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The Issues: What Black Voters Must Ask

December 2007

African American voters have much to sort out already. Candidates in all parties compete ferociously for our support, both in voting and in organizing get-out-the-vote campaigns. In deciding which campaign and what party to throw our individual and collective weight behind, we must consider everything from criminal justice to economic policy to health care access. But it is also incumbent upon us to consider where candidates stand on AIDS -- with Blacks representing over half of the epidemic today, and racial disparities widening among both those newly infected and those who die from HIV, this is undoubtedly a Black concern.

Thus, the following is a guide to help Black voters order their thoughts. There are five big AIDS questions we must all ask any candidate or any political party seeking our support in a national election.

Do You Have a National Strategy?

The United States has a wise policy when it comes to supporting poor countries' AIDS programs: Before getting foreign aid, they must first have a national strategy for directing their resources. Yet, 26 years into our own epidemic, we still don't have our own overarching strategy for ending it. Little wonder, then, that we still log an estimated 40,000 new infections each year.

As an Open Society Institute report pointed out in May, this is a particularly crucial point for African Americans -- the absence of an overarching strategy with measurable goals and accountability both allowed us to miss the Blackening of the epidemic for too long and, now, has kept us from targeting resources where they are most needed.

But AIDS advocates have in recent months zeroed in on this glaring hole in America's response to the epidemic. And all Americans who care about stopping HIV must make their votes dependent upon a candidate not only pledging to have a plan, but also laying out that plan's priorities.

Will You Support Policies that Reduce Black Infections?

Perhaps the most direct way the next president can impact the Black AIDS epidemic is by lifting the ban on federal funding for syringe exchange programs. A fifth of all HIV infections among Black men and Black women, respectively, still comes through sharing dirty needles; and among Black women infected through sex, 17 percent of their positive male sex partners were themselves infected through dirty needles. We know how to stop these infections -- immediately. But our elected leaders don't have the political courage to do it.

The wrongheaded ban on federal funding for needle exchange has been in place since 1989, when Congress decided the programs encouraged drug use and, thus, undermined the "war on drugs." There was no evidence of that claim at the time, and in the years since a tidal wave of studies (many funded by the U.S. government) have established that the programs are both our most effective and least expensive tool for stopping HIV's spread -- and that they do nothing to encourage drug use. In fact, some studies show the programs actually help funnel drug users into recovery.

Congress authorized the president to lift the ban if the Department of Health and Human Services certifies the programs don't spur drug use -- and the department did so, way back in 1998. President Clinton failed to act, however, and the issue has not come back up. Meanwhile, studies show that the 36 states and territories that have cobbled together programs with local funds are finding success. In fact, a 2005 federal study attributed a slow but steady decline in new Black infections nationally in part to the stunning success of New York City's syringe exchange program. If every city had a fully-funded program we could replicate that success nationally. Black voters must demand that the next president commit to this proven prevention solution.

Similarly, surveys have shown that African Americans are far more receptive to health education information of all sorts when it comes from Black community sources. In 2004, Kaiser Family Foundation surveyed 18 to 24-year-old African Americans who had been exposed to HIV-prevention messages through a Kaiser/Viacom campaign targeting Black media; more than half said they talked to their sex partners about safety as a result of what they saw. Any viable HIV prevention campaign directed at Black people must be funneled through our community's trusted voices -- from media and pulpits to celebrities and community organizers. We must ask our elected officials: Will you devote substantial resources to helping our community's voices get the word out about AIDS?

Will You Support Community-Based HIV Testing?

Similarly, we must ask candidates if they will devote substantial resources to HIV testing campaigns that are organized by and rooted inside our own community, and that connect people to appropriate care. The Centers for Disease Control and Prevention estimates that as much as a quarter of the 1.2 million Americans believed to be HIV positive do not know they are infected. Data strongly suggest these undiagnosed infections drive the epidemic's growth.

CDC has launched a massive campaign to get more people tested, changing the guidelines given to health care providers to make it easier for them to administer tests. And African Americans already get tested at rates more than twice that of whites. Nevertheless, CDC estimates a whopping half of all positive Blacks don't know they're infected. So to truly close the knowledge gap, public health will have to tap into the growing willingness among our community's traditional institutions to facilitate testing. It must fully support testing efforts based at churches, social events, conventions and other community gatherings.

Will You Guarantee Access to Adequate Treatment?

Perhaps the most glaring political failure of the Bush administration when it comes to AIDS has been its active neglect of the AIDS care safety net. At a time when there are more Americans living with HIV than ever before, the AIDS budget has remained largely flat since the onset of the Iraq war. As a result, in a country with overflowing wealth, Americans with HIV/AIDS now linger on waiting lists that are hundreds-deep for services as basic as public insurance to pay for expensive but lifesaving medications. Two thirds of African Americans who are in treatment for AIDS survive because of public health insurance, yet Medicaid systems are collapsing in nearly every state, buckling under financial pressures. So, one of the most important questions to ask any presidential candidate is if he or she plans to rebuild our care system.

The problem is poised to get worse: As testing campaigns convince more and more people to learn their status, those who are positive and do not have private insurance will further crowd into the system. And it's not just medicines. AIDS service providers across the country are no longer able to sustain counseling services, nutrition programs, drug recovery programs and the host of other support structures that make it possible for people to succeed in HIV treatment. Our next president's commitment to fully funding access to AIDS treatment and care must be unequivocal.

How Will You Stop the Stigma?

Finally, the president occupies a powerful bully pulpit for setting the national tone on a range of issues and ideas. It is long past time that America have a president brave enough to stand up and set a tone that embraces all Americans, regardless of sexual orientation or HIV status, and encourages an open, honest dialogue about sexuality and health in general. By doing so, the president -- who still garners more U.S. media attention than any other figure -- can help our community (and all communities) begin to tackle the shame and blame that still get in the way of personal and communal health. Whether straight or gay, young or old, rich or poor, if Americans cannot talk honestly about their sexuality, they cannot figure out how to lead healthy lives.

In addition, we must ask candidates whether they will direct faith-based funding to Black Churches that are willing to lead the anti-stigma campaign. For too long we have reflexively blamed the community's slow response to AIDS on the church's damnation of the behaviors that lead to HIV risk. Today, thousands of faith leaders around the country are using their pulpits to instead wipe away personal shame and support healthy lives. Any national effort to end AIDS must include and support their efforts.

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This article was provided by The Black AIDS Institute. It is a part of the publication We Demand Accountability. Visit Black AIDS Institute's website to find out more about their activities and publications.