The New York Times - October 22, 1986
Philip M. Boffey

The Surgeon General said that, in the absence of any cure for AIDS or a vaccine to prevent it, the only effective way to slow the AIDS epidemic was through educating the public about how to avoid infection with the AIDS virus.

He rejected the idea of compulsory blood testing to identify infected individuals. He also opposed proposals to quarantine or tattoo carriers of the AIDS virus.

Dr. Koop's advice was set forth in a 36-page report that was requested by the White House and in amplifying comments at a news conference. The report is the Government's first major statement on what the nation should do to stop the spread of AIDS.

In his report, Dr. Koop said: "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.

'Silence Must End'

"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."

Dr. Koop said the AIDS epidemic had already claimed the lives of almost 15,000 Americans and was expected to have killed 12 times that number by the end of 1991. With proper education and information, he said, as many as 14,000 people who would otherwise die from AIDS in 1991 "could be saved."

He urged that education about AIDS should start "at the lowest grade possible" in elementary school and be "reinforced at home" by discussions between parents and children. He also called for stepped-up educational efforts to reach teen-agers, blacks, people of Hispanic descent and virtually "every adult and adolescent" in the country.

Dr. Koop did not specify just what parents should tell their children but left that to be decided by individual families. However, his report to the nation describes, in unusually explicit detail for a Government document, the kinds of activities that should be avoided and personal measures that should be taken to avoid the risk of infection with the AIDS virus. He said he had written the report himself "to provide the necessary understanding of AIDS."

Cue for Broaching Subject

A spokesman for the Public Health Service noted that some children asked questions about sex at a very early age, allowing an opportunity to discuss the sexual transmission of AIDS even before school begins. In some cases, the spokesman said, parents may want to bring the subject up at ages as young as 6 or 7 years of age if the child has not raised questions about sex.

The Surgeon General's report stresses that AIDS is "not spread by common everyday contact" such as shaking hands, hugging, social kissing, crying, coughing or sneezing. Nor has AIDS been contracted from toilet seats, dining at restaurants, even if an employee there is infected, eating utensils, or from hot tubs, swimming in pools or sharing linens, the Surgeon General said.

AIDS is spread primarily through sexual contact and the sharing of intravenous drug needles and syringes used for illicit drugs, Dr. Koop said. "It is contagious in the same way that sexually transmitted diseases, such as syphilis and gonorrhea, are contagious," he added.

He warned that the AIDS virus could be spread by vaginal or anal intercourse and also warned of the potential danger of oral sex. Although it has thus far infected mainly homosexual and bisexual males in this country, he said, heterosexual transmission is expected to increase in the future.

Sexual Behavior and Risks

The report warns that "men who have sexual relations with other men are especially at risk" and that "the risk of infection increases according to the number of sexual partners one has, male or female." The virus enters a person's blood stream through tiny, invisible tears in the surface lining of the vagina or rectum, which can result from insertion of the penis, fingers or other objects, the Surgeon General warned.

The only couples who are safe are those in monogamous relationships where neither partner has been exposed to the AIDS virus, or those who abstain from sexual contact or contaminated needles, he added. "Unless it is possible to know with absolute certainty that neither you nor your sexual partner is not carrying the virus of AIDS, you must use protective behavior," he said.

"Unless you know with absolute certainty that your sex partner is not infected with the AIDS virus, through sex or through drug use, you're taking a chance of becoming infected," Dr. Koop said.

Advice on Best Protection

The best protection against infection right now, barring abstinence, is use of a condom," he added. "A condom should be used during sexual relations, from start to finish, with anyone whom you know or suspect is infected."

Dr. Koop's report urged those who have engaged in high risk sexual activities to have a blood test to see if they have been infected.

Teen-age boys should be warned not to have rectal intercourse with other males, he said, and teen-age girls should be taught to say no to sex and drugs. "Do not have sex with prostitutes," he added, because they are often infected from drug needles or previous sexual partners.

Drug addicts who are unable to give up their habit must use "a clean, previously unused needle" or syringe to avoid AIDS, the Surgeon General said.

The report on AIDS is available from the United States Public Health Service by writing to AIDS, Box 14252, Washington, D.C., 20044.

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