San Francisco Examiner, Friday, November 27, 1998
Eric Rosenberg, Examiner Washington Bureau

There he is - the director of the federal agency that oversees about half of the government's AIDS research in framed snapshots with such famous battlers against the deadly disease as Elizabeth Taylor and Mother Teresa. But for a long time Fauci was public enemy No. 1 to the activists in gay health groups and the outspoken AIDS Coalition To Unleash Power.

In fact, in 1988 Larry Kramer, a New York playwright and ACT UP founding member, called Fauci "an incompetent idiot" and a "monster." Kramer even wrote a play in which someone labeled the Fauci character a "scientific fraud."

How Fauci - one of the first government scientists to launch an all-out federal attack on HIV turned around the irate activists and made them his allies is the story of a man with infinite patience and consummate political skills.

When the disease first erupted in America in 1981, he was directing a lab dealing with the immune system at the National Institute of Allergy and Infectious Diseases, which is part of the huge National Institutes of Health (NIH) in the Washington suburb of Bethesda, Md. In 1984 Fauci became head of the infectious diseases institute.

As the number of AIDS victims grew and the death toll rose, ACT UP and other groups complained that the Ronald Reagan administration in general and Fauci in particular weren't responsive to the terrible plague.

"We battled Dr. Fauci down to the wire," said Barbara Hughes, president of the Treatment Action Group, a New York-based AIDS advocacy organization. "He started out as one of our chief adversaries."

Unlocked mysteries

While he was under attack, Fauci was trying to unlock the cellular mysteries of the immune system and the deadly virus. For instance, researchers originally thought that after the virus enters the body, it lies dormant for years. But Fauci and others discovered that instead, it is quietly invading disease-fighting cells and turning them into virus-making factories.

"Tony was among the first to show that HIV continued to be actively replicating during what was believed to be a dormant phase," said Dr. William Paul, an immunologist and former director of NIH's Office of AIDS Research.

But Fauci, as a federal administrator, began to see that the government and the AIDS activists had to work together if the raging disease was ever going to be brought under control.

When protesters held a demonstration at the NIH in 1988, he invited several of them to his office for discussions.

In 1989, at a Montreal AIDS conference, he unexpectedly ran into Kramer, and the two discussed their differences. Soon afterward, Fauci aggressively sought the advice of activists. He was the first high-ranking government health official to do so.

"Tony came to community groups and asked, "What do you guys think we ought to do?' " recalls Spencer Cox, a New York AIDS activist. "It seems like a small thing now, but it was a huge deal then."

For his part, Fauci says the activists "were off base on a few things but, son of gun, a lot of what they were saying made sense."

For example, Fauci agreed with complaints that the sluggish government was not equipped to deal with the spiraling epidemic and that bureaucrats had stymied drug development by pharmaceutical companies with excessive regulations. He agreed that the bureaucratic red tape was discouraging AIDS patients from taking part in trials of possible new treatments.

Based on input from the activists and prodding from Fauci, the NIH instituted a plan in 1989 to speed the introduction of new AIDS treatments. The strategy, now standard practice, is called "parallel track," and it lets researchers conduct a clinical trial of a new treatment while at the same time allowing sick people to receive it.

Ever since, Fauci's ties to AIDS groups have remained strong, and he regularly appoints activists to advisory committees that shape research efforts.

He's also a top advisor to presidents and lawmakers on AIDS strategy. President Clinton relied on his expertise last year when the administration laid out an ambitious goal of discovering within the next decade a vaccine to prevent the virus from attacking the body. On another front, Fauci's laboratory published a study earlier this month showing that Interleukin-2, a drug that stimulates the immune system, may, along with other drugs, help the body fight HIV.

Besides his scientific duties, Fauci makes rounds twice a week to see AIDS patients, conducts laboratory meetings and manages an annual budget of $1.57 billion - $810 million of which is dedicated to AIDS research.

"He's a lobbyist for AIDS research, an administrator, and he keeps an active lab going - I don't think he gets much sleep," says Dr. Jay Levy, an AIDS expert and virologist at UC-San Francisco medical school.

Kramer, who is HIV-positive, regularly calls Fauci for advice on treatments. And when the playwright is in the Washington area, Fauci usually springs for dinner at an Italian restaurant.
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