I was inspired to highlight this significant event when I read Joe’s timelines (thanks Joe!) posted in May. I work in Health Promotion and am really interested in how community attitudes shape our approach to health.
Understanding AIDS, June 1988.
Approximately 107 million English-language versions of the brochure, Understanding AIDS, were distributed to every home and residential post office box in the U.S. between May 26 and June 30, 1988 and a Spanish-language version was distributed in Puerto Rico during that period too. This was the first time the U.S. federal government attempted to contact virtually every resident, directly by mail, regarding a major public health problem. Pre-internet, pre smartphone, this was a major undertaking by any government. Not the least significant aspect of this was the subject matter itself.
The brochure was prepared by CDC in consultation with the Surgeon General (C. Everett Koop) and a wide spectrum of public health officials, medical experts, advertising consultants, and members of the general public. They made the effort to make the presentation simple, direct, and understandable to the widest possible audience. They wanted to provide understandable information and to encourage safe behaviors that can prevent HIV infection. They also wanted to make sure that the information was in a format acceptable to as many different groups as possible. The first draft of the brochure referred to different risk groups, but after consultation, they changed this to refer to behaviours. Not everyone in a risk group engages in risky behaviour – and people engage in risky behaviour even when they’re not in a risk group. The brochure did its best to make sure that anyone at risk could identify their risky behaviours and not ignore the warning because they didn’t identify with a risk group.
Dr. Koop said he realized later that the Reagan administration had been slow to address the disease because the election had brought to power people who were antithetical to gay people, then thought to be its only victims. As the epidemic worsened, reaching drug addicts infected with contaminated needles and hemophiliacs who had received a contaminated blood-clotting factor, Reagan, in 1986, asked Dr. Koop to prepare a special report. Dr. Koop proceeded cautiously, knowing the report would be unpopular with many in the administration, with conservatives in Congress and with church groups opposed to homosexuality. He wrote 17 drafts.
There has never been a formal review of the effect of this historic document/action.However, it’s estimated that 87 million people read at least some of the brochure. 85% of them approved of the government spending $25.5 million on it and 84% were glad to get it. 2% of people were offended by it and 1020 complaints were received.
There is a lot of information about HIV/AIDS available now and we now know that risk of transmission is reduced considerably if we don’t engage in risky behaviour. As yet, there is no cure, but it’s no longer a certain death sentence and someone infected with HIV has an excellent chance of living a relatively normal life if it’s managed correctly.
But the 1980’s and 90’s were before the research and before the more widespread understanding of the condition, and people still saw AIDS as a ‘gay’ disease. It would be some years before widespread understanding that it’s risky behaviour that spreads a disease like AIDS – not a particular group of people. The “Understanding AIDS” brochure went a long way toward bringing this understanding to the general public.
Understanding AIDS The Surgeon General
“Understanding AIDS” – the national AIDS mailer David Davis Phd.
AIDS in 1988 Robert C. Gallo and Luc Montagnier