ORIGINAL

THE CURRENT CRISIS IN AIDS
BY

C. EVERETT KOOP, MD, ScD
SURGEON GENERAL
OF THE
U.S. PUBLIC HEALTH SERVICE
AND
DEPUTY ASSISTANT SECRETARY OF HEALTH
U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED BEFORE THE BERLIN INTERNATIONAL
MEDICAL SOCIETY, HARNACK HOUSE, BERLIN
JULY 1, 1987
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

| APPRECIATE THIS OPPORTUNITY TO SPEAK WITH
YOU ABOUT A RELATIVELY NEW AND VERY SERIOUS
PUBLIC HEALTH MATTER WHICH AFFECTS YOUR COUNTRY

AND MINE -- AND INDEED THE REST OF THE WORLD.

I'M TALKING ABOUT AIDS.

LET ME TAKE JUST A MOMENT TO BRING YOU UP
TO DATE ON THIS ISSUE. AND THEN |! WANT TO
EXPLORE SOME OF THE KEY QUESTIONS THAT AIDS

POSES TO OUR SOCIETIES TODAY...AND TOMORROW.

FIRST...A LITTLE HISTORY FROM THE U.S.

ALMOST SIX YEARS AGO, IN JUNE 1981, THE
PUBLIC HEALTH SERVICE PUBLISHED THE FIRST
REPORTS OF FIVE CASES OF PNEUMOCYSTIS CARINII

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

AT THE TIME...

"THE OCCURRENCE OF PNEUMOCYSTIS 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 M.M.W.R. 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 PNEUMOCYSTIS, WERE YOUNG
HOMOSEXUALS. AND, IN THAT SAME JULY ISSUE, THE
EDITOR PUBLISHED 10 NEW REPORTS OF
PNEUMOCYSTIS...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.S. ...OR “AIDS.”

AND IT’S BEEN AIDS EVER SINCE.
YOU’VE READ THE STORIES AND HAVE SEEN IT ON
TELEVISION, I’M SURE, SO | 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 IN THE U.S. 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 CLOSE TO 37,000.

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.” THE
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 Ill," OR SIMPLY "HTLV-II."
THE SAME VIRUS SHOWED UP IN THE WORK OF THE
PASTEUR INSTITUTE, WHERE IT BECAME KNOWN AS THE
"LYMPHADENOPATHY-ASSOCIATED VIRUS,” OR "LAV."
SCIENTISTS NOW AGREE TO CALL IT BY THE SINGLE
COMMON NAME OF "HUMAN IMMUNODEFICIENCY VIRUS,"

OR "H.LV."

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'S AS CLOSE TO PERFECT AS YOU CAN GET IN

THIS KIND OF SERVICE.

ON THE BASIS OF SUCH TESTING, PLUS OTHER
EPIDEMIOLOGICAL DATA, WE THINK THERE ARE BETWEEN
A MILLION AND A MILLION-AND-A-HALF AMERICANS

WALKING AROUND WITH THE AIDS VIRUS IN THEIR
SYSTEMS. ALTHOUGH, HONESTLY, IT COULD BE

400,000 TO 4 MILLION.

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 TOXOPLUSMOSIS AS YOU SEE IT HERE IN

BERLIN.

ONE MAJOR COMPLICATION FOR MAKING ESTIMATES
FOR THE FUTURE IS 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.
- 10 -

BUT IT’S NOT A 50-50 RISK. THE ODDS ARE
WORSE THAN THAT. THE POSSIBILITY OF BEING
OVERCOME BY AN INFECTIOUS DISEASE OF SOME KIND
IS VERY, VERY HIGH. IN FACT, SOME RESEARCHERS
NOW FEEL THAT ANYONE WITH THE AIDS VIRUS WILL
EVENTUALLY CONTRACT AN AIDS-RELATED DISEASE IF

HE LIVES LONG ENOUGH...AND WILL DIE FROM IT.

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 U.S. FEDERAL FUNDS THIS
YEAR, PLUS MANY MILLIONS MORE IN STATE AND

PRIVATE SECTOR FUNDS.
- 11 -

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 PNEUMOCYSTIS CARINII PNEUMONIA.

BUT I'M AFRAID THAT’S ALL A.Z.T. DOES...IT

PROLONGS SOME LIVES, IT DOES NOT SAVE THEM. FOR

SAVING LIVES, WE NEED A VACCINE.

AND EVERYBODY WANTS TO KNOW WHEN AN
EFFECTIVE VACCINE MIGHT BE AVAILABLE. | HAVE TO
TELL THEM THAT |! DON’T SEE ONE IN THE NEAR

FUTURE.
-12-

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

HAVE.

WE NEED TO REMEMBER, FOR EXAMPLE, THAT IT
TOOK 17 YEARS TO DEVELOP THE HEPATITIS B
VACCINE...AND THAT WAS A COMPARATIVELY EASY

VIRUS TO UNDERSTAND.

NOW FOR MY THIRD POINT:

 

WE DON'T KNOW VERY MUCH ABOUT AIDS...BUT WE
DO KNOW --WITH COMPLETE CERTAINTY -- THAT THE

AIDS VIRUS TENDS TO CONCENTRATE IN BODY FLUIDS
- 13 -

WHICH 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.

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.
-~ 14 -

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 CARRY -- AND TRANSMIT
-- HIGH ENOUGH CONCENTRATIONS OF THE LIVE AIDS

VIRUS.

THE BIOPHYSICAL PECULIARITIES OF THE AIDS
VIRUS ALSO EXPLAIN WHY 25 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. THIS GROUP INCLUDES DRUG ABUSERS WHO ARE

HOMOSEXUALS, ALSO.
- 15 -

WHEN WE FIRST BEGAN TO 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 AMONG
HETEROSEXUAL MEN AND WOMEN WHO ARE NOT 1.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 IN THE U.S. WERE OF SUCH HETEROSEXUAL
MEN AND WOMEN...A PERCENTAGE, BY THE WAY, THAT’S

CLIMBING.
- 16 -

ANOTHER CONCERN IS THE RISE IN AIDS AMONG
BLACKS AND HISPANICS. BLACKS ACCOUNT FOR 12
PERCENT OF THE U.S. 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.

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.
-17-

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.

| AM ADVISED THAT THERE’S BEEN A NOTICEABLY
SHARP DROP IN THE NUMBERS OF MEN TAKING PART IN

WHOLESALE, ANONYMOUS, PROMISCUOUS SEX.

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.
- 18 -

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 WAS THE BASIS FOR THE SURGEON

GENERAL’S REPORT ON AIDS, WHICH ! 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.
- 19 -

THE PRESIDENT WAS CONCERNED THAT 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.

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

CIVIL RIGHTS GROUPS.

THEY WERE ALL EXTRAORDINARILY CANDID AND

HELPFUL.
- 20 -

AFTER 8 MONTHS OF LISTENING AND WRITING, |
DELIVERED BY REPORT TO THE CABINET AND TO THE
PRESIDENT. IT WAS ACCEPTED...AND | RELEASED IT

TO THE AMERICAN PEOPLE ON OCTOBER 22, 1986.

|! WANT TO ASSURE YOU THAT AT NO TIME HAVE |

HAD ANY MISGIVINGS ABOUT ANYTHING I! WROTE.

THERE 1S MUCH SCIENTIFIC AND PUBLIC HEALTH
INFORMATION IN THAT REPORT, BUT ON THE
BEHAVIORAL SIDE, THERE WERE JUST THREE MESSAGES

THAT ARE VITALLY IMPORTANT:

THE FIRST MESSAGE IS SIMPLE ENOUGH. IT
SAYS THAT THE BEST DEFENSE AGAINST AIDS !S TOTAL

ABSTINENCE FROM SEXUAL RELATIONS.
_ 21 -

| THINK THAT’S PRECISELY THE RIGHT MESSAGE
TO GIVE TO OUR CHILDREN -- AIDS OR NO AIDS. BUT
ADULTS ARE AT RISK, ALSO, AND A RECOMMENDATION
OF TOTAL ABSTINENCE FOR THE ENTIRE POPULATION

IS, TO SAY THE LEAST, UNREALISTIC.

HENCE, MY SECOND MESSAGE IS THIS:

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
-22-

HAVE ONLY ONE CONTINUING SEXUAL PARTNER...AND

THAT PERSON IS AS FAITHFUL AS YOU ARE.

MY THIRD MESSAGE !S 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 VIEWPOINT OF EPIDEMIOLOGY, WHEN
YOU HAVE SEX WITH SOMEONE, YOU’RE ALSO HAVING

SEX WITH EVERYONE ELSE WITH WHOM THAT PERSON HAS

 

HAD SEX.
-~ 23 -

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 5 YEARS OR PERHAPS LONGER.

IF YOU DO DECIDE TO 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 TO FINISH. IF YOU’RE A
WOMEN, 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.
- 24 -

THE DIFFERENCES OF OPINION IN THE USS.

SWIRL AROUND:

O SEX EDUCATION FOR THE YOUNG, AND

O HOW TO BEST PROTECT INDIVIDUALS WHO ARE
HIV POSITIVE, OR HAVE AIDS, FROM
UNWARRANTED DISCLOSURE AND
DISCRIMINATION, WHILE PROTECTING THE

PUBLIC FROM INFECTION.
- 25 -

| WOULD LIKE TO SUMMARIZE THE LATTER.

FROM A PUBLIC HEALTH PERSPECTIVE, THE
PRIMARY PURPOSE OF ANY ACTION RELATED TO THE
AIDS EPIDEMIC IS TO PREVENT THE SPREAD OF THE
DISEASE. THERE ARE A BROAD RANGE OF OPTIONS,
SOME REFLECTING TRADITIONAL FEDERAL AND STATE
ROLES. SOME GO BEYOND THE PUBLIC HEALTH PURPOSE
AND WOULD HAVE BROADER EFFECTS ON INSURANCE,

EMPLOYMENT, AND OTHER PRACTICES.

THE CURRENT PROTECTION FROM DISCLOSURE OF
PERSONS WHO ARE HIV POSITIVE INCLUDE PRIVATE
ACTIONS SUCH AS PHYSICIAN DISCRETION, THE
HIPPOCRATIC OATH, ETC., STATE LAWS AND FEDERAL

LAWS AND REGULATIONS:
- 26 -

O STATE LAWS ARE A PATCHWORK AND VARY
SUBSTANTIALLY. THEY INCLUDE LAWS
PROTECTING PHYSICIAN PATIENT PRIVILEGE
AND CONFIDENTIALITY OF MEDICAL RECORDS,
STATE LAWS GOVERNING REPORTING OF
COMMUNICABLE DISEASES, ESPECIALLY
SEXUALLY TRANSMITTED DISEASES, AND NEW
STATE LAWS SPECIFIC TO AIDS. THE NEW
STATE LAWS ARE GROWING RAPIDLY IN NUMBER
AND ARE INCONSISTENT AS TO PROHIBITED OR
MANDATED DISCLOSURES. MOST STATES HAVE
NOT CLASSIFIED AIDS AS A SEXUALLY

TRANSMITTED DISEASE.
- 27 -

THE PROBLEM WITH ALL OF THIS IS THAT
POTENTIAL OR ACTUAL DISCLOSURE MAY "CHILL"
VOLUNTARY TESTING, STIGMATIZE THE INFECTED AND

POSSIBLY LEAD TO ACTUAL DISCRIMINATION.

INSOFAR AS DISCRIMINATION IS CONCERNED,
PROPER OR IMPROPER DISCLOSURE BY CUSTODIANS OF
INFORMATION MAY RESULT IN ACTIONS BEING TAKEN
AGAINST PERSONS WHO ARE HIV POSITIVE OR WHO HAVE

PROGRESSED TO FULL BLOWN AIDS.

THE CURRENT PROTECTIONS ARE MIXED:

O STATE COURTS HAVE UNIFORMLY RULED THAT
INFECTED CHILDREN ARE ENTITLED TO ATTEND

SCHOOL.
- 28 -

O ONLY A HANDFUL OF STATES PROHIBIT
INSURERS FROM TESTING AND DENYING
INDIVIDUAL HEALTH INSURANCE TO THOSE

INFECTED.

O FOR EMPLOYMENT, HEALTH CARE, AND OTHER
SERVICES, LEGAL PROTECTIONS VARY STATE
BY STATE USUALLY DEPENDING ON THE
INTERPRETATION OF HANDICAPPED
DISCRIMINATION STATUTES IN A FEW STATES,
AND IN A FEW STATES, NEW AIDS-SPECIFIC

STATUTES.
O

-~ 29 -

IN THE UNITED STATES A FEDERAL STATUTE

KNOWN AS SECTION 504 OF THE

REHABILITATION ACT PROHIBITS

DISCRIMINATION AGAINS THE HANDICAPPED BY

THOSE INSTITUTIONS SUPPORTED BY FEDERAL

FUNDS. A RECENT SUPREME COURT DECISION

KNOWN AS THE ARLINE DECISION MEANS THAT

PEOPLE WITH AIDS WILL BE PROTECTED.

HOWEVER, THE REACH OF THIS PROTECTION IS

UNCLEAR, BUT LIMITED.
~ 30 -

IN PROTECTING THE PUBLIC FROM INFECTION,
THE PRINCIPLE SITUATIONS OF CONCERN INCLUDE
SEXUAL PARTNERS, HEALTH WORKERS, MORTICIANS AND
OTHER HIGH RISK OCCUPATIONS, PRISONERS,
CUSTOMERS OF PROSTITUES, AND MOST RECENTLY
ASSAULT VICTIMS. THE LATTER ARE INDIVIDUALS WHO
ARE INTENTIONALLY INFECTED, BY SEXUAL MEANS, OR
BITING, ETC. A SMALL NUMBER OF CASES HAVE
RECEIVED INORDINATE PUBLICITY AND PROBABLY

EXAGGERATES THIS PROBLEM.

THE CURRENT PROTECTIONS FOR CONSENTING
SEXUAL PARTNERS ARE MINIMAL. SOME STATES

REQUIRE, BY EXISTING SEXUALLY-TRANSMITTED
- 31 -

DISEASE LAW, OR SPECIAL AIDS LAW, "CONTACT
TRACING" FOR THOSE TESTING POSITIVE. BUT, MOST
RELY SOLELY ON VOLUNTARY DISCLOSURE. THE TWO
LARGEST TESTING PROGRAMS, -- BLOOD BANKS AND
MILITARY RECRUITS, -- DO NOT ROUTINELY PROVIDE

FOR CONTACT TRACING.

OTHER PROTECTIONS OF THE PUBLIC ARE MIXED:

OQ FEW STATES OR CITIES TEST PROSTITUTES,
BUT MANY ARE CONSIDERING STEPS IN THIS

DIRECTION.
O

- 32 -

IN ALL STATES CURRENT LAWS AGAINST
CRIMINAL ASSAULT THEORETICALLY APPLY TO
HIV CARRIERS WHO BITE OR RAPE AND THERE

ARE SEVERAL COURT CASES PENDING.

FOR HIGH RISH PROFESSIONS, PARTICULARLY
HEALTH WORKERS, PROTECTION DEPENDS
PRIMARILY ON PRACTICE RATHER THAN LAW.
THERE ARE GUIDELINES ISSUED BY THE
CENTERS FOR DISEASE CONTROL IN THIS

REGARD.
- 33 -

O THE JUSTICE DEPARTMENT HAS ANNOUNCED
TESTING OF FEDERAL PRISONERS. IN
ADDITION, SOME STATES ARE DOING THIS,

BUT FOLLOW-UP STEPS OR OTHER USE OF
RESULTS REMAIN UNCLEAR. MOST LOCAL
JURISDICTIONS THAT |! HAVE VISITED ARE
HESITANT TO TEST BECAUSE THEY DO NOT
HAVE MEANS OF SEGREGATING PRISONERS AND
FEAR FOR THE LIVES OF THOSE WHO MIGHT BE

KNOWN TO BE HIV POSITIVE.
- 34 -

THE POTENTIAL PROBLEM CAUSED BY THIS MIXED
TYPE OF PROTECTION IS SUBSTANTIAL IF THE PUBLIC
IS NOT PROTECTED AND INCLUDE NOT ONLY INFECTION
OF UNSUSPECTING PERSONS, BUT ALSO A POTENTIAL
FOR BACKLASH IF GOVERNMENTS ARE NOT PERCEIVED TO

BE TAKING ALL OF THE PRUDENT STEPS.

THE EXTENT OF THE PROBLEM IS INCREASING
WITH THE SPREAD OF DISEASE, PARTICULARLY IN HIGH
INCIDENCE AREAS AND FOR HETEROSEXUALS. STUDIES
SHOW THAT HOMOSEXUAL MEN, BUT NOT HETEROSEXUAL
INDIVIDUALS, HAVE SUBSTANTIALLY CHANGED

BEHAVIORS TO REDUCE RISKS.
~ 35 -

CURRENT CONTROVERSY IN THE UNITED STATES IS
BETWEEN THOSE WHO FAVOR MANDATORY TESTING AND
THOSE WHO DO NOT. THE MOTIVATION OF THE FORMER
GROUP IS MIXED, MOST OF THE PUBLIC HEALTH PEOPLE

ADHERE TO THE LATTER STANCE.

THE TWO AREAS OF MOST HEATED CONTROVERSY
ARE PREMARITAL TESTING AND THE TESTING OF

HOSPITAL ADMISSIONS.

HIGH RISK PEOPLE ARE USUALLY NOT GETTING
MARRIED IN THE UNITED STATES. THE OLD LAWS
PERTAINING TO MARRIAGE LICENSES AND TESTING FOR
SYPHILIS ARE NOT APPLICABLE BECAUSE FOR SYPHILIS

THERE WAS A CURE; THERE IS NO SUCH THING
- 36 -

AVAILABLE FOR AIDS. SEVENTY-FIVE PERCENT OF
THOSE GETTING MARRIED HAVE ALREADY BEEN LIVING
TOGETHER. THE COSTS OF SUCH TESTING IS
EXORBITANT IN REFERENCE TO THE NUMBER OF CASES
FOUND, AFTER WHICH THERE IS NO PROGRAM AVAILABLE
EXCEPT EDUCATION. IT IS ESTIMATED THAT IN THE
STATE OF NEW HAMPSHIRE, ABOUT TO ENACT A LAW, IT
WOULD COST $100,000 TO FIND A SINGLE HIV

INFECTED PERSON IN PREMARITAL SCREENING.

THE TESTING OF HOSPITAL ADMISSIONS IN
MANDATORY FASHION IS OPPOSED BY MOST PUBLIC
HEALTH AUTHORITIES. A COMPROMISE PLAN IS UNDER
DISCUSSION WHERE ONLY SURGICAL ADMISSIONS WOULD

BE VOLUNTARILY TESTED IN ORDER TO REDUCE THE
. 37 -

TENSION CURRENTLY EXISTING IN OPERATING ROOMS
WHERE SURGEONS AND OPERATING ROOM NURSES ARE AT
HIGHEST RISK BECAUSE OF ACCIDENTAL INJURY TO
THEMSELVES WHILE OPERATING ON AN HIV INFECTED
PERSON. SUCH TESTING IS COMING, WHETHER WE WANT
IT OR NOT, AND AT THE PRESENT, PLANS CALL FOR

THE AVOIDANCE OF DISCRIMINATION WHEREVER

POSSIBLE BY LABELING NO PATIENT SERO POSITIVE,

BUT LABELING THOSE VOLUNTEERS WHO TEST NEGATIVE

IN SOME APPROPRIATE FASHION.

THE REASONS FOR SURGICAL TESTING ARE REAL
BECAUSE DOCTORS ARE REFUSING TO OPERATE, AND

NURSES ARE LEAVING THEIR JOBS. IN HIGH RISK
- 38 -

AREAS, MEDICAL STAFFS ACKNOWLEDGE THAT THEY ARE
NOT GIVING THE BEST CARE TO SOME PATIENTS
BECAUSE OF FEAR OF HIV POSITIVITY AND IT IS

KNOWN TOO THAT SOME CLASSES OF PATIENTS POST
OPERATIVELY DO NOT DO AS WELL IF THEY ARE HIV

POSITIVE.

OUR ONLY HOPE AS A NATION -- INDEED AS A
CIVILIZATION -- IS THAT WE ALL DO OUR PART TO
STOP THE SPREAD OF AIDS...THAT WE WILL PROTECT

AND SAVE THE LIVES OF PEOPLE AT RISK.

THAT’S A TALL ORDER -- AND THERE ARE MANY

SAYING IT CAN’T BE DONE.

BUT, THEY'RE WRONG.
- 39 -

| THINK WE WILL EVENTUALLY AGREE ON THE

TASKS THAT REALLY MATTER -- AND GET THEM DONE.

MY PERSONAL HOPE IS THAT I'LL STILL BE

AVAILABLE TO HELP!

THANK YOU.