The Wall Street Journal - November 8, 2004
Marilyn Chase

Back in the heady 1990s, Patty Stonesifer was leading Microsoft Corp.'s interactive-media group, launching new software, and demonstrating for a reporter a new videogame with her trademark brio, saying, "Isn't this cool?"

Now she manages operations and giving for the Bill and Melinda Gates Foundation, the world's largest private philanthropy. The foundation has current assets of $27 billion, set to rise to $30 billion under new pledges from its founder.

Ms. Stonesifer, one of nine children of activist parents involved in Indianapolis food banks, says of her early influences, "It wasn't philanthropy, but service. You did what you could to help."

After making her mark on high tech, she retired in 1997, a millionaire at 40. But soon she found herself back in the gravitational field of Microsoft founder Bill Gates. He launched her on a different mission: addressing inequities in education and global health.

As president and co-chairman of the Gates Foundation, Ms. Stonesifer has played midwife to the rebirth of the world's richest man as a philanthropist and benefactor, deploying a chunk of his personal fortune to prevent and treat some of the world's worst diseases: AIDS, tuberculosis and malaria.

She personally reviews several dozen of the 3,000 grant applications received each month, helping award 300 per year. She travels the world, seeking powerful partners for her ventures and advocating for solutions to global health crises. The mother of two grown children from a prior marriage, she now is married to Michael Kinsley, opinion editor of the Los Angeles Times. The two are among Seattle's social elite, mingling with writers, Web moguls, AIDS scientists and two generations of Gates activists.

So what qualified a high-tech executive to make the leap from wiring the world to curing AIDS? "One of the things that dismays the Gates family and myself is how little we were involved in the [AIDS] epidemic before," she said in an interview last year. "Each of us who has resources, skills and influence, also has a responsibility. It's the No. 1 health priority for us."

During her transformation, there were awkward moments -- for example, when South African President Nelson Mandela visited Seattle and asked an audience of social activists to stand if they'd done anything to help end apartheid. Ms. Stonesifer stood, "but only in the most modest way," she says. She suddenly sensed her prior commitment to key social issues had been inadequate. "I don't know that I did enough," she says. "I feel the same way about AIDS. I was aware, but I didn't know what we should be asking our government and others to do in this challenge."

Tackling inequities in health and education and solving business problems have similarities, she says: identifying needs, opportunities, neglected areas, strategic partners. Proving a concept and scaling it up has been the approach "since we opened our checkbook," she says. "It's a pretty virtuous cycle."

What is most different about philanthropy? "You have to work harder to make sure you're doing the right thing," she says. "There is no equivalent of a marketplace reaction." Instead, the foundation conducts studies and internal reviews to ensure its money is well spent.

"I'm quite sure we're using our dollars well," she says. "The challenge is to make the best use of our dollars."

Wise use of millions in AIDS grants means not duplicating others' work, and daring to ruffle feathers. When the foundation sought a site for AIDS prevention, it chose India, where five million people are infected and one billion at risk. Amid a decorous society unused to frank sex talk, the foundation proposed clinical services for people in the sex trade, some of whom she met last March in Mysore.

"I saw families in the most difficult situations, having the same concerns as I had," she says. "They want their family to be safe, well-fed, well-protected. In Mysore, I saw women with families or young men who were commercial sex workers. Some were the age of my kids." All shared with her "the same interest in protecting themselves and their families." Whether the foundation can prevent the spread of AIDS in India is uncertain.

"We have a high tolerance for risk," Ms. Stonesifer says. "I created some of the worst products in the world at Microsoft," she recalls with a laugh. Fighting AIDS, TB and malaria are "inherently risky ventures.

But, she adds, "it's worth the risk. The return, if we get it right, is so huge."

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