Dr. Fauci on Larry Kramer, Reagan, and Pandemic Parallels

In previous columns about the similarities between coronavirus and AIDS, I've dealt with Ronald Reagan's and Donald Trump's responses to their respective pandemics, the return of those eerie words "I'm positive," and, in a discussion with world-renowned epidemiologist Dr. Michael Osterholm, issues surrounding contract tracing.

But there is no one more suited to discuss the early days of the AIDS epidemic and these initial days of COVID-19 than Dr. Anthony Fauci, whose name and background need no introduction. He is a Presidential Medal of Freedom winner, has been dubbed America's doctor, and is arguably the world's leading authority on infectious diseases, epidemics, and pandemics.

So when I was offered the opportunity to speak with Fauci, I thought it might be interesting to talk about some of the similar obstacles, hindrances, and threats he's experienced in fighting both HIV and COVID-19.

On Sunday, during an interview with Fox's Chris Wallace, Trump called Fauci "an alarmist." I asked Fauci if anyone had called him that before.

"You know, in the beginning of what is now known as AIDS, I wrote an article in the fall of 1981 for a medical journal, just a couple months after the first cases were recognized," he said during a phone conversation from his office at the National Institutes of Health. "In that article, I said anyone who thinks this outbreak, which was then known as GRID [gay-related immune deficiency], will stay confined to a group of individuals doesn't have any evidence to back that up. I felt that the virus could very likely explode into a very serious outbreak. In fact, to my dismay or horror, that's what happened. But when that article was published, some people did indeed call me an alarmist."

There's been so much talk recently about the intersection of politics and science. We've seen how stupid political decisions were made over sound science by Republican governors who rushed through phases of regulations to open their states early, all in an attempt to appease their president. And politics most assuredly hovered over the early days of the AIDS epidemic.

"Indeed, politics did step in the way of science back in the 1980s, but it was a different kind of politics," Fauci observed. "There wasn't necessarily the divisiveness that we see now in our political landscape today. Back then, the federal government, particularly the first term of the Reagan administration, didn't recognize or even pay attention to the importance of the emerging AIDS outbreak. There was a lot of stigma, because the disease mostly and severely affected the gay population during an administration that was very conservative. At that time, the gay community was not readily accepted as an important political group, as they are now, and thank God that's changed dramatically over the years."

And over the last few months, plenty has been written about masks being the new condoms in terms of helping protect against contracting a virus; however, the battle raging between mask wearers and those who won't because of their civil liberties isn't the first time that a fight broke out about wearing protection.

"That's true, and in the very early years of the AIDS outbreak, some gay men, not all, but some, thought that recommendations to use condoms was infringing upon their sexual freedoms," Fauci recalled. "What they didn't appreciate, that was very clear, was that the virus was spreading through sexual contact. They were protesting condoms at a time when there was little known about this particular virus and no treatments available to even remotely combat it."

There has been so much controversy surrounding hydroxychloroquine as a treatment for COVID-19, even as recently as Tuesday, when Trump campaign spokesman Tim Murtaugh got into a heated exchange about the benefits of the drug with CNN's Brianna Keilar. I asked Fauci if there was also controversy around the introduction of AZT.

"It's a totally different situation," Fauci implored. "AZT was the first drug that clearly showed some efficacy against HIV, so even though it had some terrible side effects, the virus itself was much, much worse than the drug. The drug prolonged, not for a long time, but prolonged the life of the individuals who were HIV-infected.

"The argument about hydroxychloroquine has been rapidly settled. Several clinical trials have proven that the drug isn't effective against the coronavirus. So you're really comparing apples and oranges. AZT was a very big advance because it was the only drug at the time that showed efficacy against HIV and AIDS. Hydroxychloroquine does not have any effect against coronavirus."

In terms of a drug or vaccine for COVID-19, there have already been promising clinical trials on numerous treatments. I wondered why it seems much easier to develop a COVID vaccine than one for HIV.

"That's a very good question, and I'm glad you asked that," Fauci said. "The success of a vaccine development is really predicated on whether the body is capable of making an immune response against the particular virus in question. With HIV, it's extremely unique among virtually any virus in that the body just does not make an adequate immune response against it."

To Fauci, that is what's so particularly troubling about HIV, because one of the predicates of vaccinology is that if you can mimic natural infection in a vaccine and get the body to develop a similar, natural infection, you have a very good chance of getting a good vaccine.

"In order to get an HIV vaccine, you would need one that does almost better than a natural infection," Fauci explained. "The human body makes a very good immune response to polio, smallpox, and measles, for example. And coronavirus is somewhat similar to these viruses, because we know that the body can make a good immune response against COVID. The vast majority of people who get infected with coronavirus clear the infection by making a good response. The same cannot be said for HIV."

Since the viruses seem so different on many levels, I asked Fauci what might be the strongest common denominator between the early days of AIDS and these initial days of COVID-19.

"Both infections are heavily influenced by behavior," Fauci replied without missing a beat. "It was clear during the early years of AIDS that acquisition or transmission of HIV was by behavior. [Defenses against the virus included] not having lots of sex partners. Using condoms. Knowing the status of your sexual partners."

"Today, with a completely different virus, behavioral components still dictate whether or not you put yourself at risk of infection. Wearing a mask, avoiding crowds, keeping physical distance of at least six feet, and washing hands. Both of these viruses involve common sense about avoiding infections."

And speaking of common sense, I asked Fauci if he had a message to the part of the LGBTQ+ community that has been photographed partying on Fire Island in recent weeks.

"Be careful! I know this time of year involves fun at the beach, but this is not a trivial infection," Fauci warned. "You don't want to put yourself into a situation where you irresponsibly pass it on to someone at a high risk of getting sick. Stay safe. It's up to you. The gay community has been through a terrible scourge of HIV, so don't put yourself in danger of getting sick from another virus that has thrust itself upon us."

What was once thrust upon Fauci was the radical Larry Kramer. At the height of the AIDS epidemic, the combative Kramer famously called Fauci "an incompetent idiot." More recently, presidential adviser Peter Navarro said Fauci has been "wrong about everything."

I told Fauci I didn't think that it was very fair to Larry to be compared to Navarro, and he laughed.

"Larry was iconic, and he fought vigorously for what he called 'his people,' Fauci remembered. "He frightened anyone in the scientific community, in the government, and anyone who he thought wasn't doing enough about AIDS."

"And yes, he had it in for me because I was a scientist and a part of the government. But I started listening to him, and what he said was true. So one day I called him and asked him to tell me more. We started out as adversaries, then advocates for the same cause -- we were both after the same thing -- and later became acquaintances and friends. Towards the end of his life, we got very close, and I think you can say that Larry and I both loved each other."

Given his unbridled dedication, bold perseverance through so much trauma and sickness, and relentless pursuit of cures, I think we can all agree with Larry that we love Dr. Fauci too.

JohnCasey is a PR professional and an adjunct professor at Wagner College in New York City, and a frequent columnist for The Advocate, a sister publication of Plus. Follow John on Twitter @johntcaseyjr.