The following address by the late C. Everett Koop, MD, Sc.D., Surgeon General of the U.S.  Public Health Service, was presented to the Christian Life Commission of the Southern Baptist Convention in Charlotte, North Carolina on March 23, 1987

Greetings to hosts, guests, and friends:

I'm pleased to come before you to renew our valued friendship and to share my thoughts with you. I feel comfortable doing this, because we've shared many other serious moments together over the past few years, ever since the president made me the country's Surgeon General.

I've been no stranger to controversy, it's not by design, I assure you, but the public health problems that really matter today are very complex, and they generate a great deal of discussion, some of it helpful, some of it not so helpful, some friendly, some not so friendly.  Throughout this time, however, the Southern Christian Life Commission has been a support and a comfort to me, we've not always agreed on every point of every issue, but I’ve always known that, whatever your position, you took it for the same reasons I took mine: to save lives, to preserve human dignity, to demonstrate compassion and to take responsibility in the midst of confusion.

We have, for example, confronted together the profound moral and ethical questions raised by “Baby Doe,” and all the answers are not in yet by any means and we've faced the issue of pornography in American life and we've dared to point out the harm that such trash visits upon the community and upon the family.  Now I need your support and your comfort once again, we have another issue before us and before the country, and it is testing our moral fiber like no other. The new issue we face, together, the issue of AIDS.

What is it? And what should we do about it? So much has been written and said about AIDS that I won't take the time to go over it all again, instead, let me emphasize just a few key points from my own perspective as your Surgeon General.  First, AIDS is a mysterious, contagious disease, it's a virus, we've seen it, we've named it, we also know how it gets passed from person to person. It is passed either in blood or in semen, as a result, the disease has been most prevalent among homosexual and bisexual men and among drug abusers who borrow intravenous needles from other addicts who have AIDS.

Lately, however, AIDS has begun appearing in heterosexuals who are not drug abusers, apparently they contracted the disease through heterosexual relations with a carrier of the virus, and that's a development of major concern.  But having said all that, I must nevertheless tell you that science still doesn't know the true nature of the AIDS virus, and until we do, we have no way of developing an effective vaccine against it. In addition, the disease is spreading, in fact, the number of victims is doubling every 13 or 14 months, as of a year ago, for example, we had had a total of 16,000 cases of AIDS reported to public health authorities since the first reports of AIDS were made back in June of 1981.  

Today that overall 5-year total is 30,000 cases, over half of those victims have already died of the disease, and the rest apparently will, by this time next year we will have added over 23,000 new cases of AIDS, and by the end of 1990 my colleagues in the public health service predict that a quarter of a million people will have contracted AIDS.

So we must be very clear about this disease in at least two respects: it is spreading among more Americans and it is killing more Americans as it spreads, the situation we have today is very much like the situation in Europe several centuries ago, when smallpox and the bubonic plague destroyed hundreds of thousands of lives and changed the course of history. I deeply hope and pray that such a catastrophe will not happen, it shouldn't happen, but we can't let that be decided by default, collectively as well as individually, we need to do things that have to be done.  And right at the top of the list is need to become informed of what this threat really is.

That was what motivated president Reagan to direct me, back in February 1986, to gather together everything we knew about AIDS and put it into a plain-English report to the American people, during the preparation of the report, I met with individuals and groups from across the spectrum of society, groups like your own Christian life commission the national council of churches the synagogue council of America and the national conference of Catholic bishops, the National Education Association, and the National P.T.A.  And I talked with the National Coalition of Black and Lesbian Gays and the Washington Business Group on Health, 26 groups in all.  

They were all extraordinarily candid, and each one also pledged — as you did — to help get my report into the hands of every American. After 8 months of listening and writing, I delivered my report to the cabinet and to the president, it was accepted and I released it on October 22, 1986. You may recall that my entire report is not very long, and I only devoted 92 words to the topic of education AIDS education in particular and sex education in general. But those 92 words have captured most of the attention of the media, of parents, of educators, and of public officials at all level of government, and I want to spend a moment or two talking about it. 

The reason people have become so interested in my views on education is that the issue goes to the heart of each person's own system of moral and ethical values, or lack thereof, I believe I introduced the subject in a straightforward way. I said in my report that, “education about AIDS should start in early elementary school and at home so that children can grow up knowing the behavior to avoid to protect themselves from exposure to the AIDS virus. The threat of AIDS can provide an opportunity for parents to instill in their children their own moral and ethical standards.”  Some people were unduly alarmed by that phrase, “early elementary school,” would that include kindergarten? I'm afraid so, I concluded the report with exactly the same thought, I said, “education concerning AIDS must start at the lowest grade possible as part of any health and hygiene program. There is now no doubt that we need sex education in schools and that it must include information on heterosexual and homosexual relationships. The threat of AIDS should be sufficient to permit a sex education curriculum with a heavy emphasis on prevention of AIDS and other sexually transmitted diseases. And I would not change any of the words in that paragraph either. Sex education can and should be non-threatening. It can teach good values. It can help develop the child's own sense of personal responsibility, and it can strengthen the concept of “the family.”

This kind of sex education should unfold according to the developmental age of children and to their different levels of awareness and curiosity. I don't see any reason to cling to a rigid schedule based on chronological age. If the curriculum is well-planned and thoughtfully carried out, then it will be possible to bring to the attention of the children the facts about sexually transmitted disease — and AIDS in particular — along about the junior high school years the years of early adolescence. If this makes us uncomfortable, if it is awkward to do, if it appears to conflict with other information we might have, those are problems that we, as adults, have to resolve in a way that enables us to nevertheless tell our children what they need to know and have a right to know. I'm not saying it's easy, but it's far from impossible.

For example, in my report you will find two straightforward precautions, the first one is simple enough, it advises you to find someone who is worthy of your respect and your love, give that person both, and stay faithful to him or her. In other words, short of total abstinence, the best defense against AIDS is to maintain a faithful, monogamous relationship in which you have only one continuing sexual partner, and that person is as faithful as you are.   

My second message is for people who don't yet have a faithful, monogamous relationship for whatever reason, so this second message Is, proceed with extreme caution: it's important that you know with absolute certainty that neither you nor your partner is carrying the AIDS virus, if you're not absolutely certain, then you must take precautions, and the best one available — though far from perfect — is to use a condom from start to finish. 

From my viewpoint, as a public health officer, I tell people that when they have sex with someone, they're also having sex with everyone else with whom that person has ever had sex. This kind of information is clear enough and straightforward enough to tell children. There's nothing terribly esoteric about it, and I don't believe it is unnecessarily frightening. Yet, many adults — parents and teachers alike — are having trouble coming to terms with it.

The more I’ve thought about this phenomenon, the more I’ve come to believe that the difficulty is not in the facts themselves concerning sexuality, human reproduction, and AIDS. Rather, the difficulty is in the significance of those facts relative to the totality of a sensitive and affirmative human relationship. Such a relationship will include some fulfilling sexual activity, but it is not defined only by that activity. There's much more to a loving, caring, respectful, and tolerant human relationship than just “good sex.” A relationship devoid of love and responsibility is like a piece of pie that's all crust and no filling, and young people ought to be advised of that. 

Novelists call it “true love,” sociologists call it “marital fidelity.” The Surgeon General calls it “monogamy.” But whatever you call it, we all want that well-rounded, balanced, loving, and fully considerate relationship.  A relationship that's enriched by sex, not overwhelmed by it or devoid of it either. Such a relationship is an ideal but “real life” isn't always like that. It's imperfect, it's give-and-take. Most grown-ups know and come to accept human imperfection, but children don't, and won't, without a compassionate understanding of the imperfect nature of many human relationships, a child's education will be, itself, very imperfect.   

So if parents are to educate their children about human relationships — sexual and otherwise — they must first understand and accept. The nature of their own, for many, that's hard to do, parents — and adults in general — are not very good about talking to each other about their sexuality. They feel frustrated, guilty, and even angry because they are unable to do the thing that. They know — intellectually and emotionally — they should do, but they just can't. And those feelings of frustration and guilt make it all the more difficult for them to tell their children about the full dimensional nature of an ideal human relationship.

Nevertheless, I want parents to try. I want parents to do this with compassion, with respect and with love, and with some understanding not just of the child who's listening, but also of the adult who is speaking. Still, it remains as my sincerest wish that the parents of this country will be the primary teachers of sex and human relations to the children of this country. I say that, knowing full well that many parents simply can't do it, but the task should not therefore be left, by default, to the movies, to television, or to the street-corner. We can't do that and still protect the millions of young lives that are at risk of AIDS.

Just as a kind of footnote, let me share with you just what children learn from the media. Some research was recently done by Michigan state university to see what kinds of sexual experiences children were exposed to through movies and television. The researchers found, for example, that a large number of 7th- and 8th-grade girls watch between 1 and 2 hours of soap operas every day after school. And what are they seeing? The researchers report that, among other things, sexual intercourse between unmarried partners is shown or discussed on mid-day soap operas on an average of 1.56 times an hour.

In the evening, a larger number of 9th and 10th-grade girls and boys watch 3 to 4 hours of television, on those prime-time evening shows, acts of unmarried intercourse are shown or discussed on an average of once an hour. The same researchers also found that over 60 to 70 percent of those 9th and 10th-graders saw the top 5 “R”-rated films, in which sexual intercourse between unmarried partners occurred on the average of 8 times per film. In the worst films, it occurred 15 times.

This kind of research illustrates the fact that America’s children don't live in a vacuum, and, therefore, we all must work together to help our children grow up and cope with the real world of pleasure and danger. And for me, that's the compelling reason why our schools, churches, synagogues, and other community institutions must do whatever possible to provide our children with the best available information — physical, sexual, emotional, and psychological — to help them negotiate their own way through the human condition. I think in today's world, which is run by a disappointing generation of adults — children have a right to all the help they can get.

 I've been talking so far about some issues in the context of our fight against AIDS, but I believe that much of what needs to be done because of AIDS also needs to be done because of other difficult problems as well.  For example, I mentioned earlier in my remarks the fact that we  — you and I — have stood together in opposition to the spread of pornography in our society.  I would have to say that nothing is a more powerful weapon against this disgusting material than the honest truth about human sexuality.  That's not the only answer, of course, and I won't let pornographers off the hook as easily as that.

But I believe that a child who is given the facts about his or her own sexuality — in a matter-of-fact yet caring manner — is a child who will feel more secure as an evolving adult and will have only contempt for pornography.  Similarly, I think of those million or so teen-age girls who have unwanted pregnancies each year, and I think about the 400,000 of them who resort to abortion and who plunge themselves and their families into such an abyss of personal tragedy, and I wonder how many of them might have escaped that fate, if their parents or teachers or clergy had told them about their own sexuality how important it was to understand it and make it a part of their lives, and not allow sexuality to take over their lives.   

Yes, it is true, that we have ahead of us an enormous challenge in the form of the spreading and deadly disease of AIDS. And it is also true that the single weapon we now have available to us in the fight against AIDS is education, education, and more education, especially of our young people, 'who are so vulnerable. But we should be providing this information not only because of the threat of AIDS, we should be providing it because knowledge of human sexuality is a child's best defense against many of the most grateful and exploitive phenomena of modern society — and there are a great many, I’m sorry to say.  

This, then, is the message I’ve been relaying to the American people since October 22. Reduced to its essentials, the message has three parts:

First, if you don't know what you're doing, don’t do it, abstain. This is the core of my message to young people, who are still in the process of learning about their own sexuality and who are not yet ready to assume all the responsibility that comes with a total human relationship.

Second, if you're an adult and abstinence is not an acceptable alternative, your best possible defense against AIDS — and against a great deal more in this world — is a faithful, monogamous relationship.  As Lee Iacocca might say, “If you've got one keep it, if you don't have one find it.”

And third, if you're an adult who understands your own sexuality but you just haven't found that magical monogamous partner yet, then please be careful and, among other things, use a condom from start to finish.   

Let me again emphasize that we're talking about a disease that now threatens everybody, everywhere.  It is no longer primarily a disease attacking the homosexual communities of San Francisco, Los Angeles, and New York City. It is now appearing in all 50 states and among heterosexuals, and that means the rest of us. I've delivered this message — and variations of it — many times in the past few months, but it doesn't get any easier. It's essentially a grim message and I guess I’m something of a grim courier.

My only hope is that every American who hears or reads my message, will believe it and do his or her part to stop the spread of AIDS ought to protect and save the lives of people at risk, including and especially our young people. And that they will help return sexuality back to its rightful place in the spectrum of human experience, have it again be a part of the total complex of human, caring, interpersonal relations.

Now, a final word. You, as Christians, will continue to be tested by tremendous questions that arise from the turmoil of current events, these questions make you examine and re-examine who you are and what you stand for. This is not an age for the faint of heart or of soul. One of those questions involves homosexuality. You can't avoid it if you're going to discuss AIDS.  If you regard homosexual behavior as sin, please remember that one of the fundamental teachings of Christianity has been to “separate the sin from the sinner.” You may hate the sin but you must love the sinner. And let me repeat again the crux of our battle, it is a battle, against a disease, not against people.

This is especially true when we consider the innocent victims of this disease:  The wives of bisexual men, the spouses of IV drug users, the wives and husbands of promiscuous spouses. And I’m afraid we must also count the babies born to IV drug users or otherwise infected mothers, they are being abandoned and are dying alone in hospital nurseries. They are the most innocent victims of all. When AIDS intrudes upon your own lives, please remember that the sick and the dying require our care and our compassion, no matter how the illness was contracted.

Thank you for your understanding and support in the years ahead, as in the years past. God bless each one of you.