Ending the United States HIV epidemic 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 US. As the 2020 Democratic primary begins its early voting, TheBody asked prominent writers and activists to consider how each Democratic candidate would fare in ending a health crisis that is now in its fourth decade if elected.
Sen. Amy Klobuchar of Minnesota hasn’t always been the most formidable candidate in the race to become the Democratic nominee and, eventually, the United States president. But her determination, persistence, and increasing fortitude have paid off to keep her in the race far longer than many predicted.
Upon reviewing Klobuchar’s record, I was initially less than amazed. As someone who began working and volunteering in HIV prevention in 1991, who has committed their life and career to helping people learn substantive tools for experiencing mental, social, and sexual health over the last three decades, I wasn’t particularly impressed when Klobuchar joined the race for the 2020 Democratic nomination. I didn’t feel she had the passion, experience, or personal commitment to reducing HIV transmissions. However, once I started reading and learning about her priorities, I became more convinced that she could significantly change the course of the HIV epidemic if elected.
First let’s look at her plans. Klobuchar has stated she intends to maintain the Affordable Care Act and create a pathway to universal health care. Clearly, accessible health care will be necessary to carry forward the plan to end the epidemic. It would encourage people to get tested for HIV and engage in treatment and prevention when necessary. This change not only would increase access to prescription drugs, but also expand opportunities for all individuals to attend regular doctor visits and blood draws.
Where Klobuchar has shown insight in this regard is her commitment to accessing generic drugs legally and safely when needed. Within the first 100 days of her presidency, she has pledged “allowing the personal importation of safe, affordable drugs from other countries to decrease drug costs,” as well as to “crack down on drug companies that pay makers of generic drugs to delay cheaper versions from getting into the market.”
It’s important to note here that most people living with HIV in the U.S. have access to brand medications at low or no cost. The AIDS Drug Assistance Program (ADAP) no longer has a waiting list, and there are several programs established to make antiretrovirals accessible to those who need them the most.
Also of relevance: Many consumers of pre-exposure prophylaxis (PrEP) in the U.S. are already safely importing their medications through one of the six verified pharmacies that globally assists people in getting effective drugs at reasonable prices. This has been especially necessary for many people with Medicare Part D insurance coverage who are disqualified from receiving any financial assistance from Gilead (the manufacturer of both forms of PrEP). Although importing generics is a concept that is novel to most U.S. citizens, it is a normal and accepted means by which people access PrEP in most parts of the world.
Klobuchar will further normalize and validate this decision, clearing up any ambivalence about the efficacy and legality of the process. This is an important reminder that medical consumers do not have to be constrained by pharmaceutical price-gouging, that they have the ability to take control of their health and go outside the established system if and when it’s necessary. A good leader demonstrates how to think outside the box in ways that help people live healthier lives and make better decisions. Klobuchar has pledged do this if elected president.
Another relevant and unique contribution Klobuchar makes to this discussion is her ability to assert confidence and strength even when she has been uncertain or ambivalent. Her public persona during this campaign began as literally shaky, seeming to lack the leadership and authority a presidential candidate typically shows. Her demeanor ascended to satire when Saturday Night Live’s Rachel Dratch portrayed Klobuchar as someone nervous, unsure of herself, literally quivering.
All that changed during the candidate debate on Dec. 20, 2019. A new Amy Klobuchar emerged—one who is confident, centered, firm, reasonable, and not taking shade from anyone (especially not Mayor Pete Buttigieg). She was strong, aggressive, and demonstrated an ability to stand up for herself and her beliefs, and not back down from a confrontation.
This is precisely the strength and energy that is needed not only to fight Donald Trump, but to fight HIV. HIV activists and educators commonly begin their work by feeling uncertain, unsure, ungrounded in their messaging. But bolstered by time and knowledge, we come out swinging, confidently asserting facts and information, and debating when necessary. Klobuchar represents this “underdog” spirit—perhaps trepidatious at first, but able to argue passionately when the situation calls for it.
Furthermore, Klobuchar is uniquely positioned to end the epidemic by how she models effective use of personal tragedies to create relevant policies. By being so bravely outspoken about her father’s struggles with alcoholism, she has already shifted the narrative around substance abuse from shame and stigma to a normal problem that affects many families. Similarly, the ability to fight HIV and help people engage in treatment and prevention has largely stemmed from the sharing of personal experiences in community. When people “come out” and share their own personal struggles, traumas, and triumphs, it makes room for others to feel they are not isolated. Klobuchar has already done an exemplary job of removing shame and stigma from the issues of familial substance abuse, thereby demonstrating how relevant our private experiences are to creating social change. I believe such disclosures are necessary to combat a health issue as stigmatizing as HIV.
Despite these numerous strengths, Klobuchar still has some areas she could improve on if she is serious about ending the epidemic as the next U.S. president.
She has yet to publicly comment on decriminalizing HIV status. Thirty-four states have something in their laws making people living with HIV more vulnerable to criminal prosecution. These archaic laws are almost exclusively enforced against men of color, reinforcing the U.S.’s appalling history of racism, slavery, and criminalizing Black men’s bodies. Why would someone voluntarily get tested for HIV if doing so automatically makes their sexual expression a crime? Klobuchar needs to address this miscarriage of justice if she has any real intention of ending the epidemic.
She also seems to be reluctant or unwilling to share information about undetectable equals untransmittable (U=U) in her platform. U=U is a scientific statement that asserts that a person living with HIV cannot sexually transmit HIV while they are virally suppressed. The Prevention Access Campaign was formed in 2015 to help people around the world receive this message, make healthier sexual decisions, and end social and legal stigma against people living with HIV who are targeted for being “dangerous” or vectors of disease. More than 960 global agencies have signed on to the U=U Consensus Statement, pledging to share only medically accurate information with their patients and communities. The Centers for Disease Control and Prevention (CDC) confirmed its own agreement with this statement in 2017. Yet Klobuchar has remained mysteriously silent on this matter. There is no way any person or community can end the HIV epidemic without clearly sharing accurate medical statements confirming that people living with HIV cannot transmit the virus sexually when they are virally suppressed.
And finally, I have yet to hear Klobuchar demonstrate a comprehensive understanding of how systemic racism actively contributes to the HIV epidemic. The CDC considers people of color to be at much higher risk of acquiring HIV in their lifetime, due to a complicated pattern of limited health care access, a justified mistrust of medical systems, regular discrimination and disdain received from medical professionals, criminal prosecution for living with HIV (as noted above), geographic restrictions to clinics, and the systemic reinforcement that Black lives do not matter as much as white lives.
Klobuchar can model how vital it is for white people with privilege to listen when people of color share personal experiences that have reinforced systemic mistrust of health care professionals. She is positioned to nationally demonstrate empathetic interactions that could prove valuable at local nonprofits and HIV health organizations. She can show others in leadership what it looks like to invite dissenting perspectives to the table, respect shared pain, include narratives to guide public policies, and support people of color in leadership roles.
What could make Klobuchar’s platform even stronger and more distinct from those of other candidates is to definitively state an approach to sexual health and education for everyone in the U.S. She has already gone on the record to ensure funding for Planned Parenthood and reinstate Title X funding in her first 100 days. In recent years, Planned Parenthood has not only provided safe options for birth control, but in many areas, it has become a trusted source of PrEP and STI screening and treatment.
Building on her commitment to support sexual health and family planning, she could go one step further and establish a Presidential Commission on Sexual Health committed to providing informed education on birth control, HIV prevention and treatment, and STI prevention and treatment for all Americans. She could gather providers, therapists, health care workers, and activists to collaborate on statements to help all people discuss consent and communication, knowing how to learn one’s “yes,” learn one’s “no,” and learn one’s “maybe.” Creating a sexual education system based on proactive, responsible, and empowered sexual pleasure and protection would go a long way toward helping people effectively treat and prevent HIV and other STIs, as well as improve the quality and quantity of intimate relationships. Implementing and normalizing this type of innovation and communication will support and enable a Klobuchar presidency to end the HIV epidemic.