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.
I have met Colorado Sen. Michael Bennet several times, both in Washington, D.C. and in Colorado. He is an affable and earnest fellow. He is even a competent senator, working hard to build bipartisan connections in a hostile and partisan Senate, and he has represented Colorado constituents well. But, as president?
All questions of electability aside, while he has championed many LGBTQ rights and abortion rights causes, I doubt he has the vision necessary to stem the tide of new HIV diagnoses or provide medical and social support for those of us living with HIV. When 30% of HIV-negative millennials in a recent study said they prefer not to interact with someone living with HIV—and 28% said they wouldn’t hug someone living with HIV—his silence on HIV and AIDS is deafening and deadly.
As a moderate Democrat from my home state of Colorado, Sen. Bennet has stood safely in the middle of many policy decisions, working to build compromise. But now is not the time for moderate, safe steps. Bold actions are necessary to capitalize on scientific advancements that can end the HIV epidemic. Treatment as prevention and the undetectable equals untransmittable (U=U) campaign, along with access to preventive pre-exposure prophylaxis (PrEP), which stops new HIV transmissions, are revolutionary. Taken in tandem with HIV risk education, anti-stigma campaigns, and comprehensive services for people living with HIV, we have the tools to end the epidemic. But we need bold programs and legislation aimed specifically at supporting impacted communities who are vulnerable to not only HIV but being violently pushed to the margins of our society. Sex workers, immigrants, working poor, unstably housed, Black and Latinx people, women, youth, lesbians, gays, people of trans experience, folks with mental health challenges or substance use issues, and so many others deserve to be more than an afterthought.
Unlike many of the other presidential candidates, Sen. Bennet has not responded to the 2020 Presidential Candidate HIV Questionnaire or presented a plan to end the HIV epidemic. Disappointingly, we are left to interpret his current positions and policies on issues impacting people living with HIV and our intersectionality with other communities vulnerable to interpersonal, structural, and institutional violence.
In February 2018, Sen. Bennet joined 96 other senators voting in favor of FOSTA/SESTA, holding online servers responsible for platforms advertising sexual services in an effort to end sex trafficking in the United States. Instead, FOSTA/SESTA has had a profoundly negative impact on sex workers’ personal safety, putting this marginalized community at even greater risk. The bills have made it virtually impossible for sex workers to proactively screen clients, advertise safely, or share information about clients with one another. Sen. Bennet has not signed on to support the recently introduced SAFE SEX Workers Act, which would simply study the impact of FOSTA/SESTA. Bodily autonomy, the right to determine what will and will not happen to your body, is a longstanding value within the HIV community. Hence, supporting sex workers’ rights to determine what they choose to do with their bodies, how they choose to work, as well as valuing sex work as work, aligns with HIV advocacy, also acknowledging that the current climate to criminalize sex work carries a higher risk of violence.
Sen. Bennet was part of the “Gang of 8,” a bipartisan group in 2013 that negotiated an immigration compromise, known as the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013. This bill, which passed the Senate but died in the Republican-led House, would have created a pathway to citizenship as well as increased funding for border protection. In 2019, Sen. Bennet joined a bipartisan group that filed an amicus brief to the Supreme Court challenging President Trump’s decision to terminate the Deferred Action for Childhood Arrivals (DACA) program. The current administration’s immigration policy is abusive, violates human rights, and impacts people living with HIV and their families.
When we police immigrants, we are significantly impacting communities of color. Restricting access to the U.S. for people who have legitimate legal claims on asylum, putting them in an immigration and customs system that is violent and dehumanizing, restricting health care access while in detention, holding children in camps, and separating families based on HIV status are current administrative practices. We need a bold revision of the entire U.S. immigration policy, not just bits and pieces, to ensure the rights and dignity of immigrants and their families are upheld.
In 2017, Sen. Bennet introduced the Medicare-X Choice Act or public-option insurance plan, in collaboration with Sen. Tim Kaine of Virginia, instead of a “Medicare for All” plan as many other presidential candidates support. Sen. Bennet believes in a more moderate, incremental approach that would exist within the current health insurance market. His plan, in part, continues to require employers to provide insurance and allow states to expand Medicaid. Back here in Colorado, roughly 8% of Coloradans who purchase their own insurance and 6.5% who are uninsured could take advantage of the option, with no projected cost to date. Medicare-X is not popular here—and it doesn’t seem to gain much traction nationally either.
While health care for people living with HIV is imperative, because our lives really do depend on accessing medical care, believing that families and low-income individuals will be able to afford an insurance plan on the current market is ridiculous. As we have seen with higher premiums, larger deductibles, and shrinking drug formularies, the current health care system is broken both for the HIV community and for the United States. Further efforts by the current administration to dismantle the Affordable Care Act (ACA) make it less and less likely that the current system could provide medical care to the 11% of people living with HIV who currently have no health insurance. The plan’s slow implementation would do little to offset the ongoing ACA challenges and would result in many people living with HIV losing coverage if the current administration’s efforts succeed to overturn ACA’s protections for people with pre-existing conditions.
Sen. Bennet has voted in support of the Prescription Drug Pricing Reduction Act of 2019, regretting that it was unable to include an amendment that would allow Medicare to negotiate lower drug prices. Sen. Bennet has led many bipartisan efforts to control the high cost of medications, protecting seniors from high out-of-pocket Medicare costs, introducing the Ensuring Timely Access to Generics Act, and increasing competition and working to increase transparency by drug manufacturers and pharmacy benefit managers. This is a good start to break the stranglehold big pharma has on medications, but it needs to go much further to impact the lives of people living with HIV. In the age of U=U, it is unacceptable that people in the United States living with HIV do not have access to lifesaving medications and that PrEP can cost nearly $2,000 in the United States versus $8 in Australia.
Sen. Bennet introduced the American Family Act in 2019, which could reshape how poverty impacts children by expanding the child tax credit and paying out benefits to lower income families on a monthly basis, which would result in large increases to monthly income. This bill did not pass but could easily be passed through a budget reconciliation when Democrats have control of the House, Senate, and White House. Columbia University’s Center on Poverty and Social Policy estimated that 4 million children would no longer live below the federal poverty line if the bill was signed into law. While this is a bold plan to address childhood poverty, we need more actionable plans to impact working wage, family medical leave, intergenerational poverty, unstable housing, food insecurity, and especially HIV programs that incentivize people remaining in poverty to ensure access to support programs across the United States.
LGBTQ+ Rights and Equity
Sen. Bennet has signed on to the Equality Act, one of the first presidential candidates to do so. Human Rights Campaign former president Chad Griffin describes Bennet as a “Champion for LGBTQ equality.” Sen. Bennet has pledged to “fight to protect all Americans from discrimination, whether based on race, gender, sexual orientation, or disability.” In 2018, Sen. Bennet was a co-signer on a letter to Defense Secretary James Mattis opposing the Trump Administration’s ban on transgender troops serving in the military.
While appreciating Sen. Bennet’s leadership on these important points, many are hoping he will also speak out against the challenges to Title VII of the Civil Rights Act of 1964, preventing employment discrimination based on sex, and the proposed revision in the waiver of Section 1557 of the ACA which prohibits health care entities from discrimination based on race, color, national origin, sex, age, or disability.
Laws That Criminalize People Living With HIV
Repeatedly encouraged by Colorado advocates living with HIV, Sen. Bennet has not signed on to any of the Senate companion bills to Rep. Barbara Lee’s Repeal Existing Policies that Encourage and Allow Legal HIV Discrimination Act (REPEAL HIV Discrimination Act). Even though Colorado modernized its HIV-specific statutes, removing two that specifically targeted people living with HIV, many other states have refused to review their laws to ensure they include up-to-date HIV science and remove stigmatizing language. Sen. Bennet was a co-sponsor of the First Step Act, a bipartisan bill to reform the criminal justice system, which includes restricting the use of restraints on pregnant women, expands release for the terminally ill, and requires access to feminine hygiene products. Hopefully, as he continues to work on criminal justice reform, he can be convinced to support the REPEAL HIV Discrimination Act, as it parallels his views on reducing mass incarceration and its impact on communities of color.
Access to All Reproductive Choices, Including Abortion
Sen. Bennet has been a strong supporter of comprehensive sexual health and reproductive choices for all women. In 2015, he was given a 100% rating by Population Connection Action Fund’s Congressional Report Card. He has protested the ongoing efforts by Senate Republicans to defund Planned Parenthood and has worked to ensure access to quality family planning. He believes that unintended pregnancies can be reduced by offering nonstigmatizing comprehensive sex education via legislation similar to a bill that passed in Colorado during the 2019 legislative session. Bodily autonomy demands that people be empowered to make decisions about what does and does not happen to their bodies. For women living with HIV, this has been a radical concept, that they can choose to be sexually active or not, that they can choose to have children or not, that they can date, marry, or not.
While Sen. Bennet is a United States senator elected to represent Colorado at the national level, it cannot be ignored that recent Colorado statistics indicate a drastic increase in new HIV diagnoses statewide. After reaching a nadir of 327 new diagnoses in 2013, the last few years have consistently seen over 400 new diagnoses, with 2019 on track to have the most diagnoses in the last decade. Additionally, annual HIV diagnoses among young, gay Black and Latinx men have more than doubled since 2010, indicating that HIV care and prevention services in Colorado are not reaching these key populations. Colorado has a population of 5.7 million, with an estimated 16,600 people living with HIV, including those who have HIV but have not yet been diagnosed.
So no, Sen. Bennet will not likely be the president to end the HIV epidemic. He is a moderate centrist who excels in bipartisan negotiations and legislation, but fails to engage or support legislation or to directly addresses the needs of the most marginalized of people including people living with HIV. Colorado HIV advocates have met with him in Washington, D.C. His silence on addressing HIV issues and responding to HIV specific questions makes him an unlikely HIV champion.
Ending the HIV epidemic both in the U.S. and globally will take passion, dedication, leadership, and long-range planning to address stigma, discrimination, structural barriers, and ongoing challenges to quality culturally relevant health care and services. Sen. Bennet, when you are done chasing your presidential dream, we will be here and ready to work with you. People living with HIV, activists, advocates, and allies from Colorado are ready to partner with you to head back to the Senate and draft some real legislation that can change the lives of people living with HIV and truly end the HIV epidemic.