Capitol Hill turbulence challenges AIDS chief

WASHINGTON — WASHINGTON -- Patricia S. Fleming, a long-time Washington insider, has taken charge of the administration's office of AIDS policy at a time when activists are calling the new, Republican-controlled Congress a "disaster" for anyone trying to get federal money or develop new programs to combat the fatal disease.

But the new director seems undaunted by the prospects.


Now in her second week at the job, Ms. Fleming, who has spent 19 years working on Democratic Congressional or Cabinet committees, believes that the key to making progress against the AIDS epidemic lies where hostility may be greatest -- Capitol Hill.

"This is where the work needs to be done -- especially with this new Congress," said the former special assistant to Health and Human Services Secretary Donna E. Shalala.


"The focus of this office is going to be different, more centered within Washington: I'll be trying to have impact on programs and policies here," she said.

Her strategy differs sharply from that of her predecessor, Kristine Gebbie, who resigned in July at the request of President Clinton after less than a year in the post.

By the end of her tenure, Ms. Gebbie, a former Washington state public health official, had alienated AIDS activists, who said she couldn't handle the political complexities of the job. At the same time, some members of the administration criticized what they said was her inability to publicize the administration's accomplishments, such as increased funding for research or faster federal approval of some AIDS drugs.

Now AIDS activists say what was a tough job has become tougher. "The largest impediment to moving ahead on a federal level to fight the AIDS crisis was always Congress," said Peter Staley, founding director of the New York-based Treatment Action Group, an organization that lobbies for new AIDS treatments.

"That was the old Congress. With the Congress we have now, it's a disaster," he said.

A 1957 graduate of Vassar, Ms. Fleming began working in medical research but then postponed her career to raise three sons. She later switched to public service, working as a legislative assistant to Democrat members of Congress.

Ms. Fleming served as acting AIDS policy director for three months before being appointed to the post earlier this month. "It is so obvious what needs to be done; there isn't any great decision to be made. The big decision was whether to take this job," she said.

Her first priority is to complete a report on adolescents, requested by the president, that will examine populations of youths most at risk -- and identify HIV prevention programs that work.


Next on her list is developing programs that "empower" women, particularly women of color, so they can protect themselves against HIV, which causes AIDS, the new director said.

Pointing to recent studies proving that AZT administered to pregnant HIV-positive women can prevent transmission of the virus to the baby, Ms. Fleming called for greater access to AIDS tests -- and increased availability of treatments for AIDS patients.

Although Ms. Fleming's understanding of AIDS issues is widely recognized in the AIDS community, it is her insider knowledge that appeals most to many activists.

"She comes to this job with years of experience on Capitol Hill and she knows how the institution works," said Daniel Bross, executive director of AIDS Action, a lobbying group. "And since she is open and direct, but is easy to talk to, she will be particularly effective in working with some of the new members of Congress."

Still, other AIDS advocates express concern that no matter who fills the position, the job may be too difficult.

"[Ms. Fleming] is well-placed. She knows a lot of the players and she is a good person. But that job is kind of a set-up," said Lynda Dee, a Baltimore attorney and member of the AIDS Clinical Trial Group executive committee, which conducts large-scale studies of new AIDS drugs. "The way the country is right now, I'm not sure how effective anyone can be in that job."