Address AIDS? Yes We Can!

An Obama Administration Could Bring Meaningful AIDS Policy Changes

AIDS advocates were overwhelmingly thrilled by President-elect Barack Obama's victory Tuesday, expressing hope that Obama's election will bring meaningful changes to health care reform, science-based prevention, and a National AIDS strategy -- all of which he promised during the campaign.

And there is a real hope that the first black president -- who has spoken out against health disparities in minority populations and homophobia in the black community -- will frankly address the epidemic in the United States which overwhelmingly affects African-Americans, Latinos and gay men.

"We are excited about what it feels like when the entire world is ignited with hope all at once. We will makes sure the visionary commitments are kept in the first 100 days," said Health GAP Director of U.S. Government Affairs Paul Davis.

"This is a great opportunity for the AIDS community," Housing Works Vice President of National Advocacy and Organizing Christine Campbell agreed. "I think we finally have a president who will listen."

But with an economic crisis surely the number one item on the agenda, advocates realize that more effort than ever is needed, and that budget decisions are as important as policy ones.

"Our biggest fear is that people will wrongly conclude that because money is tight we can no longer tackle AIDS," said David Bryden, Communications Director of Global AIDS Alliance.

The biggest changes will include who Obama appoints in key matters relating to national and global ADS policy, and advocates are pushing for champions of people living with AIDS to be included. But for now different groups of advocates have released recommendations for the Obama transition team, including AIDS In America, and the Global AIDS Roundtable. Here's some change we could see with an Obama administration:

Universal Health Care

With Obama promising health care for all Americans, it's a question mark what will happen to health insurance for people with AIDS -- currently a patchwork of coverage through Medicaid, Medicare, Ryan White and private insurance. No one knows how quickly health reform will be brought up, or most of the particulars of an Obama plan, but AIDS advocates are ready to be part of the debate.

"Health care is going to take up a lot of the oxygen in the room and HIV/AIDS can't get left behind in this discussion," said AIDS Action Political Director Bill McColl. "We can't lose the benefits we've gained. We must protect what we have while expanding it."

Science-Based Prevention

Obama has stated his support for comprehensive sex education and made repealing the ban on syringe exchange part of his platform. Advocates are optimistic that Democrats in Congress will use their larger majority and support of Obama to pass bills that fund and promote scientifically proven prevention efforts at home and abroad -- even though this didn't happen during the Dems' last two years of rule.

The Community AIDS and Hepatitis Prevention Act of 2008 (H.R. 6680), sponsored by Rep. José Serrano, would eliminate the Health and Human Services rider that prohibits federal funding for syringe exchange. There's still no Senate companion bill, and advocates will have to work to convince some of the more conservative members on both sides of the aisle to support this legislation. Nonetheless after 10 years, this ban could finally be overturned soon.

Advocates also want $200 million poorly spent on abstinence-only education redirected towards the first federal funding for comprehensive sex education.

National AIDS Strategy

Obama supports the development of a National AIDS Strategy, making advocates hopeful that a coordinated blueprint with benchmarks to address the epidemic can finally get on the agenda. Such a plan would have to include goals for reduced HIV incidence, increased care access, and reduced racial and gender disparities. Although the National AIDS Strategy coalition is giving the Obama administration a year to create a blueprint, some think that the work needs to start sooner.

"One defense offered was that one year to implement is what Obama put in his plan, so that is what we should hold him to," said Housing Works President and CEO Charles King. "Meanwhile, it took Bush, Paulson and company, working with Congress and the banks and Wall Streeters, less than a month to develop a $700 billion plan to address the credit crisis."

Ryan White Care Act

Obama is a "strong supporter" of the Ryan White CARE Act. And while that's a relief, Ryan White is in such flux, it's unclear what "strong support" even means. Advocates are divided over whether to see what Obama and Congress have in store before reauthorizing the Ryan White Care Act. While most advocates say that we should hold off Ryan White reauthorization, until we know what health care reform should look like, Campbell argues that we should rework Ryan White first, so it can fit into a universal health care system.

"We can't keep counting on a grant program for the long term," Campbell said. "If medical care has a better platform to stand on, what does that mean for support services? We need to figure this out now."

PEPFAR and Global Prevention

In Bush's semblance of a positive legacy, the President's Emergency Plan for AIDS Relief passed this year with $48 billion to fight AIDS, tuberculosis and malaria worldwide. And advocates have been worried that the appropriations for this legislation could stall with the financial crisis. They are optimistic, however since the support is reiterated on the Obama/Biden transition website Obama supported , and Biden even reiterated his support last month.

PEPFAR has had success providing treatment to millions of people, but failed in lowering new infections. Advocates will work with the Obama administration to reinterpret some heinous Bush prevention policies. Bush's first day of office he reinstated the "global gag rule," which won't provide funding to any organizations that provide abortion. Advocates expect Obama to rescind this.

In addition, there is the chance (though not the promise) that an Obama administration could reinterpret the so-called "prostitution pledge" which won't allow global organizations receiving U.S. funds to work with sex workers.