Thirty-five years ago, Americans opened their mailboxes during the HIV-AIDS epidemic to discover a sealed package from the U.S. government. The mass mailing came whether they wanted it or not, and it came with a warning: “some of the issues involved in this brochure may not be things you are used to discussing openly.”
The 1988 mailer, which came from the U.S. Public Health Service, marked a bold step in sex education, launching a public discussion about HIV-AIDS that was grounded in science and influenced public health efforts on diseases from covid-19 to mpox.
It also caused a firestorm, embroiling the man behind the effort, Surgeon General C. Everett Koop — a charismatic evangelical whom President Ronald Reagan had nominated six years earlier, thinking Koop’s faith meant he would never do anything of the sort.
“He was a guy who surprised everybody,” said Anthony S. Fauci, the retired director of the National Institute of Allergy and Infectious Diseases, who worked with Koop on AIDS matters.
At the time of the appointment, Reagan and his administration believed they had found the perfect nominee. Koop, a pediatrician, had no background in public health. He was fiercely opposed to abortion and “strongly disapproved of homosexuality,” as he later wrote in his autobiography, “Koop: The Memoirs of America’s Family Doctor.” And he frequently cited the ways his Christian beliefs shaped his medical practice.
His nomination had been incredibly contentious, sparking protests on the left, in the public health community and among organizations such as Planned Parenthood. But his appointment had cemented the Reagan administration’s commitment to the Christian right.
The administration and its allies were confident that Koop would be an evangelical Christian first and a public health advocate second. Much to the administration’s shock, the opposite turned out to be true.
During his tenure, Koop used his position as a bully pulpit. Making “a special point of wearing my uniform,” he wrote, he appeared on talk shows, at high schools and at churches to share his views on everything from smoking to nutrition. As Time magazine put it, “Surgeon General C. Everett Koop has an opinion, which he will give you with great certainty at high speed.”
He did not, however, share his views on the emergence of a new disease: HIV-AIDS.
While Koop disapproved of homosexual acts, he believed, as a physician and a Christian, that his work entailed protecting the public’s health. And he came to believe, too, that conservatives in the “Reagan administration attempted to thwart my attempts to educate the public about AIDS,” he wrote.