIDOTHYMIDINE, OR A.Z.T. -- HAS
GONE THROUGH A SO-CALLED "FAST-TRACK” APPROVAL PROCESS AND IS NOW
BEING USED TO PROLONG THE LIVES OF AIDS VICTIMS DYING OF PNEUMO-
CYSTIS CARINII PNEUMONIA,
10

BUT I’M AFRAID THAT’S ALL A.Z.T. DOES...1T PROLONGS SOME
LIVES, IT DOES NOT SAVE THEM. FOR SAVING LIVES, WE NEED A
VACCINE.

PEOPLE WANT TO KNOW WHEN AN EFFECTIVE VACCINE MIGHT BE
AVAILABLE. AND I HAVE TO TELL THEM THAT I DON’T SEE ONE IN THE
NEAR FUTURE.

WE’RE MOVING AHEAD ON THIS FRONT AS QUICKLY AS WE CAN. BUT
VACCINE DEVELOPMENT IS ONE THING THAT CANNOT BE RUSHED, WITHOUT
CREATING MORE PROBLEMS THAN WE ALREADY HAVE,

WE NEED TO REMEMABR THAT IT TOOK 19 YEARS TO DEVELOP THE
HEPATITIS B VACCINE...AND THAT WAS A COMPARATIVELY EASY VIRUS TO
UNDERSTAND.
ll

NOW, FOR MY THIRD POINT:

WE DON’T KNOW VERY MUCH ABOUT AIDS...BUT WE DO KNOW -- WITH
COMPLETE CERTAINTY -- THAT THE VIRUS IS TRANSMITTED FROM ONE
~ PERSON TO ANOTHER EITHER IN BLOOD OR IN SEMEN.

‘THIS IS 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. SOME
SEX PRACTICES 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 ARE CONCENTRATED ENOUGH TO CARRY -- AND TRANSMIT
-- THE LIVE AIDS VIRUS. - AP? 4eeer eet wh sora

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12

OTHER LESS CONCENTRATED BODY FLUIDS -- SALIVA, FOR EXAMPLE,
OR TEARS OR PERSPIRATION -- DON’T CARRY THE VIRUS AND THERE ARE NO
~ SUBSTANTIATED CASES OF THIS HAVING OCCURRED.

THE BIOPHYSICAL PECULIARITIES OF THE AIDS VIRUS ALSO EXPLAIN
WHY 17 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.

WHEN WE FIRST BEGAN TO CONFRONT THE AIDS EPIDEMIC, THE PEOPLE
AT HIGHEST RISK WERE 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.
13

BUT NOWADAYS WE‘RE RECEIVING MORE AND MORE REPORTS OF THE
AIDS VIRUS OCCURRING AMONG HETEROSEXUAL MEN AND WOMEN WHO ARE NOT.
I.V. DRUG ABUSERS. IN FACT, THEIR HETEROSEXUAL ACTIVITY SEEMS TO

BE THEIR ONLY RISK FACTOR, —

AS OF LAST WEEK, 4 PERCENT OF ALL REPORTED AIDS CASES WERE OF
SUCH HETEROSEXUAL MEN AND WOMEN,..A PERCENTAGE, BY THE WAY, THAT’S
CLIMBING,

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,
14

SO THE DEMOGRAPHY OF THIS DISEASE IS 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,

— 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.

I AM ADVISED BY THEIR LEADERSHIP THAT THERE’S BEEN A
NOTICEABLY SHARP DROP IN THE NUMBERS OF MEN TAKING PART IN
WHOLESALE, ANONYMOUS, PROMISCUOUS SEX,
15

AS A RESULT, A DECLINE IS ALREADY OCCURRING IN THE INCIDENCE
OF OTHER SEXUALLY TRANSMITTED DISEASES AMONG HOMOSEXUAL MEN. SUCH
AS GONORRHEA, HEPATITIS B. AND SYPHILIS.

BUT NOW WE NEED TO DIRECT OUR INFORMATION AND EDUCATION
EFFORTS OUT TO HETEROSEXUAL MEN AND WOMEN.,.WHICH IS TO SAY, TO
SOCIETY AT LARGE. |

THAT’S VERY HARD TO DO IN THIS COUNTRY. WE'RE VERY LARGE AND
VERY DIVERSE.

SO WE‘VE HAD TO SET SOME PRIORITIES AND MAKE SOME TOUGH
CHOICES. BUT I THINK WE MADE THE RIGHT CHOICE. WHEN WE DECIDED 10
FOCUS ON TELLING YOUNG PEOPLE THE FACTS ABOUT THE THREAT OF
AIDS.
16

WHAT WE’RE DOING, THEN, IS FOCUSING ON THOSE PIECES OF
INFORMATION THAT ARE ESPECIALLY PERTINENT TO -- AND CAN BE READILY
UNDERSTOOD BY -- YOUNG PEOPLE. .

- THAT WAS THE UNDERLYING PLAN FOR THE SURGEON GENERAL ’S REPORT
ON AIDS, WHICH I 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.

THE PRESIDENT FELT 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 I COULD TO SET THE RECORD
STRAIGHT,
17

FOR THE NEXT 8 MONTHS I MET WITH CONCERNED INDIVIDUALS AND
GROUPS FROM ACROSS THE SPECTRUM OF SOCIETY...

GROUPS LIKE THE NATIONAL EDUCATION ASSOCIATION AND THE
NATIONAL P.T.Avsae

THE NATIONAL COUNCIL OF CHURCHES AND THE CHRISTIAN LIFE
COMMISSION OF THE SOUTHERN BAPTIST CONVENTION...

THE SYNAGOGUE COUNCIL OF AMERICA AND THE NATIONAL CONFERENCE
OF CATHOLIC BISHOPS...
18

1 TALKED WITH THE NATIONAL COALITION OF BLACK AND LESBIAN GAYS
AND THE WASHINGTON BUSINESS GROUP ON HEALTH....AND MANY, MANY
OTHERS...26 GROUPS IN ALL. |

THEY WERE ALL EXTRAORDINARILY CANDID AND HELPFUL.

AFTER 8 MONTHS OF LISTENING AND WRITING, I DELIVERED MY
REPORT TO THE CABINET AND TO THE PRESIDENT. “IT WAS ACCEPTED, . AND
| RELEASED IT TO THE AMERICAN PEOPLE ON OCTOBER 22, 1986.

I WANT TO ASSURE YOU THAT AT NO TIME HAVE I HAD ANY
MISGIVINGS ABOUT ANYTHING I WROTE.
19

| HOPE YOU'VE ALL READ IT. IF NOT. PLEASE GET OUT A PENCIL
AND TAKE DOWN THIS ADDRESS: |

AIDS. ..POST OFFICE BOX 14252,..WASHINGTON, D.C....20044
LET ME REPEAT THAT FOR YOU:
AIDS...POST OFFICE BOX 14252,,.WASHINGTON. D.C....20044
THERE IS MUCH SCIENTIFIC AND PUBLIC HEALTH INFORMATION IN
THAT REPORT, BUT ON THE BEHAVIORAL SIDE. THERE ARE ESSENTIALLY

JUST TWO MESSAGES AND I HOPE THEY REACH EVERY ONE OF THIS
COUNTRY’S YOUNGSTERS,
20

THE FIRST MESSAGE IS SIMPLE ENOUGH. IT SAYS...

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, MONOGAMOUS RELATIONSHIP IN
WHICH YOU HAVE ONLY ONE CONTINUING SEXUAL PARTNER...AND THAT
PERSON IS AS FAITHFUL AS YOU ARE.
21

MY SECOND MESSAGE IS FOR PEOPLE WHO DON’T YET HAVE A FAITHFUL
MONOGAMOUS RELATIONSHIP FOR WHATEVER REASON, UNLESS YOU KNOW WITH
ABSOLUTE CERTAINTY THAT NEITHER YOU NOR YOUR PARTNER 1S CARRYING

THE AIDS VIRUS, YOU MUST USE CAUTION.

REMEMBER, FROM THE VIEWPOINT OF EPIDEMIOLOGY, WHEN YOU HAVE
SEX WITH SOMEONE, YOU’RE ALSO HAVING SEX WITH EVERYO SE WITH
WHOM THAT PERSON HAS HAD SEX.

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 YJ YEARS. oe Pendtwrs AMCEr
JS
22

IF YOU DO DECIDE TO HAVE SEX WITH SOMEONE AND YOU ARE NOT.
ABSOUTELY CERTAIN ABOUT HIS OR HER SEXUAL HISTORY, THEN -- IF
YOU’RE A MAN -- USE A CONDOM FROM START TO FINISH. IF YOU’RE A
WOMAN. 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
AVAILABLE.

NOW, LET ME PAUSE FOR A MOMENT AND FOCUS ON AN ISSUE THAT IS
GAINING ALMOST AS MUCH ATTENTION AS THE AIDS VIRUS ITSELF. THAT
ISSUE 1S.,.HOW SHOULD WE EDUCATE OUR YOUNG PEOPLE ABOUT AIDS AND
ABOUT THEIR SEXUALITY. WHO SHOULD DO IT? AND WHEN?
23

FIRST OF ALL, LET’S BE ABSOLUTELY CLEAR ABOUT MY PERCEPTION
OF WHO DOES WHAT IN EDUCATING AMERICA’S CHILDREN. 1 BELIEVE THAT
EDUCATION IS A LOCAL MATTER... THAT PARENTS AND THE COMMUNITY
CONTROL WHAT GOES INTO THEIR SCHOOLS... THAT THE SYSTEM HAS WORKED
VERY WELL FOR US FOR OVER 200 YEARS AND I HAVE ABSOLUTELY NO
DESIRE TO QUARREL WITH OR CHANGE IT,

T ALSO BELIEVE THAT THE FEDERAL GOVERNMENT SHOULD CONTINUE TO
PLAY A STRONG SUPPORTING ROLE IN PROVIDING TIMELY. FACTUAL. AND
IMPARTIAL INFORMATION TO THE SCHOOLS FOR THEM TO USE. I TRIED TO
DO THAT IN THE SURGEON GENERAL'S REPORT ON AIDS AND I THINK I WAS
SUCCESSFUL.
24

AND WHEN I OFFER ADVICE -- WHICH HAS ALWAYS BEEN A MAJOR
ASPECT OF THE SURGEON GENERAL’S JOB, BY THE WAY -- IT IS JUST
THAT: ADVICE.

YOU MAY RECALL THAT MY FOUR PREDECESSORS -- AND I -- HAVE
BEEN ADVISING PEOPLE TO STOP SMOKING. SOME STILL DO, BUT MOST
PEOPLE NOW DON’T. SO THAT’S THE KIND OF ADVICE THAT THE AMERICAN
PEOPLE HAVE BEEN HEARING...AND HEEDING.

HENCE, IN ADDITION TO THE FACTS ABOUT THE DISEASE OF AIDS,
I’VE BEEN ADDING MY ADVICE THAT ONE OF THE BEST THINGS OUR SOCIETY
MIGHT DO TO PROTECT ITS YOUNG PEOPLE FROM THIS MORTAL THREAT IS TO
EDUCATE THEM ABOUT HUMAN REPRODUCTIVE BIOLOGY ‘AND THEIR OWN
SEXUALITY... AND DO IT IN A WAY THAT IS FACTUALLY CORRECT AND
PERSONALLY SENSITIVE.
25

MOST SCHOOLS NOW OFFER SOME MINIMUM KIND OF SEX EDUCATION
DURING THE JUNIOR HIGH OR MIDDLE SCHOOL YEARS AND THAT’S A GOOD
THING. ALTHOUGH IT MIGHT BE A LITTLE LATE. 1 PERSONALLY WOULD
URGE THAT THE MATERIAL BE PRESENTED EARLIER, AMONG THE 9-, 10-,
AND 11-YEAR-OLDS, |

OF COURSE, DEVELOPMENTAL AGE IS MORE IMPORTANT THAN
CHRONOLOGICAL AGE.

MY OWN PREFERENCE, ALSO, WOULD BE TO HAVE CHILDREN INTRODUCED
TO THE SUBJECT OF REPRODUCTIVE BIOLOGY WITHIN A MORE GENERAL
DISCUSSION OF THE NATURE OF SENSITIVE AND AFFIRMATIVE HUMAN
RELATIONS.
26

THERE'S MORE TO MALE-FEMALE RELATIONS THAN JUST “GOOD SEX,”

AND YOUNG PEOPLE OUGHT To UNDERSTAND THAT. WE MAY NOT ALWAYS
ACHIEVE THE IDEAL RELATIONSHIP, BUT THE IDEAL SHOULD BE AT LEAST
UNDERSTOOD BY YOUNG PEOPLE AS BEING A REASONABLY GOOD YARDSTICK,

MALE-FEMALE RELATIONSHIPS OUGHT TO BE EQUITABLE, RESPECTFUL,
LOVING, AND CARING. THAT’S THE IDEAL THAT CHILDREN SHOULD KNOW
ABOUT. AND THEY SHOULD ALSO KNOW THAT MOST PEOPLE SETTLE FOR LESS
AND THAT’S WHAT IS COMMONLY KNOWN AS “THE HUMAN CONDITION.”
THERE’S NOTHING WRONG WITH THAT IDEA EITHER,

THESE ARE IMPORTANT CONCEPTS CONCERNING HUMAN RELATIONSHIPS
AND SEXUALITY AND I HAPPEN TO THINK THAT PARENTS OUGHT TO BE THE
ONES TO TEACH THEM,
27

THE DIFFICULTY. OF COURSE. 1S THAT IF PARENTS ARE TO EDUCATE
THEIR CHILDREN ABOUT HUMAN RELATIONSHIPS -- SEXUAL AND OTHERWISE
-- THEY MUST FIRST UNDERSTAND AND ACCEPT THE NATURE OF THEIR
OWN. AND FOR MANY, THAT’S HARD TO DO,

PARENTS -- AND ADULTS IN GENERAL -- ARE NOT VERY GOOD ABOUT
TALKING TO EACH OTHER ABOUT THEIR SEXUALITY. AND THEN THEY FEEL
FRUSTRATED, GUILTY. AND EVEN ANGRY ABOUT THEIR INABILITY TO HANDLE
THIS TOPIC, THIS 1S CLEARLY A MAJOR REASON WHY SUCH THIRD PARTIES
AS "DEAR ABBY" AND “DR. RUTH” ARE SO POPULAR. THEY DO ALL THE
DIFFICULT VERBALIZING FOR US,
28 i—

IT’S DIFFICULT FOR PARENTS. ..BUT I WANT PARENTS TO TRY. I
WANT PARENTS TO TALAK ABOUT THIS WITH COMPASSION. WITH RESPECT
..-WITH LOVE...AND WITH SOME UNDERSTANDING NOT ONLY OF THE CHILD
WHO’S LISTENING. ..BUT ALSO OF THE ADULT WHO IS SPEAKING.

BUT WHEN PARENTS CAN’T GET THE JOB DONE, THEN I BELIEVE
THERE’S A COMPELLING SOCIAL NEED FOR OUR SCHOOLS. CHURCHES,
SYNAGOGUES, AND OTHER COMMUNITY INSTITUTIONS TO DO WHATEVER
POSSIBLE TO PROVIDE OUR CHILDREN WITH THE INFORMATION THEY NEED TO
UNDERSTAND THEIR SEXUALITY AND TO PROTECT THEMSELVES FROM AIDS,
29

OUR ONLY HOPE AS A NATION...AND AS A CIVILIZATION...1S THAT
WE AMERICANS WILL DO OUR PART TO STOP THE SPREAD OF AIDS. .THAT WE
WILL PROTECT AND SAVE THE LIVES OF PEOPLE AT RISK, INCLUDING
UNSUSPECTING YOUNG PEOPLE...AND THAT WE WILL RETURN HUMAN
SEXUALITY BACK TO ITS RIGHTFUL PLACE, AS PART OF THE TOTAL COMPLEX
OF HUMAN, CARING, INTERPERSONAL RELATIONS.

AND THE THING THAT KEEPS ME GOING THESE DAYS IS THAT I TRULY
THINK WE WILL.

THANK YOU,

Heat # tf