Challenging an Epidemic of Misinformation

By Christie Moffatt

The focus of this year’s World AIDS Day is on challenging myths and focusing on facts about HIV, rethinking stereotypes and being positive about HIV. On this day we might also honor those who took up such challenges in the early years of the AIDS epidemic. U.S. Surgeon General Dr. C. Everett Koop (1916–2013), whose personal papers are available to researchers at the National Library of Medicine and online through NLM’s Profiles in Science, helped the nation face the most fearsome new pandemic of the century. Dr. Koop educated the public on prevention and protection, argued against mandatory testing and quarantine of the infected, and denounced discrimination against AIDS sufferers in schools, the workplace, and housing.

C. Everett Koop’s (1916–2013) two terms as U.S. Surgeon General from 1981 to 1989 coincided with the rise of the AIDS epidemic in the United States, an epidemic that, scientists and health officials then predicted, would turn into the greatest public health catastrophe of the twentieth century. After his superiors relegated him to the sidelines of the AIDS debate during his first four years in office, Koop dedicated al­­­most all of his time and energy to the disease in his second term. In October 1986, he was finally authorized to issue a Surgeon General’s report on AIDS. In plain language the 36-page report discussed the nature of AIDS, its modes of transmission, risk factors for contracting the disease, and ways in which people could protect themselves, including use of condoms. Twenty million copies were eventually distributed to the public by members of Congress, public health organizations, and Parent-Teacher Associations. It projected that in 1991, 270,000 cases of AIDS would have occurred. The prediction was too pessimistic, as the total reported cases of AIDS in the U.S. through 1991 turned out to be 206,000, a measure of the effectiveness of Koop’s AIDS education campaign. In a speech presented upon the release of this report, Koop emphasized that since education was the best and only strategy of prevention against AIDS, and since AIDS was spread primarily through sex, school children from grade three onward should receive sex education.

Former liberal critics of Koop were pleasantly surprised while his conservative supporters were taken aback by the explicit language and the lack of moral censure in his AIDS report, and above all by Koop’s promotion of sex education in elementary schools. Yet, as Koop himself saw it, his approach to AIDS was consistent with his long-standing professional commitments as a pediatric surgeon, as well as with his religious faith: “My position on AIDS was dictated by scientific integrity and Christian compassion. . . . My whole career has been dedicated to prolonging lives, especially the lives of people who were weak and powerless, the disenfranchised who needed an advocate: newborns who needed surgery, handicapped children, unborn children, people with AIDS.”

Nearly two years later, in May of 1988, Koop sent an eight-page, condensed version of his AIDS report, titled “Understanding AIDS” to all 107,000,000 households in the United States, the largest mailing in American history and the first time that the federal government provided explicit sex information to the public.

Understanding AIDS, 1988

I Take It the Surgeon General’s ‘AIDS’ Pamphlet Came Today!, 1988 Courtesy Gary Brookings and the Richmond Times Dispatch

Years later, Dr. Koop reminisced that “We entitled the mailer, “Understanding AIDS” hoping that it could come close to required reading in every American home. My hope was that parents, grandparents, children and teenagers would set a time when they could sit down together and review the information in those eight pages. It was my hope that schools would do the same thing in classrooms that were appropriate.”

Through his report, this mailer, and his many speeches and interviews on AIDS Koop did more than any other public official to shift the terms of the public debate over AIDS from the moral politics of homosexuality, sexual promiscuity, and intravenous drug use, practices through which AIDS was spread, to concern with the medical care, economic position, and civil rights of AIDS sufferers. Similarly, Koop promoted redefining the prevalent scientific model of the disease, from a contagion akin to bubonic plague, yellow fever, and other deadly historic epidemics that required the strongest public health measures—mandatory testing and quarantine of carriers—to a chronic disease that was amenable to long-term management with drugs and behavioral changes.

We invite you to learn more about Dr. C. Everett Koop on NLM’s Profiles in Science, in particular, from the narrative section of the Koop collection titled “AIDS, the Surgeon General, and the Politics of Public Health” written by Dr. K. Walter Hickel, formerly a historian in the Digital Manuscript Program at NLM. The collection features nearly 400 speeches given by Dr. Koop, many related to AIDS. Several are also accompanied by personal reminiscences of the speeches, prepared by Dr. Koop at the time of their donation to the Library in 2003.

Christie Moffatt is Manager of the Digital Manuscripts Program in the History of Medicine Division at the National Library of Medicine and Chair of the NLM Web Collecting and Archiving Working Group.