A Defiant Casualty of the War on AIDS : Few pushed themselves--and the health care system--as hard as Dr. Don Francis. He’s burned out.

It should have been the crowning moment of his life.

Amid the post-inaugural hubbub, Don Francis got a phone call last month from President Clinton’s transition team. Would he be interested in running the Centers for Disease Control in Atlanta and launching a new national battle against AIDS?

His resume seemed perfect: He was a brilliant public health doctor who had mobilized early reaction to the epidemic. A straight talker who knew how to crack heads. Someone born to put out fires and who smoldered with just enough impatience to get the job done.

But Don Francis turned them down cold.

“I’m far too angry to work in the system now, especially after what I’ve been through in the last 10 years,” he says, staring out his front door at a steady, drenching rain. “I fought this battle as long as I possibly could, and everybody has limits. Even me.”

In the long, frustrating story of America’s fight against AIDS, there have been many unsung heroes. Yet few have pushed themselves--and the U.S. health-care system--as relentlessly as Francis. Like a swift kick in the face, he’s never been much for subtlety. When AIDS first erupted, he was a one-man band of alarm. When politicians dragged their feet, he blew the whistle. Did it mean the end of his career? He was ready to go down swinging.

It wasn’t supposed to happen this way. Francis started out in the U.S. Public Health Service 20 years ago, fighting smallpox and other infectious diseases in Africa, Asia and Europe. He never dreamed that the mere mention of his name might one day raise hackles in the White House. Or that he would quit public service because of burnout and disillusionment.

But AIDS changed him, like millions of other Americans. And with changes came enemies.

“There are lots of s.o.b.s out there who still hate me,” he says with a rueful laugh. “That’s because I’ve made some people very, very uncomfortable. Including me.”

Bug-chasers don’t become boat-rockers overnight, but Francis got there in a hurry. He never had much use for bureaucrats, and he didn’t think twice about taking on the scientific Establishment. Although he ultimately left the CDC under fire, many of his earlier suggestions have become real today, including expanded AIDS testing, safeguards on the nation’s blood supplies and early medical intervention for those infected with HIV.

His efforts have not gone unnoticed: Francis was featured prominently in “And the Band Played On,” journalist Randy Shilts’ scathing indictment of AIDS policy, and his story will be given star treatment in HBO’s upcoming adaptation of Shilts’ book. He’s writing his memoirs, and there is talk of other television films as well. Beyond that, Francis hopes to parlay publicity from the HBO special into an AIDS vaccine fund-raising campaign.

But he has more than Hollywood on his mind. After leaving his CDC post in Atlanta in 1985, Francis served as the agency’s liaison to California’s AIDS programs through February, 1992, and he continues to work as a private consultant. He helped develop San Francisco’s pioneering response to the epidemic, and he’s also lobbied Congress to pass AIDS legislation.

In the world of AIDS activists, Francis is a bona-fide legend, a man whose rage over governmental foot-dragging never diminished. To skeptics, he’s a junior-grade loudmouth who never knew his place, a hustler in a lab coat with little regard for scientific truth.

Either way, he doesn’t look the part.

Amiable and low-key, Francis seems younger than his 50 years, and a boyish smile blossoms on his face as he pads about his roomy Hillsborough home, south of San Francisco. These days, the man who once declared war on Washington mutters about garden plants and a pet parrot who screeches inconsolably in her cage. Dressed in deck shoes, khaki pants and sweater, he welcomes visitors with the breezy bonhomie of a successful Bay Area physician.

But all that can change in a second. Get Francis talking about AIDS and his jaw tightens. He becomes visibly tense, recalling battles with politicians whose hatred of homosexuals outweighed their duty to save lives.

At one point, he starts pounding the table and obscenities pour out--crude, pointed jabs that hit their mark.

“If I’ve learned anything,” he says curtly, “it’s that there are really bad, truly evil people in the world. I didn’t used to believe that. I wanted to believe that you could simply do your work as a doctor and nobody would mess with you. But I was dead wrong.”

Leaning forward, Francis shakes a finger at those who stood in his way, recalling their presence and lashing them with invective. It’s easy to see how he fought the AIDS wars--and why he couldn’t go on forever. Even if it meant turning down the job of his life.

“Don Francis did battle with giants, and he managed to survive,” says Dr. Michael Gottlieb, a prominent AIDS expert from Los Angeles. “But the sad sidelight on this is that tilting against the system takes a big toll on you. At some point, the warrior gives up the fight and settles for a country cottage. That’s what happened to this guy.”

The roots of rebellion sprouted early.

Francis was born in Los Angeles, but his family soon moved to Marin County, where he and a brother grew up. His father and grandfather were both physicians, and Don decided to become a doctor as well--but not just any doctor. It was the dawn of the ‘60s, and politics mattered.

Indeed, Dr. Cyril Francis had always given his boys room to be independent and outspoken. After years of friction with the Veterans Care Administration, he quit his federal job in disgust and passed on some advice: If you challenge a political system from within, you’ve got to live on the edge. You’ve got to be ready to fall.

The lesson stuck. In junior high, Don was appalled by the racist politics of then-Arkansas Gov. Orval Faubus. He decided that the best way to answer the governor’s national fund-raising appeals was to send him phony Confederate money. Boxfuls of the stuff.

His stunt drew media attention, including a plug from San Francisco Chronicle columnist Herb Caen. But the young activist also got hate mail and learned his first political lesson.

“You stick out your neck, you hear from the crazies,” Francis says. “It’s a law of nature.”

Years later, after he had graduated from UC Berkeley and enrolled at medical school in Chicago, Francis began playing for higher stakes. Vietnam was on fire, and so were the cities.

“I distributed pamphlets which said America was burning from within because of racism and it was burning from without because of the war,” he recalls. “I got pretty hot and wrote that physicians had to take a stand. And the dean went ballistic on me.

“He called me into his office, and this s.o.b. told me that I was a disgrace to the medical profession. Can you believe it? I held my temper, but it wasn’t easy to do.”

Revolted by the war, Francis wanted to be a conscientious objector, but his draft board scoffed. He was prepared to continue his medical studies in Canada when an academic mentor offered a novel suggestion. If he served two years in the U.S. Public Health Service, under the auspices of the CDC, Francis could meet his military obligation.

It proved to be a turning point.

Suddenly, he was battling epidemics in Nigeria, Sudan, India and Bangladesh and was praised by colleagues for helping to wipe out smallpox. He learned to make painful choices between healing the sick with limited resources or letting them die and immunizing others against disease. He was confident that America would never permit such a scourge at home.

By 1979, Francis had earned a doctorate in microbiology from Harvard, and he had married Karen Starko, a doctor who would go on to discover the link between aspirin and Reye’s syndrome in children. That year, he was assigned to study hepatitis-B among gay men at a CDC center in Phoenix. He didn’t know it, but the stage had been set for the fight of his life.

From the start, Francis ran into stone walls. When an aide from the cost-cutting Grace Commission visited him, asking about the hepatitis program, Francis threw the man out of his office. He shouted that the project needed more money and less harassment.

The climate worsened in 1981, when scientists reported the first cases of what would later be called AIDS. Francis found similarities between the disease and feline leukemia--which also had a long latency period--and was one of the first to suggest that AIDS was caused by a retrovirus. His work with gay men and hepatitis transmission helped him chart the epidemic, and by 1983 he had moved to Atlanta, where he set up a CDC lab to study the disease.

But there was little support from the Reagan White House. The Administration didn’t consider AIDS a priority, Francis charges, and government doctors who would normally have attacked the disease with gusto were handcuffed by homophobic restrictions.

For the first time, Francis’ freedom to act as a doctor was stifled by politics. And that, more than anything, triggered his anger. He never forgave those who held him back.

“What we came up against was cruel and unacceptable,” Francis recalls. “We didn’t get enough money to set up a proper lab. Our requests for research and prevention funds were laughed at. We couldn’t even buy airplane tickets to pick up blood specimens from New York.”

Soon, he was fighting AIDS battles on several fronts.

In 1984, he was appalled when Dr. Robert C. Gallo, a prominent researcher at the National Cancer Institute, announced the discovery of the virus causing AIDS. According to Francis’ research, a team of French scientists at the Pasteur Institute in Paris had already identified the virus and a test to detect it. It was unethical, he argued, for a U.S. scientist to make such a claim.

The bureaucracy struck back.

“I don’t think Gallo ever forgave him,” says Gottlieb. “Eventually, there was a campaign launched in the system to destroy Don, to deny his pension. It got ugly.”

Today, Gallo stands by the validity of his discovery. He declines further comment on the AIDS research issue, citing continuing litigation, and he has little to say about Francis.

“I’ve only met this man three times in the last decade,” Gallo declares. “I hear that he did excellent work in San Francisco. But when it comes to this (criticism from Francis), there’s obviously a lot of self-promotion going on. I’ll let the literature speak for itself.”

Others are less circumspect. Joseph Onek, Gallo’s lawyer, charges that Francis “always self-aggrandizes himself. There’s a lot of bad blood between these guys, and for whatever reason, he (Francis) has decided to make this into a crusade. It’s unwarranted.”

While he fought Gallo, Francis also took on the nation’s blood banks. Angered that they weren’t responding quickly enough to the dangers of AIDS-tainted blood, he thundered at them in meetings in 1983 to protect the uninfected.

“How many people have to die?” he shouted, pounding the table. “How many deaths do you want for the threshold? Five? One hundred? Just tell us, and then we’ll act!”

Eventually, blood banks screened out HIV-positive donors through the use of an AIDS test. Spokesmen deny they were stalling and contend there was little data in the early 1980s showing that people could get AIDS from blood transfusions.

“In 1993, it’s easy to say you know exactly what would have happened in early 1983,” says Dr. Tom Zuck, an Ohio physician who is president of the Council of Community Blood Centers. “And it’s easy for a junior-level staffer (like Francis) to say certain things, compared to a person with great responsibility. When you’re down low, you can say anything you want.”

By the mid-’80s, Francis had concluded that the Reagan Administration would not provide money for serious research. So he shifted gears, moving toward prevention programs. He proposed a $32-million program called Operation AIDS Control, which was shot down. According to a colleague at CDC, the agency was expected to “look pretty and do nothing.”

It was time to get out.

In 1986, Francis stunned his colleagues by requesting a transfer to the Bay Area, where he would serve as CDC’s liaison officer to the state on AIDS. There was plenty of work to be done, and it didn’t matter that he was all but giving up on a fast-track federal career.

This time, Francis vowed, things would be different.

“I had been personalizing all of the setbacks, especially when it came to AIDS,” he says. “We’d work hard, but it was like being on a losing team. So when I came back to California, I wanted to put distance between myself and the system. I’d be an adviser and nothing more.”

It was a pipe dream.

Although the state had a more progressive approach to the epidemic than the federal government, money was still a problem. Almost immediately, Francis was drawn into grueling budget battles with former Gov. George Deukmejian. As the disease raged, he was incensed that state AIDS workers were barred from using the word counseling in safe-sex programs.

“Don was the sane, professional presence that we so desperately needed,” says Bruce Decker, a Los Angeles health-care consultant who chaired a state task force on AIDS and worked closely with Francis. “We were amateurs, and he steadied the boat. You can’t ask for more than that, because he threw himself into his California work and left a lasting impression.”

But which hat was he wearing?

Was it the politician, who badgered the Legislature for more funds? Was it the diplomat, who was jeered at several gay forums for his endorsement of expanded AIDS testing? Or was it the activist, who persuaded the Grateful Dead to help fund a San Francisco needle-exchange program for HIV-infected addicts?

Francis’ role confusion increased when he got closer to the homosexual world. One memorable night, he stayed late at a party in Leonard Bernstein’s New York City apartment and was the only straight man left in a roomful of gay men. They began making remarks about how physically attractive he was, cracking jokes, and the doctor was stunned.

“Here we were, with Leonard Bernstein playing Chopin on the piano, and these guys were talking about me like I was a sex object,” he remembers. “I respected them and their AIDS work. But it amazed me that the conversation could get to such a crude level, so fast.”

On another occasion, Francis caught flak from lesbian activists who protested the “male exclusive” nature of condom distribution programs. When they demanded that San Francisco provide more female contraceptives, he lashed back, saying there was an epidemic to be fought.

“These condoms were for AIDS, and people were dying,” he says. “It was all politics.”

Politics. His old nemesis. It almost cost Francis his job in 1987, when hostility from his enemies in the bureaucracy reached a crescendo. He was summoned back to Atlanta by CDC Director James Mason and told that an obscure regulation required him to serve two years back in the main headquarters. He would no longer be focusing on AIDS but on tuberculosis.

“I hit the roof and wrote a letter to the agency that was probably too extreme,” says Francis. “Some friends persuaded me to tone it down, and they interceded to cancel the reassignment. So it worked out OK. But that was the writing on the wall. I had to leave.”

Today, Francis works at home and serves as a consultant for Genentech, a biomedical research complex near San Francisco. From time to time, he testifies as an expert witness in AIDS-related lawsuits against blood banks, still angered by their lack of action 10 years ago. He and his wife are raising two boys, settling into suburban life . . . and worrying about the future.

The epidemic of the century is still out of control, Francis says: America needs to raise funds for an AIDS vaccine. And federal support must be won for the early intervention programs he helped create, linking HIV-infected people to a network of medical programs.

But when it comes to high-powered federal jobs, Don Francis has checked out. He says it’s time for someone younger--and less embittered--to tilt at Washington windmills.

“I remember what my father said a long time ago, and I learned to live on the edges of the system,” he explains. “I also learned about falling off the edge.”

Some friends worry that Francis seems isolated now. Gottlieb, for one, speculates that his colleague is disheartened because he’s no longer in the forefront of national AIDS policy. Others say he needs a new challenge, even though he may not admit it to strangers.

They would do well to read the retirement speech that Francis delivered last year. A large crowd gathered in Atlanta, giving him a standing ovation when he charged that America’s public-health system should be sued for malpractice. It was like nothing had changed.

“A society that allows narrow political vision to guide public-health policy is doomed to succumb to disease,” he said, firing off one last warning. “Some people think we should listen to these dark and primitive voices. Nonsense !”