Francis was central figure in epidemic's early years, is key player in Shilts book
As is chronicled in Randy Shilts' groundbreaking work And the Band Played On, scientist Dr. Don Francis watched the AIDS epidemic unfold, literally, before his eyes.
In 1981, as the first reported cases of AIDS became public, Francis was already internationally renown for helping to eradicate smallpox and for containing the world's first outbreak of the Ebola virus in Africa. And he was widely respected in gay health circles for his work in developing the Hepatitis B vaccine.
Francis quickly became a central figure in the early years of the AIDS epidemic, heading up the Centers for Disease Control's AIDS laboratory and helping French researchers prove HIV as the cause of AIDS.
And the Band Played On details Francis' struggle to secure desperately needed AIDS funding, his work to change the sexual behavior of the gay community and his fight to convince the blood industry that its donors were spreading the virus.
Today, Francis is president and co-founder of VaxGen, a firm working on developing an AIDS vaccine. His company is currently involved in Phase 3 studies in locations including Chicago and Thailand that involve 8,000 volunteers. His vaccine study—in the second of a three-year process—is the only one in the final stage, "when you find out if it's safe," he said.
He began his discussion with Windy City Times by setting the scene for the emergence of AIDS, which was initially thought to only strike gay men.
"Realize the perspective. At the time we had been involved with multiple diseases in the gay community," including gay bowel syndrome, gonorrhea and syphilis. "When a disease was introduced into the incredibly sexually active gay community, it could spread quickly. ( There was a ) set pattern it followed.
"In 1981, we saw this disease that was no longer diarrhea and a little bit of jaundice ... this one had an incredible mortality. It was a concern from day one that this could be very bad to have a fatal sexually transmitted disease.
"Everything we did ( at the CDC ) for the first three years was done at the expense of other diseases. That response did not filter to the Reagan Administration.
"All of this was done on a shoestring. When I came in to head up the ( AIDS ) lab, we didn't have anything. ... It was a time as depressing as you'll ever find in public health. The Reagan Administration was perfectly happy to do essentially nothing.
"A year later, in July 1982, we had 400-700 cases in gay men in coastal areas. We had the IV drug users, the hemophiliacs. This was starting to look like a major problem. It looked like mortality with AIDS was 100%. This was hundreds, if not thousands, of deaths. Very rapidly we knew we were in a situation that was truly dangerous to the public health. ( But ) it was our role to cut government back. ... Since it was gay men, it played right into their ( Reagan officials' ) hands. ... We couldn't get the attention of the press until the transfusions came. ... ( The media ) did not force this down the administration's throat until years later.
"In 1985, I just gave up on the federal government. I moved to California. I knew the state wanted to do something. It was the network of gay men in all sectors ... that drove the political will at the local level.
"Then there was this incredible thing of homosexuality coming out of the closet. Then everyone got forced out of the closet. If everyone knew a gay person ... it happened because their best friend's son in Omaha died of AIDS. It really brought homosexuality out of the closet in the best and worst ways," he said. The worst way in that so many people died, but the best in that it showed the true strength of the gay community.
He noted that a generation later, his own children, aren't fazed by gay issues, and "it's just not a big deal anymore, and boy, is that a switch. If there's anything good that came out of AIDS, that would be it."
While he applauded sections of the gay community for the way they dealt with AIDS, he noted that some activists worked just as hard against early AIDS efforts.
"Community involvement is always wonderful, but somebody's got to take it on in a scientific way," he said, adding that some doctors had been doing partner notification, for instance, for decades. "Now it's the AIDS industry that's keeping the status quo."
"You need government leadership to make sense of this. Once the leadership was lacking the first few years it was hard for the government to get back on top. It's really hard for administrations to deal with AIDS. It's easier for Democrats, but I can't say they've been outstanding either. ... Public health should be removed from the political system. ... The CDC is a really amazing organization—if it could just be separated from the government."
"We still don't have appropriate education in schools," he noted. In 1986, California's legislature voted on its first AIDS-related bill, a measure that would have required AIDS education in schools. It was vetoed by the governor, Francis said, who approved a bill requiring that any sex education had to stress abstinence.
He pointed to countries such as Switzerland, which has "programs that are just revolutionary," including subsidized needle exchange. "They just took AIDS very seriously. ... They take care of HIV-infected people."
Fed up with the politics involved in public health, Francis moved to the private sector in the mid-1980s.
"I just retired. ... I don't want to do it anymore. I'm burnt out. Nobody cares about a vaccine, so it's easier to carry on. I just have to. It's not an easy field. I'd much rather get things done than deal with the politics. It's a terrible disease. You have to take it on. ... It's been impossible for society to deal with. I've used a whole company to drive a vaccine. Investors will take a risk with a vaccine—government won't."
