The Man Who Would Be President?

During those innocent pre'hanging-chad days of the 2000 presidential race, New York state senator Tom Duane'a gay, HIV-positive Democrat'was dismayed to find Vice President Al Gore's understanding of the AIDS pandemic woefully inadequate. And when Duane arrived at the Democratic National Convention in Los Angeles that August, he was further irked to discover that his party's platform qualified AIDS as a crisis only in terms of foreign policy. It would take some swift maneuvering on the part of the senator and his colleagues to add tackling domestic AIDS to the Democratic to-do list. Today, Duane says the top contenders for the Democratic ticket have come a long way, taking laudable steps toward both fully comprehending the issues surrounding AIDS and addressing the subject in their campaigns. 'For a whole host of reasons,' he says, 'it gives me great hope.' By December 1, 2003'World AIDS Day'all nine Democratic candidates had signed the Global AIDS Alliance's 'Presidential Pledge to Action on Global AIDS.' In the pledge each candidate promised to double U.S. global AIDS spending so that at least $30 billion would be spent by 2008 as well as to support trade policies that increase international access to generic medications, make broader debt cancellations for poor nations, and develop microbicides and an HIV vaccine. The five candidates most plausibly in the race for the nomination'Wesley Clark, Howard Dean, Richard Gephardt, John Kerry, and Joseph Lieberman'all released statements commemorating World AIDS Day in which they highlighted their commitments to fighting HIV. Clark, a retired four-star Army general, was the lone candidate to give a speech on the matter, during which he announced the details of his AIDS plan. At press time Clark and Dean were the only candidates to include comprehensive AIDS 'battle plans' in their public platforms. Clark, ever trying to reverse his general-come-lately status as a policy-naive newcomer with no political record, has presented the most trenchant plan. In addition to the $30 billion pledge, he promises a greater multilateral approach to international AIDS by pledging more money to the U.N. Global Fund and the Global Alliance for Vaccines and Immunization. He also says he would base HIV policy decisions on 'the best available science, not on right-wing ideology,' and give drug companies financial incentives to develop vaccines. Each candidate has also presented his own plan to improve health coverage in the United States. This is vital to the fight against HIV. A move toward universal health care'as well as efforts to control rising health care costs'is the most important way the Democrats can help Americans with the disease, since many HIVers suffer under the crippling expense of treatment even if they have full medical coverage. Picking apart the differences between the top contenders' plans is tricky if paying for HIV care is a major concern. Currently all the plans focus primarily on expanding group health coverage in some way for the 44 million uninsured Americans. But some notable differences stand out. Lieberman has one of the most audacious proposals'a plan to spend $150 billion over 10 years on an American Center for Cures, which would combine public and private ventures to speed development of cures for chronic diseases, including AIDS. The concept is a bold one, but like Gephardt's proposal to spend $2.5 trillion over 10 years to insure 31 million Americans, it is so grandiose that it has drawn fire from both Democrats and Republicans and is unlikely to come to fruition. Gephardt's plan is said to be very pricey because it doubles as an economic stimulus for businesses. Oddly enough, among the top five Democratic contenders' plans, Gephardt's, which is more than 21/2 times more expensive than the most costly of his competitors, is the only one that neither identifies significant ways to improve the quality of health care nor focuses substantially on reducing health care costs. The others offer a hodgepodge of tactics: increasing access to generic medications, curbing malpractice suits, improving information technology in order to lower health care overhead costs. (For a full rundown on the differences between the candidates' plans, link to the Commonwealth Fund's Web site.) Health plans aside, it all comes down to the candidates' political records, which is where Clark draws a blank slate. In the congressional anti-AIDS marathon, Kerry and Gephardt run neck and neck, putting colleague Lieberman to shame. In the Senate, Kerry is the number 1 Democrat for mobilizing senators to battle HIV both globally and domestically, and his commitment is long-standing. With support from staffers dedicated to fighting AIDS, in 1990 he cosponsored the first Ryan White Comprehensive AIDS Resources Emergency Act, and he has done the same for all subsequent reauthorizations. In recent years he and now' Republican majority leader Bill Frist have led the fight to increase global spending'only to be preempted by the president's spending plans in each of the past two years. In June 2003, Kerry gave a passionate speech at the Global Business Coalition on HIV/ AIDS awards dinner, in which he called for the full $3 billion in spending for this year's global AIDS push instead of the $2 billion Bush requested. He criticized the U.S. fight against HIV as too incremental and lambasted the Bush administration for stiffing the U.N. Global Fund. 'History and conscience alike,' he said, 'will hold us accountable for this truth: We have a way to stop AIDS if we have the will to act.' On the other hand, according to Ernest Hopkins, director of federal affairs at the San Francisco AIDS Foundation, Gephardt 'has the most demonstrably clear record of strong support and leadership on HIV of any of the folks in the race. I don't think we could have done half of the things that we've been able to do without the strategic support from his staff.' Like Kerry in the Senate, Gephardt was a cosponsor in the House of the potentially vital Early Treatment to HIV Act, first sponsored by House Democratic leader Nancy Pelosi in 2001. It would allow HIV-infected Americans without an AIDS diagnosis to qualify for Medicaid. The representative has long badgered Congress for more money to fight HIV, and his commitment is unwavering, made apparent upon his return from a 1999 congressional delegation trip to Africa. In 2002 he told The New York Times, 'I came away knowing and believing that this is the moral issue of our time.' But the difference is clear when it comes to Lieberman. 'Senator Kerry has decided to be a leader on these issues and to bring others along,' Hopkins says, 'whereas I think Senator Lieberman arguably has been one of the people who has been brought along.' Although Lieberman's voting record on AIDS is a good one, Hopkins believes the senator has not taken the lead on the issue the way Gephardt and Kerry have. On the positive side, while many fear Lieberman's religious convictions as an Orthodox Jew and his 'moral leader' status might make him agree more with Bush about sexual matters (remember the senator's caustic reaction to 'Monicagate'?), he has stated he supports comprehensive sex education without the focus on abstinence that has been the president's crusade. As a Washington outsider, former Vermont governor Dean has less of a record to show for himself even though he is a physician. Vermont has only about 400 people with HIV disease, among the smallest number of patients in the United States. But his words speak louder than actions, gaining him Duane's endorsement: 'There is something very compelling to me as a person living with HIV about having a doctor in the White House.' Indeed, Dean touts his MD status in his AIDS platform, in which he pledges to increase funding for care and treatment, promote proper sex ed, and 'support research and development without political interference.' As governor, he was originally opposed to needle exchange programs in Vermont, but he reconsidered after analyzing the supporting data, indicating that he can be swayed by science in a way that the Bush administration cannot. He has stridently criticized Bush's $15 billion global AIDS plan, calling it a cynical ploy to distract from the administration's lack of attention to condom distribution, and has lambasted the president's 'preposterous' push for abstinence. His medical insight was clear in his recent response to a Human Rights Campaign questionnaire, in which he wrote that he empathized with the 'costs associated with staying healthy.' In sum, we are eons from 1984, when neither Ronald Reagan nor Walter Mondale ever mentioned AIDS on the campaign trail. The black age of political ignorance about and indifference toward AIDS has faded as the international repercussions of that time of inactivity have become tragically apparent. It is up to the current policy makers'wiser only by default'to pick up the pieces. Fasten your seat belts...