Shifting Blame: C. Everett Koop’s AIDS Rhetoric of Guilt and Redemption

Darlene K. Drummond, Dartmouth College


C. Everett Koop narrated two distinctly different stories about AIDS, one for general audiences and another for black audiences. His approach demonstrated an evolution in scapegoating rhetoric from agent to scene that positioned blacks as immoral, culpable in the spread of the virus, and ultimately responsible for meeting their own health care needs.

In July 1982, the Morbidity and Mortality Weekly Report (MMWR), a publication of the Center for Disease Control (CDC) revealed 34 new cases of a rare pneumonia among male and female racially Black, Haitian IV drug abusers. The disease became known as the 4-H disease as four groups of people were categorized as high-risk for contracting AIDS (i.e., heroin addicts, homosexuals, hemophiliacs, and Haitians). The CDC began tracking AIDS by race officially in 1983 with a report of two female cases –one Black and the other Hispanic, with no risk factors other than having sex with infected males. In a second report that year, the CDC detailed 16 cases of male heterosexual, non-IV drug users found in prisoners in New York and New Jersey. Seven were Black, seven White and two Hispanic.  From 1981 through 1988, Black Americans accounted for 26% of AIDS cases with Black homosexuals disproportionately affected compared to other racial groups, and with heterosexual contact and intravenous drug use as the primary modes of transmission (Sutton et al. S351).

C. Everett Koop became the most prominent and visible spokesperson on issues impacting public health in the United States in his role as Surgeon General during Ronald Reagan’s presidency from 1981–1989. His impact, documented through films, television interviews, editorials, medical publications, hundreds of speeches, and media caricatures, spanned such issues as smoking, abortion, domestic violence, disability rights, and AIDS (Schraufnagel 276). For example, he published eight scientific reports that established the addictiveness of nicotine and the dangers of smoking that led to the passage of legislation requiring warning labels on cigarettes. These warnings led to a decrease in smoking rates saving thousands of lives (Arias 396). Many believe he applied rigid scientific principles to issues of health, elevated the position of Surgeon General, and became one of the most trusted people in America (Kessler et al. 7109).

Becoming the spokesperson on AIDS was one of Koop’s most difficult challenges. He was prevented by the Reagan administration from discussing AIDS publicly from 1981- 1986 until the release of the Surgeon General’s Report on AIDS (Memoirs 194-239). Two studies exist on Koop’s AIDS rhetoric. The first assessed the 1986 report, while the second interrogated Koop’s 1988 direct mailer to U.S. citizens. Tina Perez and George Dionisopoulos in their 1995 Communication Studies article focused on the conservative politics of the Reagan administration and perceptions of the sexually explicit language included in the 1986 Surgeon General’s Report on AIDS. They argued that Reagan’s attempt to employ a strategic silence backfired as the public increasingly viewed AIDS as the major health issue of the time especially after the release of the report. They also concluded that many people probably thought that his conservative, anti-abortion, fundamentalist views would lead him to write a water-downed, vague document about immoral behavior in support of the Reagan Administration’s efforts to keep AIDS out of the spotlight. Robin Jensen and Abigail King (593-598) critiqued Koop’s 1988 “Understanding AIDS” mailer. They concluded that Koop’s portrayal of his protagonist, AIDS, in educating the American public, created comparisons that presented AIDS as an entirely unique problem requiring unparalleled preventive behavior.  His central authoritative metaphor they labeled “the surgeon’s plague,” which “equated AIDS with an unprecedented plague” based on Koop’s authority and the research of experts that differentiated it from previous plagues.  In addition, they described a second authoritative metaphor that they labeled “the general’s war.”

Both studies give us insight into the handling of the AIDS crisis in the 1980s by examining key documents written and designed for mass distribution to general audiences. However, neither informs us of how Koop addressed the subject of AIDS in person before different audiences. Since the Black community was disproportionately affected by AIDS in the 1980s, it is reasonable to assume that prominent health officials like C. Everett Koop would specifically seek out and accept opportunities to address key social, political, and educational groups within this community. Of the nearly 350 speeches delivered by Koop during his tenure as Surgeon General, only three were delivered before predominantly Black audiences – a major civil rights organization, a public forum, and high school. My essay extends the aforementioned works by examining the rhetoric of Koop before two different audiences. I compare and explain his rhetoric in his boilerplate speech, The Current Crisis in AIDS, designed for general audiences, and his Address delivered to a predominantly Black audience, the National Association for the Advancement of Colored People (NAACP). Both speeches are part of The C. Everett Koop Papers made available online to the public through the Profiles of Science database of The National Library of Medicine. I sought answers to the following questions: Did Koop’s AIDS message developed for general audiences remain the same or change before predominately Black audiences? If changed, how and why? 

To answer these questions, I examined the text of each speech to identify which, if any, term of Kenneth Burke’s pentad as presented in Grammar of Motives, --act, scene, agent, agency, or purpose, was featured “in developing a vocabulary designed to allow this one term full expression with the other terms being comparatively slighted or being placed in the perspective of the featured term” through its accompanying  philosophy: if scene then materialism, agent then idealism, agency then pragmatism, purpose then mysticism, and if act then realism (127–28). I argue that Koop narrated two distinctly different stories about AIDS, by featuring different pentadic terms for general audiences and Black audiences that demonstrated an evolution in scapegoating rhetoric from agent to scene. I assert that each approach was grounded in the invocation of science as authoritative and the conservative sociopolitical climate of the decade. Through the process of victimage Koop shamed Black audiences by distancing the moral from the immoral, encouraging moral panic, implying black-on-black crime and evoking the name of Ronald Reagan. He offered redemption through education for both audiences but advocated self-determination for Black audiences. Thus, his rhetoric of guilt and redemption positioned the Black community as immoral, culpable in the spread of AIDS, and ultimately responsible for meeting its own health care needs.

The Current Crisis in AIDS Speech: Blame the Agent

After the release of the 1986 report, Koop averaged 65 requests a day and began delivering speeches to the public in 1987. Since he could not fulfill all speaking requests, he created a video presentation on February 18, 1987 for general audiences based on the 1986 report and titled it, The Current Crisis in AIDS. Koop called it his primer on AIDS and used it as his first opportunity to voice concern about the rise of AIDS among black and brown people (Reminiscence Current Crisis). The speech was delivered orally on numerous occasions before state legislatures, public forums, schools, universities, national and international organizations.

In The Current Crisis in AIDS, Koop told the following story: there is this mysterious disease called AIDS (agent) that is transmitted through blood and semen and the use of dirty needles (agency) that is spreading (act) throughout the United States (scene) that will kill you (purpose). The dominant components were the agent, AIDS, followed by agency, its transmission through blood and semen and the use of dirty needles. Koop’s objective was to update the American people on AIDS and provide information to them about educating young people about it.

Burke suggests that cultural, social and historical periods when personified by a speaker, are generally indicative of idealism (Grammar 171). Objects exist by virtue of our perception of them, as ideas residing in our awareness (Kant). Our experience of things is about how they appear to us. For Koop the very existence of AIDS was the most important factor in the spread of its virus. He perceived AIDS as very powerful and God-like in its ability to determine who lived or died. In positioning AIDS as the central character in his story, Koop gave audiences a clear threat upon which to place blame instead of one another.

Idealist see the world through the lens of science and employ familiar analogies to account for new events (Baert 90-1). This is exactly what Jensen and King witnessed in their analysis of the 1986 Surgeon General’s Report on AIDS with Koop alluding to but not explicitly naming various plagues while creating new authoritative metaphors (i.e., the surgeon’s plague and the general’s war) in an effort to help audiences see AIDS as a uniquely different phenomenon. Koop employed a similar strategy in The Current Crisis in AIDS in alluding to plagues but did not use any authoritative metaphors. He introduced AIDS, the agent in his story generally as “a rare lethal disease,” a “very dangerous form of infectious pneumonia,” “some kind of bug” and ended with a chronology of specific names indicative of the increasing status of this invisible phenomenon. “The National Cancer Institute called it ‘the Human-Cell Lymphotropic Virus Type III’ while the Pasteur Institute called it ‘Lymphadenopathy-Associated Virus’ until 1984 when all scientists agreed to call it by a single common name of ‘human immunodeficiency virus or H.I.V.’ and in its deadliest form ‘Acquired Immune Deficiency Syndrome’ or ‘AIDS’ for short.”1 In ending with these scientific names inclusive of the word virus, audiences could easily envision the Godlike qualities associated with it, because they knew that a virus is an extremely complex microscopic infectious non-living parasite that is only able to multiply within the living cells of a host. This strategy also gave audiences hope. Because cures and treatments had been devised for other viruses (e.g., hepatitis B) of which they would be aware and of which Koop reminded them, they could envision its eventual defeat. In addition, he talked about experimental treatments and specifically mentioned the drug A.Z.T.

Idealism was the predominant philosophy evident in Koop’s storytelling, although pragmatism through the featuring of agency was also significant. Agency, or the means through which AIDS thrived was “two body fluids --blood and semen-- that carry the live AIDS virus in quantities sufficient to be transmissible” and from “a dirty needle borrowed from an addict who already has AIDS.”  Koop wanted people to understand that the only way the virus is passed from one person to another is through the transfer of blood or semen from one person to another through sexual activity and/or the sharing of drug paraphernalia that enabled the transfer. He did not detail or describe specific sexual practices but stated certain sex acts that occurred between men resulted in problematic bleeding This approach implies a limited threat in which one is less likely to become a victim of the disease through heterosexual activity.

Like many Reagan supporters who were part of the Religious Right, Koop was an evangelical Christian who believed homosexuality was a sin (Lord 143). However, he toned down his views to teach everyone regardless of their sexual orientation the importance of safer sex practices. As Koop articulated, he had one major responsibility as both a Christian and physician and that was to save lives by doing as Christ taught and “separate the sin from the sinner” (Memoirs 209). Therefore, Koop used impartial, scientific language that permitted listeners to set aside any emotional baggage they connected with AIDS or sexual behavior. This also served to promote the DHHS as a scientific, equitable organization. 

Koop reminded the audience over and over again that AIDS had only one purpose and that was to kill. The implicit scene in which the virus thrived and eventually killed was society-at -large or more specifically, the United States. Koop stressed the high risk of contraction and death for all Americans by enumerating the number of new cases and deaths from year to year, and by predicting future cases. He said, “As of January 1986, we had a cumulative total of 6,000 reported cases. Today [February 1987] that total is 30,000. Over half of them have already died of the disease and the rest will.” He suggested by the end of 1990 the cumulative total would be over a quarter of a million, and that on the basis of testing and epidemiological studies, between a million and a million-and-a-half Americans would have the AIDS virus in their systems. However, Koop indirectly signaled that this issue was a crisis for only a few select groups but had the potential to quickly escalate and effect the whole of America, particularly white heterosexuals. He said that there was a rise in cases among heterosexuals where “their heterosexual activity seems to be their only risk factor,” and reiterated that homosexual and bisexual men were at the highest risk. Then, in two sentences he indicated which racial groups were most at risk with, “Blacks account for 12 percent of the population, but they account for 25 percent of all AIDS cases. Similarly, Hispanics account for 6 percent of the U.S. population, but they account for 14 percent of all AIDS cases.” He did not mention specific rates among whites, Asians, Native Americans are other ethnic or racial groups in the United States. The underlying message was clear –if you are a member of one of the affected groups, then you should be concerned, and if not, then you will probably be fine.

In stressing agent (AIDS) and agency (transmission) within a scene of the United States at-large, Koop alleviated any guilt he felt for the failure of the DHHS to provide a cure for AIDS and laid the foundation for his and the DHHS’s redemption by introducing the education of young people as the primary solution to the problem of AIDS. As the rates of sexually transmitted diseases and teen pregnancy rose significantly in the 1980s, the Public Health Service took the lead in addressing these concerns through sex education, even though banning sex education in schools was a top priority of the Religious Right. Nevertheless, in promoting sex education, Koop was reflecting the private-public mosaic that characterized American health care in general since many Americans viewed private organizations like Planned Parenthood, and research organizations such as the Alan Guttmacher Institute (many of whom received grants or funding through the federal government) as providing the most honest, balanced and complete form of sex education available (Lord 141).

Koop articulated a sex education agenda that promoted (1) abstinence, (2) monogamy with the use of condoms, and (3) responsibility –both parental and moral. He offered reassurances that the focus would be on the facts about the threat and ways to prevent contraction. To increase his credibility, he listed key individuals (e.g., Ronald Reagan), a variety of religious (e.g., National Council of Churches) and educational organizations (e.g., National Education Association) he had consulted. To appease the religiously conservative, he privileged abstinence as the safest behavior and only endorsed monogamy “as the best defense” when one had a faithful sex partner He encouraged the use of a condom at all times unless one knew absolutely that he or she, and one’s partner, were both free of the virus. Koop pointed out that sex educators teach important biological and physiological information that parents may not be equipped to provide. He stressed, “The social and spiritual development of your children is your business. Don’t pass it up. Don’t pass it by...but pass it on.” In addition, he indicated that everyone, especially parents and educators had a moral responsibility to teach children how to protect themselves. The clear message of Koop’s boilerplate speech was that AIDS, a threat to all Americans, was a deadly disease with no current cure; and that all Americans should trust medical science to eventually find one, but in the interim, exercise moral responsibility in educating themselves and others to avoid it.

Address to the NAACP: Blame the Scene

On July 8, 1987, five months after the creation of his boilerplate speech, Koop delivered his first speech on AIDS titled Address before a predominantly Black audience at the annual convention of the NAACP in New York City. The theme for the convention was The Struggle: Yesterday, Today and Tomorrow. His panel included John E. Jacob, President and CEO of the National Urban League, Jesse Jackson, Chairman of the Board of Operation Push, and Reverend Leo Hamilton, President of the New York Baptist Ministers Conference (NAACP). Koop was invited to speak and introduced to the audience by Benjamin L. Hooks, a practicing attorney and civil rights leader, who served as the Executive Director of the NAACP from 1977–1992. At the time the NAACP faced major challenges with a 50% decline in membership and a severely depleted budget (Pinderhughes 118). Nonetheless, Koop believed this was his best opportunity to speak to a major organization that could address the disproportionate number of AIDS cases in the black community (Reminiscence Address NAACP). 

Varying narratives emerge when circumstances and viewpoints change (Carmack, Bates, and Harter 93). So was the case with the story Koop weaved before the NAACP that in an environment of 1980s immorality (scene) the AIDS virus was spread (act) by Blacks and Hispanics (agents) who engaged in risky behaviors (agency) intentionally or unintentionally resulting in death (purpose). Blame placed on the agent, AIDS, in Koop’s boilerplate speech shifted to the scene in the NAACP speech, an immoral environment that enabled the transmission of the virus through intravenous drug abuse, homosexuality, bisexuality, heterosexual multiple-partner activity, and infected mothers giving birth. Being Black or Hispanic became the precursor or necessary condition for the spread of AIDS through such behaviors.

Burke teaches us that actions are produced by agents and therefore provide us with information about what those agents value and represent (Grammar 15-20). The dominating scene-agency ratio in Koop’s rhetoric is indicative of a materialistic pragmatism. In advancing a materialistic philosophy, scientists explain events in terms of physical laws and downplay spiritual ones, while pragmatism focuses on the means and consequences of behavior (Grammar 131, 275). Koop accomplished this by arguing that there was persuasive scientific evidence of the disproportionate rates of AIDS within black and brown communities that could result in “greater losses,” “death due to the fatal nature of AIDS,” and the “opportunity for further discrimination.” His evidence was meant to bolster his central idea that “In containing the AIDS virus, science and morality advance hand-in-hand toward the same goal.”

Koop set the scene (a period of immorality in 1980s America) by first delineating an increase in sexually transmitted diseases specifically in the number of cases of herpes, syphilis, and gonorrhea –facts not mentioned in the boilerplate speech. For example, he stated, “As of June 20th for the current year, while there were 8,300 new cases of AIDS reported, 362,575 new cases of gonorrhea and 15,355 new cases of syphilis were recorded.” Koop suggested that the spread of all sexually transmitted diseases was due to the behavior of individuals who were sexually active, unfaithful, and had multiple sex partners. Inclusion of this information on other sexually transmitted diseases can be viewed as a good tactic.  STDs disproportionately affected the black community and the presence of STDs serves as markers of risk-facilitating HIV transmission (Sutton et al. S351).

To further set the scene in which the act (the spread of the AIDS virus) occurred, Koop stressed the primary agents were Black and Hispanic communities “where AIDS has disproportionately taken its toll,” “have significantly large numbers of AIDS cases,” and “are disproportionately represented in infant AIDS cases.”  He provided proof through the enumeration of facts that included:

(1) One of every 8 Americans is Black, but among Americans with AIDS, 1 in 4 is Black –24% of the total cases reported, (2) Among those AIDS patients below 30 years of age, a staggering 47% are Blacks and Hispanics, (3) Among Blacks with AIDS, 35% are I.V. drug abusers, (4) The people at highest risk [are] homosexual and bisexual men. About 40% of Blacks fit into that category, and (5) More than half of the number of infants with AIDS are Black and another 24% are Hispanic.

Koop did not mention the rates of AIDS among any other U. S. racial groups, the American population in general, or other countries throughout the world. This audience-centered approach simultaneously positioned AIDS as foremost a black and brown problem while directing audience attention to the issues with which they must contend.

Guilt through Identification and Dissociation

Humans are defined by the negative, and as suggested by Burke in the Rhetoric of Motives, there is no they without we. In positioning AIDS as a black and brown problem instead of an American one, using the word “disproportionately” excessively, and never mentioning the dominant American racial group of Whites, Koop articulated a racial division in which Blacks were they –a group to which he did not belong and a silent we –Whites to which he did. Thomas Nakayama and Robert Krizek (300) indicate that an invocation of science privileges a traditional Western approach to ontology and epistemology above critical-cultural ones. I see Koop’s scientific approach as the foregrounding of whiteness as the norm within an invisible rhetorical construction to exert influence over the audience.

Society works because there are rules and laws which dictate what is right or wrong, good or bad, acceptable or unacceptable in human conduct (Engels 307). With the statement, “I am not apologizing if that sounds like a lesson in morality,” Koop continued to set the scene by tying specific behaviors he deemed immoral directly to the agents of his narrative. Although transmission through blood, semen and the use of dirty needles was at the heart of agency in the boilerplate speech, multiple-partner activity and mother-to-child transmission were not mentioned. Sexual practices associated with homosexuality and bisexuality were downplayed. Now Koop expanded agency in the NAACP narrative. Specific high-risk behaviors of black and brown people were directly linked to transmission, including intravenous drug abuse, homosexuality, bisexuality, heterosexual multiple-partner activity, and infected birthing. This blending of agent, act, and agency is apparent in such statements as:

(1) Among Blacks with AIDS, 35% are I.V. drug abusers. These are men and women who abuse drugs intravenously using dirty paraphernalia they’ve borrowed from another drug user who already carries the virus; and (2) 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 than half of the number of infants with AIDS are Black and another 24% are Hispanic. Nearly all of these children received the virus from their infected mothers either in utero or during delivery.

In tying the behaviors of black and brown individuals to this scene of immorality, Koop advanced a correlation between the quality of that environment and its inhabitants.

His focus on morality enabled religious and social-status identification with this NAACP audience and disassociation from those Blacks who engaged in immoral behaviors. Koop was a highly educated, upper-class, middle-aged, evangelical Christian. The NAACP was dominated by college-educated, upper-class, middle-aged individuals (Pinderhughes 116). His fellow panel members Jackson, Hooks, and Hamilton were all Baptist ministers and Jacob was the son of a Baptist minister. Black people (87%) are the most religiously committed ethnic group in the United States. A majority are Protestant (i.e., Baptist, Methodist), politically conservative, and more likely than the U.S. population as a whole to oppose abortion and homosexuality. Those with college degrees most closely resemble white evangelical Protestants (Sahgal and Smith). This was the perfect setting for Koop to tap into these shared values. In contrast, socioeconomically, blacks at highest risk for HIV tend to have lower income and education levels, higher rates of unemployment, limited access to quality health care and are younger (CDC). We can shape community and participate in victimage together when we define ourselves in opposition to another group (Mackey-Kallis and Hahn 3). Koop defined himself and the religious within his audience in opposition to the scapegoated immoral scene effectively othering black and brown gays and drug users, thereby creating a community of the moral at righteous odds with the immoral.

In expressing a sense of urgency about the spread of the AIDS virus within black and brown communities, as Koop claimed was his intent in a 2003 reminiscence, he encouraged moral panic. Moral panics are situations in which groups come under attack by those in power because they are believed to pose a grave and immediate danger to society –a threat constructed as the threat-bearing qualities of the group under fire (Nussbaum 250). In stressing the uncleanliness of IV drug users, alluding to promiscuity through multiple-partner activity, and enumerating the rates of mother-to-child transmission (unlike the boilerplate speech), Koop portrayed homosexuals, bisexuals, and the non-monogamous regardless of sexual orientation as enemies of the family. Black and brown families were already threatened. Children born during the 1980s had a 50% chance of living in single-parent families and births to single women constituted 37% of brown and 67% of black births (Murry et al. 134-135). Koop’s inventory of threat-bearing qualities was linked to the idea of a crisis of morals whereby all that we value as humans is endangered deflecting concern or interest for the targeted group as people we should care about, to simply a symbol of what is wrong in society.  In describing a scene of immorality in which too many individuals within black and brown communities engaged in behaviors deemed deplorable by the moral or religious, Koop blemished the overall image of both.

It is impossible to talk about the actions of actors and the means through which actions are enabled without considering the intent of the actors (Grammars 289). In the boilerplate speech, the purpose of the agent, AIDS, was simple –infect and kill. However, in the NAACP narrative, the purpose was ambiguous and more complicated since the agents were apart of black and brown communities. Koop implied that if black and brown people persisted in such high-risk behaviors as intravenous drug abuse, homosexuality, bisexuality, and having sex with multiple partners or someone already infected, then they were intent on killing others. But, if they just said “no to drugs,” “abstained from sex,” “maintained a faithful monogamous relationship” and “used a condom from start to finish,” then the intent to harm others evaporated. As Burke reminded us, the choices humans make freely as indicated in the actions they undertake, denote character and though about what should or should not be done (Language 11).

Because blacks tend to have sex partners of the same race, their chances of HIV contraction are higher since the rates of HIV tend to be higher among this group (CDC). Therefore, Koop’s strategy of casting blacks as both predators and the preyed upon was linked intentionally or not to the idea of black-on-black crime. Rates in violent crimes presented a significant morbidity and mortality issue for the black community during the 1970s and early 1980s. For example, 94% of black victims were slain by black assailants in 1983 (Palley and Robinson 59-60). Black-on black crime was such a concern of the NAACP that it included the following in its 1980 policy resolutions: “The NAACP calls upon black communities, law enforcement agencies, and courts of law to recognize that crimes committed by blacks against blacks, are as unlawful, are as humanely devastating and are as undesirable in our black communities as crimes committed by blacks upon whites, or any group” (Policy Handbook 51). This indirect tie of the spread of the AIDS virus to black-on-black crime further encouraged moral panic among audience members.

Additionally, with a scene-agency ratio dominating his approach, Koop considered the social impact of AIDS and in a twisted way the political scene on the reception of his message. He stated:

The Black and Hispanic communities have significantly large numbers of AIDS cases. I’m concerned about the subsequent social impact. I fear it will provide greater opportunity for discrimination against Blacks and Hispanics in our society. To echo comments of a prominent national leader on this issue: ‘America faces a disease that is fatal and spreading. This calls for urgency, not panic. It calls for compassion, not blame. And it calls for understanding, not ignorance. It’s also important that America not reject those who have the disease, but care for them with dignity and kindness.’ That national leader is Ronald Reagan.

The president had no credibility with this audience. He was booed when he addressed the NAACP at its annual convention in Denver in 1981. Blacks overwhelmingly supported the Democratic Party with Reagan receiving less than 7% of their votes (Sahgal and Smith).

No one on the panel with Kopp supported Reagan either. John Jacob, as President of the National Urban League, opposed the policies of Reagan which called for a reduction in spending on urban problems by advocating an Urban Marshall Plan (Rice). Jesse Jackson, as head of Operation PUSH and unsuccessful in this 1984 bid for the Democratic nomination, blamed Reagan’s policies for a reduction in government domestic spending, an increase in unemployment, and encouragement of economic investment outside of inner cities (Ralph). Even the Executive Director of the NAACP, Benjamin Hooks (1045), a Republican, believed Reagan was indifferent to civil rights and attempted to roll back affirmative action while touting reverse discrimination. Koop indicated some knowledge of the negative views his fellow panel participants held of Reagan, as indicated in his 2003 Reminiscence that, “Jesse Jackson told me what he had told me several times before that I was the only good thing about the Reagan Administration.”

Evoking the name of Ronald Reagan reminded audience members that they had not received support from the Reagan administration on any of the issues they deemed important and probably could not expect assistance with this issue either. Koop had successfully initiated victimage through distancing the moral from the immoral, encouraging moral panic, implying black-on-black crime, and evoking the name of Ronald Reagan. Now to complete this cycle of guilt and redemption, all that remained was for Koop to purge his own guilt and assist his moral community in purging theirs.

Redemption through Education and Self-Determination

Koop credited science for discovering AIDS and tracking the transmission of its virus through specific communities, but denied his audience hope by failing to mention the possibility of a cure or research to find one. He did not mention any available resources, arrangements underway by the DHHS to provide resources, or even the possibility of any in the immediate future. He simply stated: “I am willing to support those efforts which show greatest promise of efficiency using limited resources. We must identify resource needs and methods of securing private and public support to meet these needs.” As in the boilerplate speech, he offered AIDS education that promoted abstinence, monogamy with the use of condoms, and personal and moral responsibility as the solution. But then went further in laying the responsibility for that education at the feet of the NAACP with, “I invite the Black organizations, such as the NAACP to establish a planning committee to set strategies to meet the goal of a culturally relevant AIDS prevention for Blacks.” Koop made it clear that the AIDS epidemic in the Black community could only be solved by the Black community with:

Strategies should be developed that utilize Black community organizations, utilize Black health professionals, and most important, strategies must involve Blacks in efforts of majority organizations, connect AIDS with other STD and teen programs, and develop training programs especially for teachers and counselors. Judging from a history of success, often under very adverse conditions, I am confident that Black organizations with the support of the community, will swiftly and successfully shift into a battle mode to deal with the AIDS challenge.

With this closing, Koop was thereby redeemed and purged of any guilt he felt for his failure and that of the Public Health Service to lend support.

Koop’s directive that the NAACP create its own culturally relevant AIDS prevention advanced an ideology of self-determination that more than likely resonated with this audience both positively and negatively. In the complex sociopolitical environment in which Koop spoke, his audience was predominantly protestant and valued self-help, but belonged to congregations that were less likely to provide social services than previous decades. However, this solution allowed his moral audience to purge any guilt they felt for distancing themselves from the deplorable immoral individuals of the community while simultaneously providing those individuals with assistance. Self-determination creates suppositions about the abilities of human beings and their bond to a larger community too which they belong (McKeen 410). As a civil rights organization, the NAACP exercised self-determination in its fight to secure equal rights for people of color by using the legal system (Pinderhughes 115-117). John Jacob’s National Urban League promoted self-help including grass roots efforts to address crime, single parenthood, male responsibility for fatherhood, and efforts to improve educational and employment opportunities for Blacks (Rice). Jesse Jackson’s Operation PUSH advocated black self-determination by championing education through its PUSH-Excel program which emphasized keeping inner-city youth in school and assisting them with job placement. PUSH was also successful in committing companies with a large presence in Black communities to adopt affirmative action programs to hire more blacks at higher-levels and to purchase supplies from black wholesalers and distributors (Ralph).

In the United States, The Black Church adopted a self-determination tradition with slaves helping each other survive the horrors of the plantation system through self-esteem, encouragement and skills.2 The Black Church changed based on the sociopolitical context of the time but always provided social services to the black community (Lincoln and Mamiya 11). During Reconstruction and the Twentieth century, the autonomous institutions of the Black Church made loans to small businesses, founded and supported institutions of higher education, financed banks, insurance companies and other organizations (Lincoln and Mamiya 242). These acts of self-help were an acknowledgement that Whites had not and probably would not live up to their own obligations to the black community (McKeen 413).

The Black Church was viewed as accommodationist during 1877-1950s Jim Crow with an emphasis on racial uplift and assimilation to White society. However, its actions were part of a self-determination tradition that emerged as an attempt to resist stereotypes used to justify marginalization of Blacks in American society since Post-Reconstruction Republicans had abandoned the cause of racial justice for freed blacks. In resisting racial and economic oppression during the 1950s-1960s Civil Rights Movement, the Black Church provided leadership, the membership base for various organizations, meeting places, communication networks and financial support in efforts at self-determination. After numerous legislative victories such as the Civil Rights Act of 1964 and the Voting Rights Act of 1965, some churches in the 1970s espoused a liberation theology of self-determination to achieve equality with Whites through resistance rather than accommodation. During this time non-profit Community Development Corporations, affiliated with but separate from the church, were created to provide outreach in the form of economic and social resources to individuals to address structural injustices (Barber 252-54).

The Black Church fulfilled the role of a mediating structure providing a linkage between large bureaucratic organizations and individual citizens as church-state boundaries blurred and churches were able to compete for government funding for charitable services. Black churches and non-profit organizations were five times more likely than other churches or organizations to seek such funds until the early 1980s when the political scene changed. President Ronald Reagan and fellow conservatives argued that federal spending on social services was too high and advocated for less government intervention. They demanded that nonprofits and religious institutions assume a greater responsibility for social services. 

This was the sociopolitical environment in which Koop spoke. He had a predominantly religious audience who valued self-determination, but affiliated with organizations that were less likely to provide social services than previous decades, coupled with a presidency that promoted less government spending. In addition, the NAACP lacked the means to provide resources due to a depleted budget.


This essay is the first to compare and contrast addresses from the same speaker to different audiences on the topic of AIDS while simultaneously incorporating the speaker’s own reflections on the moment. It demonstrates that although a speaker can address the same topic before different audiences, the key narrative weaved can be very different. I argued that Koop presented two distinctly different AIDS narratives, one for general audiences and another for Black audiences. It was an AIDS scapegoating rhetoric of guilt and redemption. Although he shifted from an idealistic pragmatism to a materialistic pragmatism, Koop consistently exhibited an attitude that valued scientific knowledge and the need for individuals to exercise personal responsibility. Koop’s pragmatism suggests that as individuals, we have the capacity to think rationally about the facts medical science provides on the transmission of AIDS, to determine whether or not our own sexual behavior is suspect, and if found to be so, the ability to cease or modify those behaviors to the benefit of the larger community. However, scientific evidence alone cannot resolve questions of personal responsibility in healthcare, and rhetorical strategies must respond to varying constraints and require different attributions of responsibility for various audiences (Kirkwood and Brown 60).

Koop persuaded both audiences that the immediate solution to the problem of the spread of HIV/AIDS was education. The sociopolitical environment played an important role in the design and reception of his messages before both audiences. In order for general audiences of U.S. Americans, primarily Whites, to understand that AIDS education was the answer, they had to understand just how deadly this new disease was. Therefore, scapegoating HIV/AIDS served to direct attention away from the disproportionately affected in society to the threat to all by circumventing the conservative rhetoric and stances of the 1980s Reagan administration and Religious Right. Similarly, in scapegoating an immoral scene in which black and brown people were the agents, Koop’s comments served to underscore specific conditions within these communities which would focus attention on them directly. Religiously conservative and homophobic, politically anti-Reagan, and socially engulfed by high rates of black-on-black crime and single-parent households, the audience was primed for victimage. Through social-status and religious identification that created a community of the moral, Koop’s audience was able to purge their guilt, disassociate from the immoral among them, and be redeemed in adopting his education solution.

We know that Koop was instrumental in the AIDS education of the general public through the positive reception of this mass mailer, opinion pieces, and media appearances. There is also evidence that Koop’s NAACP audience may have been inspired by his message. At its 1987 meeting the NAACP adopted two resolutions. The first was a policy on teenage pregnancy that encouraged parent-child communication about sex education and the responsibilities of parenthood (Policy handbook 157). This policy went hand-in-hand with Koop’s assertion that families should take the lead in educating youth about sex.

The NAACP also called for the elimination of racial disparities in the country’s approach to dealing with the AIDS epidemic and its disproportionate rates among black and brown communities.  It called for government and private assistance in funding minority HIV/AIDS programs, and for Congress and the Administration to enact and sign laws to fund AIDS research and provide public financial assistance to AIDS patients (Policy Handbook 155-156). This provision was an acknowledgement of the facts presented by Koop about the disproportionate number of HIV/AIDS cases in minority communities. It also supported the current socio-political position of the black community that the government had a responsibility to share in providing social services to its citizens. The NAACP’s call would be answered in 1989. As Sutton et al. (S352) noted, the CDC for the first time, funded HIV-prevention organizations to provide capacity-building assistance to local and regional community-based organizations that served people of color.

The second resolution passed at the 1987 convening of the NAACP acknowledged the responsibility the black community had for its own people. It issued a national call to action to the entire black community and announced it would embark on an educational campaign to ensure the black community received accurate information about HIV and its transmission (Policy Handbook 155-156). This statement of intent was in line with the black community’s history of self-determination and the education efforts of black gay and lesbian organizations already underway. It also supported the socio-political position of the black community that although the government had the primary responsibility for providing social services to its citizenry, the affected black community should also do everything it could to prevent the spread of the AIDS virus too.

However, due to its complex bureaucratic structure, extensive mission to address political, educational, economic, social and educational rights of all citizens, and persistent homophobia, the NAACP was slow to devise an AIDS education program. In 2013 with Gilead Sciences, Inc., the NAACP committed to enlisting the Black Church as change agents in addressing the impact of HIV in the black community. It established The Black Church & HIV Initiative to bring together religious institutions, faith leaders, and community members to commit to ending the epidemic in black America. So far, the Initiative has convened stakeholders in 30 cities with the greatest HIV burden, trained more than 1,800 faith leaders across 45 faith leader workshops, committed more than 140 faith leaders to preach from the pulpit on AIDS as a social justice issue, and encouraged six denominations to issue public endorsements in support of the Initiative. In addition, the Health Programs Department and Advisory Committee of the NAACP created additional resources to assist congregations including infographics, videos, national and local fact sheets, and an activity manual entitled, The Black Church & HIV: The Social Justice Imperative. The manual advocates a four-stage social justice approach integrated with HIV activism in the Black Church. The stages include awareness, engagement, mobilization, and sustainable change (Bryant-Davis et al.). Like Koop, the manual emphasizes the importance of education, but notes political involvement is essential in influencing decisions for resources to address the educational inequality that impacts access to HIV care and treatment. The NAACP’s Initiative in utilizing the Black Church in addressing the spread of HIV is a clear indication that it views this health issue like Koop, as first and foremost an issue of morality.


1. Throughout this essay you will notice that Koop consistently in his speeches uses the phrases infectious pneumonia, the AIDS virus and the spread of AIDS and never uses the designation HIV. He conflates HIV and AIDS. However, HIV is the virus that spreads through the body destroying T cells which help the immune system fight off infections. The pneumonia he refers to is now known as Pneumocystis pneumonia and is one of a number of severe opportunistic illnesses that results from damage to the immune system. It is a flu-like illness that individuals may experience during the first stage of HIV infection. AIDS is the third and most severe stage of HIV infection in which one’s T Cells have fallen below 200 and an increasing number of opportunistic illnesses result. Symptoms mimic severe pneumonia and include a high fever, chills, weakness, weight loss, and swollen lymph glands. For more information on the differences between HIV and AIDS refer to the CDC’s website and its numerous references.

2. I use “the Black Church” to refer to churches belonging to black protestant denominations, just as the scholars Franklin Frazier, C. Eric Lincoln and W.E.B. DuBois did –not as a monolith but to highlight a common historic and sociopolitical identity of churches with predominantly black membership.

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