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Higher Education Modules

Responding to AIDS: History, Politics and Visual Culture

Class 2: U.S. Government (In)Action
Introduction

The United States government remained largely silent in the face of the AIDS crisis in the early 1980s. Elected leaders often avoided the issue and funding requests for research and patient care went unfulfilled. In Class 2, students are asked to analyze and evaluate the action and inaction of the government in the decade following the emergence of AIDS. The class begins with a personal look back at AIDS policy failures by epidemiologist Donald P. Francis. Historian Daniel M. Fox then outlines the origins of what he calls a “crisis of authority” that shaped the anemic response to AIDS. Primary sources highlight the central role played by Surgeon General C. Everett Koop in developing the government’s first authoritative response, along with reactions to the controversial Surgeon General’s Report on Acquired Immune Deficiency Syndrome. For additional context and insight on the relationship between the fields of public history and public policy, students may be asked to read historian Allan M. Brandt’s article on lessons from the history of sexually transmitted diseases. Students should be asked to complete the assigned readings before coming to class. Discussion questions may be provided to students in advance of reading.

Readings
Secondary Sources:

Fox, Daniel M. “AIDS and the American Health Policy: The History and Prospects of a Crisis of Authority.” In AIDS: The Burdens of History. Edited by Elizabeth Fee and Fox. Berkeley: University of California Press, 1988, pp. 316-340. Available online at http://publishing.cdlib.org/ucpressebooks/view?docId=ft7t1nb59n&chunk.id=d0e5593&toc.depth=1&toc.id=d0e5593&brand=ucpress

Francis, Donald P. “Deadly AIDS policy failure by the highest levels of the US government: A personal look back 30 years later for lessons to respond better to future epidemics.” Journal of Public Health Policy 33 (2012): 290-300.

Primary Sources from the Profiles in Science: The C. Everett Koop Papers digital archive:

Koop, C. Everett. “Introduction to the AIDS Archive.” 2003.

—. “Surgeon General’s Report on Acquired Immune Deficiency Syndrome.” United States Public Health Service, Office of the Surgeon General, October 1986, brochure.

MacDonald, Gary B., and AIDS Action Council. Letter from Gary B. MacDonald, AIDS Action Council to C. Everett Koop. (Oct. 22, 1986) Available online at http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBWL

Price, Joyce. “Koop Urges Early Sex Education to Fight AIDS.” Washington Times Section A, (Oct. 23, 1986): 1, 10. Available online at: http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBVH

“A Doctor’s Good Advice” [Letter to the Editor of the Washington Post]. Washington Post Section A, (Oct. 24, 1986): 26. Available online at http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBVK

McLaughlin, Loretta, and Boston Globe. “Playing Politics on AIDS.” Boston Globe, (Nov. 2, 1986). Available online at http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBVB

"Flying the Koop" [Op-Ed]] Washington Times, (27 October 1986). Available online at http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBVF

Buckley, William F. Jr. “Reservations About Dr. Koop’s Advice…” Unidentified newspaper, (1986). Available online at http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/QQBBVD

Supplemental Reading:

Brandt, Allan M. “AIDS in Historical Perspective: Four Lessons from the History of Sexually Transmitted Diseases.” American Journal of Public Health 78 (April 1988): 367-371. Available online at: http://dash.harvard.edu/bitstream/handle/1/3372905/Brandt_AIDS_Lessons.pdf?sequence=1

Discussion Questions
  1. What does successful control of any dangerous epidemic require according to Donald P. Francis? How did the agenda of the Reagan White House conflict with good public health practices? Why did the Reagan administration reject an AIDS prevention plan for the country?
  2. How and why had infectious diseases declined in importance prior to the emergence of AIDS, while chronic degenerative diseases were increasingly prioritized? What was the justification for emphasizing increased individual responsibility for health and what were its consequences? How did the unfulfilled promises of science and rising costs lead to a “crisis of authority”? How did this crisis influence actions in the areas of surveillance, research, paying treatment costs, and organizing services for persons with AIDS?
  3. How and why was Surgeon General C. Everett Koop restricted in responding to the AIDS epidemic? What are the main features of his landmark Surgeon General”s Report on Acquired Immune Deficiency Syndrome? Why was the report considered so important and how and why did people respond so vociferously to it?
Supplemental Questions
  1. How are the four lessons from the history of sexually transmitted diseases, identified by Allan M. Brandt, relevant in the context of the early AIDS epidemic? Are those lessons still important to keep in mind today with HIV/AIDS or other diseases? Consider and explain whether or not you agree with Brandt’s analysis and assessment.

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