THE VOICE OF CHICAGO'S GAY, LESBIAN, BI, TRANS AND QUEER COMMUNITY SINCE 1985

Surgeon General C. Everett Koop was the first social conservative in the United States' federal government to produce a document on AIDS for the American people. President Ronald Reagan empowered Koop to write a special report on AIDS in December 1985. Koop had become surgeon general at the beginning of Reagan's first term, but not without a very contentious nomination fight. Democrats fiercely opposed Koop, particularly because of his antichoice stance on abortion, which grew out of his religious convictions as a Christian. Four years later, in the minds of the upper-administration officials, Koop's beliefs made him the perfect candidate to write a special report on AIDS that would emphasize morality, defined as a commitment to heterosexual marriage as the key institution of the American family and nation, rather than condoms and sex education. Much to the disappointment of many conservatives, Koop failed to live up to their expectations. ( 1 )

Instead of producing a document that emphasized what was increasingly becoming a kind of conservative dogma about the need to push marriage over frank conversations about sex, Koop stressed his commitment to public health and accumulated a wide range of information about the epidemic. He consulted myriad AIDS Service Organizations ( ASOs ) and nongovernmental organizations ( NGOs ) , from the U.S. Catholic Conference and the National Council of Churches to the AIDS Action Council and the National Coalition of Black Lesbians and Gays, to determine their positions on AIDS prevention. ( 2 ) Koop then wrote dozens of drafts of the report over the course of six months. In the end, he and his staff presented what they considered a balanced report that detailed how to prevent the spread of AIDS.

The final surgeon general's report, released on October 22, 1986, delineated an education program for both school-age children and adults at the same time that it placed a conversation about AIDS in a larger political context. At the press conference to announce the report's release, Koop drew particular attention to the racial disparities of the epidemic, noting that African Americans accounted for 25 percent of all people with AIDS but only 12 percent of the general population, statistics that AIDS workers in San Francisco regularly cited. ( 3 ) This statistical data allowed Koop to argue that race and racism helped shape the epidemic, a point I have not found in any other contemporaneous document created by the U.S. government.

The most contentious recommendations in Koop's report, however, were his calls for condom usage and AIDS education at a young age:

Many people—especially our youth—are not receiving information that is vital to their future health and well-being because of our reticence in dealing with the subjects of sex, sexual practices, and homosexuality. This silence must end. We can no longer afford to sidestep frank, open discussions about sexual practices—homosexual and heterosexual. Education about AIDS should start at an early age so that children can grow up knowing the behaviors to avoid to protect themselves from exposure to the AIDS virus. ( 4 )

Using the terms "frank" and "open" resonated with the rhetoric of contemporaneous AIDS activists, who wanted to instigate discussions about the way people actually had sex. Instead of shying away from talk of same-sex sexual practices, Koop wanted to "deal with [ homosexuality, promiscuity of any kind, and prostitution ] , but [ do ] so with the intent that information and education can change individual behavior, since this is the primary way to stop the epidemic of AIDS." ( 5 ) This informational responsibility was best met by the federal government, so long as it never utilized certain forms of intervention, in particular compulsory testing and quarantine. Koop concluded that his work was a central feature of his identity as a Christian. In his memoir he writes, "My position on AIDS was dictated by scientific integrity and Christian compassion. I felt that my Christian opponents had abandoned not only their old friend [ Koop himself ] , but also their own commitment to integrity and compassion." ( 6 )

Koop's "commitment to integrity and compassion" pleased a wide range of AIDS workers. Gil Gerald, the executive director of the National Coalition of Black Lesbians and Gays, commended Koop: "because of your positions favoring sex education for school age children, against compulsory mass blood testing, and against quarantining persons with AIDS, ARC, or who test positive for HIV antibodies. To be quite honest the report and your statements exceeded our expectations. Please count on our support for promoting the recommendations you outline in issuing this report. We urge you to use the prestige and influence of your office to see that the federal response to AIDS as a health concern in Black and Brown communities is adequately addressed." ( 7 )

Koop presented his message of scientific reasoning mixed with Christian compassion to the general public. The federal government printed more than 20 million copies for distribution, while smaller organizations helped to disseminate the report; the National Parent Teacher Association, for example, sent out 55,000 copies of the report to parents and educators across the country. ( 8 ) Emboldened by his new position as an AIDS spokesman, Koop went on the road, giving speeches across the country. In an address to the California legislature in March 1987, Koop told the people assembled for the Joint Session on AIDS, "Our decisions regarding the way we pay to care for AIDS patients contaminate our entire social and political decision-making itself. We must not allow that to happen. Such an effect on our public life would be an 'AIDS-related complex' every bit as serious as the more recognizable A.R.C.'s like pneumonia and cancer." ( 9 )

Koop's call for condom use and AIDS education for young people pitted him against other self-defined social conservatives who advised the president. Some conservative activists claimed that Koop had betrayed his Christian roots, including Carl Anderson from the White House's Office of Public Liaison, who in 1986 ended his decades-long friendship and mentorship of Koop over his report's recommendations. ( 10 ) William Bennett [ then Secretary of Education ] , too, found Koop's action particularly troubling. Bennett sent Koop's California legislature speech, along with an angry cover letter, to Gary Bauer, who had recently left the Department of Education to work in the White House as Reagan's chief domestic policy advisor. He highlighted sections of Koop's speech in Sacramento as "straight homosexual propaganda, listed out of their tirades: our reaction is a disease too! I warn you: Sooner or later, and probably sooner, [ Koop ] will endorse school-based clinics." ( 11 ) Robert Sweet, a senior aide for education, expressed real concerns about condoms: "To date, Dr. Koop has resisted attempts by nearly everyone to modify his promotion of condoms as a solution for the AIDS epidemic rather than to promote fidelity, chastity and sex within marriage." ( 12 )

Bauer responded to these warnings by initiating an investigation into Koop's research. Concerned that the government was "preparing materials that [ were ] offensive to people concerned about their children's education," Bauer called on one of his former aides at the Department of Education, John Klenk, to put together a packet of information on the organizations Koop consulted for his report. ( 13 ) Klenk found references to GMHC and was especially troubled by a series of the group's safe-sex brochures called the "Safe Sex Comix." [ A reproduction of the comix appear in the book. ] He wrote that the comic books "are obscene. They also present what everybody acknowledges is high-risk behavior—namely anal sex—in an exciting and favorable light. . . . Is this the kind of AIDS information the Surgeon General wants young people to receive?" ( 14 ) Klenk sent Bauer several versions of the comics. ( 15 ) Klenk's illustrated memo convinced Bauer, who tried to keep Koop from reprinting the report unless he agreed to remove the discussion of condoms from the document. Koop refused. ( 16 )

1 ) In addition to Koop's rejection of his conservative image, people who worked for him came to see him as the antithesis of social conservatism. Willard Cates, who began working for the CDC's Abortion Surveillance Unit in 1973 feared the loss of his job in 1981 when Koop became surgeon general. Much to his surprise, Cates noted that Koop "turned out to be arguably the best surgeon general we've had in my lifetime in terms of a very independently minded, health-oriented, grandfather figure, and it sort of changed my mind about who should be surgeon general" ( Willard Cates interview with Rebecca Sharpless. Transcript of audio recording, May 25-26, 2004. Population and Reproductive Heath Oral History Project, Sophia Smith Collection, Smith College, Northampton, Mass., 65 ) .

2 ) C. Everett Koop, " [ Notes on the ] Surgeon General's Report on AIDS" ( 1986 ) profiles.nlm.nih.gov/QQ/Views/Exhibit/documents/aids.html ( accessed May 20, 2007 ) .

3 ) C. Everett Koop, "Statement by C. Everett Koop, M.D.," Oct. 22, 1986, Sweet Files, box OA 16785, folder " [ US Public Health Service AIDS Information Packet ] [ 2 of 2 ] ," RRPL, 3.

4 ) Ibid.

5 ) C. Everett Koop, "Surgeon General's Report on Acquired Immune Deficiency Syndrome" ( 1986 ) profiles.nlm.nih.gov/QQ/Views/Exhibit/documents/aids.html ( accessed May 20, 2007 ) , 4.

6 ) Koop, C.E. ( 1991 ) Koop: The Memoirs of America's Family Doctor. New York: Random House. 216.

7 ) Gil Gerald, "Letter to C. Everett Koop, M.D.," Oct. 24, 1986, Koop Papers, box 114, file 1, NLM, 1. Editorials in the New York Times and the Washington Post praised Koop's actions, while the editorial at the Washington Times, a much more conservative newspaper, suggested that Koop needed "to heal himself." See editorial, "A Doctor's Good Advice," Washington Post, Oct. 24, 1986, A26; editorial, "Dr. Koop's Decent AIDS Dissent," New York Times, Oct. 25, 1986, A26; and editorial, "Flying the Koop," Washington Times, Oct. 27, 1986, A26.

8 ) Koop, Koop, 212.

9 ) C. Everett Koop, "Speech to the Joint Session on AIDS of the California Legislature," Mar. 6, 1987, Bauer Files, box OA 19222, folder "AIDS VII ( 5 of 5 ) ," RRPL, 9.

10 ) Koop, Koop, 134.

11 ) William Bennett, "Note to Gary," 1987, Bauer Files, box OA 19222, folder "AIDS VII ( 5 of 5 ) ," RRPL, 1 ( emphasis in original ) .

12 ) Robert Sweet, "Memo for Gary Bauer Re: PHS Plans to Distribute Information on AIDS . . . ," Mar. 13, 1987, Sweet Files, box OA 16630, folder "Working Group on Health Policy AIDS [ 9 of 13 ] ," RRPL, 1.

13 ) "Minutes DPC," Jan. 21, 1987, Bledsoe Files, box OA 17012, folder "320-AIDS Policy ( 1 ) ," RRPL, 2.

14 ) John Klenk, "Note to Gary L. Bauer," Aug. 10, 1987, Sweet Files, box OA 16784, folder "AIDS/Klenk [ 1 of 2 ] ," RRPL, 1.

15 ) These brochures would soon resurface when Senator Jesse Helms held them up on the Senate floor and said, "The comic books do not encourage and change any of the perverted sexual behavior [ sic ] . In fact, the comic book promotes sodomy and the homosexual lifestyle as an acceptable alternative in American society." Helms went on to call for a ban on sexually explicit material in AIDS education, which passed 94 to 2. See Congressional Record, October 14, 1987, S14202.

16 ) Gary Bauer, "Memo to Howard H. Baker, Jr.," Mar. 24, 1987, WHORM Subject File, ID# 480629, FG 022-10, RRPL; Gary Bauer et al., "Memorandum for Howard Baker ( DRAFT ) ," May 28, 1987, Risque Files, box OA 18383, folder "AIDS Binder ( 6 ) ," RRPL.