An AIDS Fighter on a Tightrope

WASHINGTON —  The door opens to a narrow row house in the southeast section of town and Dr. R. Scott Hitt steps in out of the heat. The room is smoky and cluttered with papers. A neglected cigarette burns in an ashtray.

Gray suit buttoned and white collar crisp, he has just descended into one of the bunkers where the political war on AIDS is fought, this one the home of an activist working to bring down the cost of dreadfully expensive new drugs for people who will die without them.

A leading Los Angeles AIDS doctor, Hitt is here as chairman of President Clinton’s Advisory Council on HIV/AIDS. He listens attentively to a financial wish list. His physician self tells him it is perfectly justifiable, but his political self knows it is patently impossible.

“If you could ask for one thing, what would it be? We can’t be asking for 20 things,” Hitt says bluntly. “We are not going to get 20 things.”

It is his willingness to accept this political fact of life and move on that has most disturbed critics in the 15 months since Hitt was made one of Clinton’s chief advisors on AIDS. He maneuvers between two often hostile camps: an administration that has done more than any other about AIDS and a gay community that will be satisfied with nothing less than a cure.

Under Hitt’s direction, the advisory council that was roundly dismissed as irrelevant before it even met appears to be getting through to an administration many believe got off to a slow start on AIDS.

Within the first six weeks, Hitt and his panel churned out eight recommendations on what the White House should do immediately about AIDS. Clinton promptly followed all eight, most notably assembling in record time a White House conference on the disease President Reagan wouldn’t even mention.

Hitt was pretty proud of that. But a lot of people in the AIDS community dismissed it as no big deal.

Some activists wonder whether this handsome 37-year-old doctor with a million-dollar house in the Hollywood Hills, a silver Mercedes and one of the most lucrative AIDS practices in the country has what it takes to squeeze money out of a tight-fisted Congress or advise Clinton on needle exchanges and miracle drugs most AIDS patients cannot afford to buy.

“He’s not tough enough on Clinton and he will have to take a long hard look at his role in this community after Clinton’s presidency is over,” fumed Steve Michael, a Washington AIDS activist. “We can make Clinton a better president on AIDS, but Scott Hitt has got to help us. He can’t be standing there covering the president’s flanks.”

Even some council members were wary at first of his unimposing style, but quickly came to respect him. “Scott is a directed cannon, not a loose cannon. He isn’t stupid; he does not embarrass the president,” said council member Benjamin Schatz, who is executive director of the Gay and Lesbian Medical Assn. in San Francisco.

“He’s blond and good-looking and likes to have fun, so some people mistook him for a lightweight,” Schatz said. “Why aren’t heterosexual women with large breasts taken seriously? Well, he’s the gay male equivalent of that.”

The legacy of other gay activists who have managed to enter Clinton’s inner circles--only to be booted for remarks considered impolitic-- taught Hitt something about the workings of Washington: When one has the ear of the president of the United States, it is wiser to whisper than to scream.

Indeed, Hitt gets high marks at the White House. “He usually does it with a quiet voice, but he provides the right kind of leadership around there,” said White House Chief of Staff Leon Panetta. “He is very respected among the people concerned about AIDS.”

In Los Angeles’ gay power circles, Hitt has long been known as an activist who spends his days fighting the virus with medicine, his nights and weekends fighting it with politics. His friends call him the “Ever-Ready Doctor.” Countless evenings at home are devoted to phoning and faxing, as he juggles a busy, not to mention emotionally grueling, practice.

He has distinguished himself in his field, having treated more than 1,000 HIV patients at Pacific Oaks Medical Group in Beverly Hills, the nation’s largest HIV private practice. He is a founding director of the Victory Fund, which raises thousands of dollars for gay political candidates, and a founder of Access Now for Gay and Lesbian Equality, a civil rights group.

It was in front of the stone fireplace in the living room of Hitt’s contemporary bungalow that Bill and Hillary Clinton won the early trust of gay leaders out of 1992’s crowded field of Democrats vying for the presidential nomination. His endorsement subsequently helped deliver the gay vote for Clinton in droves.

Three years passed before Clinton rewarded Hitt’s loyalty, enough time for the president to fall from grace among gays and lesbians for his retreat on homosexuals in the military, his slowness in naming an AIDS commission, and his failure--in the view of many activists--to come out swinging against the epidemic.

Even when the council was finally named, friends warned Hitt that running the advisory commission would be a thankless job. This would be the largest and most diverse such panel ever assembled: 40% of its 30 members are HIV-positive; half are homosexual or bisexual; a third are people of color; all have been personally affected by the epidemic and are strongly opinionated about AIDS.

Hitt would be the first openly gay person selected to lead a presidential advisory council--the third focused on AIDS under Presidents Bush and Clinton. Its mandate would be to guide the president on national AIDS policy with a $240,000 annual budget and no support staff. Even before its first meeting, the council would be dismissed as irrelevant by many in the AIDS community. Nothing it accomplished would ever be enough.

“I told him he was opening himself up to a disappointment, that this was another in a long line of commissions about AIDS,” said David Mixner, a former Clinton advisor on gay issues whose recent book, “Stranger Among Friends,” details his disappointment in the president. “But he has built an astounding record in a very short time, and it has a lot to do with Scott’s unique ability to push, push, push. He goes 18 hours a day.”

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The capital has that rumpled look it gets in late summer. Backs of dress shirts are stained dark with sweat and hairdos are beginning to frizz. Hitt’s black loafers click against the marble floor in the Hart Senate Office Building. He has just paid homage to Nevada Sen. Harry Reid, a moderate Democrat and member of the powerful Appropriations Committee that is vital to deciding how much federal money is spent on AIDS.

A wall of pay phones beckons, and Hitt stops to check on a patient. The subject matter switches from politics to medicine. Sentences pour from his mouth as he inquires about pathology reports and prognoses. It is as if he has been speaking a foreign language all morning and has just lapsed comfortably into the effortless fluency of his native tongue.

“Who thought that, the pathologist?” Hitt demands, sounding utterly self-assured for the first time today. “Well, the surgeon doesn’t know. Get a second opinion on what we need to do for this guy. He’s been in pain for four weeks.”

It was clear from the start that this Washington stuff would not be easy, even for a whiz kid from Tucson who graduated from high school at 16, started medical school at 20, established himself as a cutting-edge AIDS physician by 30 and was called to serve by the president at 36.

On the day Hitt was at the White House being told by Vice President Al Gore that he would chair the council, 50 gay elected officials from around the country happened to be down the hall preparing for a historic meeting with the administration’s senior advisors. The officials watched in shock as four Secret Service agents put on rubber surgical gloves before touching the bags and briefcases they had set out for routine inspection.

The agents said later the gloves were “for protection.” Clinton was furious. And Hitt learned the lesson that within the walls of the White House, no gesture is insignificant.

“This was an historic day with so many gay and lesbian leaders invited to the White House, and it was overshadowed by a mistake some guards made. That’s frustrating,” Hitt said.

It would not occur to him until later that this concept of the bad eclipsing the good was no mishap; it was the culture of politics. For all of his efforts to laud this president for his achievements in the war on AIDS, it seemed to him that the news media emphasized the president’s failings while activists dismissed most praise as pandering.

The council’s last report in July lauded Clinton for his “strong commitment” to increased funding for the Ryan White CARE Act that funds community-based care for AIDS patients, his opposition to dismantling Medicaid, and a 43% increase in discretionary AIDS funding when other federal budget increases averaged 3%. It also chastised Clinton for “lack of action” in AIDS prevention and discrimination, calling for “greater courage and leadership” on the president’s part.

Some grumbled the report was too soft.

“How do you judge the president?” Hitt responds from the backseat of his third taxicab of the day as he lurches through Washington on one of his monthly visits. “One way is to say the epidemic is still going on, people are still dying and damn it, we’re upset. The other way is to say this president has done more than every other combined, and that’s just as wrong. Who couldn’t do more than the other presidents combined? The answer is somewhere in between.”

Not that he’s reticent about criticizing the president. Hitt concedes he has lost the enthusiasm he had for candidate Clinton four years ago and rates his performance on gay civil rights as “underwhelming.” But on AIDS, he says, Clinton has been “good to very good” in many areas.

Still, there are miles to go in the fight against AIDS, the No. 1 killer of Americans between 25 and 44. Yet whatever the council has achieved under Hitt’s leadership can perhaps best be measured in inches: The president’s mention of the disease in this year’s State of the Union address and his nomination acceptance speech last month; the panel’s insistence that Clinton stand firm against cuts in Medicaid, upon which half of AIDS patients rely; its influence in repealing part of a defense bill that would have forcibly discharged HIV-positive members of the military; its public reproval of Clinton for failing to show more courage in AIDS prevention.

“We could spend a trillion dollars on AIDS,” Hitt says. “Our recommendation could be to fund everything. But our job is to help the president prioritize and then follow up on what he does. Discretionary spending on AIDS went up 43%. Maybe it should have been 80%, but 43% is something to be happy about.” In all, Hitt said, the federal government spends more than $3 billion a year on AIDS research, treatment and care.

He mentions that because of improvements in care, Sherman Oaks Medical Center has recently closed its AIDS unit. Similarly, the AIDS Healthcare Foundation recently announced it is closing its oldest hospice, in Elysian Park, in part because of similar successes in treating AIDS.

It’s nearly 5 o’clock. Hitt will spend the night at a friend’s home and head back to Los Angeles in the morning to see patients. His practice has been bringing in less money lately, partly because his patients are responding to new drug therapies.

“He has nothing to gain from this. He’s not trading up for a better job,” one Los Angeles AIDS activist said. “This Congress is not going to approve a gay man in a high government position. Maybe this guy really is all about making advances on AIDS.”

Hitt’s thoughts turn to one of his oldest patients, a man who is not responding to those new drugs that seem to be working miracles for so many. He wonders aloud what to try next. Whatever he does in Southern California might buy a few more months. Much of what he does in Washington might not be felt for years. But at least the president is listening. And for Hitt, that’s something.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Profile: Russell Scott Hitt

Physician and chairman of the Presidential Advisory Council on HIV/AIDS.

* Born: Sept. 28, 1958

* Residence: Hollywood Hills

* Education: University of Arizona, University of Arizona School of Medicine.

* Career highlights: Partner at Pacific Oaks Medical Group, the nation’s largest private-practice provider of HIV/AIDS health care.

Member of board of directors of AIDS Project Los Angeles.

* Personal: Partner Alex Koleszar, a computer consultant and artist.