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BMJ. 2007 December 1; 335(7630): 1160.
PMCID: PMC2099526

Scott Hitt

Chaired US presidential AIDS council

The full force of AIDS was just beginning to emerge when R Scott Hitt started to practise medicine in 1983 in Los Angeles. The term AIDS was only months old. The first journal article—five rare cases of Pneumocystis carinii in young men, all active homosexuals, in Los Angeles—had been published just two years before in MMWR: Morbidity and Mortality Weekly Reports. The virus itself had yet to be identified and only a few hundred Americans had died from it.

As an openly gay man and physician, at a time when both society and the profession stigmatised homosexuality, Hitt took on the challenges of the epidemic that would decimate his community. With his tall, classic California good looks, intelligence, and winning manner, he quickly became a leader in the medical and political fights against HIV.

He was a member of the Pacific Oaks Medical Group in Beverly Hills, which grew to become one of the largest private HIV medical practices in the country. He served on the governing board of the AIDS Project Los Angeles, a charity that provides social and medical services.

The Reagan administration was slow to respond to the crisis as the death toll mounted into the thousands, then the tens of thousands, a year. Anger rose within the gay community. The pressure group ACT UP emerged and took to the streets with demonstrations.

Hitt took a different tack. He remembered the adage that “money is the mother's milk of American politics” and set out to change the political dynamic. He was one of the founders of Access Now for Gay and Lesbian Equality (ANGLE) in 1989. The group of Los Angeles powerbrokers included political consultant David Mixner. The group raised prodigious sums from the Hollywood community to advance gay and AIDS issues.

Bill Clinton was governor of Arkansas. His campaign for the Democratic nomination for president was struggling in 1991 when he prepared to speak at the Palace Theater in Hollywood and became the first presidential candidate to speak publicly before a gay crowd.

Hitt would later recount how in the wings of the stage, they told Clinton that half of the audience was HIV positive and would probably be dead within a few years, all in the prime of their lives. The candidate's eyes went wide. A few minutes later he would say to the audience, “I have a vision and you're part of it.” He pledged to fight the epidemic. More than 37 000 Americans would die of AIDS that year.

That landmark event opened cheque books and generated volunteer support that contributed to saving Clinton's political life.

President Clinton created the Presidential Advisory Council on HIV/AIDS (PACHA) in 1995 and named Hitt as its first chairman, at the age of 35, in which capacity he served until 2000. It was the first time that an openly gay man had led a presidential advisory body.

Despair permeated the air when PACHA first met. More than 51 000 Americans would die of the infection that year, the peak of the epidemic, before protease inhibitors miraculously began to ease the affliction. From then on, cadaverous bodies on their death beds began to shed their grey pallor, fill out, and take on a pink glow of health in a resurrection worthy of Lazarus.

As chairman of the council, Hitt faced competing pressures from the gay and AIDS communities and the Clinton administration. Some within the community thought he was simply a good looking fellow who had parleyed his political connections into an appointment; they expected little of him. On the other side, the president was often reluctant to take on controversial aspects of fighting HIV that the council recommended, such as frank prevention messages and support for needle exchange programmes that would reduce transmission among injecting drug users.

Often Hitt was the glue that held the council together. His heart was in the streets but his head realised that too strident an approach would only alienate the president. He sought to craft the council's recommendations to avoid inflammatory rhetoric and to make them effective. But he never backed down from stating his views.

The issue came to a head in the spring of 1998, when the council, drawing on scientific evidence demonstrating the efficacy of needle exchange programmes in reducing HIV infections without increasing injecting drug use, called for the federal government to fund the programmes.

The president went halfway: he lifted restrictions that prohibited funding the programmes, but he refused to appropriate any money to support them. It is a decision that Clinton, years after leaving office, would acknowledge was wrong. He wished he had had the political courage to do the right thing.

Hitt's response to the administration's decision was pointed. “At best this is hypocrisy, at worst, it's a lie. And no matter what, it's immoral.” That type of toughness solidified his credibility within the community. Several members of the council resigned in protest, but Hitt felt an obligation to stay and continue to fight for people living with HIV infection.

In 2000 he was the driving force behind creating the American Academy of HIV Medicine, which trains and certifies healthcare workers as specialists in treating HIV. He thought it essential that physicians know how to manage the increasingly sophisticated options for treating the disease. And he pressed for state government recognition of the specialty.

Hitt was a native of Tucson, Arizona, and a bit of a child prodigy, completing high school at the age of 16. He entered the University of Arizona College of Medicine in Phoenix at 20, about two years earlier than the norm. He was diagnosed with colon cancer in 1999 and underwent numerous operations and treatment to fight the disease. He leaves his partner of 27 years, Alex Koleszar.

R Scott Hitt, physician and chairman of the US Presidential Advisory Council on HIV/AIDS, 1995-2000 (b 1958; q University of Arizona 1983), died from colon cancer on 8 November 2007.


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