In the Time of AIDS, A Nonstop Crusader
'A Force of Nature' Takes on a Modern Scourge

By Manuel Roig-Franzia
Washington Post Foreign Service
Saturday, August 9, 2008

MEXICO CITY

She drags colleagues out of bed for 5 a.m. runs in Hanoi and Bangkok. She touches down in Jamaica just long enough to deliver a wedding toast after stops in Washington and Atlanta. Once, she even quick-changed into a ball gown in the bathroom on the same day that she had flown from Washington to New York and back again for a soiree.

And now Helene Gayle, Global Poverty and AIDS Fighter, is trying to make small talk in a taxi lurching through the snarl of traffic here. "Nice weather," she says. "When does it get cold here?"

That conversational ground covered, Gayle is back inside her head. Deep inside. Her lips are pursed, emphasizing high cheekbones that would be the envy of any runway model. She's gazing into space, surely "processing something," as her brother Jacob Gayle says she tends to do, "multitasking more than any other human being could imagine." She's riffling through briefing papers for the 17th International AIDS Conference here. She's checking her BlackBerry for the fifth time in the past five minutes.

She has the reserved, socially cautious demeanor of the scientist who dwells in facts. And, as the head of CARE, she has to emote with passion and charisma to lead one of the world's largest charities, operating in 71 countries, with 13,000 employees and a $545 million budget.

Somehow, they co-exist, these two Helene Gayles. The shy one and the one whom Bill Gates and his foundation once trusted with hundreds of millions of Microsoft-minted dollars, the one who kicks it in India with Richard Gere and talks shop with Bono. The one who makes the scene in designer gowns.

"She's an introverted loner," her brother says.

"She's a force of nature," says Aparajita Ramakrishnan of the Avahan India AIDS Initiative, a program launched by Gayle.

"A world-renowned woman -- it's so natural for her," U.S. Rep. Barbara Lee (D-Calif.) says.

A quarter-century after the emergence of AIDS, Gayle, 52, a pediatrician and epidemiologist by training, has cemented her place in an elite class of international decision makers who are shaping what the next quarter-century of the disease might look like. Theirs is a community of scientists, physicians and fundraisers who tend to slide back and forth from government gigs to charities to academia, just as Gayle has hopscotched from big jobs at the Centers for Disease Control and Prevention and the Gates Foundation to the helm of CARE.

Many in this interlacing world think Gayle will be shortlisted for something big -- secretary of health and human services or surgeon general -- if Barack Obama is elected president. Gayle, who has been donating money to Obama's campaigns since 2004, but also gave to Hillary Rodham Clinton's presidential campaign, said in an interview that she wouldn't rule out a return to government. CARE provided "in some ways my dream job," she says, but if a big government post were dangled in front of her, she'd "have to weigh that seriously."

For now, though, she inhabits a universe of disease chasers that has matured from the early, confused days of "the gay plague" -- a time when Gayle says activists sometimes threw tomatoes at her -- to a full-fledged global movement.

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."

* * *

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."

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."

* * *

The scientist prefers to talk about numbers. She loves to talk about numbers: the infection rates, the studies, the columns of figures that fill her head.

"I am an epidemiologist," she says, as if that should explain everything.

Last year, Gayle rattled the philanthropy world by pulling out of a U.S. government food aid program because she determined it was inefficient and hurt African farmers. The decision cost CARE $45 million a year and drew tut-tuts from some charities. But she put faith in her numbers.

"It cost 33 cents on every dollar in transaction costs," she says in a flat, unemotional tone in the lobby of the swank Hotel Nikko here. Case closed.

At the conference this week, she sat stoically on a panel of the Black AIDS Institute, a group that complains that not enough attention is being paid to the disease in its community. Activist Phill Wilson decried "a direct attack against black America." "Dreamgirls" actress Sheryl Lee Ralph reached for ear-drum-splitting decibels, demanding "a seat at the table."

Some panelists smiled or chuckled. Gayle stared straight ahead. She drew a slender finger across the edge of her chic, short-cropped do and maintained her bureaucrat's poker face, one she has shown countless times, friends say, before getting everyone back on track with a single, concise dissection. When it is her turn, she speaks in measured terms: "We can't make statements without having the data."

Getting out of the room is not concise. One step and it's, "Hey, Helene!" Hugs ensue. She's a full-body hugger, so this takes a while. One more step, and the process is repeated.

"That was feisty!" an old friend says.

"Sure was," Gayle responds. She pounds a fist into her palm, but her smile seems to say, "I wish it was a little less feisty."

Later, she chuckles about the smoke and fury in the session.

"You get black people in a room -- we're a loud people," she says.

The next evening, she has ditched the pricey, shimmery gold Stuart Weitzman flats she uses to race around at mach speed for an elegant, open-toed black pair, and she has also, uncharacteristically, ditched a strict adherence to numbers. There might not be scientific proof that reducing abuse of women in Africa or teaching Afghan girls to be engineers -- two projects close to her heart -- lead to lower AIDS infection rates, but "so what," she says.

"We need the evidence, but we also ought to do the right thing," she says. "Sometimes we do things because we just know it's the right thing to do."

Seconds later, she's out the door of the big conference room. She's got three parties to get to, an award to hand out and a driver waiting. But first she wants to say hi to the Indian health minister, of course. On the way, she pauses for a minute-and-a-half of consultation with a pal from Thailand.

"I can meet you in Bangkok," he calls out to her as she disappears into the crowd.

Half an hour later, she drops into the U.N. Red Ribbon Awards dinner between the tortilla soup and the main course. Twenty minutes pass and her assistant is calling the driver. It's time to go.

"Really?" he asks.

Back in the car, they race to another reception, and Gayle is talking about how CARE can be more effective advocating for change than delivering services. Then she goes silent, back inside her multitasking head. The only sounds are the Mexico City traffic and her fingernails on the BlackBerry.