Where the Candidates Stand: The Democrats
The Black AIDS Institute sent surveys to all eight declared Democratic candidates in October 2007. Of those, only Sen. Chris Dodd had responded in full by publication time. A spokesperson for Sen. Hillary Clinton answered some of the questions in a phone interview. Representatives for John Edwards, Sen. Barack Obama and Gov. Bill Richardson stated their campaigns' intent to respond, but had not done so by publication time.
|Sen. Hillary Clinton||Sen. Chris Dodd||John Edwards|
|Rep. Dennis Kucinich||Sen. Barack Obama||Gov. Bill Richardson|
Below, we review the Democratic field on our five big questions (see The Issues on page 8), drawing on the limited responses to our survey, public statements, and previously published candidate surveys. Absent answers to our survey questions, we focus on the candidates leading in the polls at press time and on candidates who have exceptionally good or bad records on a given question. Ultimately, whomever wins the Democratic nomination must be asked to offer full, detailed answers to questions about how they will stop the Black AIDS epidemic.
On Creating a National Strategy
Six of the Democratic candidates have committed to developing a national strategy for America's response to the AIDS epidemic: Sen. Hillary Clinton, Sen. Chris Dodd, John Edwards, Rep. Dennis Kucinich, Sen. Barack Obama and Gov. Bill Richardson.
- In response to our survey, Dodd wrote, "Fighting HIV/AIDS requires coordination between a national strategy and community initiatives. This means enlarging the public health footprint to provide direct community services and having the structure to integrate local activities into a larger community response." He went on to call for "direct support of community activities." Dodd also vowed to create an AIDS czar with authority to coordinate actions across agencies.
- A Clinton spokesperson told the Black AIDS Institute that the senator strongly supports a national AIDS strategy with explicit goals and a timeline for achieving them. The campaign subsequently released its AIDS platform on November 27, which stated, "Federal efforts to tackle HIV/AIDS are diffuse and uncoordinated today.... Hillary will tie all of the federal efforts together into a single comprehensive national strategy."
- Edwards was the first to release an AIDS platform, on September 24, and in it he vowed to craft a national strategy "through an honest, comprehensive and fast-tracked process that involves stakeholders from the public and nonprofit sectors." As part of the strategy, Edwards would mandate a cabinet-level annual report on where the country stands on meeting its goals and would appoint a "strong director" for the Office of AIDS Policy. "Our disappoints [in stopping AIDS] can be explained in part by the failure to create a national strategy," the platform states.
- Obama similarly vowed to craft a national AIDS strategy in his October 16 AIDS platform. The platform specified that "in the first year of his presidency, he will develop and begin to implement a comprehensive HIV/AIDS strategy that includes all federal agencies." The platform said Obama's strategy will include "measurable goals, timelines, and accountability mechanisms."
On Reducing Black Infections
All of the leading Democratic candidates have issued AIDS platforms that forcefully commit to addressing the epidemic's racial disparities. During a June 28 Democratic debate at Howard University, hosted by Tavis Smiley, the candidates took turns answering NPR host Michel Martin's question about AIDS among African American youth. All eight responded by making strong calls for a focus on stopping AIDS in Black America in particular.
Notably, seven of the eight Democrats support federal funding for syringe exchange programs. Only Sen. Mike Gravel has not publicly stated his support, though he said in the Howard University debate that he believes the Black epidemic is worsened by the so-called "war on drugs," declaring, "If they really want to do something about what's happening to the health of the African American community, it's time to end this war."
All eight Democrats have signaled their support for comprehensive sex education in our nation's schools. Edwards, Kucinich and Obama said they would end funding for abstinence-only sex education programs.
- Notably, Kucinich has already voted twice in the House for needle exchange funding. Kucinich is also sponsor of a bill, dubbed the JUSTICE Act, which would make condoms available in federal prisons and encourage state prisons to do the same. Edwards, Obama and Richardson have stated their support for the bill.
- Dodd, in response to our survey, declared that, as president, he would both lift the syringe-exchange funding ban and target prevention resources in Black communitybased organizations and media outlets. He further stated, "My leadership will exemplify ... reliance on science and outcomes. Prevention policy should focus on what is known to work in preventing the spread of HIV/AIDS in the population generally and especially among adolescents. This will be an important element of education policy as well as health policy."
|Sen. Joe Biden||Sen. Mike Gravel
- A Clinton spokesperson told the Black AIDS Institute that she will fund syringe exchange; increase funding for the Minority AIDS Initiative, which sets aside money to support AIDS campaigns rooted in communities of color; and increase support for nontraditional public health partners, in particular clergy and faith leaders. In a statement announcing her AIDS platform, the campaign stressed its focus on reducing rates among African Americans, Latinos, gay men and women. At the June 28, Democratic presidential primary debate hosted by Tavis Smiley at Howard University, Clinton said, "Let me just put this in perspective: If HIV/AIDS were the leading cause of death of white women between the ages of 25 and 34 there would be an outraged outcry in this country." On prison prevention, Clinton told AIDSvote.org only that more study is needed, stating, "I will take steps to better understand how HIV/AIDS is transmitted in prisons and to address this problem."
- Edwards vowed to fund syringe exchange in his September AIDS platform and lodged his support for the JUSTICE Act in response to AIDSvote.org's survey. His platform stresses the epidemic's disproportionate impact on African Americans overall and on Latina women. It declares, "Any serious effort to end the HIV/AIDS epidemic must begin in the African American and Latino communities, including among the incarcerated population, and address their prevention and treatment needs. We must also continue to work intensively with overlapping groups like gay men." [Emphases added.]
- Obama vowed to fund syringe exchange in his October AIDS platform, and also specified his support for the JUSTICE Act. His platform declares that "HIV has hit some communities harder than others" and vows "Obama will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health." During the Howard University debate, Obama framed the issue broadly, saying, "The problems ... are all interconnected. To some degree, the African American community is weakened. It has a disease to its immune system. When we are impoverished, when people don't have jobs, they are more likely to be afflicted not just with AIDS, but with substance abuse problems, with guns in the streets. So it is important for us to look at the whole body here."
On Encouraging Blacks to Get Tested
- Obama has perhaps the most significant record on HIV testing among African Americans because he has already led by example: During an August 2006 trip through sub-Saharan Africa, he spoke at length about the need for personal and political leadership on AIDS and took a public HIV test of his own. Since then, he has continued to use his existing bully pulpit to highlight the need for testing.
- Dodd, however, is the only candidate who has committed to targeting resources to Black community-based testing campaigns -- a vow he made in response to our survey. Dodd stressed, "Any testing must be coupled with counseling for both those who test positive and those who test negative but may engage in high risk behavior. Testing sites need to be used as education opportunities to prevent people from spreading or contracting HIV." The Centers for Disease Control and Prevention recently issued new guidelines for HIV testing that remove a longstanding recommendation that it be closely tied to counseling; the change was meant to make HIV testing easier for health care providers to administer and, thus, encourage more providers to offer tests to patients. The Black AIDS Institute has joined other AIDS organizations in warning that counseling must remain a crucial component of testing.
On Ensuring Access to Appropriate Care
All eight Democrats have vowed to increase funding for the Ryan White CARE Act, which is the primary vehicle for federal funding of AIDS care services. And seven of the eight candidates (excluding Sen. Joe Biden) have stated they will support the Early Treatment for HIV Act, which would expand Medicaid to allow poor people living with HIV but not yet diagnosed with AIDS to qualify for public insurance.
However, most of the candidates have said their primary response to ensuring access to AIDS care is to reform the broader health care system. Ultimately, the candidate who receives the Democratic nomination must be pressed to answer how he or she will ensure access to AIDS treatment and care even if broader reforms are unsuccessful or delayed. Two-thirds of African Americans in treatment for HIV/AIDS now pay for it with public insurance, but each of those programs face financial crises.
- In response to our survey, Dodd vowed both to support Medicaid expansion (he has twice cosponsored the bill) and to ensure that state-run, federally funded AIDS Drug Assistance Programs (ADAP) are adequately funded so that there are no waiting lists for service. He has cosponsored each of the bills authorizing the Ryan White CARE Act. In his response to our survey, he stated, "Failure to invest more is completely counterproductive and will actually add to our public health costs as we are left treating an uncontrolled disease. Treating HIV/AIDS early and preventing transmission is an investment in our future."
- A Clinton spokesperson told the Black AIDS Institute that, while ADAP funding is key, it must be increased within the context of more funding for Ryan White overall. Clinton's AIDS platform stresses that her broader health reform plan guarantees "access to affordable, quality health insurance" and does not allow insurers to deny coverage based on preexisting conditions. The platform further states that Clinton will "strengthen" Medicaid, offering subscribers an array of plans "with benefits at least as good as the typical plan offered to Members of Congress." Clinton is a lead sponsor of the Early Treatment for HIV Act and, notably, has been a key player in the ongoing debate about Ryan White CARE Act reform. As southern states have argued for a funding system that directs more resources toward their burgeoning epidemics, Clinton has led members in blocking changes that decrease funding for urban centers such as New York City. The Black AIDS Institute has argued that the entire funding pie must be increased to accommodate both new and old epidemics.
- While in the Senate, Edwards co-sponsored both the Early Treatment for HIV/ AIDS Act and the Ryan White reauthorization bill. His AIDS platform reiterates his support for Medicaid expansion and stresses that, even with broader health care reform, fully funding Ryan White is "essential to ensure culturally competent care is available." He also vows to "put an end to waiting lines for HIV drugs" in state ADAPs. Like the other leading candidates, he stresses broader reform, stating, "True universal health care must be the foundation for a national HIV strategy."
- Obama has also cosponsored the Early Treatment for HIV Act and, in his AIDS platform, states he is "a strong supporter" of the Ryan White CARE Act. However, his AIDS platform speaks in most detail about access to treatment and care when discussing his broader universal health care plan, which he vows to sign into law by the end of his first year.
On Eradicating Stigma
Of the range of stigmas associated with HIV/AIDS, perhaps none has been so detrimental to Black America's handling of the epidemic as bias against gay and bisexual men. The federal government sends a signal to America through the legal status it grants lesbian, gay, bisexual and transgender citizens, and on that score the Democratic candidates widely support existing LGBT civil rights initiatives. According to GMHC, all eight Democrats support banning employment discrimination based on sexual orientation and gender identity; two candidates -- Gravel and Kucinich -- support marriage rights for LGBT Americans and the other six support civil unions.
Also according to AIDSvote.org, five Democrats -- Dodd, Edwards, Kucinich, Obama and Richardson -- have committed to lifting the longstanding ban on HIV-positive travelers and immigrants entering the U.S.
- On using the president's bully pulpit to fight stigma in general, Dodd answered the Black AIDS Institute survey by stating, "It is important to unite the American people to undertake this challenge and to provide an environment and resources that encourage people to engage early with healthcare providers to stop the spread of HIV/AIDS and achieve better health." Dodd also vowed to dedicate resources to Black faith leaders who are working to combat stigma.
- Clinton's AIDS platform stresses that she will work with faith leaders in the Black community on a host of issues, though it does not specify fighting stigma as among them. A campaign spokesperson also told the Black AIDS Institute that she would revive public health's effort to reduce infections among gay and bisexual men, particularly Black gay and bisexual men.
- Obama has already begun using his bully pulpit to fight stigma. His public HIV test and repeated call for personal responsibility in dealing with HIV in Black America represent the sort of leadership we must have from our next president. During the Howard University debate, Obama declared, "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."