Dr. Helene Gayle has seen it all. From the Reagan/Bush era of the 1980s, through the Clinton administration, and on to another Bush presidency, Gayle has plugged away at the U.S. Centers for Disease Control and Prevention (CDC). From 1995 to 2001, she directed the agency’s National Center for HIV, STD and Tuberculosis Prevention—which means she was the federal government’s primary scientist charged with stopping the spread of HIV/AIDS both at home and abroad. Hers was the largest of the agency’s 11 centers, operating with an annual budget of around $1 billion in fiscal year 2001.
Now, after 17 years of public sector service at the CDC, Gayle has moved to the private sector. While still a U.S. Public Health Service commissioned officer officially employed by the U.S. government, she is currently on loan to the Bill and Melinda Gates Foundation—the world’s largest philanthropic organization created by the Microsoft founder and his wife to finance global health and other initiatives aimed at decreasing social inequities. Gayle oversees the Gates Foundation’s HIV/AIDS and tuberculosis programs and offers the group a long-term vision in dealing with these epidemics, particularly in developing-world nations.
The long haul is something Gayle is certainly familiar with. As U.S. health policy has morphed, and as epidemiological studies have often shown little reason for hope, she’s gone on cajoling policy makers and individual Americans into staying the course on prevention. “When I came to the CDC in 1984, AIDS was just beginning,” she reflected in a July 2000 interview with Kujisource (a publication of the Black AIDS Institute), during the historic 13th International AIDS Conference in Durban, South Africa. “I stayed because it is the public health issue of our time. … HIV/AIDS is so much broader than just discussing a particular virus. It is the paradigm for public health, because it involves addressing so many other related issues—poverty, gender, race, homophobia—that have broad ramifications.”
From the start, Gayle was keenly aware of the racial disparities involved in HIV/AIDS. As early as 1983, African Americans, who represent 13 percent of the U.S. population, accounted for 26 percent of national AIDS cases. Gayle says that everyone was slow to comprehend and react to that imbalance. As head of the CDC’s Center with responsibility for HIV prevention, she has sounded a regular refrain about the virus’s disproportionate attack on communities of color. In doing so, she has particularly attempted to drive home the risks for Black gay and bisexual men and heterosexual Black women.
Increasingly, public health has focused on the relationship between these two groups, often suggesting a pronounced risk caused by straight-identified Black men who have sex with men but do not disclose that fact to their female partners. Gayle has stressed that the important issue in this discussion is that the community must both combat the homophobia that discourages honest sexual communication and empower women in their sex lives, giving them the information they need to protect themselves.
Gayle has also been a tireless campaigner for boosting federal funding for prevention efforts targeted at communities of color. She believes the best way to do this is to increase the overall available funding pool, rather than “robbing Peter to pay Paul.” In speeches, she has warned against this latter tactic, expressing concern that legislators may pit one community against another rather than providing enough resources to help everyone. “Given what we know and what we have to use, our failure to invest adequately in HIV prevention in the U.S. and worldwide is unacceptable,” she told a gathering at the Durban conference. “We must take a balanced, comprehensive approach that focuses on prevention and treatment for all populations,” she added, “and not do a balancing act that [involves helping] one population or another.”
For Gayle, while the past 20 years have certainly offered some surprises, the early knowledge about HIV’s primary modes of transmission means that the epidemic has “followed somewhat predictable patterns,” she says. “There’s a lot more that we could have done along the way to change that. That’s a critique on one hand. But it also says to me that, when we do get started, we can have a major impact.” In sum: We know how to beat this, we just have to decide we’re willing to do so. And to Gayle that means a far more significant commitment to funding prevention programs. “We’re not doing all that we could do.”