The surgeon general made public health a divine commandment.
Photo by Reuters
When C. Everett Koop accepted his post as the U.S. surgeon general in 1982, few thought he would become one of the most outspoken advocates of sex education in public schools. Koop was an emerging leader within the Christian pro-life movement, and his conservative credentials caught the attention of Ronald Reagan’s team, who approached him about serving as surgeon general even before the 1980 election. Koop’s appointment reflected Reagan’s appreciation for the conservative evangelicals who voted him into office.
Koop would eventually defy expectations from both the left and the right through his bold approach to addressing AIDS, including his call for frank talk and comprehensive sex education. He has been remembered this week for the distance he created between himself and his former allies on the Christian Right. But far from leaving his religious friends behind, Koop drew upon his role as a Christian and as surgeon general to pull conservative religious groups into the fold of AIDS education, calling upon religious groups to take an active role in defining sexual morality and public health, an effort that reverberates today.
For the first five years of the epidemic, Koop monitored CDC reports from the sidelines. Despite his position as “America’s Doctor,” as he recounts in his memoir, Koop was “completely cut off from AIDS.” In those early years, religious conservatives William Bennett, who was the secretary of education, and his undersecretary Gary Bauer served as the White House’s key spokesmen on AIDS. As Jennifer Brier notes in her recent history of AIDS, they worked together to formulate a strategy that emphasized “morality, local control, and a strong executive branch” and marginalized approaches that supported behavior that they deemed immoral. In an internal memo for the Department of Education, Bauer emphasized that “heterosexual sex within marriage is what most Americans, our laws and our traditions consider the proper focus of human sexuality.”
By the summer of 1985, almost 16,000 cases of AIDS had been reported in the U.S. alone. But there were virtually no treatments at the time—the “AIDS cocktail” was still a decade away. Following an unusual visit to the Department of Health and Human Services, Reagan finally declared AIDS a top priority and asked the surgeon general to prepare a report. After months of research, Koop released the Surgeon General’s Report on Acquired Immune Deficiency Syndrome on Oct. 22, 1986. The 36-page document urged Americans to fight the epidemic as a unified group, rather than condemning certain populations disproportionately affected by the disease. In saying this, Koop attempted to shift the rhetoric of AIDS beyond its association with homosexuality and drug use. As he noted, “We’re fighting a disease, not people.” Koop’s report went further than what most observers had anticipated from the evangelical doctor, calling for comprehensive safe-sex education “at the lowest grade possible.”
Media coverage was generally quite positive, but it quickly honed in on Koop’s call for sex education. The Los Angeles Times declared: “Koop Urges AIDS Sex Course in Grade School.” Phyllis Schlafly, founder of the conservative Eagle Forum, denounced the AIDS report for looking “like it was edited by the Gay Task Force” and accused Koop of advocating that third-graders learn the rules of “safe sodomy.” Airing his frustration to reporters, Koop retorted, “I’m not surgeon general to make Phyllis Schlafly happy. I’m surgeon general to save lives.”
But Koop’s message on AIDS did not end there. Under his leadership, the Public Health Office produced a trimmed-down version of the AIDS report as part of a massive national education campaign. In 1988, 107 million copies of the pamphlet, Understanding AIDS, were mailed to every household in the United States. The national mailer described how the disease was—and how it was not—contracted. It outlined the types of behaviors that people needn’t fear engaging in, such as casual contact, kissing, or donating blood, and it dismissed the rumor that AIDS could be spread by mosquitoes. And it specified, explicitly, the behaviors that put one at risk, including needle sharing, anal sex “with or without a condom,” oral and vaginal intercourse without protection, and sex with multiple partners. The brochure even included a section called “What Is All This Talk about Condoms?”
Koop’s approach to AIDS education put medicine ahead of politics, and it drew criticism from leaders within the Christian Right. But it would be a mistake to read his prescription for HIV prevention simply as unbiased medical advice, unfettered by religious and sexual politics. As Paula Treichler has noted, while Understanding AIDS presented much-needed facts about the disease, it also reproduced a visual hierarchy of moral blame. Photographs in the pamphlet represented the epidemic’s “innocent victims,” focusing on women and children, rather than the populations most affected and most at risk. Gay men reading Understanding AIDS would be hard-pressed to see themselves in the pamphlet (unless, perhaps, the photo of a construction worker was meant to conjure images of the Village People).
Koop later complained that his position on sex education was commonly misrepresented in the press. “Often I would spend several minutes of a speech extolling abstinence and monogamy (for social and moral reasons as well as health reasons)” Koop explained in his memoir: “And then at the end I would say that those foolish enough not to practice abstinence or mutually faithful monogamy should, for their protection and their partner's protection, use a latex condom.” “Usually the press would repeat only the last phrase,” he objected: “That annoyed me.”
Anthony Petro is assistant professor of religious studies at Boston University. He is currently working on a book called After the Wrath of God: AIDS, Sexuality, and American Religion.