The HIV/AIDS epidemic has affected the lives of millions of Americans over the last thirty years. Since the start of the epidemic in the 1980s more than 575,000 Americans have died of AIDS, and more than 56,000 people are infected with HIV each year. Over a million people are currently living with HIV in the United States. Despite the steadily climbing death toll over the last three decades, the U.S. didn’t have a comprehensive strategy to combat HIV/AIDS until 2010. The National HIV/AIDS Strategy (NHAS) launched on July 13, 2010, with the goal of reducing new HIV infections, increasing access to care, improving health outcomes for people suffering from HIV, and reducing HIV-related health disparities.
Major strides have been made since the NHAS’s implementation. The Affordable Care Act (ACA) allowed for preventive services like HIV testing to be offered without co-pay or deductibles and created more coverage options for HIV through Medicaid expansions or the Health Insurance Marketplace. Both the NIH and CDC have conducted groundbreaking research and provided guidelines on adopting new technologies to improve health outcomes.
The FDA approved pre-exposure prophylaxis (PrEP), a pill that reduces the risk of new infections. Public-private partnerships have led to increased funding for major HIV/AIDS treatment access programs, new initiatives to combat HIV-related domestic violence and workplace discrimination, and more collaboration between agencies and organizations for better service delivery at the state and local levels.
Despite these gains, there’s still work to be done. HIV/AIDS continues to disproportionately affect transgender people, communities of color, young people, and men who have sex with men. With election day on the horizon, let’s take a look at how each candidate intends to continue the fight against HIV/AIDS.
Hillary Clinton’s HIV/AIDS Policy Proposals
Hillary Clinton created a firestorm when she spoke at Nancy Reagan’s funeral in early 2016. She praised the former first lady’s “low-key advocacy” on fighting HIV/AIDS, stirring up anger within the gay community still reeling from the Reagan administration’s indifference to the spread of the disease. Clinton has since apologized for claiming that the Reagans started a national conversation about HIV/AIDS and used the uproar as an opportunity to address her plans for combating the epidemic at home and abroad.
Clinton hopes to carry the NHAS forward, ensuring that advocates and stakeholders assist the Office of National HIV/AIDS Policy in its execution. She supports robust investments in and protection of funding for HIV-related research by entities like the NIH and CDC. Secretary Clinton plans to hold pharmaceutical companies accountable for skyrocketing drug costs and lower the price of medications that help to prevent and treat HIV. She plans to cap monthly and annual out-of-pocket costs for prescription drugs at $250, end subsidies that drug companies get for direct-to-consumer advertising, and invest that money in research instead.
Prior to the ACA, 70,000 people living with HIV were uninsured. Since the ACA, 47,000 should have been newly eligible for Medicaid; however, some states’ refusal to expand coverage left many without care. Clinton plans to not only extend coverage, but also reform outdated and stigmatizing HIV criminalization laws and enforce the Americans with Disabilities Act to fight HIV-related discrimination. In addition to improving health outcomes domestically, she will continue the U.S.’s legacy of fighting HIV/AIDS in the developing world and increase global funding.
Donald Trump’s HIV/AIDS Policy Proposals
Donald Trump has not directly addressed HIV/AIDS, but his healthcare proposals will have a significant impact on those suffering both at home and abroad. Trump wants to repeal and replace the ACA with a vague jumble of business-friendly measures that would block grants to Medicaid and take the burden of healthcare spending off the government and put it onto individuals. According to the Committee for a Responsible Budget, Trump’s plan would snatch coverage away from 21 million people and cost between $330 and $500 billion over a decade.
Trump would also privatize the Department of Veterans Affairs healthcare system, rendering it more of an insurance provider than a network of hospitals. This would drastically affect the VA’s ability to treat HIV/AIDS patients, as it is currently the largest single provider of medical care to people with HIV in the United States.
Efforts to improve HIV/AIDS prevention and treatment have historically been pit up against racist, sexist, and homophobic stigma, and activists fear Trump’s xenophobic rhetoric will stall progress made amongst high risk populations like gay men and transgender people and, even worse, set efforts back. And with his emphatically nationalistic views, internationally-focused initiatives like PEPFAR will surely suffer.
Continuing the Fight Against HIV/AIDS
As First Lady, Senator, and Secretary of State, Hillary Clinton has a history of facing the HIV/AIDS struggle head on. She advocated for more coordinated efforts among global leaders, increased funding for research (especially for pediatric AIDS), co-sponsored legislation to expand healthcare coverage to low-income people with HIV, defended the the Ryan White CARE Act, and launched a campaign abroad to create an AIDS-free generation.
Donald Trump, on the other hand, hasn’t addressed the epidemic at all and does not have a comprehensive strategy to fight HIV/AIDS. In fact, his paltry, confusing healthcare proposals will only prevent people from receiving the care they desperately need. And there’s no telling how a Trump presidency will affect the progress we’ve made thus far globally.
The United States has a legacy of leading the world in the fight against HIV/AIDS. In order to sustain and expand this legacy, we need a leader who will fight through lingering stigma to provide care to at-risk individuals, ensure prevention and treatment initiatives are accessible and affordable, invest in innovation and protect current research funding, and assist the developing world in their own efforts to curb the epidemic. Hillary Clinton offers the best chance in continuing this fight.