America, Meet Tony Fauci. HIV/AIDS Activists Have Known Him a Long Time

#WhereIsFauci.

That’s the hashtag that trended on Twitter early in the afternoon of Wednesday, March 18. Once again, President Donald J. Trump had convened his coronavirus (COVID-19) team, including Vice President Mike Pence and the White House coronavirus response coordinator, Ambassador Deborah Birx, M.D., this time to announce (inaccurately, it turned out) that the Food and Drug Administration (FDA) had “approved” a common anti-malaria drug for treatment against the virus.

But for the second day in a row, conspicuously absent from the lineup was Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID) since 1984. His prior presence at the conferences had been widely praised by scientists, health providers, and the public for providing a voice of longtime expertise—he oversaw most of the government’s medical response to the U.S. AIDS crisis years ago—honesty, and clarity up at the podium.

Standing beside Trump, Fauci seemed to know how to walk a line between truth-telling—he gently corrected Trump on a timeline for a COVID-19 vaccine—and going easy on the president, such as not directly blaming him for a lack of COVID-19 tests, even while calling the insufficient number of tests a “failing.” He also refrained from correcting Trump for repeatedly calling COVID-19 “the Chinese virus,” which several reporters pointed out could be read as racist and as encouraging discrimination against Asian Americans.

But suddenly, just as soon as he’d emerged before the American public, Fauci was gone. Had Trump sidelined him? After all, only the previous day, Trump, not one to enjoy sharing the spotlight, had snidely remarked to Fauci that he was becoming a “major television star.”

On Twitter, Joy Behar, the Trump-hating cohost of The View, tweeted, “Where is Fauci? He often contradicts Trump.” The liberal pundit John Aravosis tweeted: “Actually, remember the other day when Trump said that Fauci had become ‘a TV star.’ And I said that this means Trump is pissed at Fauci getting so much attention? How much do you want to bet Trump has banned Fauci from the briefings because Fauci is becoming too well-liked.”

Meanwhile, others conjectured that Fauci could no longer stand compromising his own integrity and credibility by standing next to Trump as he prematurely touted a common anti-malaria drug as an effective COVID-19 treatment in the absence of large-scale trials. The White House communications staff later tweeted that Fauci was in fact making other media appearances, but the loss of his presence in those briefings was clearly noted by pundits and activists.

It all added up to the sudden absence of someone who the public had seized on as a voice of authority and truth on COVID-19 amid Trump administration chaos and obfuscation. Traditional and social media clamored for Fauci’s return.

But in some ways, Trump was right: The straight-talking, down-to-earth, Brooklyn-accented 79-year-old Fauci, who has held his post through six presidential administrations and more than a few epidemics (including AIDS, SARS, Ebola, and Zika) dating back to Reagan, was suddenly becoming a much-trusted household name.

A Long and Complex History

It was all a bit amusing to watch for the handful of veteran AIDS activists who have a long history with Fauci, one that went from frustrated and adversarial to friendly and collaborative in the space of only a few short years in the late 1980s and early 1990s.

In that time, Fauci, simultaneously sitting down amiably with some ACT UP activists while parrying more belligerent public protests from their comrades, opened himself up to activist recommendations. Most notably, he dramatically loosened HIV-drug clinical trial requirements so that a far greater number of desperate patients could try new compounds (an approach called “parallel tracking”), expanded research on HIV/AIDS and its treatment in underrepresented women and/or people of color, and gave activists and people living with HIV seats at the table of the planning committee of the AIDS Clinical Trials Group (ACTG).

Fauci also played a key role in getting the federal research apparatus to incorporate those recommendations, in what amounted to perhaps the first time that federal health bureaucrats acceded almost fully to community and activist demands.

“He’s the man for this moment,” says Peter Staley, an ACT UP and Treatment Action Group (TAG) veteran who grew so close to Fauci that they would often have dinner together at the Washington, D.C., home of Fauci’s assistant, James Hill, Ph.D. “He’s always had skills that are matched for epidemics. He’s one of the best scientists on epidemic control, but he can translate the complexities of epidemics into lay terms in a way that engenders trust to almost any audience he speaks to.”

Says Jim Eigo, also an ACT UP treatment activist veteran, “Fauci was a sparring partner with us, and then a friend.” He recalls the letter of recommendation for parallel tracking that he and other ACT UPers sent to Fauci.

“Lo and behold,” says Eigo, “he read the letter and liked it, and the following year he started promoting the idea of a parallel track for AIDS drugs to the FDA. Had he not helped us push that through, we couldn’t have gotten a lot of the cousin drugs to AZT, such as ddC and ddI, approved so fast. They were problematic drugs”—they would prove to have serious side effects—“but without them, we couldn’t have kept so many people alive,” he says. Those drugs held the line until protease inhibitors and NNRTIs emerged in the mid-to-late 1990s to form a truly effective treatment combination.

Also, adds Eigo, “Fauci, despite being straight and Catholic, was not only not homophobic, which much of medical practice still was in the late 1980s, he also wouldn’t tolerate homophobia among his colleagues. He knew there was no place for that in a public-health crisis.”

However, some ACT UP veterans have less rapturous memories of Fauci. “I would say that at the beginning of his encounters with us, he was a pretty typical bureaucrat, making excuses for the slow pace of drug investigations and approval,” says Ann Northrop, adding, “I still give him credit for turning into someone who listened more to the activist point of view and eventually became more of an ally.”

Maxine Wolfe, who worked primarily on ACT UP’s women’s committee, is not as measured. She recalls activists pressuring the National Institutes of Health (NIH, of which NIAID is a part) to hold a women and AIDS conference in 1990. “They wanted it to be all government people, and we set it up so it wasn’t,” she recalls. “The audience was mostly women, many living with HIV, and those who worked with women. Fauci gets up on a stage and says to about 1,600 of us, ‘I really don’t know anything about women and AIDS, but I’m going to talk to you about the virus and how it operates.’ And one of the women living with HIV grabbed the mic that had been set up in the audience for questions and said, ‘I don’t have a degree in anything but street-logy, but I don’t need an AIDS 101. I need to know what you’re going to do about women and AIDS.’

“Then,” continues Wolfe, “someone puts in Fauci’s face a petition of what was needed,” including expanding the definition of AIDS to include women-specific complications of AIDS and putting women in trials. “He was very arrogant and believed he had all the answers and did not admit [to being wrong or ignorant about] one thing.”

She adds, “He definitely loves being in the spotlight and loves people looking up to him.”

Fauci and Coronavirus: What Happens Now?

Regardless of what Fauci did or didn’t do at the height of the U.S. HIV/AIDS crisis, the question now is: What role will he continue to play against COVID-19?

Despite his recent absence from press conferences, “I’ll bet he’s still working those 19-hour days,” says longtime HIV doc Howard Grossman, M.D., a former head of the American Academy of HIV Medicine. (Fauci is a well-known workaholic.) “We need him doing that a lot more than we need him in front of a camera making Trump look good.

"He’s an honorable and very smart man dealing with a lunatic president and trying to get good information out there," Grossman continued. "He’s survived so many bad leaders but always managed to move the scientific agenda forward. You don’t stay in that job without figuring out how to keep on doing your work in the face of the worst kind of Republican governments.”

To put Grossman’s remark in context, it’s worth remembering that Ronald Reagan did not so much as offer a public comment on AIDS until 1987, six years into the epidemic; that Bill Clinton’s administration welshed on its promise to federally fund needle exchange; and that George W. Bush, although significantly advancing the fight against global AIDS, tasked anti-HIV efforts to Christian evangelicals who silenced both LGBT and harm-reduction voices in the U.S. and abroad.

Staley, as well, applauds the fine line currently being walked by Fauci, who himself in early March told Politico, “You don’t want to go to war with a president, but you got to walk the fine balance of making sure you continue to tell the truth.”

“He needs to stay in his scientific lane, because the political lane will gobble him up and spit him out,” says Staley. “His job is to keep himself in the room [with the presidential COVID-19 response team] and maintain Trump and Pence’s trust. He is not a member of the Resistance, and for us to want him to have a Resistance moment against Trump so we can pump our fists in the air, while countless lives are on the line, is just selfish and self-indulgent.”

But Wolfe echoes many in saying that, Fauci aside, she wonders why epidemiologists from the Centers for Disease Control and Prevention (CDC), who can actually talk in detail about the infection curve, are being sidelined by the Trump administration. “I appreciate it when Fauci corrects Trump on the facts,” she says, “but he’s not an epidemiologist. He’s a clinician and a bureaucrat who funds research. He can tell you to wash your hands, but he’s not telling us that much about the actual virus.”

For others, though, he’s a much-needed credible scientific presence to offset Trump. Says Judith Feinberg, M.D., board chair of the HIV Medicine Association, “I think Tony’s done an outstanding job of communicating to the American public in this dire moment, and in the face of lagging national leadership.”

She says she doesn’t think it’s wise for Fauci to, for example, call out Trump for calling COVID-19 “the Chinese virus.” Says Feinberg: “As long as he and Dr. Birx call COVID-19 by its correct name, that is probably all they can do. Don’t forget, after all, that the NIH is part of the executive branch.”

By which she means that Fauci serves at the pleasure of the president, who could, if sufficiently perturbed by Fauci, do what he’s done to other distinguished career public servants: kneecap or extinguish their career in government. “He’s expressed to me personally his desire to stay in his job until there is some finality to this long arc of AIDS research he’s overseen for decades, where we finally get a vaccine or a functional cure,” says Staley. “That’s probably his major motivation for staying at that desk right now.”

In other words, he better go on walking that line.