Koop in fact never doubted that AIDS was connected to questions of sexual morality and that religious groups should play a formative role in shaping AIDS education. “Knowing what Christians believe,” Koop explained, “I felt I was in a unique position to understand their point of view.” He aspired to draw his religious supporters into his AIDS campaign:
I saw a unique opportunity for these groups to join together to produce a morally based sex education program that would conform to their moral standards and also serve to protect a generation of youngsters from AIDS. I hoped that we could work together after the release of the report to unite morality and science.
Koop embarked on a lecture tour, and his first stop was Liberty University, where he was invited by Jerry Falwell, founder of the Moral Majority. The surgeon general described Falwell in a later reflection on his visit as “one of the most understanding and far sighted members of the religious community in reference to AIDS.”
Speaking to his Liberty University audience, Koop first advocated monogamy, which “may sound like a morality lesson,” he explained, “but it also happens to be good science. In containing the epidemic of AIDS, science and morality advance hand-in-hand toward the same goal.” Koop’s second message advised caution for single people, describing as “fool-hardy” all those “who will not be abstinent or will not achieve a faithful monogamous relationship and, therefore, will expose themselves and others to the AIDS virus.” His reluctant advice to such foolhardy people was the following: “Don’t have sex with someone who could carry the virus of AIDS … a person who, for example, practices high-risk behavior. That includes homosexuals, intravenous drug users, prostitutes, and other persons who have many different sex partners.” Finally, Koop continued, if you do have sex with such a person, “a decision that could have serious health consequences—then, if you’re a man, at least use a condom from start to finish. If you’re a woman, make sure your partner uses a condom."
Over the past few years, I have assigned Understanding AIDS and Koop’s lectures in courses on the history of American Christianity and religion and medicine. Following Koop’s advice about using a condom from start to finish, I like to pose the question: When, exactly, does sex start? How should lesbians regard these suggestions? What kinds of assumptions are built into this advice? This isn’t meant to be a damning critique of Koop’s message. But slowly, students begin to see how difficult, if not impossible, it is to describe HIV prevention in a way that fully escapes politics. As AIDS activists contended at the time, sex is political.
Koop clearly favored abstinence and monogamy not simply as scientific measures to prevent the spread of AIDS, but as moral lessons. In pointing this out, I don’t simply intend a criticism of Koop’s moral approach to sex education. Koop proves an interesting figure in the history of American religion and public health not only because his AIDS message drew criticism from the far right, but also because he struggled to maintain ties with conservative Christians. He represents a pivotal, and often pivoting, figure both in the history of the Christian Right and in the development of AIDS education, including later programs that have emphasized abstinence training. He offers an important contrast to the loudest and most vitriolic leaders within the Christian Right, who regarded AIDS as no less that God’s wrath for sexual immorality. As he often said, he was the surgeon general for everyone, not just for Christians.
But it would be shortsighted to assume that placing medicine before politics translated into a public health program free from moral claims. Koop’s focus in HIV prevention on abstinence, monogamy, and, as a last choice, using condoms reversed the priorities of a number of public health leaders, who started with the assumption, from a pragmatic standpoint, that people would engage in sex and so needed to be equipped with the proper education and prevention tools. Koop’s emphasis has since been picked up, and often extended, by other American evangelicals, such as Kay and Rick Warren. In the past decade, their HIV & AIDS Initiative at Saddleback Church has led the way for many American Christian to become involved in AIDS relief work, often focusing on sub-Saharan Africa. Perhaps one of Koop’s most lasting legacies, then, was to render public health no less than a divine commandment in itself, and thus the proper domain of religious attention as well.