In the Time of AIDS, A Nonstop Crusader

Once, they talked about a cure. They schemed about vaccines or therapies to vanquish the virus invading African villagers, Indian shopkeepers, Mexican prostitutes, Haitian beggars and American city dwellers. They got worked up about "microbicides," gels they hoped could protect against transmission. In their parlance, these were "technologies." But the virus is still spreading and the technologies, well, they haven't turned out as hoped. And still there is no cure.

So Gayle and a cadre of public health powerhouses are now more likely -- finally, some would say -- to talk about changing the way people behave, especially persuading them to have sex with fewer partners.

"It's unfortunate this wasn't recognized earlier," Helen Epstein, author of "The Invisible Cure: Africa, the West, and the Fight Against AIDS," says in an interview. "I was thrilled at the conference to see that Helene Gayle, who'd long supported a more technical approach, is coming around to the view that behavioral approaches are very good and have a lot of potential." Gayle was showcased at the Mexico City gathering -- introduced as "one of the best known people at the conference" -- just days after the CDC announced that the U.S. HIV rate is much higher than previously reported. Like others here, she was in no mood to crow.

"Some of our hopes we'd placed in prevention technologies have had some setbacks," Gayle said onstage at a conference session. Later, she was characteristically matter-of-fact about what lies ahead:

"There's not going to be a vaccine tomorrow."

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One of five children in an African American family, Gayle was raised in a predominantly white Buffalo suburb and never got a sense "of limits" growing up. Her mother had a master's degree in social work; her father was a successful businessman. When she went off to the University of Pennsylvania for medical school, she was one of only about eight black women in her class of 160, she says.

"If you wanted to be a dentist, you could go see our uncle. You wanted to be a pediatrician, go see Aunt Lydia," says Jacob Gayle, deputy vice president of the Ford Foundation and head of its HIV/AIDS initiative. "We had family friends who were lawyers and diplomats."

Their mother suffered from mental illness -- most likely schizophrenia or bipolar disorder, Helene Gayle says -- at a time when such conditions were stigmatized and poorly understood. The children shuttled among several homes after their parents divorced, and eventually their mother spent time in a psychiatric hospital.

"That's not a comfortable thing when you're a child," Gayle says.

Gayle was hit by a car in seventh grade and spent six months in traction. To this day, she walks with a hint of a limp because one leg is slightly shorter than the other.

Gayle went to work for the CDC, rising to become the director of the National Center for HIV, STD and TB Prevention. "We had to keep an eye on her because she was always pushing the envelope, but we secretly loved what she was doing," says Victor Zonana, who was a spokesman at the Department of Health and Human Services. "She was scrupulous about [just] playing an inside game."