Within minutes of greeting a disinterested, naive-to-AIDS visitor, he dives into a discourse so impassioned, so engaging, so effortlessly compelling, that it would seem better directed toward a panel at the National Institutes of Health. And within the same breaths, he also manages to indirectly attack his AIDS-research colleagues, AIDS patients, government health officials, and the citizens of the United States of America.
His gentle, helpful, gregarious, yet mildly self-effacing style is just the sort that, in another medical context, might be described as a skillful bedside manner. But just as a gentle physician might speak venomously of an illness that had felled a favorite patient, Francis' phrases are laced with scorn.
"Why is there so little interest in a vaccine, when that's the only way the disease would be stopped? And why is there so much interest in anti-virals? Once you are HIV-infected, you know you have something to gain from treatment. In this day and age, why do you hear nothing about vaccines, even though they are the cheapest form of treatment? To me, it's an interesting social question. For me, it's easier to discuss vaccines in Thailand than in the United States," he says, ramping up with every passing word. "Diphtheria, polio, whooping cough -- with these awful, awful diseases, there was a common social value seen in vaccines. But there's an exception with AIDS, this incredible, incredible disease with 100 percent mortality."
It is with this almost irresistible force of verbiage and will that Don Francis has single-handedly managed to push his 14-year-old idea for a novel type of AIDS vaccine through a harrowing gauntlet of opposition.
He has moved past the protests of gay activists, who have said that money spent on trials for this vaccine might take away from AIDS treatments; past government health care officials, who declined to fund efficacy trials for the drug; and past rival scientists, who say his vaccine is doomed to fail.
Now, Don Francis' vaccine is being injected into thousands of volunteers in the U.S. and Thailand as part of a trial to see whether it will vanquish the greatest epidemic in the world.
On March 18, 1999, at 25 Van Ness Ave., an S.F. Department of Public Health worker pushed a needle into the arm of a healthy, sexually active gay man, emptied a cylinder full of colorless, watery liquid, covered the pinprick with a band-aid, and brought Don Francis' struggle full circle back to San Francisco. This city's two test sites were among the last of 59 around the country to begin hosting Phase III vaccine trials, the first FDA-approved trials in history to test whether an AIDS vaccine will actually work.
Don Francis began fighting AIDS in 1981. He was among the first to warn that the disease could become an epidemic of global proportions. He was among the first to recommend massive government funding to stanch the disease. He campaigned to close San Francisco bathhouses, and to pressure blood banks to take precautions against spreading AIDS. He was also the central figure in Randy Shilts' book And the Band Played On, the seminal chronicle of the AIDS epidemic. And for the past 11 years he has battled every sort of foe to champion gp120, a type of vaccine he described in a 1985 scientific paper.
If Don Francis fails -- and much of the scientific community seems to have rallied around the notion that he will -- his efforts will be remembered as a footnote in the history of AIDS.
If Don Francis wins -- if the clear, watery liquid injected into vaccine trial volunteers spawns effective HIV antibodies in the flesh of the first San Francisco volunteer and thousands like him -- this former Marin County kid will become a pivotal figure in world history. He will have brought within sight the end to one of the greatest of all epidemics. He will have given full lives to children of Zimbabwe, Zambia, and Swaziland who now, in the shadow of AIDS, have a life expectancy of less than 40 years.
He will have vanquished what scientists call history's cleverest disease, and he will have done it with warm words, a well-stocked medicine bag, and venom for everything and everyone standing in his way.
Most in the world AIDS establishment believe Francis' vaccine will not work. The entire scientific infrastructure of the United States of America has been unable to come up with an effective vaccine for AIDS, and does not think a scurrilous firebrand from the Bay Area has succeeded where the establishment failed.
Five years ago, the federal government refused to fund so-called Phase III trials for gp120 -- that is, experiments that would show whether the vaccine actually works -- citing weak evidence of the vaccine's potential efficacy. A paper last year in the Journal of Virology suggested this vaccine may have no immunological effect at all. And even Francis' admirers say that his AIDS vaccine may not be the most promising among the dozens that companies are now attempting to devise.
But if Francis has faced no small amount of scientific opposition over the last decade, his most formidable opponent by far has been the AIDS virus itself. AIDS is a retrovirus, which means it insinuates itself into the genetic makeup of a cell, wrapping its own genetic code into a host cell's DNA. And as scientists know from battling diseases such as leukemia, it is extremely difficult to get rid of a virus or bacteria when it is inside a cell.
The human immunodeficiency virus is astonishingly elusive. It is able to mutate more rapidly than other disease-causing organisms, morphing itself like Arnold Schwarzenegger's foe in Terminator 2 to slough off any weapon thrown at it. HIV mutates and transforms itself 100 times faster than common influenza viruses, so there are dozens of strains and subgroups and recombinant types of the retrovirus. This makes it a particularly slippery target for vaccines and remedies. Just as a remedy targets one strain of HIV, a different strain takes its place. In the case of vaccines, as the body's immune system is fortified to attack one sort of HIV, mutant cousins the body isn't prepared to defend against manage to insinuate themselves into cells.