While the Reagans Stayed Silent on AIDS, Their Surgeon General Thankfully Did Not

I will not forget how Dr. Koop's conviction that responding to AIDS could be "dictated by scientific integrity and Christian compassion," gave one fellow surgeon hope for a future where others like him, suffering from this devastating disease, might not be left to do so alone.
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AIDS awareness red ribbon
AIDS awareness red ribbon

On March 24, Douglas Brooks, Director of the Office of National AIDS Policy stepped down after two years of serving in the Obama administration. In a White House blog post, he expressed his gratitude for the opportunity to be in such a vital leadership position in the fight to end AIDS. An HIV positive, openly gay, African-American, Brooks' prominent role in shaping U.S. AIDS initiatives and policies underscored how far we've come in the national conversation about AIDS research, prevention, and care.

Unfortunately, Hillary Clinton's March 11 gaffe that still has her team scrambling for damage control served as a painful reminder of how different that conversation used to be. Andrea Mitchell interviewed the Democratic Presidential Candidate moments before Nancy Reagan's funeral service, and Clinton erroneously praised the former First Lady's actions on HIV/AIDS as "very effective, low-key advocacy" that "penetrated the public conscience." When she'd prefaced her commentary with, "It may be hard for your viewers to remember how difficult it was for people to talk about HIV/AIDS back in the 1980s," Clinton's memory was, apparently, having a hard time of its own.

President Reagan's non-existent policy on the AIDS crisis is an ugly stain on that era -- a stain that still seeps into today's conversation surrounding the disease. At its onset and for the following six long years, the Reagan administration virtually ignored the mysterious virus that was killing thousands of people, primarily gay men, and decimating communities at unprecedented rates. The Reagans' lackluster response stalled funding and research efforts through which countless lives might have been saved.

Clinton's comments re-opened wounds for many of us directly or indirectly associated with the early outbreak of the epidemic that claimed our loved ones too soon and prompted a quick apology and further conversation about the pressing needs for ongoing research, expanded health care and increased global funding for HIV/AIDS prevention and treatment. The question remains whether Clinton's apology will be the necessary olive branch to assuage her supporters, lessen the criticism and strengthen the dialogue.

Regardless, one slice of that dialogue that should be included is a noteworthy thread of the Reagan legacy on HIV/AIDS that warrants our praise: President Reagan's nomination of Dr. C. Everett Koop as Surgeon General of the United States.

I doubt that Reagan intended for Koop's appointment to have far-reaching implications that would positively address the AIDS crisis, but it was an inspired move that proved monumental for those AIDS victims who, until then, felt mostly blame from a society that largely believed them to be responsible for their own infection.

When Ronald Reagan nominated C. Everett Koop in March of 1981, I was nine years old, then living in Canada, too young and too distant from the U.S. system of government to know what being a Presidential nominee for public office actually meant. I didn't understand how much Koop's spiritual leanings--a devout evangelical Christian--played into Reagan's decision as part of the game where politicians repay their base. Koop's nomination satisfied Reagan's most conservative domestic policy advisors who'd brandished their influence to get him elected.

I also didn't understand that those same spiritual leanings troubled those who justifiably feared the Religious Right's ability to impact government policy on national healthcare issues. Groups advocating for women's and gay rights, the American Public Health Association, and progressives in Congress delayed Koop's nomination process for over eight months before he was finally confirmed in November 1981.

However, by the end of his eight-year tenure as U.S. Surgeon General, C. Everett Koop's groundbreaking work to reframe the international conversation about HIV/AIDS from one about issues of morality to one about issues of appropriate medical care made him important enough in my world that I'd remember him for good.

My father was a surgeon, too. A leading expert in general and thoracic surgery. At the height of his thriving career, he was one of the first doctors trained in thoracic medicine to practice in the Canadian Maritimes. In 1985, that work was cut short when, at 42, he suffered a heart attack and underwent a quadruple bypass. Eight months later, it was discovered that he'd been given AIDS-tainted blood during surgery. My father tested HIV positive.

In the 1980s, Canadian politicians were no less apathetic in developing public health policy on the emerging AIDS crisis than their U.S. counterparts. Since the disease primarily impacted what many judged an immoral segment of society -- homosexuals, intravenous drug users, sex workers -- unfair stigma fuelled fear and slowed effective action. The same hysterical calls to decrease the risk of infection through casual contact with mandatory testing, public identification, and quarantines reverberated through our neighborhoods. And the same moral condemnation that kept Ronald Reagan and his conservative supporters silent about the escalating epidemic was also voiced in many of our church communities.

My father was a committed Christian and struggled with society's perception of his disease and its causes. As a doctor, he felt disempowered by the limitations of his and the greater health system's knowledge about the facts of HIV. Unwilling to risk the possibility of infecting his patients, my father ended his medical practice and took an advisory position. And refusing to allow his family to endure any form of ostracism as a result of his HIV status, he kept his illness secret from almost everyone.

I watched my father, the man whose charisma and brilliance had made him larger than life, gradually shrink beneath the weight of isolation prolonged by the general public's, the church's and the health community's failures to effectively address his disease with compassion and support.

But, in 1986, responding to mounting public pressure from activist groups, President Reagan finally instructed his Surgeon General to report on the AIDS crisis. After months of independent research, meetings and interviews with leading scientists and medical experts, a diverse array of vocal groups in the fight against AIDS, and AIDS patients themselves, Dr. Koop wrote a 36-page public report on AIDS. In clear, simple language, the report distilled the facts and the myths -- particularly with regard to the virus's transmission -- and recommended important protective measures, including advocating for sex education in schools and condom use, a bold stance that alienated him from many of his conservative supporters.

By also demanding that the public acknowledge the multiple faces of AIDS, each deserving equal and appropriate care, C. Everett Koop became the ally my father so desperately needed. Here was a man of deep faith, a practitioner of medicine prioritizing his responsibility to draw attention to the plight of AIDS victims and provide necessary support ahead of any personal moral stance. "It is time to put self-defeating attitudes aside and recognize that we are fighting a disease -- not people," Koop said.

In the next two years, Koop's courageous advocacy -- some of the first public conversations about HIV -- along with his 1988 mass mailing of an 8-page pamphlet, "Understanding AIDS," to every U.S. household, began a tidal shift in both perception and action in the fight to control the disease's spread, end discrimination, and seek effective treatments and a cure.

As Hillary Clinton and her campaign set the record straight on the Reagans and AIDS, we must not forget C. Everett Koop's legacy -- a legacy that profoundly impacted the global response to this catastrophic pandemic. A legacy that, 20 years later, ties to the progress inherent in the leadership of Douglas Brooks.

I will not forget how Dr. Koop's conviction that responding to AIDS could be "dictated by scientific integrity and Christian compassion," gave one fellow surgeon hope for a future where others like him, suffering from this devastating disease, might not be left to do so alone.

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