BUSH: Under him, National Institutes of Health officials warned AIDS researchers to cut words like sex workers, anal sex and needle exchange from funding proposals. KERRY: Cosponsored a 2001 act to support research into HIV-preventing microbicides—but didn’t cosponsor upon reintroduction in 2003. IF BUSH WINS: Gay Men’s Health Crisis head Ana Oliveira says to expect “further incursions of conservative politics into science and public health,” plus “the flight of the nation’s best scientists from the NIH, CDC and other agencies.” IF KERRY WINS: “We’ll see an evidence-based discussion that promotes public health, condoms, generic meds and research on sexuality and drug use,” Oliveira predicts.
RYAN WHITE CARE ACT
BUSH: Requested in his first two budgets that the CARE Act be flat-funded. For ’05, requested a tiny boost for state AIDS Drug Assistance Programs (ADAPs), which are short $217 million, but nothing for other care and support services. KERRY: Cosponsored the CARE Act in 1990, 1995 and 2000—and has consistently voted for its full funding. IF BUSH WINS: With the CARE Act $425 million behind its projected need, if Bush’s budget is passed, “the HIV-care infrastructure will crumble,” says Lei Chou of the Access Project, which advocates for AIDS-services programs. IF KERRY WINS: “The chances of passing a recent Institute of Medicine proposal to create a federal entitlement for [HIVers] will significantly improve,” Chou predicts.
BUSH: Promised an unprecedented $15 billion over five years but has given most money not to the multilateral Global Fund but to a U.S.-run program that earmarks one-third of prevention funds for abstinence groups and prefers name-brand drugs over far cheaper generics. KERRY: Introduced the Senate act that OK’d Bush’s $15
billion—and urges $30 billion for global AIDS, with half going to the Global Fund. IF BUSH WINS: “The Global Fund will dissolve,” says Jen Cohn, MD, of Health GAP, resulting in “five times fewer people treated than could have been.” IF KERRY WINS: If he sticks to his word, “the Global Fund will be fully funded and the U.S. will support generics,” which will help stabilize economies and governments, Cohn predicts.
…Cheney or Edwards?
When VP Dick Cheney was in the House, he was one of 13 members to vote against the first major bill to fund HIV counseling and testing—and he supported measures to cut federal AIDS research and let health plans deny coverage to DC HIVers. * In his five years in the Senate, VP challenger John Edwards has cosponsored the 2000 bill to reauthorize Ryan White, voted against earmarking a third of Bush’s global-AIDS prevention funds for abstinence-only groups and called for full funding for ADAP.
BUSH: Proposed letting states choose more Medicaid money up-front if they agree to long-term block grants that cap funding regardless of need—a potential disaster for the 55 percent of HIVers covered by Medicaid. KERRY: Cosponsored the Early Treatment for HIV Act (ETHA), which would allow more low-income HIVers to get Medicaid. Opposes block grants for Medicaid. IF BUSH WINS: “He’d continue to support state waivers to eliminate high-cost Medicaid categories,” like HIVers, says San Francisco AIDS Foundation’s Ernest Hopkins. IF KERRY WINS: “He’d likely be open to efforts to expand Medicaid,” says Hopkins—and, if Democrats can retake Congress, to improve coverage for HIVers.
BUSH: In 2004, proposed no new funding for Housing Opportunities for Persons Living With AIDS (HOPWA) and only tiny rises in prior two years. Proposed replacing the Section 8 (housing assistance) program with a block grant. KERRY: In 1999, sponsored a winning amendment to add $7 million each to HOPWA and to boost housing options for poor disabled people, including PWAs. Opposes block-granting Section 8. IF BUSH WINS: “We’ll have more homeless people with AIDS,” says New York City AIDS Housing Network’s Jennifer Flynn. “We could lose Section 8 funding for 600,000 households.” IF KERRY WINS: He’ll likely avoid block grants, which Flynn calls “a recipe for future budget cuts and higher rent.”
BUSH: Has done nothing about the 1993 amendment that bans foreign HIVers from the U.S., even though his AIDS advisory council favors lifting it. KERRY: Voted for the ban but now says he will work to have it lifted. IF BUSH WINS: “Folks with HIV will still not be allowed
into the country unless they obtain an exception for a hetero marriage,” says Doug Haxall of Immigration Equality Los Angeles. IF KERRY WINS: Lifting the ban “will make a huge difference to [foreign HIVers] wanting to visit and live here,” says Haxall. But expect a brouhaha the minute he tries to lift it.
…Laura or Teresa?
Literature-loving First Lady Laura Bush’s AIDS nods have been rare—such as an October 2003 visit to a Botswana AIDS clinic funded by a U.S. drug company. “I hope what they’re doing here…is showing people…what the real face of America is like,” she told PWAs there, seven months after the U.S. had invaded Iraq. * Her challenger, heiress Teresa Heinz Kerry, recently had this to say to needle-exchange and condom opponents: “If you’re really Christian, as you claim, you want an alive body you can make into a Christian rather than a dead one that’s hopeless.”
BUSH: Under him, the CDC has moved money from groups that help neggies stay that way to those that do HIV testing and urge HIVers not to spread the bug. KERRY: Endorses traditional prevention methods—and says he’ll lift the ban on federal funds for needle exchange. (So did Clinton.) IF BUSH WINS: More bucks will move from community-based to faith-based and abstinence-only groups, says the Center for AIDS Prevention’s Steve Morin. IF KERRY WINS: We’ll see the reverse, says Morin. But if he tries to lift the needle-exchange ban, expect the kind of controversy that made Clinton back down.