Which Candidate Would Better Handle the HIV/AIDS Epidemic?

By Todd Heywood, RH Reality Check. Posted October 1, 2008.

While both candidates for president have made statements that they want to combat HIV/AIDS, a comparison of the voting records, public statements and other actions shows John McCain has very few specifics to address the crisis and has a history of supporting legislation that damages and impedes the process of addressing the HIV epidemic in America.

First, here are what Barack Obama and McCain, respectively, have said about the HIV/AIDS crisis in general statements:

"We are all sick because of AIDS -- and we are all tested by this crisis. It is a test not only of our willingness to respond, but of our ability to look past the artificial divisions and debates that have often shaped that response. When you to go places like Africa and you see this problem up close, you realize that it's not a question of either treatment or prevention -- or even what kind of prevention -- it is all of the above. It is not an issue of either science or values -- it is both. Yes, there must be more money spent on this disease. But there must also be a change in hearts and minds, in cultures and attitudes. Neither philanthropist nor scientist, neither government nor church, can solve this problem on their own -- AIDS must be an all-hands-on-deck effort." -- Obama; Lake Forest, Calif.; World AIDS Day 2006; Dec. 1, 2006.

"The spread of HIV/AIDS, and the efforts of the international community to combat it, will be remembered by history as one of the defining issues of our time. The ethical implications of not doing everything in our power to slow the spread of this disease are severe. The most basic morality requires that we commit ourselves to combating HIV/AIDS everywhere." -- McCain in a 2003 speech on the floor of the U.S. Senate.

Obama's plans to combat HIV/AIDS can be found here.

McCain's plan to combat HIV/AIDS is not available on his Web site.

National Strategy on HIV/AIDS in America

Currently the United States requires that all foreign countries receiving HIV funding provide a comprehensive HIV/AIDS strategy that outlines specific outcome-based measures for the success or failure of funded programming and prevention of transmission of HIV in the grant country. However, the United States itself, 27 years after the cases of this epidemic were identified, still does not have a national strategy on HIV/AIDS in America.

McCain has never addressed the issue of whether or not he would support a comprehensive HIV/AIDS strategy for America.

Obama has stated that in the first year of his administration he will develop a comprehensive HIV/AIDS strategy for America that will specifically encompass every department of the federal government.

Needle Exchange Programs

In 1989, marking the "war on drugs," Congress and President George H.W. Bush created a law preventing the funding of needle exchange programs. However, studies have shown time and again that providing clean needles does not increase drug abuse, and more importantly they prevent the transmission of HIV, Hepatitis B and C, and other diseases among intravenous drug users. Some of the studies even indicated that needle exchange programs funnel drug users into treatment and out of the addiction cycle.

Congress has authorized the president to lift the needle exchange ban if the Department of Health and Human Services certifies that needle exchange programs do not contribute to drug abuse. The DHHS made that certification in 1998, but no president has used his congressionally authorized power to lift the ban.

McCain has never stated whether or not he would use the congressional power afforded presidents in 1998 to lift the ban on needle exchange programs to address the spread of HIV/AIDS in the intravenous drug using population in America.

Obama has stated he would lift the ban on needle exchange programs, and he has made it part of his HIV/AIDS platform on his Web site.

HIV Testing

One of the most crucial impacts on prevention of HIV transmission is found in the simple acting of widespread testing for the virus. The Centers for Disease Control has recommended routine testing as part of an annual physical, but as with millions of Americans without basic health insurance, very few are getting the annual physical. As a result, testing has fallen onto community organizations who provide anonymous or confidential testing. Any comprehensive HIV/AIDS strategy must address the issue of access to testing within impacted communities.

McCain has not made public statements about testing.

In a show of support for the idea of HIV/AIDS testing, Obama and his wife, Michelle, have both taken HIV tests publicly in 2006 in a trip to sub-Sahara Africa and have called on others to follow suit.

Access to Treatment

In addition to testing, it is imperative from a public health perspective to make sure that those persons testing positive for HIV have access to adequate medical care, including access to anti-retroviral medications, which have made HIV a manageable, chronic disease in the United States, rather than the death sentence it used to be. However, many HIV-positive Americans die without access to these necessary medications because of wait lists for AIDS drug assistance programs, which are funded only a certain amount to provide HIV medications to patients.

McCain voted against a federal program titled Early Treatment with HIV Act. ETHA would expand Medicaid coverage to low-income persons who are living with HIV but have not been diagnosed with AIDS. McCain was a co-sponsor of the original Ryan White CARE Act, which authorized funding to states to assist in treating HIV. McCain did not sponsor the 2000 Ryan White CARE Act reauthorization. In 2003 McCain voted against increasing funding to the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis by $940 million. He also voted against increasing treatment worldwide by $800 million that same year.

Obama has co-sponsored ETHA as well as the Ryan White CARE Act legislation. He also has outlined a concise plan, within his larger health plan, to assure access to health care for those infected with HIV.

Confronting Stigma

In all the issues surrounding HIV/AIDS, nothing is as painful and important as the need to address the stigma of being HIV-positive. Many people would rather never get tested than to hear the words "YOU ARE-- HIV-positive" from a medical care provider. The reasons for this are overwhelming. They run the gamut of issues from family prejudices on sexuality to taboos about sexuality in American culture, fear of disease and death, and simple ignorance about how HIV is spread.

While McCain has made comments about how terrible the epidemic is, he has also taken serious actions as a senator to support legislation that adds to the stigma of being HIV-positive in America. Among the things McCain has supported is a 1993 ban preventing HIV-positive individuals from coming to the United States as tourists, students or on other visas. He also voted in 1991 to involuntarily test all patients going in for surgery and to imprison any health care worker who is HIV-positive and participates in surgery.

In a debate at Howard University, Obama said the following:

"One of the things we've got to overcome is a stigma that still exists in our communities. We don't talk about this. We don't talk about it in the schools. Sometimes we don't talk about it in the churches. It has been an aspect of sometimes a homophobia, that we don't address this issue as clearly as it needs to be."

Obama also supports the lifting of the ban on immigration and other visas to persons with HIV, a ban passed in 1987 with the assistance of McCain.

Science or Dogma to Drive HIV Prevention Programs?

Since George W. Bush became president, the United States has been aggressively supporting abstinence-only education programs. Those programs have been shown to fail, but it has not stopped the president and his supporters from pushing this broken agenda on this country and the world. The recently passed President's Emergency Plan For AIDS Relief (PEPFAR) included a provision that demanded that 33 percent of all HIV prevention programs presented in other countries and funded under PEPFAR be abstinence-only programs.

Comprehensive prevention programs include development of new modes of prevention as well as education programs targeting groups most at risk for HIV infection with effective programs.

Obama is the Democratic sponsor of the Microbicide Development Act, which would fund a program at the National Institutes of Health to develop a topical anti-HIV agent to use in conjunction with other activities to prevent the spread of HIV. Obama also supports the JUSTICE Act, which would assist in the prevention of HIV transmission in U.S. prisons by allowing the distribution of condoms to prisoners. Current law makes possession of condoms in federal prison a crime. Obama also supports the end of abstinence-only-until-marriage prevention programs and replacing them with programs based on proven comprehensive reproductive health education.

Obama is also a co-sponsor of the Prevention First Act, which would provide young Americans with information about abstinence, contraception and condom use to reduce unintended pregnancies, disease transmission and abortions. The bill would also lift the 33-percent abstinence-only education component of PEPFAR. Obama has said the United States should "rewrite much of the bill to allow best practices -- not ideology -- to drive funding for HIV/AIDS programs."

Obama also is opposed to federal funding of abstinence-only programs.

"We can't ignore the fact that abstinence and fidelity, although the ideal, may not always be the reality -- that we're dealing with flesh and blood men and women and not abstractions, and that if condoms and, potentially, things like microbicides, can prevent millions of deaths, then they should be made more widely available." -- Obama to Los Angeles Times

McCain in March 2007 was unable to tell reporters on board his "Straight Talk Express" bus if he thought condoms were effective in preventing the spread of HIV. The New York Times ran the following transcript of the conversation on its blog:

Reporter: "Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?"

Mr. McCain: "Well I think it's a combination. The guy I really respect on this is Dr. Coburn. He believes -- and I was just reading the thing he wrote- that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn't succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I'm not very wise on it."

(Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

Mr. McCain: "I haven't thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don't know if I would use taxpayers' money for it."

Q: "What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush's policy, which is just abstinence?"

Mr. McCain: (Long pause) "Ahhh. I think I support the president's policy."

Q: "So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?"

Mr. McCain: (Long pause) "You've stumped me."

Q: "I mean, I think you'd probably agree it probably does help stop it?"

Mr. McCain: (Laughs) "Are we on the Straight Talk express? I'm not informed enough on it. Let me find out. You know, I'm sure I've taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception -- I'm sure I'm opposed to government spending on it, I'm sure I support the president's policies on it."

Q: "But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: 'No, we're not going to distribute them,' knowing that?"

Mr. McCain: (Twelve-second pause) "Get me Coburn's thing, ask Weaver to get me Coburn's paper that he just gave me in the last couple of days. I've never gotten into these issues before."

The Veep Choices on HIV/AIDS

Sen. Joe Biden of Delaware, Democratic nominee for vice president, has a mixed record on HIV/AIDS issues. While campaigning for the nomination for president this year, he would not commit to a national strategy on HIV/AIDS, but he did sponsor the Prevention First Act, ETHA, and Ryan White CARE Act and the reauthorization. He has also stated that he supports needle exchange programs and supported the funding of research for microbicides, which would prevent the transmission of HIV. Biden also supports a move toward science-based education programs and away from the ideological programs such as abstinence-only. While he has supported such legislation, he has also supported the ban on HIV-positive people traveling to the United States and supported a 1991 bill that would have imprisoned health care workers with HIV who participated in surgeries.

Alaska Gov. Sarah Palin, Republican nominee for vice president, on the other hand, has a scant history on HIV/AIDS issues. While in March she declared a Native HIV/AIDS awareness program, she has stated that she is opposed to "explicit" sex-ed programs. She later amended her statements in a 2006 governor's debate, by saying:

"I'm pro-contraception, and I think kids who may not hear about it at home should hear about it in other avenues."

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