Ending the HIV epidemic in the United States will take effort far beyond implementing policies about HIV. A president who wants to end the epidemic must consider health care policy, reproductive justice, mass incarceration, housing, immigration, and myriad other issues that drive the epidemic’s numbers in marginalized populations across the U.S. As the 2020 Democratic primary begins its early voting, TheBody asked prominent writers and activists to consider how each Democratic candidate, if elected, would fare in ending a health crisis that is now in its fourth decade.
Six presidents have helmed the United States’ response to its HIV epidemic, and this era has been defined by the contrasting leadership styles, plans, and results that governed it. No president entered office with a detailed plan to address, let alone end, the HIV epidemic, and some never had one at all. The seventh president to oversee a national response to end the HIV epidemic within the next decade could be someone who already has a prodigious set of detailed policy proposals that recreates a federal government up to the task and fashions environments that allow all people to access the care and services they need.
Sen. Elizabeth Warren is seeking this highest office. The president of the United States directs over a dozen federal departments and dispenses billions of new dollars to health care and service providers, can change outdated policies and implement new ones for a 21st-century response, and can push Congress to deliver needed authorizations and appropriations to do so. And Warren has 75-plus detailed plans to do just that. If anyone has demonstrated the capacity and forethought to use the powers of the presidency to lead this country toward a future where new HIV infections become rare enough to consider the epidemic over, it’s Elizabeth Warren. Let’s look at what she has said and done with her voice on the national stage.
In an op-ed published on World AIDS Day last year, Warren concludes, “We need more than words on paper to combat this virus. We need a government-wide approach that prioritizes comprehensive services including housing, mental health care, and robust support for community health centers. We need to repeal laws and regulations that discriminate against or even criminalize people living with HIV. We need policies that lift up communities affected by the virus here at home, and support countries and people struggling under the weight of the epidemic around the world. Only then will we achieve the goal of a world free of AIDS.” I believe even a cursory observer of this campaign season would acknowledge that this paragraph embodies Warren’s career, campaign, and vision for America’s future.
Warren’s is the only campaign with a policy or plan on “preventing, containing, and treating infectious disease outbreaks at home and abroad.” This section not only outlines a pledge to end the HIV epidemic by 2025, but also demonstrates a deep understanding of the inherently intertwined nature of socioeconomic factors that enable the expansion of infectious diseases, of the lack of access to comprehensive medical services to prevent and treat infectious diseases, and of the consequences of more global affairs like climate change, the opioid epidemic, and the undue influence of corporate power that exacerbate these problems.
This section does fail to mention the growing STI epidemics of chlamydia, gonorrhea—and primary, secondary, and congenital syphilis, as well as viral hepatitis, both of which are inextricably tied to increased transmissibility of HIV, mortality of people living with HIV, and ever-present health disparities. But I’m convinced that a President Warren would invariably integrate efforts to address and eliminate these public health issues with all efforts to transform the health care industry and end the HIV epidemic.
Warren has also woven her proposals to end the HIV epidemic within her plan to “secure LGBTQ+ rights and equality.” She acknowledges both the disproportionate impact of HIV on (especially Black and Brown) gay and bisexual men and transgender women and the countless social, economic, racial, justice, and discrimination-related factors that contribute to poorer health care access and outcomes, including mortality, that LGBTQ people face.
Warren’s plans to guarantee health care access through Medicare for All, plans to systemically transform how the criminal system treats LGB and particularly transgender people, and plans to fundamentally challenge the culture by empowering LGBTQ people economically and protecting them from the day-to-day stigmas and discrimination that plague their lives in both urban and rural areas are all critical to a comprehensive response that addresses the underlying issues that contribute to LGBTQ people’s higher rates of HIV. Other policy proposals, including an end to the FDA’s ban on blood donation from gay and bisexual men, her broad housing affordability platform and specific plans for both LGBTQ youth and seniors, and use of diplomacy to protect LGBTQ people globally, demonstrate her thorough understanding of the breadth of issues central to the dignity and wellbeing of all LGBTQ people.
And finally, let’s look at Warren’s pledges to sew together our patchwork health care system.
In her World AIDS Day op-ed, Warren writes, “People living with HIV have historically faced a number of barriers to accessing care due to pre-existing conditions, restrictive eligibility requirements, and high costs from insurance companies. Communities of color also have to contend with systemic racism when it comes to accessing health care and other services.” And it is this set of impediments, both historical and current, both structural and individual, that Warren has both based her entire campaign around breaking down and has defined her universal health care proposals against.
Much has been debated about her ultimate goal, a Medicare for All system where eventually everyone is covered by high-quality health care. But in discussing actually ending the HIV epidemic in this decade, even more important are Warren’s overarching set of policies, attitudes, and what we can predict to be her governing philosophies should she be elected.
Warren’s entire campaign is undergirded by a fundamental desire to recognize the need to root out the corporate corruption that puts profits over people. In the health care industries, that allows insurers to deny basic lifesaving care to people, pharmaceutical companies to manufacture prices that keep the best lifesaving drugs like HIV treatment regimens and curative hepatitis C treatments out of the hands of people who need them, and hospitals and health care systems to arbitrarily adjust costs that ultimately bankrupt people and families.
Warren isn’t satisfied with platitudes and grand gestures—she has plans to use executive action to both hold industries accountable and immediately pursue options that rapidly expand coverage to as many people as possible. Her desire to transition to a Medicare for All system, with a three-year transition that includes implementation of a national public option, would be the most progressive expansion of health care access since 1965 and has to be the most reasonable and relatively realistic universal health care option proposed by a presidential candidate.
Taken altogether—the plan to dramatically scale universal access to care, the understanding that just medical care isn’t enough to reverse disparities in the HIV epidemic, and the commitment to extirpate greed from the health care industries—Warren has the most exhaustive and comprehensive set of plans to move us toward ending the HIV epidemic.
But we’ve been through enough presidential campaigns to know and deeply understand that campaign pledges and plans are just that—words on paper or the internet. Warren herself would admit as much. So what do Warren’s seven years as a United States senator—her actions—tell us about what she would actually do?
In examining Sen. Warren’s record prior to her presidential nomination run, the following is clear: She’s comprehensive and intersectional, tackling the overarching issues while minding the details. She sponsored the Comprehensive Addiction Resources Emergency (CARE) Act to create a Ryan White-like federal program to massively scale up ($10 billion per year for 10 years) services to comprehensively increase treatment and prevention access, improve research and training, and help communities heal from the opioid crisis.
She’s consistently supported the Ryan White HIV/AIDS Program, other discretionary public health programs throughout the Centers for Disease Control and Prevention, and strengthening social safety net programs across the departments of Health and Human Services and Housing and Urban Development, including the Housing Opportunities for Persons with AIDS (HOPWA) program. She’s consistently supported reauthorizing and expanding investments in the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, and other international health programs. She’s introduced a number of bills to bolster biomedical research and expand National Institutes of Health funding, including the Medical Innovation Act and the National Biomedical Research Act. And her record shows consistent support for bills and initiatives to roll back outdated policies that harm people with HIV, including co-sponsoring the HIV Organ Policy Equity (HOPE) Act of 2013, the Equality Act, and the Repeal Existing Policies that Encourage and Allow Legal (REPEAL) HIV Discrimination Act and supporting institutional changes to policies that discriminate solely based on HIV status, i.e., against servicemembers living with HIV. Her unequivocal support for and understanding of the necessity of reproductive health providers for both the basic dignity of women’s (and men’s) health and their role in HIV prevention, care, and reduction of health disparities is readily apparent.
In 2018, Sen. Warren was one of 97 senators to vote in favor of SESTA-FOSTA, the anti–sex trafficking bill that was loudly opposed by the sex worker community for conflating human trafficking with consensual adult sex work. This year, she did introduce the Senate’s version of a bill to study the unintended consequences of this law. And when she rolled out her aforementioned plan of LGBTQ protections, she tweeted her openness to decriminalizing sex work. These words and measures may or may not be enough to make up for past actions, but they seem to demonstrate a signal that—while navigating the political calculus for a general election in a country that only recently reached 52% support for decriminalizing sex work—a Warren administration would work with and/or hire advocates to move policies forward that treat sex workers with dignity, recognizing the need to adequately provide sex workers with public health services to help achieve an end to the HIV epidemic.
Elizabeth Ann Warren is not perfect. As a human being myself, I can sympathize. And like any white individual of a certain age in America, she has blind spots. But a better friend to the HIV community—who is qualified, accomplished, and open-minded enough to effectively seek and occupy the presidency—I doubt we could find. If any one person can help guide us toward an end to the HIV epidemic from the executive office of the president, with the compassionate vision for an equitable society; the bold determination to repair corruption, undo injustice, and uphold humanity; and the shameless zeal to get the details right, her record shows that it might just be our first woman leader too. Elizabeth Warren can help end the HIV epidemic, if only we just let her.