For many people who work daily with AIDS issues the 2004 presidential election offers the possibility of a change in a federal administration that they have had a difficult relationship with. Despite some successes'most significantly President Bush's embrace of global AIDS issues'activists have been frustrated by an administration that has responded with inadequate funding, prevention policies driven more by ideology than public-health concerns, and no meaningful plan to expand access to care.
While none of the Democratic candidates has been a particularly strong leader on AIDS, those with a public record have been largely supportive on the issues. The senators (John Edwards of North Carolina, John Kerry of Massachusetts, Joe Lieberman of Connecticut, and former senator Carol Moseley-Braun of Illinois) and representatives (Richard Gephardt of Missouri and Dennis Kucinich of Ohio) have voted almost uniformly in favor of positions favored by AIDS advocacy groups. Kerry and Gephardt have both at times sought to carve out more leadership roles in responding to the epidemic'Kerry by introducing important global AIDS legislation and Gephardt through sponsorship of the Early Treatment for HIV Act (also sponsored by Kucinich).
Never having served in Congress, Howard Dean points to his record in expanding health access as Vermont's governor and his support for prevention programs at the state level, including signing needle exchange legislation. Neither retired Army general Wesley Clark nor the Reverend Al Sharpton has served in elective office, making it harder to assess their records.
To be sure, none of the current crop of Democratic candidates has made AIDS a central focus of their campaign. They are missing the opportunity to use AIDS to illustrate some basic themes'how the multibillion dollar tax cut for the rich came at the expense of services for the most vulnerable, how disparities of race and class still mean life or death in this country, and how billions being spent in Iraq would better be spent saving lives in the global AIDS crisis.
But although the candidates aren't focusing on AIDS in their speeches, they have all indicated strong support for AIDS issues. Almost all of the candidates used World AIDS Day to highlight AIDS stances'uniformly calling for significant increases in global spending, trade policies that enhance drug access in the developing world, expanded access to care and treatment domestically, prevention driven by science, and support for HIV research.
Perhaps equally encouraging, the Democratic candidates are talking about expanding health access for the more than 44 million Americans who currently lack health insurance. Of those, only Kucinich, Moseley-Braun, and Sharpton call for a 'single-payer' program that would cover all Americans. The rest of the candidates have proposed programs to expand health coverage to millions of additional Americans through a combination of public-private mechanisms and tax credits. All pledge to significantly reduce the number of uninsured. (For a detailed analysis of the candidates' plans, visit the nonpartisan Commonwealth Fund's Web site at www.cmwf.org. You will need Adobe Acrobat reader to view the report 'Health Care Reform Returns to the National Agenda: The 2004 Presidential Candidates' Proposals.')
In the end, we'll get good AIDS policy in this country only if we stand up as citizens and voters and insist that our leaders'of whatever party'do what is right. The first step in that is registering to vote, becoming informed, becoming active, and voting as if your life depends on it. It very well may.
Anderson is executive director of the Washington, D.C.'based National Association of People With AIDS.