How the next president of the United States addresses global health challenges as well as the HIV/AIDS epidemic at home and abroad will have important implications for the U.S. and the world. Domestically, more than one million people are living with HIV/AIDS, a number that continues to grow. Globally, the HIV/AIDS epidemic impacts millions of lives each year, with the biggest burden in the developing world, particularly Africa. Affected regions also face multiple other health challenges including malaria, tuberculosis, lack of access to clean water and health care workforce shortages.
The presidential candidates vary in the extent to which they have discussed HIV/AIDS and global health issues to date. Some have issued specific plans for addressing domestic and international HIV/AIDS, as well as global health more broadly. Others have spoken or written publicly about some of these issues, but have not offered their own proposals. While HIV/AIDS has received more attention than other global health issues, some candidates have discussed how they would address a variety of health challenges and related development issues such as alleviating poverty, providing foreign development assistance, investing in clean water and bolstering health care infrastructures and workforces. Candidates have also addressed how they would tackle health coverage and cost issues in the U.S. more broadly. This Issue Spotlight presents brief summaries of each candidate's position on global health and HIV/AIDS, along with a selection of quotes and relevant resources.
REPUBLICANS: Sen. John McCain (R-Ariz.)
DEMOCRATS: Sen. Hillary Rodham Clinton (D-N.Y.) | Sen. Barack Obama (D-Ill.)
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Hillary Rodham Clinton introduced a plan to address HIV/AIDS, both domestically and globally, and a broader global development plan, in November 2007. On domestic HIV, Clinton proposes the creation of a National HIV/AIDS Strategy. She supports expanding Medicaid coverage to all low-income people living with HIV/AIDS and increased funding for the Ryan White Program**. Her plan focuses on eliminating disparities in the epidemic's impact, particularly in minority communities, and calls for increased funding for initiatives targeted at these communities. Regarding HIV prevention, she proposes to increase funding for evidence-based HIV prevention strategies and supports federal funding for needle-exchange. As part of her broader domestic health reform plan, the American Health Choices Plan, Clinton would promote universal coverage by strengthening public programs and employer-based insurance and by creating new coverage options for the uninsured. To ensure that coverage is available and affordable for people living with HIV/AIDS and those with other health conditions, Clinton would prohibit insurers from denying coverage based on preexisting conditions and would provide a premium affordability tax credit based on income. On global HIV, Clinton proposes to provide $50 billion by 2013 for U.S. global AIDS efforts through PEPFAR*, including an increased commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through her broader global development plan, Clinton would increase development assistance and consider consolidating program authority under a single cabinet-level poverty and international development agency. She would also provide $1 billion annually to malaria programs, and invest in education, expand opportunities for women and children, address health infrastructure needs, and support debt cancellation as strategies to improve health and reduce poverty.
- Quotes
- "In many ways, our fight against HIV/AIDS is at a crossroads. While we have made progress in education and developing medicine that keeps those living with HIV/AIDS healthier, we need to be vigilant in ensuring that people are getting the information and care they need. I believe with leadership and smart investments we can significantly reduce the number of new infections, develop treatments that turn HIV/AIDS into a chronic but manageable condition, and expand toward an eventual vaccine." Plan to Fight HIV/AIDS At Home And Abroad, November 27, 2007
- "As President, I will wage the fight against AIDS with the passionate commitment it demands. I will ask for $50 billion over five years to combat HIV/AIDS, and I will ask for more money to tackle tuberculosis and malaria around the world as well. I will build on the funding levels in PEPFAR and on the leadership that the President and Mrs. Bush have shown, to demonstrate that the fight against HIV/AIDS, TB, and malaria is an American commitment that exemplifies what we can do if we seek bipartisan solutions to nonpartisan problems." - Global Summit on AIDS and the Church, November 29, 2007
- Additional Resources
John McCain has not put forth a formal plan or strategy to address HIV/AIDS domestically or globally, or global health more generally. McCain has a broader domestic health reform plan that seeks to expand access to health coverage using tax policy to shift people from employer-based coverage into the individual insurance market, though he does not advocate policies to prohibit insurers from denying coverage based on health status. He would provide tax credits to assist people in affording coverage and would permit the purchase of insurance across state lines to increase competition in the insurance market. On global HIV, McCain has expressed support for U.S. global AIDS efforts through PEPFAR*. If elected, he would call for a new international organization, the "League of Democracies", to link democratic nations together, and to address challenges including HIV/AIDS in sub-Saharan Africa. McCain would also establish a goal of eradicating malaria in Africa.
- Quotes
- "It's critical that we face this crisis head-on, which is why I have consistently supported the most aggressive global AIDS program in the history of this pandemic, the President's Emergency Plan for AIDS Relief (PEPFAR)." - World AIDS Day Statement, December 1, 2007
- "My administration will seek to engage on a political, economic, and security level with friendly governments across Africa. Many African nations will not reach their true potential without external assistance to combat the entrenched problems, such as HIV/AIDS, that afflict Africans disproportionately. I will establish the goal of eradicating malaria -- the number one killer of African children under the age of five -- on the continent." - Foreign Affairs, November, 2007
- Additional Resources
Barack Obama introduced a plan to address HIV/AIDS, both domestically and globally, and a broader global development plan, during 2007. On domestic HIV, Obama proposes the creation of a National HIV/AIDS Strategy. He supports expanding Medicaid coverage to all low-income people living with HIV/AIDS and supports the Ryan White Program**. He would focus on eliminating disparities in the epidemic's impact, particularly in minority communities. Regarding HIV prevention, he supports comprehensive sex education and supports federal funding for needle-exchange. Through his broader domestic health reform proposal, Obama would promote universal coverage by building on the existing public and employer-based system and by creating new coverage options for the uninsured. His plan would prohibit insurers from denying coverage based on preexisting conditions or from charging higher premiums based on health status and would provide premium subsidies to low and moderate-income individuals to ensure that coverage is both available and affordable for people living with HIV/AIDS and those with other health conditions. On global HIV, Obama proposes to provide $50 billion by 2013 for U.S. global AIDS efforts through PEPFAR*, including an increased commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Through his broader global development plan, he would double foreign assistance to $50 billion by 2012, and coordinate and consolidate foreign assistance initiatives into a restructured USAID. He supports increased U.S. investment in the health infrastructures of developing countries so they can better address public health challenges, including infectious diseases and basic health care, and supports debt cancellation.
- Quotes
- "I'll work to dispel the stigma surrounding this disease, which is what Michelle and I tried to do by taking a public HIV test in Kenya a while back. I'll expand the President's Emergency Plan for AIDS Relief by $1 billion a year in new money over the next five years so we can reach more people in places like Southeast Asia, India, and Eastern Europe, where the pandemic is growing. . . And we'll work to eliminate the extreme poverty that permits HIV/AIDS, tuberculosis, and malaria to flourish by doubling our foreign assistance from $25 billion per year to $50 billion per year by 2012." - World AIDS Day Statement, November 30, 2007
- "We are all sick because of AIDS - and we are all tested by this crisis. It is a test not only of our willingness to respond, but of our ability to look past the artificial divisions and debates that have often shaped that response. Yes, there must be more money spent on this disease. But there must also be a change in hearts and minds, in cultures and attitudes. Neither philanthropist nor scientist, neither government nor church, can solve this problem on their own - AIDS must be an all-hands-on-deck effort." - World AIDS Day Speech, December 1, 2006
- Additional Resources
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