ORIGINAL

TALKING POINTS WITH SLIDES
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

PRESENTED TO THE ASSOCIATION MARSEILLE-EuRoPE 1992
MARSEILLE, FRANCE
JANUARY 16, 1989
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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

(SLIDE: TITLES)

AIDS IS A LIFE-THREATENING DISEASE AND A MAJOR PUBLIC
HEALTH ISSUE FOR ALL NATIONS. ITS TOTAL PHYSICAL, SOCIAL,
PSYCHOLOGICAL, MORAL, POLITICAL, AND ECONOMIC IMPACT HAS BEEN --
AND WILL CONTINUE TO BE -- DEVASTATING,

HOW YOU AND I RESPOND TO THIS DISEASE WILL AFFECT ALL FUTURE
GENERATIONS ON THIS PLANET.
(SLIDE: P.H.S. PROGRAMS)

AS MANY AS 1.5 MILLION PEOPLE IN U.S.A. ALONE MAY BE
INFECTED ALREADY. YOUNG PEOPLE. OTHERWISE HEALTHY PEOPLE. MOST
WILL PROBABLY DIE. BUT WE STILL HAVE NO VACCINE TO PREVENT
FURTHER INFECTION. NO CURE.

IN THE MEANTIME, THIS IS WHAT WE’RE DOING...

* SURVEILLANCE TO MONITOR THE SPREAD OF THE DISEASE ...

* RESEARCH ON RISK FACTORS, HOW THE DISEASE IS TRANSMITTED,
NEW DRUGS TO TREAT INFECTIONS, BETTER WAYS TO DETECT
THE PRESENCE OF INFECTION, WAYS TO HELP PERSONS AT
HIGH RISK, AND RESEARCH ON VACCINES ...

* DEVELOPING GUIDELINES FOR HEALTH CARE WORKERS AND OTHERS ...

* EXPLORING NEW METHODS OF HEALTH CARE DELIVERY TO PERSONS
WITH AIDS vo.
(SLIDE: PREVENTION PROGRAMS)

WE'VE ALSO PLACED A GREAT DEAL OF EMPHASIS ON A STRONG
NATIONAL PROGRAM OF PUBLIC INFORMATION AND EDUCATION, WHICH -- IN
THE ABSENCE OF A SAFE, EFFECTIVE, AND GENERALLY AVAILABLE
VACCINE, IS THE ONLY TRULY EFFECTIVE PREVENTION PROGRAM WE HAVE,

BUT WE ARE ALSO CONCERNED ABOUT MAINTAINING THE INTEGRITY
AND PURITY OF THE BLOOD SUPPLY ... WORKING WITH STATE AND LOCAL
GOVERNMENTS ON CONFIDENTIAL SCREENING AND TESTING PROGRAMS ...
GETTING AIDS INFORMATION INTO DRUG TREATMENT PROGRAMS ... AND SO
ON,
(SLIDE: MMWR TIMELINE)

THE FIRST REPORTS OF THE DISEASE APPEARED IN THE CENTERS FOR
DISEASE CONTROL’S MORBIDITY AND MORTALITY WEEKLY REPORT OF JUNE
5, 1981, AND CONCERNED FIVE, PREVIOUSLY HEALTHY, YOUNG HOMOSEXUAL
MALES LIVING IN LOS ANGELES, HAD PNEUMOCYSTIS CARINII PNEUMONIA,
A RARE, OPPORTUNISTIC DISEASE.

THIS SET IN MOTION A SERTES OF EPIDEMIOLOGIC AND CLINICAL
INVESTIGATIONS TO ANSWER KEY QUESTIONS: WHAT? WHO? WHY? HOW?

“WHAT”: DISEASE GOT ITS NAME IN MMWR OF SEPTEMBER 24, 1982:
ACQUIRED IMMUNE DEFICIENCY SYNDROME, OR AIDS.
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“WHO”: HOMOSEXUAL MEN, IV DRUG USERS, HAITIANS, PERSONS
WITH HEMOPHILIA, TRANSFUSION RECIPIENTS, INFANTS, FEMALE SEX
PARTNERS OF AIDS CASES, AND PRISONERS.

(SLIDE: MODES OF TRANSMISSION)

"WHY": TRANSMISSION OCCURS BECAUSE OF THESE HIGH-RISK

BEHAVIORS,

(SLIDE: PHOTO OF THE AIDS VIRUS)

CONFIRMED, APRIL 1984, THAT AIDS WAS CAUSED BY A SPECIFIC,

HUMAN RETROVIRUS, A BLOOD TEST WAS DEVELOPED THAT SHOWS THE

PRESENCE OF VIRUS ANTIBODIES IN PERSON’S BLOODSTREAM; THEREFORE,
THE VIRUS IS PRESENT (“SEROPOSITIVITY”).
(SLIDE: SCIENTIFIC JOURNALS)

SINCE 1982, U.S. SCIENTISTS HAVE BEEN PRODUCING A STEADY
FLOW OF REPORTS FOR THE SCIENTIFIC LITERATURE, THE FOUNDATION
FOR ALL INFORMATION, EDUCATION, PATIENT CARE, AND BROAD-SCALE
RESEARCH PROGRAMS.

ALSO THE BASIS FOR GUIDELINES FOR LABORATORY WORKERS, OTHER
HEALTH WORKERS, EDUCATORS, SOCIAL WORKERS, ETC.

(SLIDE: P.H.S. TELEPHONE HOTLINE)

 

IN FEBRUARY 1983, WE SET UP A NATIONWIDE, TOLL-FREE TELE-
PHONE HOTLINE SERVICE IN OUR HEADQUARTERS OFFICE. VERY IMPORT-
ANT FOR DEALING WITH FALSE INFORMATION, HARMFUL RUMORS, ETC.
(SLIDE: ATLANTA CONFERENCE )

FIRST INTERNATIONAL CONFERENCE ON AIDS DREW OVER 3,000
SCIENTIST AND JOURNALISTS TO ATLANTA, IN APRIL 1985. HELPED
FOCUS WORLDWIDE ATTENTION ON AIDS AND THE NEED FOR GLOBAL
COOPERATION.

(SLIDE: GRAPH OF MEDIA COVERAGE)

 

AS MORE WELL-KNOWN PEOPLE IN ARTS, SPORTS, FILMS, AND
POLITICS DIED OF AIDS, THE MEDIA AND THE PUBLIC TOOK GREATER AND
MORE SYMPATHETIC NOTICE OF THE DISEASE AND ITS VICTIMS. AIDS NO
LONGER LIMITED TO REPORTS IN SCIENTIFIC JOURNALS,

PUBLIC NOW READY TO BELIEVE THE TRUTH: IT CAN HAPPEN TO
ANYONE WHO IS ENGAGED IN HIGH-RISK BEHAVIOR.
(SLIDE: CAPITOL DOME)

AIDS HAS BECOME A TRULY NATIONAL HEALTH ISSUE. TRUE, MOST
CASES ARE STILL FOUND IN FOUR MAJOR CITIES: NEW YORK, SAN
FRANCISCO, LOS ANGELES, AND MIAMI, FLORIDA. HOWEVER, AS OF
TODAY, THERE HAVE BEEN 10 OR MORE CASES REPORTED FROM EVERY
STATE SINCE JUNE 1981,

AS A RESULT, U.S. GOVERNMENT, STATE GOVERNMENTS, PLUS LOCAL
AGENCIES AND PRIVATE GROUPS HAVE INCREASED THEIR SUPPORT FOR
WHOLE RANGE OF AIDS-RELATED PROGRAMS. THIS FISCAL YEAR, OVER $2
BILLION IN FEDERAL FUNDS FOR RESEARCH, EDUCATION, AND PATIENT
CARE. COULD BE MATCHED BY STATE AND LOCAL AGENCIES.

THIS WILL MEAN A COMBINED TOTAL OF NEARLY $5 BILLION IN
TAXPAYER SUPPORTED EFFORTS, OR ABOUT $156,000 FOR EACH OF 32,000
AIDS VICTIMS THIS YEAR.
(SLIDE: $.G.’S REPORT)

EARLY IN 1986 PRESIDENT REAGAN ASKED ME TO TELL THE
AMERICAN PEOPLE THE FACTS ABOUT AIDS. 1 SPENT THE NEXT 10 MONTHS
TALKING TO A BROAD SPECTRUM OF PUBLIC-MINDED ORGANIZATIONS,
RELIGIOUS GROUPS, ADVOCACY GROUPS, AND SO ON.

IN OCTOBER 1986 I RELEASED MY REPORT. VERY WELL RECEIVED.
WIDELY TRANSLATED, ALL MEMBER NATIONS OF W.H.0. HAVE ITs MANY
ARE USING IT. MORE THAN 30 MILLION COPIES HAVE BEEN DISTRIBUTED
IN THE U.S, ALONE.
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(SLIDE: TARGET AUDIENCES)

REPORT HELPED FOCUS THE GOVERNMENT’S PUBLIC EDUCATION
EFFORTS. AT THE SAME TIME, WE BEGAN TO MORE CLEARLY IDENTIFY
THE POPULATION GROUPS WITHIN WHICH WERE THE PEOPLE WHO PRACTICED
BEHAVIOR CARRYING A HIGH RISK FOR AIDS INFECTION:

* MINORITIES ... BLACKS AND HISPANICS APPEAR TWICE AS
FREQUENTLY AMONG AIDS VICTIMS AS IN POPULATION IN
GENERAL.

* ADOLESCENTS AND YOUNG ADULTS ... THOSE AT THE VERY
VULNERABLE AGES OF EXPERIMENTATION WITH SEX AND DRUGS,

* CERTAIN OCCUPATIONAL GROUPS ... HEALTH WORKERS, POLICE AND
FIRE PERSONNEL, EMERGENCY MEDICAL TECHNICIANS, ETC.

* SOME MEMBERS OF THE GENERAL PUBLIC ... SEXUALLY PROMISCUOUS
PERSONS, OCCASIONAL DRUG USERS, ETC.
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(SLIDE: ESSENTIAL INFORMATION)

AND THIS IS THE KIND OF INFORMATION WE HAD TO GET TO THESE
HIGH-RISK INDIVIDUALS: HOW THE VIRUS IS SPREAD ... AND HOW IT IS
NOT SPREAD ... HOW TO PREVENT INFECTION ... AND SO ON,

MAJOR NATIONAL EDUCATION CAMPAIGN NOW GOING AT FULL STEAM:

* TELEVISION, RADIO, MOVIE THEATERS, NEWSPAPERS,
MAGAZINES, BUS CARDS, AND PHYSICIANS’ WAITING ROOMS ALL
CARRY MESSAGES DEVELOPED FOR US BY ONE OF THE LARGEST
ADVERTISING AGENCIES IN THE WORLD.

* EACH WEEK OUR NATIONAL AIDS INFORMATION CLEARINGHOUSE
DISTRIBUTES MORE THAN 1 MILLION BROCHURES AND OTHER
UP-TO-DATE MATERIALS REQUESTED BY HEALTH PROFESSIONALS AND
OTHER CITIZENS.
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* OUR NATIONAL AIDS HOTLINE IS NOW MANAGED FOR US BY THE
AMERICAN SOCIAL HEALTH ASSOCIATION. THEY HANDLED OVER 1.9
MILLION CALLS LAST YEAR. THE TELEPHONE HOTLINE IS OPEN 24
HOURS A DAY, 7 DAYS A WEEK, AND PROVIDES SERVICES IN
ENGLISH AND SPANISH AND, BY TELECOMMUNICATIONS SYSTEMS, FOR
THE HEARING IMPAIRED.

* SPECIAL EDUCATIONAL PROGRAMS HAVE BEEN DESIGNED FOR USE
BY STREET WORKERS ... ELEMENTARY AND HIGH SCHOOL TEACHERS
»++ PERSONNEL MANAGERS IN BUSINESS AND INDUSTRY ... AND BY
PHYSICIANS, NURSES, DENTISTS, AND OTHER HEALTH PERSONNEL.
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(SLIDE: UNDERSTANDING AIDS)

ALL THIS EFFORT TAKES MONEY AND REQUIRES THE UNDERSTANDING
OF THE GENERAL PUBLIC, WHO PAY FOR IT ... BUT, AS I’VE INDICATED,
WHO ALSO MAY BE AT RISK,

THEREFORE, THIS PAST SPRING WE LAUNCHED ONE OF THE LARGEST
INFORMATION EFFORTS IN THE HISTORY OF PUBLIC HEALTH: WE MAILED A
COPY OF THIS BROCHURE, UNDERSTANDING AIDS, TO EACH ONE OF 107
MILLION HOUSEHOLDS IN THE UNITED STATES.

SINCE THEN, WE HAVE PRODUCED A VERSION IN BRAILLE AND OTHER
VERSIONS HAVE BEEN DONE IN 10 LANGUAGES BESIDES ENGLISH,
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(SLIDE: MAILOUT DATA -- PEOPLE WHO HAVE READ THE BROCHURE)

WE ALWAYS NEED TO EVALUATE THE EFFECTIVENESS OF THESE
EDUCATIONAL EFFORTS. FOR EXAMPLE ...

* FROM CERTAIN SCHOOL HEALTH DATA FED BACK TO US, WE ARE
FINDING OUT WHAT YOUNG PEOPLE DO KNOW ABOUT AIDS ... WHAT
THEY DON’T KNOW ABOUT AIDS ... AND HOW BEST TO FILL IN
THOSE GAPS IN THEIR KNOWLEDGE.

* WE ESTIMATE THAT SOME 87 MILLION ADULTS HAVE READ THE
BROCHURE AND THAT KNOWLEDGE OF THE DISEASE OF AIDS IS
IMPROVING,
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* AND RECENT STUDIES INDICATE THAT THERE HAS ALSO BEEN A
DRAMATIC CHANGE IN SEXUAL PRACTICES AMONG THE KEY GROUP OF
AIDS VICTIMS: HOMOSEXUALS AND BISEXUAL MEN. MUCH OF THAT
POSITIVE CHANGE IS ALSO THE RESULT OF EFFECTIVE PUBLIC
INFORMATION AND EDUCATION EFFORTS WITHIN THIS SPECIAL
COMMUNITY OF MEN AT HIGH RISK.

(SLIDE; REPEAT OF FIRST TITLE SLIDE)

WE HAVE COME A LONG WAY IN THE RELATIVELY SHORT PERIOD OF
TIME SINCE JUNE 1981, BUT OUR TASK IS FAR FROM COMPLETE.
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THE DISEASE OF AIDS HAS CHALLENGED EVERY INSTITUTION IN OUR
SOCIETY. AND IT WILL CONTINUE TO CHALLENGE US. THEREFORE, WE
MUST RESPOND BY DEVELOPING AND SUPPORTING THOSE PROGRAMS AND
SERVICES NECESSARY TO CONTROL THE DISEASE AND TO PROVIDE
ESSENTIAL SERVICES TO THOSE INFECTED,

THANK YOU,
HH EH #