This interview originally appeared in the November 22, 1985, issue of the magazine.
U. S. Surgeon General C. Everett Koop is the chief public health official in America. In an exclusive interview with Christianity Today, Koop went on record for the first time about Acquired Immune Deficiency Syndrome (AIDS) a disease he calls "a ticking time bomb." An abridged version of that interview follows:
Are the public's fears about AIDS warranted?
Yes. The public health threat is considerable. Up to now, the number of AIDS cases has been doubling about every year, and 100 percent of those who have had a diagnosis of AIDS for more than three years are dead. It is a disease we can neither cure nor prevent at the present time.
AIDS can be maintained at its approximate level today if people maintain mutually faithful, monogamous sexual relationships. The difficulty is that with the virus having leapt into the heterosexual community, you never know whether a heterosexual partner might be affected. There are reports of a very high incidence of positive virus tests among prostitutes—another source of contamination within communities.
How contagious is the AIDS virus?
AIDS is an infectious disease, but it is not highly contagious. It's very hard to get AIDS, and the best evidence of this is the hundreds of health workers who have worked with AIDS patients. None has ever been proven to contract AIDS except by one of two methods: sexual contact or a needle prick that transmitted the virus.
Should children who have contracted AIDS through blood transfusions attend public schools?
On the basis of everything we know, the likelihood of contagion between an AIDS child and a normal child is infinitesimally small. You have to get the virus from body fluids—like tears, saliva, or semen—into the bloodstream of another person to cause infection. That isn't like to happen, but it would be possible for one child to bite another child. So we can never say "never."
What is your role in addressing the AIDS problem?
The surgeon general is obligated to warn the people of this country about things that are dangerous to their health and to advise them of what they can do to promote good health. If this message is being adequately delivered some other way, my obligation is essentially moot. Some people think there is a sinister reason why I have not made public announcements about AIDS, but there is no sinister reason. One of my superiors decided several years ago that he would be the spokesman who would address the AIDS problem. There is no "real story" that isn't being told. Nothing is being hidden from the public.
Do you view AIDS as a homosexual disease?
No, AIDS is a viral disease that apparently enters the victim through the blood. Several classes of people are most susceptible to it. First, there are those who receive contaminated blood through a transfusion, and we have done our best to eliminate that risk with a screening test. The number of contaminated samples that get through is almost nil.
A second high-risk category includes people who engage in a practice that transfers blood from one person to another—primarily intravenous drug uses who pass about the same needle.
The third group is made up of practicing homosexuals. The disease first came to the public's attention in the promiscuous homosexual community.
Finally, people who receive a blood product prepared from blood that has been contaminated are at risk. However, that problem has been eliminated. The virus is very susceptible to heat, so that low-heat treated blood products are freed of the virus without destroying the efficacy of the product.
Do you plan to shut down bathhouses or take other steps to change the way public facilities are operated in order to control the disease?
I can't answer that question because the authority to close bathhouses has just been conferred on me as surgeon general.
We would prefer to see the states, rather than the federal government, take whatever action is needed. But I can conceive of certain evidence coming to the fore that might indicate it makes good sense to close bathhouses. It would be much more difficult for many people to pursue promiscuous homosexual activity if such meeting places were closed.
As surgeon general, will you address the moral aspects of AIDS and how it is transmitted?
What I have said about containing AIDS is a public health statement. But it is interpreted by people who don't like prohibition of a permissive sexual lifestyle as a moral statement.
Some might say you are not moralizing enough.
As a public health official, I'm not entitled to a moral opinion in a situation like this. But the public health opinion that I give happens to coincide with a moral position of a very large segment of the country.
Because the disease is closely related to behavior Christians consider sinful, will ministering to AIDS victims present a particular challenge to churches?
Many will have difficulty separating what they consider sinful behavior from the consequences of that behavior. It is akin to the way the churches very slowly made an about-face in their attitude toward unmarried, pregnant women. Before the 1970s, churches took a fairly harsh attitude toward unmarried women who got pregnant. There was not much love and compassion extended to them to see them through delivery. As a result of this attitude, one of the pillars of the proabortion movement was born.
In the last decade, however, churches have taken the lead in a compassionate understanding of the plight of a woman who is pregnant and would rather not be—especially those who are not married. The churches' response has been to provide alternatives to abortion. Now there are more crisis pregnancy centers in the country than there are abortion clinics. Unfortunately, we don't have a similar opportunity with AIDS, because it is a deadly disease with 100 percent mortality.