(WB) Dr. Anthony Fauci often had a combative relationship with Larry Kramer, but that didn’t stop the longtime director of the National Institute of Allergy and Infectious Diseases from fondly remembering on Wednesday the gay rights pioneer and AIDS activist upon news of his death.

“It’s a very sad day, not only for me, but for so many who have had the opportunity to interact with Larry since the very beginning of the HIV/AIDS era,” Fauci told the Washington Blade in an exclusive interview.

Although the two had a relationship that was at times friendly, other times antagonistic, Fauci said he and Kramer had conversations right up until his death, including at dinners, via email and “a lot of telephone calls, a lot of calls.”

It was in one of those phone calls a couple of weeks ago Fauci said he began to suspect Kramer’s passing would come soon. At the time, Fauci said he was calling Kramer to congratulate him on a new honor, calling it a “personal friendly thing.”

“He sounded extremely halting on the phone, barely able to get the words out,” Fauci said. “I said to myself when I hung up, ‘Gee, this is not good news. He’s getting very weak and frail.’”

Fauci acknowledged he was aware Kramer “was getting very fragile over the last several months” based on recent pictures of the HIV activist and previous phone conversations.

News of Kramer’s passing Wednesday, Fauci said, came to him via a text message earlier in the day from HIV activist Peter Staley, who urged Fauci to call him.

“It was very sad; we both were in tears on the phone,” Fauci said, becoming choked-up in his interview with the Blade.

Crediting Kramer with having an “amazing life, a full life,” Fauci recalled the late activist’s efforts in helping found ACT UP and the New York City-based Gay Men’s Health Crisis.

“He was truly an icon,” Fauci said. “He kind of forged the area, the role of the activist community and participating in the serious aspects of how you respond to a particular disease that afflicts individuals who are at risk, and actually already afflicted. And that’s Larry. I mean, that’s what Larry did.” 

As a founder of ACT UP in the 1980s, Kramer helped lead protests against NIH to encourage the development of a cure to combat HIV/AIDS and distribute it to thousands of gay men dying from the disease across the United States. 

One such protest was held at NIH on April 20, 1990. More than 1,000 demonstrators hoisted placards and shouted in bullhorns as they accused Fauci of taking insufficient action.

“I’ve had an interesting, unusual — and in some respects, wonderful — journey with Larry over the years,” Fauci conceded. “Since I was in his mind a representative of the government that he felt wasn’t moving quickly or well enough with HIV, we started off in somewhat of an adversarial role where he was attacking me for any number of reasons, and then as we got to know each other and realized that we both had a common goal that we shared, we became acquaintances, then friends, then really, really close friends.”

In the early days of the HIV/AIDS epidemic, there was no treatment. Fauci took a lead role in the development in 1987 of AZT, or zidovudine, the first antiretroviral approved for the treatment of HIV, but that drug was limited in effectiveness and carried side effects. 

It wasn’t until many years later in the 1990s — and many, many more protests from HIV activists — that more effective treatments became available against HIV/AIDS, which led to the availability today of Truvada as a prophylactic to prevent infection. Fauci has credited the gay community with having “incredible courage” in lifting stigma during the HIV/AIDS crisis to help the push forward for drugs available today.

Although Kramer had a reputation for being cantankerous and personally abrasive, Fauci said that was exactly what made him effective.

“He was very iconoclastic,” Fauci said. “He was theatrical. He was sometimes — not sometimes, but often times — rubs people very much the wrong way, but he got the attention that he needed to make the points that he wanted to make. So, you know, every once in a while, a giant among us passes, and I think this is one of those times when somebody who truly was a giant and an icon and a legend passes.”

Kramer wasn’t shy about antagonizing Fauci in recent years, publicly criticizing him for failing to develop a cure for HIV/AIDS. Nonetheless, Fauci said the two continued to be friends, although it was “a complicated relationship.”

“We gradually grew into a very deep and lasting friendship, and a friendship that he wasn’t afraid, even when we were at our very best and closest of still criticizing things that he didn’t think were the way he wanted to see me do things,” Fauci said. “So he wasn’t afraid to push back even at a time when we were close friends.”

Asked by the Blade what was Kramer’s most singularly important act in combatting HIV/AIDS, Fauci identified the late activist’s ability to “organize a group of young people.”

“He was outrageous in some respects, but he brought into his wing a group of young activists who took a very different approach, who took a very analytical approach, a very intellectual approach, a very academic approach,” Fauci said. 

Fauci identified Staley, Mark Harrington, Gregg Gonsalves and David Barr as among the HIV activists who were associated with Kramer and “came under his wing.”

“He would shake the cages and they would go and get things done in their interaction,” Fauci said. “So, I think it was a combination of him breaking down the barriers between governments and the activist community but also adding a degree of impact…by training and mentoring young activists.”

Asked what he thinks epidemiologists can learn from Kramer, Fauci said the HIV activist’s teachings are more applicable to others.

“I’m not so sure epidemiologists can learn something,” Fauci said. “But I think people who are involved in response to outbreaks and then you have a disenfranchised community that’s unfortunately…the major target of a particular outbreak that you got to learn from Larry that people speak up and make their voice known even if they’re in some respects disenfranchised. That’s the lesson that Larry learned.”

Chris Johnson is Chief Political & White House Reporter for the Washington Blade. Johnson is a member of the White House Correspondents' Association.