REPORT ON AIDS: FROM THE SURGEON GENERAL, US PUBLIC HEALTH SERVICE

   This is a report from the Surgeon General of the US Public Health
Service to the people of the United States on AIDS. Acquired Immune
Deficiency Syndrome is an epidemic that has already killed thousands of
people, mostly young, productive Americans. In addition to illness,
disability, and death, AIDS has brought fear to the hearts of most
Americans--fear of disease and fear of the unknown. Initial reporting
of AIDS occurred in the United States, but AIDS and the spread of the
AIDS virus is an international problem. This report focuses on
prevention that could be applied in all countries.

   My report will inform you about AIDS, how it is transmitted, the
relative risks of infection and how to prevent it. It will help you
understand your fears. Fear can be useful when it helps people avoid
behavior that puts them at risk for AIDS. On the other hand,
unreasonable fear can be as crippling as the disease itself. If you are
participating in activities that could expose you to the AIDS virus,
this report could save your life.

   In preparing this report, I consulted with the best medical and
scientific experts this country can offer. I met with leaders of
organizations concerned with health, education, and other aspects of
our society to gain their views of the problems associated with AIDS.
The information in this report is current and timely.

   This report was written personally by me to provide the necessary
understanding of AIDS.

   The vast majority of Americans are against illicit drugs. As a
health officer I am opposed to the use of illicit drugs. as a
practicing physician for more than forty years, I have seen the
devastation that follows the use of illicit drugs--addiction, poor
health, family disruption, emotional disturbances and death. I applaud
the President's initiative to rid this nation of the curse of illicit
drug use and addiction. The success of his initiative is critical to
the health of the American people and will also help reduce the number
of persons exposed to the AIDS virus.

   Some Americans have difficulties in dealing with the subjects of
sex, sexual practices, and alternate lifestyles. Many Americans are
opposed to homosexuality, promiscuity of any kind, and prostitution.
This report must deal with all of these issues, but does so with the
intent that information and education can change individual behavior,
since this is the primary way to stop the epidemic of AIDS. This report
deals with the positive and negative consequences of activities and
behaviors from a health and medical point of view.

   Adolescents and pre-adolescents are those whose behavior we wish to
especially influence because of their vulnerability when they are
exploring their own sexuality (heterosexual and homosexual) and perhaps
experimenting with drugs.

   Teenagers often consider themselves immortal, and these young people
may be putting themselves at great risk.

   Education about AIDS should start in early elementary school and at
home so that children can grow up knowing the behavior to avoid to
protect themselves from exposure to the AIDS virus. The threat of AIDS
can provide an opportunity for parents to instill in their children
their own moral and ethical standards.

   Those of us who are parents, educators and community leaders, indeed
all adults, cannot disregard this responsibility to educate our young.
The need is critical and the price of neglect is high. The lives of our
young people depend on our fulfilling our responsibility.

   AIDS is an infectious disease. It is contagious, but it cannot be
spread in the same manner as a common cold or measles or chicken pox.
It is contagious in the same way that sexually transmitted diseases,
such as syphilis and gonorrhea, are contagious. AIDS can also be spread
through the sharing of intravenous drug needles and syringes used for
injecting illicit drugs.

   AIDS is NOT spread by common everyday contact but by sexual contact
(penis- vagina, penis-rectum, mouth-rectum, mouth-vagina, mouth-penis).
Yet there is great misunderstanding resulting in unfounded fear that
AIDS can be spread by casual non-sexual contact. The first cases of
AIDS were reported in this country in 1981. We would know by now if
AIDS were passed by casual, non- sexual contact.

   Today those practicing high risk behavior who become infected with
the AIDS virus are found mainly among homosexual and bisexual men and
male and female intravenous drug users. Heterosexual transmission is
expected to account for an increasing proportion of those who become
infected with the AIDS virus in the future.

   At the beginning of the AIDS epidemic many Americans had little
sympathy for people with AIDS. The feeling was that somehow people from
certain groups "deserved" their illness. Let us put those feelings
behind us. We are fighting a disease, not people. Those who are already
afflicted are sick people and need our care as do all sick patients.
The country must face this epidemic as a unified society. We must
prevent the spread of AIDS while at the same time preserving our
humanity and intimacy.

   AIDS is a life-threatening disease and a major public health issue.
Its impact on our society is and will continue to be devastating. By
the end of 1991, an estimated 270,000 cases of AIDS will have occurred
with 179,000 deaths within the decade since the disease was first
recognized. In the year 1991, an estimated 145,000 patients with AIDS
will need health and supportive services at a total cost of between $8
and $16 billion. However, AIDS is preventable. It can be controlled by
changes in personal behavior. It is the responsibility of every citizen
to be informed about AIDS and to exercise the appropriate preventive
measures. This report will tell you how.

   The spread of AIDS can and must be stopped.

   C. Everett Koop, MD, ScD Surgeon General

   The Surgeon General encourages physicians to give this information
the widest possible reproduction and distribution. Up to 50 copies per
request of the report on AIDS are available free from the United States
Public Health Service by writing to AIDS, Box 14252, Washington, DC
20044; telephone (202) 245-6867.

   SURGEON GENERAL'S REPORT ON ACQUIRED IMMUNE DEFICIENCY SYNDROME

   AIDS Caused by Virus

   The letters A-I-D-S stand for Acquired Immune Deficiency Syndrome.
When a person is sick with AIDS, he/she is in the final stages of a
series of health problems caused by a virus (germ) that can be passed
from one person to another chiefly during sexual contact or through the
sharing of intravenous drug needles and syringes used for "shooting"
drugs. Scientists have named the AIDS virus "HIV or HTLV-III or LAV."
These abbreviations stand for information denoting a virus that attacks
white blood cells (T-Lymphocytes) in the human blood. Throughout this
publication, we will call the virus the "AIDS virus." The AIDS virus
attacks a person's immune system and damages his/her ability to fight
other disease. Without a functioning immune system to ward off other
germs, he/she now becomes vulnerable to becoming infected by bacteria,
protozoa, fungi, and other viruses and malignancies, which may cause
life-threatening illness, such as pneumonia, meningitis, and cancer.

   NO KNOWN CURE

   There is presently no cure for AIDS. There is presently no vaccine
to prevent AIDS.

   Virus Invades Blood Stream

   When the AIDS virus enters the blood stream, it begins to attack
certain white blood cells (T-Lymphocytes). Substances called antibodies
are produced by the body. These antibodies can be detected in the blood
by a simple test, usually two weeks to three months after infection.
Even before the antibody test is positive, the victim can pass the
virus to others by methods that will be explained.

   Once an individual is infected, there are several possibilities.
Some people may remain well but even so they are able to infect others.
Others may develop a disease that is less serious than AIDS referred to
as AIDS Related Complex (ARC). In some people the protective immune
system may be destroyed by the virus and then other germs (bacteria,
protozoa, fungi, and other viruses) and cancers that ordinarily would
never get a foothold cause "opportunistic diseases..." using the
OPPORTUNITY of lowered resistance to infect and destroy. Some of the
most common are PNEUMOCYSTIS CARINII pneumonia and tuberculosis.
Individuals infected with the AIDS virus may also develop certain types
of cancers such as Kaposi's sarcoma. These infected people have classic
AIDS. Evidence shows that the AIDS virus may also attack the nervous
system, causing damage to the brain.

   SIGNS AND SYMPTOMS

   No Signs

   Some people remain apparently well after infection with the AIDS
virus. They may have no physically apparent symptoms of illness.
However, if proper precautions are not used with sexual contacts and/or
intravenous drug use, these infected individuals can spread the virus
to others. Anyone who thinks he or she is infected or involved in high
risk behaviors should not donate his/her blood, organs, tissues, or
sperm because they may now contain the AIDS virus.

   ARC

   AIDS-Related Complex (ARC) is a condition caused by the AIDS virus
in which the patient tests positive for AIDS infection and has a
specific set of clinical symptoms. However, ARC patients' symptoms are
often less severe than those with the disease we call classic AIDS.
Signs and symptoms of ARC may include loss of appetite, weight loss,
fever, nigh sweats, skin rashes, diarrhea, tiredness, lack of
resistance to infection, or swollen lymph nodes.

   These are also signs and symptoms of many other diseases and a
physician should be consulted.

   AIDS

   Only a qualified health professional can diagnose AIDS, which is the
result of a natural progress of infection by the AIDS virus. AIDS
destroys the body's immune (defense) system and allows otherwise
controllable infections to invade the body and cause additional
diseases. These opportunistic diseases would not otherwise gain a
foothold in the body. These opportunistic diseases may eventually cause
death.

   Some symptoms and signs of AIDS and the "opportunistic infections"
may include a persistent cough and fever associated with shortness of
breath or difficult breathing and maybe the symptoms of PNEUMOCYSTIS
CARINII pneumonia. Multiple purplish blotches and bumps on the skin may
be a sign of Kaposi's sarcoma.

   The AIDS virus in all infected people is essentially the same; the
reactions of individuals may differ.

   Long Term

   The AIDS virus may also attack the nervous system and cause delayed
damage to the brain. This damage may take years to develop and the
symptoms may show up as memory loss, indifference, loss of
coordination, partial paralysis, or mental disorder. These symptoms may
occur alone, or with other symptoms mentioned earlier.

   AIDS: THE PRESENT SITUATION

   The number of people estimated to be infected with the AIDS virus in
the United States is about 1.5 million. All of these individuals are
assumed to be capable of spreading the virus sexually (heterosexually
or homosexually) or by sharing needles and syringes or other implements
for intravenous drug use.

   Of these, an estimated 100,000 to 200,000 will come down with
AIDS-Related Complex (ARC). It is difficult to predict the number who
will develop ARC or AIDS because symptoms sometimes take as long as
nine years to show up. With our present knowledge, scientists predict
that 20 to 30 percent of those infected with the AIDS virus will
develop an illness that fits an accepted definition of AIDS within five
years. The number of persons known to have AIDS in the United States to
date is over 25,000; of these, about half have died of the disease.
Since there is no cure, the others are expected to also eventually die
from their disease.

   The majority of infected antibody positive individuals who carry the
AIDS virus show no disease symptoms and may not come down with the
disease for many years, if ever.

   No Risk from Casual Contact

   There is no known risk of non-sexual infection in most of the
situations we encounter in our daily lives. We know that family members
living with individuals who have the AIDS virus do not become infected
except through sexual contact. There is no evidence of transmission
(spread) of AIDS virus by everyday contact even though these family
members shared food, towels, cups, razors, even toothbrushes and kissed
each other.

   Health Workers

   We know even more about health care workers exposed to AIDS
patients. About 2500 health workers who were caring for AIDS patients
when they were sickest have been carefully studied and tested for
infection with the AIDS virus.

   These doctors, nurses and other health care givers have been exposed
to the AIDS patients' blood, stool and other body fluids. Approximately
750 of these health workers reported possible additional exposure by
direct contact with a patient's body fluid through spills or being
accidentally stuck with a needle.

   Upon testing these 750, only 3 who had accidentally stuck themselves
with a needle had a positive antibody test for exposure to the AIDS
virus. Because health workers had much more contact with patients and
their body fluids than would be expected from common everyday contact,
it is clear that the AIDS virus is not transmitted by casual contact.

   Control of Certain Behaviors Can Stop Further Spread of AIDS

   Knowing the facts about AIDS can prevent the spread of the disease.
Education of those who risk infecting themselves or infecting other
people is the only way we can stop the spread of AIDS. People must be
responsible about their sexual behavior and must avoid the use of
illicit intravenous drugs and needle sharing. We will describe the
types of behavior that lead to infection by the AIDS virus and the
personal measures that must be taken for effective protection. If we
are to stop the AIDS epidemic, we all must understand the disease--its
cause, its nature, and its prevention. PRECAUTIONS MUST BE TAKEN. The
AIDS virus infects persons who expose themselves to known risk
behavior, such as certain types of homosexual and heterosexual
activities or sharing intravenous drug equipment.

   Risks

   Although the initial discovery was in the homosexual community, AIDS
is not a disease only of homosexuals. AIDS is found in heterosexual
people as well.

   AIDS is not a black or white disease. AIDS is not just a male
disease. AIDS is found in women; it is found in children. In the future
AIDS will probably increase and spread among people who are not
homosexual or intravenous drug abusers in the same manner as other
sexually transmitted diseases like syphilis and gonorrhea.

   Sex Between Men

   Men who have sexual relations with other men are especially at risk.
about 70 percent of AIDS victims throughout the country are male
homosexuals and bisexuals. This percentage probably will decline as
heterosexual transmission increases. INFECTION RESULTS FROM A SEXUAL
RELATIONSHIP WITH AN INFECTED PERSON.

   Multiple Partners

   The risk of infection increases according to the number of sexual
partners one has, MALE OR FEMALE. The more partners you have, the
greater the risk of becoming infected with the AIDS virus.

   How Exposed

   Although the AIDS virus is found in several body fluids, a person
acquires the virus during sexual contact with an infected person's
blood or semen and possibly vaginal secretions. The virus then enters a
person's blood stream through their rectum, vagina or penis.

   Small (unseen by the naked eye) tears in the surface lining of the
vagina or rectum may occur during insertion of the penis, fingers, or
other objects, thus opening an avenue for entrance of the virus
directly into the blood stream; therefore, the AIDS virus can be passed
from penis to rectum and vagina and vice versa without a visible tear
in the tissue or the presence of blood.

   Prevention of Sexual Transmission--Know Your Partner

   Couples who maintain mutually faithful monogamous relationships
(only one continuing sexual partner) are protected from AIDS through
sexual transmission. If you have been faithful for at least five years
and your partner has been faithful too, neither of you is at risk. If
you have not been faithful, then you and your partner are at risk. If
your partner has not been faithful, then your partner is at risk which
also puts you at risk. This is true for both heterosexual and
homosexual couples. Unless it is possible to know with ABSOLUTE
CERTAINTY that neither you nor your sexual partner is not carrying the
virus of AIDS, you must use protective behavior. ABSOLUTE CERTAINTY
means not only that you and your partner have maintained a mutually
faithful monogamous sexual relationship, but it means that neither you
nor your partner has used illegal intravenous drugs.

   AIDS: YOU CAN PROTECT YOURSELF FROM INFECTION

   Some personal measures are adequate to safely protect yourself and
others from infection by the AIDS virus and its complications. among
these are:

   o If you have been involved in any of the high risk sexual
activities described above or have injected illicit intravenous drugs
into your body, you should have a blood test to see if you have been
infected with the AIDS virus.

   o If your test is positive or if you engage in high risk activities
and choose not to have a test, you should tell your sexual partner. If
you jointly decide to have sex, you must protect your partner by always
using a rubber (condom) during (start to finish) sexual intercourse
(vagina or rectum).

   o If your partner has a positive blood test showing that he/she has
been infected with the AIDS virus or you suspect that he/she has been
exposed by previous heterosexual or homosexual behavior or use of
intravenous drugs with shared needles and syringes, a rubber (condom)
should always be used during (start to finish) sexual intercourse
(vagina or rectum).

   o If you or your partner is at high risk, avoid mouth contact with
the penis, vagina, or rectum.

   o Avoid all sexual activities which could cause cuts or tears in the
linings of the rectum, vagina, or penis.

   o Single teen-age girls have been warned that pregnancy and
contracting sexually transmitted diseases can be the result of only one
act of sexual intercourse. They have been taught to say NO to sex! They
have been taught to say NO to drugs! By saying NO to sex and drugs,
they can avoid AIDS which can kill them! the same is true for teenage
boys who should also not have rectal intercourse with other males. It
may result in AIDS.

   o Do not have sex with prostitutes. Infected male and female
prostitutes are frequently also intravenous drug abusers; therefore,
they may infect clients by sexual intercourse and other intravenous
drug abusers by sharing their intravenous drug equipment. Female
prostitutes also can infect their unborn babies.

   Intravenous Drug Users

   Drug abusers who inject drugs into their veins are another
population group at high risk and with high rates of infection by the
AIDS virus. Users of intravenous drugs make up 25 percent of the cases
of AIDS throughout the country. The AIDS virus is carried in
contaminated blood left in the needle, syringe, or other drug related
implements and the virus is injected into the new victim by reusing
dirty syringes and needles. Even the smallest amount of infected blood
left in a used needle or syringe can contain live AIDS virus to be
passed on to the next user of those dirty implements.

   No one should shoot up drugs because of addiction, poor health,
family disruption, emotional disturbances and death that follow.
However, many drug users are addicted to drugs and for one reason or
another have not changed their behavior. For these people, the only way
not to get AIDS is TO USE A CLEAN, PREVIOUSLY UNUSED needle, syringe or
any other implement necessary for the injection of the drug solution.

   Hemophilia

   Some persons with hemophilia (a blood clotting disorder that makes
them subject to bleeding) have been infected with the AIDS virus either
through blood transfusion or the use of blood products that help their
blood clot.

   Now that we know how to prepare safe blood products to aid clotting,
this is unlikely to happen. This group represents a very small
percentage of the cases of AIDS throughout the country.

   Blood Transfusion

   Currently all blood donors are initially screened and blood is NOT
accepted from high risk individuals. Blood that has been collected for
use is tested for the presence of antibody to the AIDS virus. However,
some people may have had a blood transfusion prior to March 1985 before
we knew how to screen blood for safe transfusion and may have become
infected with the AIDS virus.

   Fortunately there are not now a large number of these cases. With
routine testing of blood products, the blood supply for transfusion is
now safer than it has ever been with regard to AIDS.

   Persons who have engaged in homosexual activities or have shot
street drugs within the last 10 years should NEVER donate blood.

   Mother Can Infect Newborn

   If a woman is infected with the AIDS virus and becomes pregnant, she
is more likely to develop ARC or classic AIDS, and she can pass the
AIDS virus to her unborn child. Approximately one third of the babies
born to AIDS-infected mothers will also be infected with the AIDS
virus. Most of the infected babies will eventually develop the disease
and die. Several of these babies have been born to wives of hemophiliac
men infected with the AIDS virus by way of contaminated blood products.
Some babies have also been born to women who became infected with the
AIDS virus by bisexual partners who had the virus.

   Almost all babies with AIDS have been born to women who were
intravenous drug users or the sexual partners of intravenous drug users
who were infected with the AIDS virus. More such babies can be expected.

   Think carefully if you plan on becoming pregnant. If there is any
chance that you may be in any high risk group or that you have had sex
with someone in a high risk group, such as homosexual and bisexual
males, drug abusers and their sexual partners, see your doctor.

   Summary

   AIDS affects certain groups of the population. Homosexual and
bisexual males who have had sexual contact with other homosexual or
bisexual males as well as those who "shoot" street drugs are at
greatest risk of exposure, infection and eventual death. Sexual
partners of these high risk individuals are at risk, as well as any
children born to women who carry the virus. Heterosexual persons are
increasingly at risk.

   AIDS: WHAT IS SAFE

   Most Behavior is Safe

   Everyday living does not present any risk of infection. You CANNOT
get AIDS from casual social contact. Casual social contact should not
be confused with casual SEXUAL contact which is a major cause of the
spread of the AIDS virus.

   Casual SOCIAL contact such as shaking hands, hugging, social
kissing, crying, coughing or sneezing, will not transmit the AIDS
virus. Nor has AIDS been contracted from swimming in pools or hot tubs
or from eating in restaurants (even if a restaurant worker has AIDS or
carries the AIDS virus). AIDS is not contracted from sharing bed
linens, towels, cups, straws, dishes, or any other eating utensils. You
cannot get AIDS from toilets, doorknobs, telephones, office machinery,
or household furniture. You cannot get AIDS from body massages,
masturbation or any non-sexual body contact.

   Donating Blood

   Donating blood is NOT risky at all. YOU CANNOT GET AIDS BY DONATING
BLOOD.

   Receiving Blood

   In the US every blood donor is screened to exclude high risk persons
and every blood donation is now tested for the presence of antibodies
to the AIDS virus.

   Blood that shows exposure to the AIDS virus by the presence of
antibodies is not used either for transfusion or for the manufacture of
blood products.

   Blood banks are as safe as current technology can make them. Because
antibodies do not form immediately after exposure to the virus, a newly
infected person may unknowingly donate blood after becoming infected
but before his/her antibody test becomes positive. It is estimated that
this might occur less than once in 100,000 transfusions.

   There is no danger of AIDS virus infection from visiting a doctor,
dentist, hospital, hairdresser or beautician. AIDS cannot be
transmitted non-sexually from an infected person through a health or
service provider to another person. Ordinary methods of disinfection
for urine, stool and vomitus which are used for non-infected people are
adequate for people who have AIDS or are carrying the AIDS virus. You
may have wondered why your dentist wears gloves and perhaps a mask when
treating you. This does not mean that he has AIDS or that he thinks you
do. He is protecting you and himself from hepatitis, common colds or
flu.

   There is no danger in visiting a patient with AIDS or caring for him
or her.

   Normal hygienic practices, like wiping of body fluid spills with a
solution of water and household bleach (1 part household bleach to 10
parts water), will provide full protection.

   Children in School

   None of the identified cases of AIDS in the United States are known
or are suspected to have been transmitted from one child to another in
school, day care, or foster care settings. Transmission would
necessitate exposure of open cuts to the blood or other body fluids of
the infect child, a highly unlikely occurrence. Even then routine
safety procedures for handling blood or other body fluids (which should
be standard for all children in the school or day care setting) would
be effective in preventing transmission from children with AIDS to
other children in school.

   Children with AIDS are highly susceptible to infections, such as
chicken pox, from other children. Each child with AIDS should be
examined by a doctor before attending school or before returning to
school, day care or foster care settings after an illness. No blanket
rules can be made for all schoolboards to cover all possible cases of
children with AIDS and each case should be considered separately and
individualized to the child and the setting, as would be done with any
child with a special problem, such as cerebral palsy or asthma. A good
team to make such decisions with the schoolboard would be the child's
parents, physician and a public health official.

   Casual social contact between children and persons infected with the
AIDS virus is not dangerous.

   Insects

   There are no known cases of AIDS transmission by insects, such as
mosquitoes.

   Pets

   Dogs, cats and domestic animals are not a source of infection from
AIDS virus.

   Tears and Saliva

   Although the AIDS virus has been found in tears and saliva, no
instance of transmission from these body fluids has been reported

   AIDS comes from sexual contacts with infected persons and from the
sharing of syringes and needles. There is no danger of infection with
AIDS virus by casual social contact.

   Testing of Military Personnel

   You may wonder why the Department of Defense is currently testing
its uniformed services personnel for presence of the AIDS virus
antibody. The military feel this procedure is necessary because the
uniformed services act as their own blood bank in a time of national
emergency. They also need to protect new recruits (who unknowingly may
be AIDS virus carriers) from receiving live virus vaccines. These
vaccines could activate disease and be potentially life-threatening to
the recruits.

   AIDS: WHAT IS CURRENTLY UNDERSTOOD

   Although AIDS is still a mysterious disease in many ways, our
scientists have learned a great deal about it. In five years we know
more about AIDS than many diseases that we have studied for even longer
periods. While there is no vaccine or cure, the results from the health
and behavioral research community can only add to our knowledge and
increase our understanding of the disease and ways to prevent and treat
it.

   In spite of all that is known about transmission of the disease or
who are infected with the AIDS virus are reluctant to be identified
with AIDS. Because there is no vaccine to prevent AIDS and no cure,
many feel there is nothing to be gained by revealing sexual contacts
that might also be infected with the AIDS virus. When a community or a
state requires reporting of those infected with the AIDS virus to
public health authorities in order to trace sexual and intravenous drug
contacts--as is the practice with other sexually transmitted
diseases--those infected with the AIDS virus have gone underground out
of the mainstream of health care and education. For this reason current
public health practice is to protect the privacy of the individual
infected with the AIDS virus and to maintain the strictest
confidentiality concerning his/her health records.

   State and Local AIDS Task Forces

   Many state and local jurisdictions where AIDS has been seen in the
greatest numbers have AIDS task forces with heavy representation from
the field of public health joined by others who can speak broadly to
issues of access to care, provision of care and the availability of
community and psychiatric support services. Such a task force is needed
in every community with the power to develop plans and policies, to
speak, and to act for the good of the public health at every level.

   State and local task forces should plan ahead and work
collaboratively with other jurisdictions to reduce transmission of AIDS
by far-reaching informational and educational programs. As AIDS impacts
more strongly on society, they should be charged with making
recommendations to provide for the needs of those afflicted with AIDS.
They also will be in the best position to answer the concerns and
direct the activities of those who are not infected with the AIDS virus.

   The responsibility of state and local task forces should be far
reaching and might include the following areas:

   o Insure enforcement of public health regulation of such practices
as ear piercing and tattooing to prevent transmission of AIDS virus.

   o Conduct AIDS education programs for police, firemen, correctional
institution workers and emergency medical personnel for dealing with
AIDS victims and the public.

   o Insure that institutions catering to children or adults who soil
themselves or their surroundings with urine, stool, and vomitus have
adequate equipment for cleanup and disposal, and have policies to
insure the practice of good hygiene.

   School

   Schools will have special problems in the future. In addition to the
guidelines already mentioned in this pamphlet, there are other things
that should be considered such as sex education and education of the
handicapped.

   Sex Education

   Education concerning AIDS must start at the lowest grade possible as
part of any health and hygiene program. The appearance of AIDS could
bring together diverse groups of parents and educators with opposing
views on inclusion of sex education in the curricula. There is now no
doubt that we need sex education in schools and that it include
information on heterosexual and homosexual relationships. The threat of
AIDS should be sufficient to permit a sex education curriculum with a
heavy emphasis on prevention of AIDS and other sexually transmitted
diseases.

   Handicapped and Special Education

   Children with AIDS or ARC will be attending school along with others
who carry the AIDS virus. Some children will develop brain disease
which will produce changes in mental behavior. Because of the right to
special education of the handicapped and the mentally retarded,
schoolboards and higher authorities will have to provide guidelines for
the management of such children on a case- by-case basis.

   Labor and Management

   Labor and management can do much to prepare for AIDS so that
misinformation is kept to a minimum. Unions should issue preventive
health messages because many employees will listen more carefully to a
union message than they will to one from public health authorities.

   AIDS Education at the Work Site

   Offices, factories, and other work sites should have a plan in
operation for education of the work force and accommodation of AIDS or
ARC patients BEFORE the first such case appears at the work site.
Employees with AIDS or ARC should be dealt with as are any workers with
a chronic illness. In-house video programs provide an excellent source
of education and can be individualized to the needs of a specific work
group.

   Strain on the Health Care Delivery System

   The health care system in many places will be overburdened as it is
now in urban areas with large numbers of AIDS patients. It is predicted
that during 1991 there will be 145,000 patients requiring
hospitalization at least once and 54,000 patients who will die of AIDS.
Mental disease (dementia) will occur in some patients who have the AIDS
virus before they have any other manifestation such as ARC or classic
AIDS.

   State and local task forces will have to plan for these patients by
utilizing conventional and time honored systems but will also have to
investigate alternate methods of treatment and alternate sites for care
including homecare.

   The strain on the health system can be lessened by family, social,
and psychological support mechanisms in the community. Programs are
needed to train chaplains, clergy, social workers, and volunteers to
deal with AIDS.

   Such support is critical to the minority communities.

   Mental Health

   Our society will also face an additional burden as we better
understand the mental health implications of infection by the AIDS
virus. Upon being informed of infection with the AIDS virus, a young,
active, vigorous person faces anxiety and depression brought on by
fears associated with social isolation, illness, and dying. Dealing
with these individual and family concerns will require the best efforts
of mental health professionals.

   Controversial Issues

   A number of controversial AIDS issues have arisen and will continue
to be debated largely because of lack of knowledge about AIDS, how it
is spread, and how it can be prevented. Among these are the issues of
compulsory blood testing, quarantine, and identification of AIDS
carriers by some visible sign.

   Compulsory Blood Testing

   Compulsory blood testing of individuals is not necessary. The
procedure could be unmanageable and cost prohibitive. It can be
expected that many who TEST negatively might actually be positive due
to RECENT exposure to the AIDS virus and give a false sense of security
to the individual and his/her sexual partners concerning necessary
protective behavior. The prevention behavior described in this report,
if adopted, will protect the American public and contain the AIDS
epidemic. Voluntary testing will be available to those who have been
involved in high risk behavior.

   Quarantine

   Quarantine has no role in the management of AIDS because AIDS is not
spread by casual contact. The only time that some form of quarantine
might be indicated is in a situation where an individual carrying the
AIDS virus knowingly and willingly continues to expose others through
sexual contact or sharing drug equipment. Such circumstances should be
managed on a case-by-case basis by local authorities.

   Identification of AIDS Carriers by Some Visible Sign

   Those who suggest the marking of carriers of the AIDS virus by some
visible sign have not thought the matter through thoroughly. It would
require testing of the entire population which is unnecessary,
unmanageable and costly. It would miss those recently infected
individuals who would test negatively, but be infected. The entire
procedure would give a false sense of security. AIDS must and will be
treated as a disease that can infect anyone. AIDS should not be used as
an excuse to discriminate against any group or individual.

   Updating Information

   As the Surgeon General, I will continually monitor the most current
and accurate health, medical, and scientific information and make it
available to you, the American people. Armed with this information you
can join in the discussion and resolution of AIDS-related issues that
are critical to your health, your children's health, and the health of
the nation.

   ADDITIONAL INFORMATION Telephone Hotlines (Toll Free)

   PHS AIDS Hotline 800-342-AIDS 800-342-2437

   National Sexually Transmitted Diseases Hotline/American Social
Health Association 800-227-8922

   National Gay Task Force AIDS Information Hotline 800-221-7044 (212)
807-6016 (NY State)

   Information Sources

   U.S. Public Health Service Public Affairs Office Hubert H. Humphrey
Building Room 721-H 200 Independence Avenue, SW Washington, DC 20201
Phone: (202) 245-6867

   Local Red Cross or American Red Cross AIDS Education Office 1730 D
Street, NW Washington, DC 20006 Phone: (202) 737-8300

   American Association of Physicians for Human Rights PO Box 14366 San
Francisco, CA 94114 Phone: (415) 558-9353

   AIDS Action Council 729 Eighth Street, SE Suite 200 Washington, DC
20003 Phone: (202) 547-3101

   Gay Men's Health Crisis PO Box 274 132 West 24th Street New York, NY
10011 Phone: (212) 807-6655

   Hispanic AIDS Forum c/o APRED 853 Broadway, Suite 2007 New York, NY
10003 Phone: (212) 870-1902 or 870-1864

   Los Angeles AIDS Project 1362 Santa Monica Boulevard Los Angeles, CA
90046 Phone: (213) 871-AIDS

   Minority Task Force on AIDS c/o New York City Council of Churches
475 Riverside Drive, Room 456 New York, NY 10115 Phone: (212) 749-1214

   Mothers of AIDS Patients (MAP) c/o Barbara Peabody 3403 E Street San
Diego, CA 92102 Phone: (619) 234-3432

   National AIDS Network 729 Eighth Street, SE, Suite 300 Washington,
DC 20003 Phone: (202) 546-2424

   National Association of People with AIDS PO Box 65472 Washington, DC
20035 Phone: (202) 483-7979

   National Coalition of Gay Sexually Transmitted Disease Services c/o
Mark Behar PO Box 239 Milwaukee, WI 53201 Phone: (414) 277-7671

   National Council of Churches/AIDS Task Force 475 Riverside Drive,
Room 572 New York, NY 10115 Phone: (212) 870-2421

   San Francisco AIDS Foundation 333 Valencia Street, 4th Floor San
Francisco, CA 94103 Phone: (415) 863-2437

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