HIV 101














C. Everett Koop, MD, SCD
Former Surgeon General C. Everett Koop, MD, SCD on 30 years of HIV/AIDS

(Editor’s Note: As the 13th Surgeon General of the United States, Dr. C. Everett Koop was responsible for the public health response in the earliest days of the HIV/AIDS crisis. On November 17, Dr. Koop – now 94 years old – addressed the 2010 National Summit on HIV Diagnosis, Prevention, and Access to Care, a biennial scientific conference convened by the Forum for Collaborative HIV Research. Here are his remarks, which cover the full history of the HIV/AIDS pandemic from 1981 until today.)

When Shakespeare wrote “what’s past is prologue,” his meaning was clear: history repeats itself and continually influences the present.

This is especially true with the nation’s fight against HIV/AIDS.

Our war against HIV/AIDS started exactly 30 years ago. It was in June, 1981, when we heard about five cases of homosexual men in Los Angeles who were dying from pneumocystis carinii pneumonia. This disease is so rare that a handful of cases in a single year is like an epidemic.

Then, a month later, CDC reported 26 cases of homosexual men who were diagnosed with Kaposi’s sarcoma, an equally rare skin cancer. These first cases were ground zero in the fight against HIV/AIDS. In two short months, we were witnessing a rash of deaths from very rare diseases and no one knew why.

It appeared that some kind of “bug” – a virus, most likely – was attacking and destroying the natural immune systems of otherwise healthy adults.

Until the AIDS virus came along, nobody in public health and medicine had seen a syndrome quite like it before and no one was sure how it was acquired.

By 1983, the virus had a name -- Acquired Immune Deficiency Syndrome.

And by 1985, 12,000 cases had been reported. The number of cases jumped to 16,000 by January, 1986. A year later, there were 30,000 cases.

With the rapid spread of HIV/AIDS, we knew we were fighting a contagion. We likened the spreading AIDS situation to the arrival and spread of small pox and the bubonic plague in Europe several centuries ago.

But despite an aggressive research effort, progress was slow. Five years into the crisis, the AIDS virus remained a mystery.

However, we did know something very important: the AIDS virus is transmitted from one person to another in blood or in semen. This trait explained why in the beginning, AIDS was so prevalent among homosexual and bisexual men and intravenous drug users. It was also a warning sign of what is now commonplace in the US and around the world – cases of HIV/AIDS in heterosexual men and women.

Five years into the war on HIV/AIDS, we also knew we were fighting the AIDS battle on another front entirely -- the battle to overcome public fear.

This was a time when the country was rife with rumors and misinformation about HIV/AIDS. Americans worried about contagion through casual contact in schools, restaurants and public lavatories. There was also a pervasive bias against the people most affected by HIV/AIDS, which severely hampered our ability to respond. Politicians called for a quarantine of AIDS patients. And AIDS activists took to the streets.

As surgeon general, I saw my job as waging all-out war against disease – not people. I realized that unless every adult and adolescent was informed and knowledgeable about HIV/AIDS, this contagion would only continue to spread.

So, lesson number one in the war against HIV/AIDS is simply this: when there is a deadly disease, it is vital to give Americans the facts - - and to do it in plain English. This requires dispelling rumors and educating the public about how the disease is transmitted, who is at risk, and what people can do to protect themselves.

And in the case of HIV/AIDS, it meant having a frank and open discussion about the subjects of sex, sexual practices and homosexuality. As you know, in 1986, I issued a report to the American people on just what the AIDS threat was all about. In doing so, I consulted with the best medical and scientific experts in the country. I also met with leaders of health and education organizations to get their views on AIDS.

When it came time to do the actual writing, I concentrated on two important messages:

first: the risk of infection increases with the number of sexual partners – male or female.

and second: the best protection against infection, barring abstinence, is the use of a condom.

To get this information into people’s hands, my office distributed 20 million copies of the report through congressional offices, the public health community and parent-teacher associations.

Then, in 1988, I turned the report into an 8-page condensed pamphlet and sent it to all American households - - 107 million at the time.

I am told this was the largest mailing in US history and the first time the federal government provided explicit sex information to the public.

What was the lesson here? If you tell people the truth, in a very factual way, they will act. When it comes to bad news or controversial issues, Americans want to hear it straight. This is the case whether we are talking about sexually transmitted diseases or obesity.

In 1996, antiretroviral therapy changed the course of AIDS from a deadly disease to a chronic condition. And we are finally starting to make significant advances in developing a vaccine against HIV. But this is not time to declare victory. The war against HIV/AIDS is far from over.

Today, more than 1.1 million Americans are living with an HIV infection. And, despite the best efforts of medical science and public health, new infections continue at far too high a level - - more than 56,000 Americans become infected every year.

To give you a reality check, that is basically equivalent to the number of people who died during the Vietnam war.

Here is another reality check: more than 14,000 Americans still die of AIDS each year. And just as in the past, these deaths are usually in gay and bisexual men.

I find these statistics troubling for several reasons.

First, the prevalence of HIV/AIDS in this country remains disturbingly high.

The second reason is that our current challenges are very similar to what I faced 30 years ago.

Today, 53 percent of all new infections in the US are in gay and bisexual men. In fact, in this risk group, HIV infections have been increasing since the 1990s.

We are also falling short in reducing the incidence of HIV/AIDS in injection drug users, African Americans and Hispanics/Latinos.

Currently, almost half of all people living with HIV are African Americans. They also account for nearly half of the new infections each year.

The third reason for my concern is what is behind these trends - a growing sense of complacency about HIV/AIDS that is as dangerous as the irrational fear in the early days of the AIDS controversy. If there is a new front in our war against HIV/AIDS, it is ignorance and complacency. Simply put, HIV is no longer on the public’s radar screen. And the result is deadly serious.

Today, more than one in five people with HIV -- 21 percent -- don’t know they are infected. This number is even higher among HIV-infected gay and bisexual men and among infected teens.

And because they don’t know they are infected, many people with HIV are not getting treatment. And they are not protecting others from getting the disease.

As someone who has been speaking out on HIV/AIDS for 30 years, I want to go public once more with the same message I delivered as surgeon general – HIV is contagious and it can kill you.

The most important lesson from the past 30 years is that the nation must remain aware and knowledgeable about HIV/AIDS. And the public health community must be vigilant in its prevention and early detection efforts.

The HIV/AIDS epidemic is still very real in this country. Putting an end to the suffering requires ending the complacency and making sure that people who need effective prevention interventions have access to them.

Copyright 2018, Positive Health Publications, Inc.

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