In the Time of AIDS, A Nonstop Crusader

In those backrooms, she nudged the CDC and HHS into supporting needle-exchange programs targeting injection-drug users, who are highly vulnerable to contracting HIV. In 1998, she flew to Washington for a media conference announcing that then-President Bill Clinton's administration would federally fund needle exchange. But she got outmaneuvered by retired Gen. Barry McCaffrey, then the nation's drug czar.

"It was a tiny coup," McCaffrey says in an interview this week; he had the ear of the president and told him the program wouldn't work.

Gayle remembers feeling "betrayed."

"You realize politics often get in the way of people's best judgment," she says. "You keep on swinging."

The needle-exchange setback, though, did little to dim her star. In 2001, she called her friend Dora Warren, a CDC AIDS expert, to say she was leaving for a high-ranking job at the Bill and Melinda Gates Foundation.

"She said, 'Meet me at 7 a.m. in my office for 10 minutes,' " Warren recalls in an interview. "She said, 'Tell me what you would do if you had all the money in the world.' " With a giganticized checkbook, Gayle took on a giganticized project, setting in motion a $200 million prevention program in India, a nation then thought to be on the verge of an Africa-scale epidemic among sex workers and their clients.

"I can remember being in meetings, and people from charities saying it couldn't be done. You had people in the government saying, 'We don't want your money.' I realized that Helene was turning into Public Enemy Number One. I told her, but she just laughed and said, 'You can't please everyone,' " says Ashok Alexander, the program's director.

In 2006, she moved on to become president and chief executive of CARE, a job that now pays $400,000 a year.

All along, Gayle has remained single, though she is said to be a prolific matchmaker. In between conference sessions, she calls a friend's daughter who is tagging along as a volunteer. "Are you off with some strange man?" she teases.

"Once," Jacob Gayle recalls, "someone asked her why she'd never gotten married. She got this hurt look on her face, like, 'Have I forgotten to do something? Nobody BlackBerry'd me about this?' "

But there was -- maybe is-- a boyfriend. "He's in Seattle. I'm in Atlanta," she says. "I'm keeping my options open."

The answer is purely Gayle-istic, reminiscent of her response to a question at the conference about what she would do if she were the next head of UNAIDS, a job some think she might occupy one day: "I'm going to answer that by not totally answering that with great precision."