One on One With Barack Obama
The Politics of HIV
President-elect Obama first spoke with us back in the September/October 2006 issue of Positively Aware magazine, months before he announced his bid to run for the presidency. We thought it only fitting to reprint the interview here, in its entirety, during the month of his inauguration. His views on needle exchange, harm reduction, prevention and HIV/AIDS policy are even more relevant now than they were when he was just a young senator from Illinois. One interesting question we asked then was, "Who would be your choice for a pro-AIDS care president?" I guess we now know the answer!
Jeff Berry: What are your priorities on your agenda for national HIV/AIDS issues for 2006?
Barack Obama: This past June, the world paused to commemorate the passing of 25 years since the first AIDS case was identified. Over this time, the epidemic has evolved from one primarily afflicting the white, homosexual community to one that impacts all populations, regardless of race, ethnicity or socio-economic status. The epicenter is shifting towards women and children, and African Americans continue to experience the highest rates of new infections and deaths from HIV/AIDS compared to all other patient groups. For African American women aged 25-34 in the United States, HIV/AIDS is the leading cause of death.
The tragedy and irony of these statistics is that HIV/AIDS is a preventable disease. To that end, I believe that the most critical AIDS issue facing our nation is the need for prevention. We have not adequately educated ourselves and each other about this disease, nor have we identified effective ways to empower individuals to change their sexual practices to protect themselves from HIV infection.
Until we have an open and honest dialogue about what we need to do, or do better, we will not be able to stop the silent but deadly spread of this disease. This is not an easy task, and given that the HIV/AIDS epidemic continues to evolve, what may seem logical today may not be a top priority tomorrow. Additionally, successful eradication is unlikely without a comprehensive, large-scale societal investment in improving the educational and economic opportunities of our most vulnerable populations, which are disproportionately affected by this disease.
That being said, the following are some of the general policy priorities for my HIV/AIDS agenda.
Expansion of coverage for HIV/AIDS treatment and services. A number of programs, particularly those offered under the Ryan White CARE Act, have been instrumental in getting individuals the care they need to remain healthy and live longer. Yet too many individuals continue to fall through the cracks, and the overall federal investment is inadequate given the scope and magnitude of the epidemic. And the care we do provide must be comprehensive. Having the correct medications will not be of much benefit to an individual battling AIDS who lacks a decent meal and a place to sleep.
Promotion of screening for HIV/AIDS. Studies indicate that about one-fourth of Americans infected with HIV are unaware of their status. If we expect these individuals to make healthy decisions, seek care, and discontinue activities contributing to the transmission of this deadly infection, these individuals first need to be educated and tested. And if we expect to gain ground on the epidemic, we need to educate the public about prevention. While there have been several national public education campaigns in the U.S., many would argue that our efforts have been surpassed by those in other countries. For example, walking down the streets of Kenya, you cannot help but notice the prevention advertisements. The U.S. should follow in the steps of other countries in which public advertisements regarding education and testing are popular, prominent, and effective. Until we do, fear, stigma, ignorance, and transmission will persist.
Strengthening of the public health infrastructure. The federal government's investment in prevention is minimal compared to its investment in medical care and treatment, and is yet another example of this Administration being "penny-wise and pound-foolish." We must increase our investment in the federal and state public health agencies, as well as in our community-based organization partners -- the foot-soldiers in this war against AIDS.
Support for treatment and drug research. HIV has continued to mutate, hampering vaccine development efforts and rendering many current treatments ineffective. The federal government must expand and accelerate research for the development of effective medications and treatments. In particular, we must act expeditiously to support the development of microbicides, which hold tremendous promise for HIV prevention for women.
Provision of comprehensive sex education. Promotion of abstinence from sex outside of monogamous relationships must be part of any successful HIV prevention strategy, but it cannot be the entire strategy. Raising awareness of the virtues of abstinence cannot be a substitute for providing truthful, medically accurate, and age-appropriate information about contraception, sexually transmitted diseases, and reproductive health in general. Information about condoms and other effective tools must be made readily available. We are losing the battle against the HIV/AIDS epidemic, and we cannot allow partisan politics to trump sound, scientific policies.
Berry: What is the current state of affairs with support for HIV/AIDS care and prevention today and how do you see it becoming affected in mid-term 2006 and general 2008 elections?
Obama: I believe that health care issues on the whole will receive greater attention during the election seasons, and that has the potential to be a very good thing. I am constantly disappointed that the issues my Illinois constituents tell me they are most concerned with -- issues such as health care, energy costs, and education?get put on the back burner in favor of divisive social issues such as gay marriage or a constitutional amendment to ban flag burning. My hope is that the elections will fuel sound debate on health issues on the Hill, which will translate to greater action on HIV/AIDS care and prevention concerns.
Berry: What is your policy on harm reduction and what is your perception of the crystal meth problem?
Obama: There is no denying the link between HIV transmission and injection drug use. I believe that harm reduction and law enforcement are not mutually exclusive methods of reducing drug abuse and its health consequences. In April 2005, the U.S. Department of Health and Human Services reported that 18% of users shared their needle with others after use and 13% used a needle they suspected or knew someone else had previously used. Only 56% of users claimed to use needles purchased from a pharmacy or provided through a needle exchange program.
I understand the controversial nature of implementing harm reduction methods on a national level. However, this is not a novel concept. Many developed nations rely on harm reduction as part of the solution to control the spread of HIV/AIDS. We can either acknowledge the potential public health benefits of harm reduction, while continuing to strengthen law enforcement efforts in the war on drugs, or we can choose to allow the drug world to be a breeding ground for HIV/AIDS, hepatitis, and so many other preventable diseases.
Crystal meth use in Illinois and across the nation is skyrocketing, with no signs of improvement. According to the 2004 National Survey on Drug Use and Health conducted by the National Institutes of Health, 12 million Americans have tried methamphetamine. Abuse of crystal meth leads to a host of serious problems, including high-risk sexual behavior which increases risk for HIV/AIDS. As a U.S. Senator, I have fought for more funding for law enforcement efforts to combat meth use. However, this is not only a law enforcement issue but also a health and public health issue. A greater investment in prevention, treatment, and rehabilitation programs is long overdue. In Illinois, we have several programs, including those sponsored by the Women's Treatment Center and the Haymarket Center, which have been quite effective at using family-centered models to treat women with meth addiction, helping them to stay out of jail and with their families, and assisting them with employment training and other needs. We should support similar programs on a national level.
Berry: Who would be your choice for a pro-AIDS care president in 2008?
Obama: As I stated earlier, I expect health care to be one of the major issues in the 2008 Presidential campaign. I will not support any candidate who has not demonstrated a serious commitment to improving health and health care broadly and combating the HIV/AIDS epidemic more specifically.
Berry: Where do you see AIDS research funding in 2006? Are you committed to continued funding for OAR (Office of AIDS Research)?
Obama: Federal agencies will spend approximately $21.1 billion this year on HIV/AIDS programs. Of this funding, only 14% is directed for research. The President requested $22.8 billion for FY07 [Fiscal Year 2007] HIV/AIDS activities. Despite the 8.3% overall increase requested by the President, funding for research was reduced by 0.05% to $2.6 billion. While we certainly should not reduce funding for prevention, treatment, and international efforts, I think most would agree that continued investment in HIV/AIDS research is critical to making progress against this epidemic.
The Office of AIDS Research has been quite effective in directing HIV/AIDS related research at NIH, and should continue to receive full support.
Berry: Are you committed to being a leader in keeping the CARE Act strong and intact for the future?
Obama: The Ryan White Care Act (RWCA), which is up for reauthorization, has provided vital support for those suffering from HIV/AIDS. An important component of this statute is, of course, medical treatment. However, comprehensive and effective care must include housing, transportation, and food. RWCA was crafted with multifaceted care in mind, and that is the reason for its success. During reauthorization, we must be certain to strengthen, not jeopardize, this comprehensive approach. Additionally, in order to provide this comprehensive care, Congress must allocate adequate funding. We cannot put service providers in a position of providing care to a greater number of clients with fewer resources.
A number of contentious issues are still being discussed and negotiated by House and Senate members, including determining a fair proxy method for funding allocation, defining "core medical services," and balancing the needs of urban and rural populations, just to name a few. I have and will continue to voice my support or concerns regarding the proposed legislation, and hope the Congress will work through policy and political differences to pass a good bill this year.
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