President Barack Obama named New York City health commissioner Thomas R. Frieden the next director of the Centers for Disease Control and Prevention ( CDC ) on May 15. The dynamic Frieden has generated controversy on many fronts, including HIV.
Frieden, 48, is returning to an agency where he worked for a dozen years as an expert in infectious diseases after earning a MD and MPH from Columbia University.
Over the last seven years as NYC health commissioner Frieden pushed for a ban on smoking in bars and restaurants. Since that went into effect, the number of smokers has declined by 350,000 and teen smoking has been cut in half.
Even more contentious was his push to ban trans fats from restaurants, which went into effect at the end of 2006. His aggressive stance during this current outbreak of "swine flu" has led to the closing of a handful of schools in the city.
Roy "Trip" Gulick, an HIV specialist and head of infectious diseases at the Weill Cornell Medical College in Manhattan praised Frieden's record as heath commissioner in increasing care, "promoting needle exchange and condom use" as well as routine testing for HIV. "He is an outstanding choice for director of the CDC."
Left unsaid was the 2005 HIV "super strain" panic set off by researcher David Ho and Frieden, and fanned by the New York Times. It was based on a single patient with multidrug-resistant virus who appeared to have progressed rapidly to advanced HIV disease. That single patient was promoted as the harbinger of a new wave of deadlier HIV infections.
Other researchers doubted the uniqueness of the patient, the threat that he posed, and the likelihood that it represented a new, deadlier virus. They were to be proven right.
Many within the HIV community see Frieden as a mixed blessing. One individual readily acknowledged that Frieden "does have a passion for HIV" and he hoped that might push the Obama administration to move forward in funding syringe exchange programs.
He said Frieden takes a strong medical approach to HIV and does not fully appreciate what community based organizations and non-medical interventions can contribute to HIV prevention.
He called Frieden "a vindictive man" and repeatedly emphasized that he could not risk having his name or that of his organization associated with the man who will soon control disbursement of most HIV prevention funds in the country.
Others who are dependent upon CDC funding for their operations were similarly reluctant to speak substantively on the record about Frieden.
Housing Works, a major New York City AIDS services provider, had no such hesitation last January when Frieden's name for CDC began to circulate in the media, the group issued a blistering statement opposing the idea.
"Throughout his tenure as New York City Health Commissioner, Frieden has simultaneously employed an authoritarian my-way-or-the-highway approach and an unabashed secretiveness undignified of a public servant. He has excluded AIDS groups wherever possible from having input into life and death AIDS funding, testing, and care policymaking decisions," its president Charles King said in a written statement.
It criticized Frieden for attempting to divert funding away from community-based organizations and housing to large hospitals. "Frieden's efforts proved his indifference to the profound stigma attached to AIDS and his ignorance of the critical role supportive services play in the health of people living with the disease," the statement declared.
The position of CDC director does not require Senate confirmation and Frieden is expected to begin work in early June.