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The Supreme Court eventually struck down Koop's agreement as well, mooting the entire issue. But the process of compromise had opened a crack between the surgeon general and radical prolifers, who viewed Koop's acceptance of the review committees as "caving in" to the medical establishment. If the prolife lobbyists came away slightly disillusioned with Koop, he came away frustrated by their all-or-nothing mentality. Despite his ironclad personal views on the issues, he could see occasion for legislative compromise.

Heat from the Baby Doe issue dissipated quickly after the court decisions, and Koop retained his stature with most political and religious conservatives. But in 1986 a new crisis fell into Koop's lap, like a live grenade. As early as 1981 administration officials had detected the rumblings of a major health epidemic concentrated in groups practicing "high-risk behaviors," notably, homosexuals and intravenous drug users. Ignoring outcries from the gay community, the President avoided discussing; the disease that became known as AIDS. Not until 1986, with 10,000 cases confirmed, did he ask the surgeon general to prepare a report on the topic.

According to one HHS staff member, at the time 5,000 letters a week were pouring in from conservatives pleading against research and education funds: "God's judgment," they argued, should be allowed to run its course. Given the climate, nearly everyone expected a reproachful, moralistic report. Gay-rights leaders were openly cynical.

But Koop took his assignment seriously. He scheduled two-hour interviews, off the record, with 25 different groups, ranging from the National Lesbian and Gay Task Force to the Southern Baptists. He asked for authority to prepare the report himself, avoiding the normal bureaucratic channels that might weaken it. Working at home at a stand-up desk, he went through 27 drafts. These words set the tone of the report: "At the beginning of the AIDS epidemic many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups 'deserved' their illness. Let us put those feelings behind us. We are fighting a disease, not people."

The AIDS report was remarkably blunt, spelling out the dangers in anatomical detail, and calling for sex education "beginning at the lowest grade possible." Although prescribing abstinence and sex within monogamous marriage as the safest course, it also recommended condoms for anyone who had multiple sex partners or engaged in homosexual acts. "The silence must end," Koop declared.

The silence did end. Voices within the Reagan administration denounced Koop's stances on compulsory AIDS testing (against) and early sex education (for). But liberal politicians, such as Ted Kennedy and Henry Waxman, commended the report for its candidness and its emphasis on the health aspects of the disease. Gay-rights activists declared Koop a "certifiable AIDS hero." Congress stood behind Koop, mandating something unprecedented: that an educational booklet on the disease be mailed to every household in America.

Some political conservatives were outraged. Paul Weyrich (a founder of the Religious Right) and ERA nemesis Phyllis Schlafly mobilized against Koop, calling for a boycott of a Washington dinner scheduled in his honor. Their letter read, in part, "His report on AIDS issued last November reads as though it were edited by the National Gay Task Force. … Dr. Koop's proposals for stopping AIDS represent the homosexuals' views, not those of the profamily movement."

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The Embattled Career of Dr. Koop