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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.
In a traditional vaccine, such as the ones devised to wipe out polio and smallpox, a weakened or killed virus is injected into a person's body as a sort of feint, provoking a large immune response that combats the real disease. But science hasn't yet figured out a way to inject weakened HIV into people without making them sick.
For these and other reasons, vaccines have so far been elusive, despite increased money spent on research. The National Institute of Allergy and Infectious Diseases recently announced that vaccines will become its primary focus in combating AIDS, and the federal government has pledged $200 million to the cause. Some 30 private companies are now investigating the possibility of creating a vaccine, so far with no conclusive results.
If Don Francis is an arrogant firebrand -- and he is -- he's not your ordinary variety. Francis is an arrogant firebrand with one of the most exquisite epidemic-fighting pedigrees in the world.
At 33, not long out of medical school, the former Marin County kid was one of a small group of Centers for Disease Control doctors sent to the Sudan, India, and Bangladesh to wipe out smallpox. He was also on the front line of the cholera epidemic in Nigeria in the early 1970s. After a stint studying feline leukemia, he returned to Africa, this time to deal with the ghoulish virus that was turning the insides of people along the Ebola river in Zaire to mush. There, he forced local residents to abandon age-old funerary rites in which they handled the flesh of the fallen. Many of those affected by these edicts were outraged. But they no longer died of Ebola.
Next, he completed a doctorate that focused on the study of retroviruses, a type of virus that, unlike others, reproduces itself by reprogramming, in its own image, the genetic instructions inside a cell. After completing his Ph.D., Francis went to Phoenix, where he worked as director of a hepatitis B study that involved working closely with the city's gay community.
In 1981, Francis' hepatitis work led him to stumble across an as-yet-unnamed epidemic: A hodgepodge of bizarre, ordinarily non-lethal infections had begun killing homosexual men in New York and San Francisco. He witnessed the first outbreaks of Kaposi's sarcoma among AIDS patients, and he was one of the first scientists to suggest that AIDS was caused by an infectious agent. Later, as director of the CDC's AIDS Laboratory Activities, Francis worked closely with the Institut Pasteur to prove that HIV was the cause of AIDS. And he was one of the earliest scientists to predict that AIDS was not a passing affliction among homosexuals, but rather an emerging global scourge. His work made him the hero of Randy Shilts' book And the Band Played On, a chronicle of how folly among government officials in the Reagan administration and activists in the gay community, when combined with indifference and prejudice in society at large, made AIDS vastly more deadly than it might have been.
Francis' central role in combating the disease has brought him prestige -- he served as the CDC AIDS adviser to the state of California, special consultant on AIDS to Mayor Art Agnos in San Francisco, and chairman of the Mayor's HIV Task Force -- but it has also brought him plenty of frustration. This is true in part because epidemics thrive on just the sorts of personal liberties human beings hold dear.
It is instructive that Cuba has become one of the most successful countries in the world in stemming the spread of AIDS, despite that country's status as a global sex-tourism destination, because it has carefully educated prostitutes, and taken steps unlikely to be sanctioned in a democracy -- among them, the quarantining of AIDS patients.
Epidemiologists such as Francis have also been stymied by the utterly human desire to look away from the horrifying.
Early on, Francis and other health professionals wished to warn gay men, politicians, federal health agencies, and the public of the seriousness of the AIDS epidemic. These harbingers were met with charges that they were stirring up prejudice against homosexuals. Francis campaigned to have San Francisco's gay bathhouses shut down, after it became evident that they were the sumps where the virus lurked and spread. Outraged patrons and owners countered that bathhouses were a cornerstone of gay liberation. Francis campaigned to get blood-banking firms to take steps to prevent the spread of AIDS through blood compounds given to hemophiliacs and serum used in blood transfusions. Blood banks were slow to comply, and more people died.