Out of Mississippi, a milestone in the AIDS pandemic, or at least proof of concept: If you treat an infant early enough — in this case, within 30 hours of infection — it is possible to prevent a reservoir of HIV from being established, as well as to avoid serious damage to the immune system.
These are the optimal conditions for an AIDS “cure.” They are usually not present in adults. It is often months, even years, before adults know they are infected, by which time the reservoir is already established. This breakthrough is most applicable in the developing world, especially in southern Africa, where it is not unusual for infected mothers to arrive at the emergency room without any prenatal care. For babies at the highest risk, aggressive treatment before the confirmation of infection seems to provide a jump on the virus. The caveat: Clinical trials would need to precede broad application.
The news about a blessed child in Mississippi followed shortly after the death of a 96-year-old man, former surgeon general C. Everett Koop, who would have been as pleased as anyone.
Koop was a pioneer pediatric surgeon in the 1950s, specializing in the correction of congenital birth defects. It was Koop’s humane innovation to provide extraordinary care to the most helpless of patients. And his concern for the newly born led him naturally to sympathy for the pre-born.
I was in high school when I first saw Koop, who was delivering a pro-life lecture. A combination of impressive facial hair and thundering moral certainty gave him the aspect of a Hebrew prophet. He was actually a committed evangelical Christian. His appointment by President Ronald Reagan occasioned a serious case of the vapors among liberals. Koop was attacked as scary, intolerant and unqualified.
He became the only memorable surgeon general. Koop turned his notoriety into influence, undertaking public health campaigns against smoking, domestic violence and preventable accidents. But his main contribution concerned HIV/AIDS. In the early days of the crisis, which coincided with the beginning of the Reagan administration, fear and uncertainty produced various proposals for mandatory testing, tattooing and isolation in camps. Koop was initially ordered by a superior to keep to himself any views on the topic.
But Koop maneuvered to produce the “Surgeon General’s Report on Acquired Immune Deficiency Syndrome,” explicitly detailing the modes of HIV transmission, making clear it could not be spread by casual contact and affirming that “We are fighting a disease, not people.” One of the most important public health documents of the past century was approved in a bureaucratic end run, to protect it from those Koop called “political hacks.” At a White House Domestic Policy Council meeting, Koop distributed the report on glossy paper to discourage edits and provided a superficial summary. “There was little discussion,” Koop recalled. “I knew it had not been absorbed in depth by anyone present.”
When the document was eventually absorbed — with its precise anatomical details and recommendations of condom use and early sex education — it was the turn of conservatives for the vapors. But Koop further conspired to have a brochure containing similar information distributed to the entire IRS mailing list of 107 million households.
Some of the tributes to Koop have run along the lines that his “personal moral views never clouded his judgment” — as though he championed public health in spite of his religiously informed morality. This misses his remarkable inner consistency. “My whole career had been dedicated to prolonging lives,” he said, “especially the lives of people who were weak and powerless, the disenfranchised who needed an advocate: newborns who needed surgery, handicapped children, unborn children . . .people with AIDS.” A passion for human dignity remains ideologically unpredictable.
And Koop understood — as some of his co-religionists still don’t — that public health is the realm of likely behavior. “Total abstinence for everyone is not realistic,” he explained, “and I’m not ready to give up on the human race quite yet.” So he spoke for condom use as well as for monogamy.
In preventing the spread of AIDS, compassion requires both universal sympathy and realism about human conduct. No one deserves his or her disease. And no one at risk — sympathetic or marginalized — is beyond our practical concern, including intravenous drug users, sex workers, men who have sex with men, and children born of infected parents.
This moral affirmation is no longer particularly revolutionary, in part because Koop refused to give up on the human race.