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The Anatomy of an Epidemic

newsletter and returned to his allergy research. He still pays attention to what's happening in the AIDS field, though. He's pleased that so many antiviral drugs have been developed to combat AIDS, but he's surprised that an AIDS vaccine is proving elusive. "The virus is very clever in its ability to shift and hide" from the immune system, he concedes. "It mutates all the time."

Crusading for acceptance
Dr. C. Everett Koop, Dartmouth College '37: former U.S. surgeon general; now a professor of surgery, of community and family medicine, and of psychiatry at Dartmouth Medical School and senior scholar of Dartmouth's Koop Institute

C. Everett Koop spent most of his career as a pediatric surgeon, so a disease that appeared to affect only gay men was far outside his ken. Nevertheless, when the first MMWR reports came out, he recognized that these unexplained infections spelled trouble. The problem was that he'd been appointed but not yet confirmed as U.S. surgeon general, so he felt powerless to speak out. Even after
his confirmation in November of 1981, he had little influence at first over how the Reagan administration communicated to the country about AIDS.

Koop says that in the early 1980s, President Reagan didn't realize the implications of AIDS. "One thing that was absolutely obvious was that members of the cabinet and members of the domestic policy council kept Reagan and me apart," Koop contends. "They didn't keep him informed. It made him look as though he didn't care, or didn't know what to do about it, or was a heartless guy—all of which are wrong."

But other governmental agencies were acting. "Even if people like me are muzzled and not allowed to say what they want to, the momentum of the CDC, NIH, FDA . . . keeps rolling on," says Koop.

There was momentum in AIDS research, too. "We learned as much about AIDS in six years as we learned about the hepatitis virus in over 40 years," Koop says. "Largely that was because we had done so much bench science on cancer. A lot of the research was applicable to AIDS, and that's why we made the progress that we did." Soon, researchers had identified the virus's antibodies. "We also began to identify the virus itself," says Koop.

"We couldn't see the virus, but we could see the footprints of where it had been. That was of great help, because knowing about the virus enabled us to clean the blood supply up." By 1985, just four years

On June 5, 1981, Saxon and Gottlieb's article became the first published report on the emergent AIDS epidemic. A longer version of their article appeared in the New England Journal of Medicine on December 10 of that year.

after the first MMWR report, U.S. blood banks were able to screen for HIV.

In 1986, Koop prepared a report on AIDS that he calls "the most frank report that was ever put in the federal register. I used four words which I thought, talking about AIDS, you couldn't avoid using . . . penis and vagina and rectum and condom." Back in those days, many people worried that AIDS could be transmitted by cats, mosquitoes, doorknobs, toilet seats, and even casual social contact. "My job as a health educator for the government at that time was not only [to explain], 'This is how you get AIDS,' but perhaps even more important, 'This is how you do not get AIDS.'"

Koop made it clear that AIDS was spread by the transmission of specific body fluids—semen and blood. "I went to tremendous lengths" to emphasize that "you didn't get it from kissing a girl goodnight, and you didn't get it from driving a car that an AIDS person had driven," he says. "That was very important because people were being kept out of school because it was thought that they would contaminate other children."

Then in 1988, a flyer titled Understanding AIDS, a summary of Koop's 1986 report on the disease, was mailed to all 107 million U.S. households.

"I did a lot to help educate people," says Koop. "Essentially, what the country needed was a frank, charismatic leader who was not afraid to talk about AIDS." The fact that Koop had come into the Reagan administration as an acknowledged conservative made his forthright approach to AIDS all the more powerful.

When mandatory AIDS testing was proposed in 1987, Koop and other public health officials worried that it would result in widespread discrimination against those who were HIV-positive and might drive people with HIV/AIDS underground, away from help and counseling. AIDS testing has remained voluntary and anonymous. Koop thinks it's time to change that policy, however, so that public health departments can use


  • U.S. Public Health Service (USPHS) recommends how to prevent AIDS transmission by sexual contact and blood transfusions.
  • CDC adds a fifth risk category: female sex partners of men with AIDS.
  • World Health Organization (WHO) begins global surveillance of AIDS.
  • Researchers at Pasteur Institute in France isolate virus that causes AIDS and call it lymphadenopathy- associated virus (LAV).
  • Both Time and Newsweek run cover stories about AIDS.


  • The CDC suggests that reducing needle sharing should prevent transmission of the AIDS virus among IV drug users.
  • Dr. Robert Gallo at the National Institutes of Health (NIH) isolates a virus that causes AIDS and calls it human T-cell lymphotropic virus type III (HTLV-III).
  • Gay bathhouses begin closing in cities all across the United States.


  • LAV and HTLV-III are determined to be the same.
  • Atlanta hosts the first International AIDS Conference.
  • USPHS issues recommendations on how to prevent HIV transmission from pregnant mothers to their unborn children.
  • President Reagan mentions AIDS at a press conference.
  • Blood banks in the United States start screening for the AIDS virus.
  • Actor Rock Hudson dies of AIDS.
  • In Indiana, 13-year-old Ryan White, after contracting AIDS from a blood transfusion, is barred from school.


  • International Committee on the Taxonomy of Viruses rules the AIDS virus be called human immunodeficiency virus (HIV).
  • HIV-2 is discovered among commercial sex workers in West Africa.
  • Needle exchange programs open in Boston and New Haven, Conn.
  • U.S. Surgeon General Koop issues a report calling for AIDS education and condom use.

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