by Ashley Baxstrom

The “culture wars” weren’t always so black and white. In Friday’s presentation of “Reforming Sex,” Anthony Petro showed how politics, science, culture and media can cross boundaries and transform a national dialogue.

Petro, an Assistant Professor of Religious Studies and Faculty Fellow at NYU, spoke for the first of this spring’s Bridging Seminars by NYU’s Center for Religion and Media. The chapter, “Reforming Sex: C. Everett Koop and the Moral Politics of Public Health,” is part of a greater work-in-progress: “After the Wrath of God: AIDS, Sexuality, and American Religion.”  The respondent was Helena Hansen, a Addiction Psychiatry Fellow at NYU Medical Center.

While the paper in whole examines American religion’s role in shaping public discussion on morality and sexuality – particularly concerning public health and the AIDS epidemic – Friday’s selection focused on Surgeon General under President Reagan, C. Everett Koop, and the surprising stance the evangelical conservative took. Petro writes:

Though initially shut out of conversations about the new epidemic, by the mid-1980’s Koop took an active role in forming a national education campaign regarding HIV and AIDS and methods of prevention. In emphasizing sex education and condom use, Koop shocked his conservative friends and longstanding liberal opponents alike, turning many of the former against him and reaping praise from the latter. (82)

Koop had been appointed largely because of his prominent anti-abortion stance and the recommendations of evangelical leaders like Billy Graham. A pediatric surgeon, Koop published “The Right to Live: The Right to Die” in 1976, making a case against abortion and euthanasia. He also teamed up with evangelical writer and philosopher Francis Schaeffer to produce the anti-abortionist “Whatever Happened to the Human Race,” first published as a book in 1979 and subsequently distributed in the form of five films and multiple seminars nationwide. Koop’s 1981 appointment to the position of Surgeon General was lauded by evangelicals and criticized by members of Congress, media outlets, and political health agencies – including the American Medical Association, which cited Koop’s complete lack of public health experience.

However, as Petro showed, Koop turned out to be something of a surprise. “I began to see the valuable ways in which the Surgeon General’s position could be used to advance the health of the nation with moral suasion,” he said. (93) With the use of national media and the public eye, he disseminated information to promote a view on health that stemmed from his medical and religious respect for life, from an anti-smoking campaign to advocating for the rights of handicapped children, and most prominently in his campaign for AIDS education. Koop’s particular mix of morals and policy, however, dissatisfied his conservative backers.

Castigation by the political right, although disappointing and unpleasant, did not unduly upset me; after all, castigation seemed to be their business. But I did feel a profound sense of betrayal by those on the religious right who took me to task. MY position on AIDS was dictated by scientific integrity and Christian compassion. I felt my Christian opponents had abandoned not only their old friend, but also their own commitment to integrity and compassion. (106)

As the AIDS crisis erupted in the early 1980s, political and moral vilification of the gay community was well underway from conservative religious leaders and politicians. White House meetings on AIDS went from first including two activists from the National Gay Task Force (1983), to hosting a meeting of religious conservatives who “would place information about AIDS within the context of public condemnation of homosexuality, citing it as a moral wrong.” (100)

One of the central fault lines emerged around two positions regarding the basic approach to dealing with AIDS. AIDS activists joined many liberal and moderate religious organizations, as well as public health experts, in insisting upon a strong state-based approach that would acknowledge the need to preserve people’s basic civil rights. Religious and political conservatives, on the other hand, viewed any accommodations made to protect civil liberties in the face of AIDS as political pandering to liberals, often to gay rights groups. Illustrating this belief, nine conservative Republican congressmen, including William Dannemeyer, Robert Dornan, and Newt Gingrich, wrote a letter to the president attacking what they viewed as a liberal response and calling for “common sense guidelines that address the problem and ignore the politics.” Specifically, they called for the closing of bathhouses and mandating that all AIDS cases be reported to the CDC. (101)

From the beginning of his appointment, Koop had been largely kept out of any involvement with the AIDS crisis; but by early 1986 President Reagan asked him to prepare a report for the American people. Koop “knew from the beginning that if he were to write what he considered an unbiased report on AIDS, he would have to limit the number of political forces that could provide input or potentially hold it up. Much of this resistance, he thought, would come from the White House.” (103) He received permission from the Secretary for Health to bypass the usual clearances, and after months of research released his report in October.

His suggestions shocked conservatives and liberals alike. The Surgeon General’s Report on Acquired Immune Deficiency Syndrome presented the best medical information available to date about HIV and AIDS and sought to alleviate the fears of the American people. The thirty-six page document called Americans to fight the epidemic as a unified group, rather than condemning certain populations disproportionately affected by the disease who some felt “deserved” the illness (though they go unnamed, this would surely include homosexuals and drug users). In saying this, Koop attempted to move the rhetoric of the AIDS epidemic beyond its association with homosexuality and drug use and the idea that it was the just desserts for immoral behavior. As he noted, “We’re fighting a disease, not people.” The report also came out against compulsory testing for HIV and quarantines for those testing positive, ideas favored by some conservative leaders in Congress and the White House. But Koop’s report went even further than anyone had anticipated from the evangelical surgeon. (104)

The report and a subsequent national lecture series advocated comprehensive sex education (in schools and for all Americans) that would teach about a realistic variety of sexual activity and the use of condoms. This more than anything irked the conservative body. Respondents pushed back for education encouraging “responsible sexual behavior – based on fidelity, commitment, and maturity, placing sexuality within the context of marriage.” (107) Reagan approved this language and congressional legislation soon followed that regulated the content of AIDS publications funded by government money which did not fit within the proscribed morality.

But Koop’s message on AIDS did not end with his report. The Public Health
Office (PHO) soon began efforts to produce a trimmed down version of the AIDS report that would be cheaper to produce and more accessible to most Americans. After delayed support from the White house, Congress empowered the PHO to produce and distribute a brochure on AIDS “without necessary clearance of the content by any official,” effectively ensuring White House politics would stay out of it. The final pamphlet, called “Understanding AIDS,” was ready to go by May 1988. Koop’s office printed 107 million copies of the pamphlet to be mailed to every household in the United States, making this the largest mailing sponsored by the federal government at the time. (108)

Koop sidestepped the mainstream media and politics and sent the information straight into Americans’ homes. In six pages, “Understanding AIDS” described how the disease was and was not contracted, outlined behavior that put people at risk, and advocated the use of condoms as the best protection from HIV, after abstinence. The pamphlet spoke frankly about realistic sexual activity, while also encouraging a specific brand of safe sex, including monogamy and personal responsibility.  “If Koop differed from the Christian conservatives, it was less on the question of when to have sex or how to do it, than that of who was having sexing with whom…. Koop refused to denounce ‘homosexuality’ through the language of public health in his national campaign.” (125)

Petro argued that Koop’s work on AIDS “both arose from a specific moralistic perspective founded in conservative Christianity and codified this sexual morality in national AIDS discourse.” (111) Through his mass-media distribution and open lectures across the United States, Koop was able to transform a national dialogue.

Ashley Baxstrom is a graduate student in the Religious Studies Program at New York University.