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Helene Gayle, President & CEO of CARE USA, Lays Out for A&U’s B. Andrew Plant the Underlying Causes—Gender Inequity & Poverty, to Name a Few—That Put People at Risk for HIV and AIDS as well as Underlying Ways We Are All Affected in the Fight Against the Pandemic
It may at first seem surprising that Helene Gayle, long a leader in the global fight against HIV/AIDS, took over as president and CEO of CARE USA last year. You see, CARE is a humanitarian organization with sixty years of experience fighting poverty in some seventy countries.
But if Dr. Gayle’s experience and her move to CARE don’t at first seem to synch, she succinctly and gracefully adds perspective. “There is a lot of relationship between HIV, which disproportionately impacts people who are poor—who are marginalized, and poverty,” she says. “Vulnerability to HIV is very connected to underlying issues like poverty, gender inequality, stigma, discrimination….So the very things we work on at CARE in many ways are the underlying issues that make people vulnerable to HIV.”
Thus, the fifty-one-year-old pediatrician and public health veteran states her case, powerfully and simply, as she is wont to do. Dr. Gayle spent twenty years with the Centers for Disease Control and Prevention, rising through the ranks to become the first director of the National Center for HIV, STD and TB Prevention; at the time, it was the CDC’s largest Center, with a $1 billion annual budget. On assignment from CDC, she served as the AIDS Coordinator and Chief of the HIV/AIDS Division for the U.S. Agency for International Development. Immediately prior to joining CARE, Dr. Gayle was the Director of the HIV, TB and Reproductive Health Program for the Bill and Melinda Gates Foundation.
The first female and first African-American president of CARE is known for her work as a strong advocate of women’s health issues. Again, she easily connects all of the dots—AIDS, poverty, women’s health—with the concise statements of someone who knows her work well and respects both the challenges involved and the people the solutions potentially affect.
“I think the issues of women and HIV…there is a real intersection there,” Dr. Gayle tells me. “We know now that about fifty percent of new infections globally are occurring among women…and that is increasing in Africa…it’s closer to sixty percent there. Women are more vulnerable to a sexually transmitted disease whether that’s HIV, syphilis, or gonorrhea, both because of biology and because of social position.”
“For instance,” she continues, “women are oftentimes less able to negotiate sexual interaction because of their economic dependency; maybe they are unable to insist that their partner remain faithful or use a condom or any of the things that might prevent her from getting HIV or another STD. Increasingly we are seeing the face of HIV is in fact a woman’s face and, again, oftentimes a woman who herself is monogamous and maybe married and has only had one partner…is at risk because it is her husband’s risk or partner’s risk that puts her at risk for HIV.”
While she puts things simply, Dr. Gayle knows all too well that the answers to these global challenges are not necessarily simple. Even so, she is undaunted and is known to be tireless, literally and figuratively. Former colleagues—including two former heads of the CDC and a U.S. Surgeon General—tell of her legendary capacity to work long hours, travel nearly constantly, and still remain “present” with new ideas and a seemingly endless supply of energy.
As you might expect from someone with a résumé and list of accomplishments this impressive, Dr. Gayle never digresses in our conversation. She’s task-oriented and needs to keep moving, though always willing to circle back and ensure I have what I need.
The daughter of a beauty and barber supply business owner father and a social worker mother, Helene Gayle was finishing her medical training when AIDS was first emerging. When I sit down with her at CARE’s Atlanta headquarters, I ask her if it seems a bit like fate that she has spent a great deal of her career focusing on the pandemic.
“I’m not sure if it has as much to do with timing [beginning her medical career as AIDS emerged] or fate as it is the issues that brought me into health to begin with,” she says quickly, then easily naming those reasons, “inequality, poverty, lack of social justice….These are the very same reasons I have continued to work on HIV for so many years. I think the reasons that I got into the work I do and that I still do it are very connected. I stayed in the field of HIV because it was probably the defining public health and humanitarian issue of our time.”
When I tell her I had read that she considered herself a social activist first—before a physician or public-health worker, she says, “Still do—hopefully.” She laughs reflectively, maybe slightly uneasily, adding, “No, really, this is my form of social activism.”
Similarly, Dr. Gayle is considered a very caring person, and I ask if that too is part of why she is on this path. “It’s hard to say that we are attracted to issues because of who you are as a person, but I think by working in certain areas you help reinforce your [natural] dispositions,” she says, “so I’m not sure if it was so much who I was to begin with but I think that working in HIV/AIDS has changed my thinking in many ways and I think in many ways has made me more empathetic and a better person.”
She looks at me as if to say, “is that enough?” then continues. (She is economical in all ways, including with her words, but certainly always thorough, complete and gracious.) “When you work with such a wide range of people in some of the most dire circumstances it brings out our common humanity and it brings out the fact that we do have more in common than not and that people in even the most dire circumstances…want the same things that you and I do,” Dr. Gayle says. “They want to have a secure life, they want a situation where they can have control over the main factors that influence their lives, and things like poverty and HIV often take that away from them.”
Given the international scope of much of Helene Gayle’s work, it’s not surprising that she has great insights on that perspective. “I think that we don’t recognize how the more we become a global world, the more we are globally interconnected,” she says. “People being poor on one side of the world ultimately brings all of us down…. It affects all of our world. Look at issues like security and safety: What happens in poor countries where people end up joining up with groups just to put food on the table? [What they do] because of the circumstances they are in may threaten our security—the security of our world.”
Dr. Gayle moves rapidly to another example. “If [the issue] is poor economic growth, it ultimately means…we’re not getting the most out of our total world population. We’re not making sure that we really get the best. Who knows whether a child who is denied education because of living in poverty could be the person who grows up to cure HIV or cancer?”
We’re shooting photos simultaneously with the interview and Dr. Gayle, who is a striking woman, seems a tad more comfortable discussing her work than being photographed. Even so, she’s a veteran of the interviews that go along with high-profile positions, so she humors me and the photographer, occasionally checking in with an assistant about this or that; usually about time. Again, this is a person who accomplishes a great deal in a compressed schedule.
I found it interesting that CARE staffers call her “Helene.” After all, this lady is a physician, holds a master’s degree in public health, achieved the rank of rear admiral in the public-health service, and advised Bill Gates on his unprecedented AIDS funding. Even so, the call-me-by-my-first-name approach typifies the woman who is focused on equality and who is adept at many things—among them, putting others at ease.
“So it is the lack of the use of human potential that ultimately affects all of us and probably has broad implications in ways that we’re not aware,” she says. “It…affects who we are as a [collective] human soul.
“The misconception about HIV is that it does not affect us unless we are infected,” Dr. Gayle says. “We’re all living with HIV in many ways that affect our whole globe and our whole community. That’s undeniable.”
She has been quoted in interviews as saying she moved, “from one side of the check to the other,” when she went from the Gates Foundation to CARE, and I ask her about this. “All my career I have been on the funding side either as a government funder or a funder in philanthropy. Now I am in a situation where part of what I do is to fundraise for this organization,” Dr. Gayle says. “But I think in many ways it’s not too different from what I have always done…which is talking about the things I believe in, and you’re either talking about them and selling them to the U.S. Congress…or now I sell what we do to a range of people who all believe in what we do and fund
us accordingly.”
We turn to a discussion of how confronting AIDS in her personal life—for instance, having a friend or acquaintance who is infected or affected—differs from confronting the disease in her work life. In a heartening way, Dr. Gayle sees little difference. “I’m not sure how much I separate myself from what I do,” she says. “I have the fortune or misfortune of having a work life that is very aligned with my personal life. So, whether it is someone I know personally or whether it’s seeing in a community how HIV has decimated their lives, I don’t make a big distinction per se. And I have had friends die of HIV and AIDS. And I am happy in this day and age that fewer and fewer do die.”
What one thing would this AIDS leader tell people to help end the pandemic?
“We live in a country in which people don’t have a good sense of geography and what is going on around the globe. Be informed; be curious, about what’s going on around us, around the world. Use whatever vehicles you have in front of you to do what you can.”
We share another one of those pauses in which she raises her eyebrows as if to say, “I keep talking?” and then continues. “If you are a member of a church or synagogue or mosque, use that to inform the people who you worship with to make them a more informed and caring and compassionate group,” Dr. Gayle says. “If you are part of a sorority or fraternity or civic organization, you can help inform those people, so there are a lot of ways people don’t have to stretch beyond the organization or communities in which they are already involved to be able to affect change and to affect attitudes.
“If more people wrote letters to their Congresspersons or their Senator saying that they care about global poverty or they care about HIV…it makes a big difference,” she says. “We don’t do enough in this country to exercise our civic responsibility to hold our policymakers responsible for the things that we believe in.”
She pauses and a smile almost imperceptibly crosses her often serious face before she says, “People who have resources can always write a check. For instance, we would be happy for people to write a check for CARE. Or we’ll take your time. Volunteer.” A rare commercial from the woman who has moved to “the other side of the check.”
Dr. Gayle is getting antsy. She is courteous, but her handler is fidgeting and a few heads have looked into the conference room occasionally, obviously seeking out the organization’s missing leader. We ultimately shift to her nearby office to wind things up. I zip down my list of questions and ask her to reflect on the greatest misconception(s) about HIV/AIDS.
“It is important to realize that this is an epidemic that is still spreading, that is still serious,” she says. “I think people, particularly in the U.S., have gotten somewhat complacent because our rates of new infection have gone down. People are not seeing their friends die in the same numbers they used to. But at the same time, we still have 40,000 new infections occurring in this country [annually] and that is just unacceptable.
“While it is incredibly important that we have life-saving drugs that have made such a difference in people’s lives, we cannot treat this epidemic away,” Dr. Gayle says. “We’ve got to continue to make sure that we focus on preventing people from getting new infections to begin with….
“We’re too rich a nation to not fully fund the research, the prevention efforts and the treatment that can make a big difference not only for our lives here in this country…,” she says. “It’s important that we remember we are part of a global epidemic and that we have a responsibility as the richest, most powerful nation in the world to set an example.
“I think it’s important that we don’t take our eye off the ball in this country where increasingly this is becoming an epidemic for people of color, particularly among African-American men who have sex with men, and women are increasingly affected by this epidemic in this country. So, we can’t take our eye off the ball here even while we understand our responsibility globally.”
We’ve stayed on task, thanks to the disciplined Helene Gayle and accomplish more in our time together than in interview and photo sessions that are twice as long. It seems an appropriate way to bring her to our readers.
My final glimpse of Dr. Gayle this day is as I turn back and look into her office—which has a great view of Atlanta—as I depart: She’s already back at her desk, head down and working.
To find out more about CARE USA, please visit: www.care.org.
B. Andrew Plant is an Atlanta-based freelance writer and is Editor at Large of A&U. He interviewed Phylicia Rashad for the December issue.
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