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 differ in the extent to which they have discussed HIV/AIDS and global health issues to date. While HIV/AIDS has received more attention than other global health issues, the candidates have discussed how they would address a variety of health challenges and related development issues such as alleviating poverty and providing foreign development assistance. 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.
REPUBLICAN: Sen. John McCain (R-Ariz.)
DEMOCRAT: Sen. Barack Obama (D-Ill.)
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John McCain has not put forth a formal plan or strategy to address HIV/AIDS domestically or globally, or global health more generally, but did issue a statement in response to new CDC U.S. HIV incidence estimates, stating his intention to "continue the fight against HIV/AIDS". 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, and supported the reauthorization of 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
- "As President, I will work closely with non-profit, government, and private sector stakeholders to continue the fight against HIV/AIDS. By focusing efforts on reducing drug costs through greater market competition, promoting prevention efforts, encouraging testing, targeting communities with high infection rates, strengthening research and reducing disparities through effective public outreach, we as a nation can make great progress in fighting HIV/AIDS." - Statement on the CDC's HIV/AIDS Report, August 3, 2008
- "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 reiterated his support for a national strategy in a statement issued in response to new CDC U.S. HIV incidence estimates. 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 has expressed support for U.S. global AIDS efforts and supported the reauthorization of PEPFAR* and supports an 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
- "These new figures should bring new focus to our efforts to address AIDS and HIV here at home. As president, I am committed to developing a National AIDS Strategy to decrease new HIV infections and improve health outcomes for Americans living with HIV/AIDS. Across the nation, we also need to prevent the spread of HIV and get people into treatment by expanding access to testing and comprehensive education programs. This report also demonstrates the need for more timely data about HIV transmission so that we can effectively evaluate prevention efforts. Combating HIV/AIDS also demands closing the gaps in opportunity that exist in our society so that we can strengthen our public health. We must also overcome the stigma that surrounds HIV/AIDS - a stigma that is too often tied to homophobia. We need to encourage folks to get tested and accelerate HIV/AIDS research toward an effective cure because we have a moral obligation to join together to meet this challenge, and to do so with the urgency this epidemic demands." - Statement on the CDC's HIV/AIDS Report, August 3, 2008
- "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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