With the Iowa caucuses only a month away, the official theme of "leadership" for World AIDS Day on Dec. 1 is more than timely. Even though AIDS remains a major public-health threat and health care consistently ranks as one of the most important domestic issues for voters, it's troubling that so few of the presidential candidates have released proposals for how they would lead in the fight against the HIV/AIDS epidemic in the United States and globally.
History has demonstrated the perils of policymaker complacency toward infectious diseases like AIDS and the consequences of failing to implement comprehensive strategies to continually address their emergence, resurgence and impact. At a 1969 congressional hearing hailing the success of smallpox and polio eradication, U.S. Surgeon General William Stewart declared, "It's time to close the book on infectious diseases." Ironically, science has recently determined that it was that same year that an immigrant from Haiti infected with HIV crossed the U.S. border, introducing into America another dangerous virus that would explode into a national and global epidemic.
Since the beginning of the AIDS pandemic, 25 million people have died of this disease. Currently, 33.2 million people in the world are living with HIV, including 2.5 million children under the age of 15, according to a recently released UNAIDS report. These numbers are lower than previous estimates of global HIV infection of 39 million. But in the past year, there were still 2.5 million new HIV infections, and AIDS claimed the lives of 2.1 million people worldwide (accounting for more than 5,700 deaths each day). The 2005 U.N. Development Report underscored that "the HIV/AIDS pandemic has inflicted the single greatest reversal in human development." Its widespread impact has devastated many nations, particularly in southern Africa, where life expectancy in several countries has fallen to 38 years of age or younger--what it was in medieval times.
But AIDS is not just a global pandemic; it is a national epidemic that must remain a critical health priority for Americans. HIV/AIDS prevalence rates are at an all-time high in the United States, according to a 2006 Kaiser Foundation Report. In the quarter-century since its discovery in 1981, AIDS has infected more than 1.5 million people in America, resulting in 500,000 deaths. In some communities in the United States, HIV infection rates are higher than those in southern Africa. If Washington, D.C., were a country, its estimated HIV prevalence of 1 in 20 adults would rank it 23rd in the world--higher than half of the nations in sub-Saharan Africa.
But communities are not just defined geographically. People of color, women, youth and men who have sex with men are particularly vulnerable populations, and the epidemic disproportionately affects racial and ethnic minorities. Half of all new HIV/AIDS diagnoses in the United States occur among African-Americans, although they comprise only 12 percent of the U.S. population; and the prevalence of HIV/AIDS cases among Latinos is triple that of Caucasians. Women also represent a growing share of new diagnoses, accounting for 27 percent of all new AIDS cases in the United States in 2005, up from 8 percent in 1985. Globally, nearly half the people living with HIV are female.
Given the current and future challenges that HIV/AIDS presents, and the fact that it is the largest infectious disease epidemic of our generation, America needs progressive policies with increased funding to effectively battle this disease in the United States and around the world. While the 2007 U.S. budget laudably includes $22.8 billion for domestic and global HIV/AIDS programs, when adjusted for the size of economy and compared to other countries, the United States ranks only fifth in the world in its financial contributions to the battle against HIV/AIDS worldwide.
Furthermore, a greater focus is needed within our own country to effectively combat this disease. Even though the development and use of antiretroviral (ARV) drugs has dramatically decreased death rates from AIDS and reduced perinatal HIV transmission to less than 2 percent in the United States, there are still more than 40,000 new infections every year in our country. Nonetheless, just 4 percent of the 2007 federal spending on HIV/AIDS supports domestic prevention efforts--representing an overall decrease from 9 percent in 1995. With scientists still searching for a cure and a vaccine for AIDS, prevention is critical to stemming the tide of the epidemic. Policymakers must make AIDS eradication in both the United States and the world a paramount priority because there is still much more work that needs to be done.
That is why presidential candidates must provide details of their plans for eradicating this disease, including specifics on research, prevention, testing, treatment, access to care and other services, issues related to vulnerable populations and ensuring access to quality health care for people with HIV/AIDS and for all Americans. The next president of the United States must also move quickly to strengthen efforts of the National AIDS Policy Office, appoint a director, and expand its activities.
For a side-by-side comparison in chart form of the 2008 presidential candidates' proposed initiatives for addressing HIV/AIDS, click here to see the plans of Democratic candidates with last names starting with A-E and here for candidates whose last names start with F-Z. To see the Republican candidates' plans, click here for candidates with last names starting with A-M and here for those with names starting with N-Z. Much of the information is presented in the candidates' own words, based on a comprehensive review of information gathered from their official Web sites, interviews, speeches, debates and press statements. Several of the candidates have signed the STOP AIDS 08 pledge for "Presidential Leadership on Global AIDS and Poverty," which contains initiatives to help eradicate HIV/AIDS. Relevant components of the pledge are included in the chart and are delineated in red to differentiate these policies from the candidates' own proposals. Yet even with the existence of this pledge, a quick review of the charts reveals significant gaps in information about many of the candidates' plans to address the AIDS epidemic in the United States and worldwide.
HIV/AIDS is a public-health problem that cannot be overlooked. During the past two decades, the advocacy and research commitments of public- and private-sector organizations, the establishment of the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, combined with major contributions from philanthropic institutions have had a significant impact in fighting the AIDS epidemic, saving many lives. But we must not let the confidence that accompanies progress fallow into complacency. Despite these advances, 6,800 people are infected with HIV every day, and AIDS remains the major infectious-disease killer of our time.
Our next president, working with Congress, the public, philanthropists, health-care providers, scientists, businesses and other stakeholders and governments, must provide the leadership and mount the campaign necessary to eradicate this disease. With the 2008 elections rapidly approaching, there is a pressing need for the presidential candidates to articulate their policies to address this national and global health threat now. In so doing, by next World AIDS Day, Americans will hopefully have a presidential blueprint for making AIDS a disease found only in history books.