AIDS: 'a whole shift in attitude' New 'czar' focuses on cooperation

When Kristine M. Gebbie, the nation's first "AIDS czar," spoke in Baltimore this week, a few activist members of the audience took notes -- hoping to arm themselves with fodder for future protests.

By their own reckoning, they left with little ammunition.


"She disarmed us," says John Stuban, president of the city's People With AIDS Coalition, who attended the speech Wednesday at the University of Maryland at Baltimore. "She didn't give us much to protest."

In the four months since becoming the first national AIDS policy coordinator, Ms. Gebbie has touted as a job qualification her ability to woo cooperation from all sides.


That skill may be much needed as the nurse from Washington state tackles her new assignment which, in her own words, is "about stopping AIDS and doing something about our AIDS policy."

In fact, the job is considered so daunting that several other possible candidates, including New York City Health Commissioner Margaret Hamburg, turned it down.

Created by President Clinton to fulfill a campaign promise, the position carries a great chance of culpability but little power: Ms. Gebbie reports to Carol Rascoe, chief of domestic policy but controls only a personal staff of 20. Meanwhile, she is charged with coordinating the policies of all federal agencies having anything to do with acquired immune deficiency syndrome.

"My job is to make certain to get action when we bring all these people together," she says. Some of her priorities, as outlined in last week's speech, are:

* Coordinating AIDS research so that duplicated efforts are eliminated and a wider spectrum of questions is investigated.

* Placing greater emphasis on behavioral science so that successful methods of deterring unsafe sexual or addictive actions are studied and implemented.

* Ensuring that the president's health-reform package is comprehensive enough to meet the needs of AIDS patients.

* Pushing Congress to continue funding of the Ryan White Act, which supports state and local programs that provide many services to AIDS patients.


* Supporting needle-exchange efforts, especially programs that include counseling and referral.

* Endorsing reporting by name people with AIDS or HIV, provided that the system ensures confidentiality and treatment.

And Ms. Gebbie says she must get the AIDS prevention message out: Americans must drop their "pseudo-Victorian outlook" toward sex and "talk much more openly about sexual activity."

Critics have called her a political lightweight from out West. Nonetheless, one of her first actions was announcing that all 3 million federal employees, from Cabinet leaders to postal workers, would receive AIDS prevention education beginning sometime next year.

A divorced mother of three, Ms. Gebbie, 50, says she has occasionally gained insight into what young Americans know and don't know about AIDS from her children, ages 17, 19 and 22.

As a parent, she said, she understands the reluctance to think of children as sexual beings or to discuss sex with them. "But we can teach that sex is a positive part of life even as we teach that . . . you don't want to mess with it at an early age," Ms. Gebbie says.


Born in Sioux City, Iowa, she received her nursing degree from St. Olaf College in Minnesota and a master's in nursing from the University of California at Los Angeles.

Her career has spanned the fields of academics and public health. At various times, she taught at UCLA, ran the Oregon state health department and was in charge of health programs in Washington state. She was also a member of the Reagan administration AIDS Commission.

Any spare time she spends hiking, reading detective novels and knitting. Three- to four-mile walks constitute her daily exercise routine.

Ms. Gebbie is scheduled to return to Baltimore Nov. 9 to participate in an AIDS "town meeting" at the Johns Hopkins University.

On the podium or in conversation, she talks so quickly that she occasionally has to gasp for breath. In recent months, she has stumped around the country, addressing minority groups, lobbyists, academics and activists.

And Ms. Gebbie is a Clinton loyalist. "My job represents a whole shift in attitude in Washington," she says over and over in speeches, informal talks and interviews.


Such public appearances are seen by some AIDS activists as a savvy maneuver. "What she's doing is really hitting the speech circuit to build support in the [AIDS] coalition, and it is the smart thing. It is very much a political move on her part," says Denny Lee of ACT UP -- New York.

The gambit may be working in some circles. Several Maryland public health officials, AIDS activists and community organization leaders said last week that they came away from her speech more enthusiastic about her role as AIDS czar than they had been initially.

"She spoke to state officials and local gay and lesbian groups and people in the streets who are not infected and said, 'I'm part of you.' And she said, 'I'm a mother and I care,' " says Kathleen F. Edwards, director of the state AIDS Administration. "But she also said, 'I'm an academic; I used to teach,' and 'I'm a nurse, and I know about patient care.' "

Still, not everyone has been impressed. In a recent speech in Dallas, Ms. Gebbie said she would urge educators to stop teaching that abstinence is the only way to avoid disease. That brought a blast of criticism from right-wing leaders. And some AIDS activists point out that the real battles on Capitol Hill are yet to come.

"Clearly, the jury is still out. There are going to be some fairly objective measures of her influence that we won't be able to see for at least a year, maybe two," says Jeff Levi, policy coordinator for the AIDS Action Council, a Washington lobbying organization that represents about 1,000 AIDS groups nationwide.

He lists two indicators: whether people infected with the human immunodeficiency virus receive the services they need under the Clinton health care reforms and how AIDS funding fares in the next budget.


Another test will be whether the president continues to back Ms. Gebbie, says Brenda Pridgen, the Baltimore AIDS coordinator. If he does, Ms. Gebbie will be "a very effective advocate," Ms. Pridgen says.