How Election Results Impact AIDS Response

Courtesy of the Black AIDS Institute

Tuesday’s results present at least three major challenges to those of us who are committed to a stronger, more vigorous national fight against AIDS.

First, many of the strongest Congressional AIDS champions will no longer occupy key leadership positions to advance an AIDS-friendly agenda. At the top of the list is House Speaker Nancy Pelosi, whose tireless work to increase AIDS funding has been critically important. As a result of the Republican takeover of the House, Rep. Pelosi will be replaced as Speaker by Rep. John Boehner of Ohio.

The retirement of Rep. David Obey of Wisconsin also represents another loss for AIDS advocates. As chair of the House Committee on Appropriations – and especially as the leader of the Appropriations Subcommittee on Labor, Health and Human Services and Education – Obey played a key role in preserving and strengthening federal support for vital AIDS programs.

The elections also signal an important loss of influence for the Congressional Black Caucus. The CBC has been instrumental in increasing federal support for AIDS programs in Black communities, establishing the Minority AIDS Initiative and working to increase funding for essential AIDS services. As just one example of how this transition will diminish the CBC’s ability to support a robust AIDS response for Black America, longtime AIDS champion Rep. Barbara Lee will no longer be a member of the majority in the House Appropriations Committee.

Second, the focus on deficit reduction will make it increasingly difficult to argue for the funding increases needed to combat AIDS in Black communities. In particular, the new Republican majority campaigned on a platform of reducing federal spending on discretionary programs, such as the Ryan White CARE Act, the HIV prevention program at CDC, and substance abuse and mental health services for people living with HIV.

Those of us who have been involved in AIDS advocacy since the epidemic’s early days have long known that federal money can’t solve every problem. But it’s hard to tackle a threat as big as AIDS without the energetic support of the federal government.

We know, for example, that HIV prevention has long been under-prioritized. Real federal funding for prevention services has declined over the last decade, and today prevention programs account for only three cents of every dollar the federal government spends on AIDS. Each year, more than 56,000 Americans (nearly half of them African American) become newly infected with HIV – compelling proof that you get what you pay for (or that you don’t get what you fail to pay for). We simply won’t be able to turn the epidemic around in Black communities without stronger federal support for HIV prevention. President Obama has proposed one of the first increases in HIV prevention spending in the last decade, but the fate of this proposal remains unclear as Congress returns for a special “lame duck” session.

Additional funding is also needed to keep low-income Americans living with HIV alive and well. As of October 2010, eight states had established waiting lists for their AIDS Drug Assistance Programs (ADAPs), 20 had imposed restrictions to contain costs, and 13 were considering new cost containment measures. As a result of funding shortfalls, nearly 3,600 Americans who need AIDS drugs are currently unable to obtain them.  Every forecast suggests that this problem is certain to grow unless additional federal support is forthcoming.  Given changes in governorships and state houses, it is highly unlikely that state legislatures will do much to address the needs of ADAP programs.  For thousands of Americans living with HIV, Congressional willingness to appropriate additional funds for this discretionary program could mean the difference between life and death.

Third, the new Republican majority in the House will enter power with a commitment to repeal the health care reform legislation enacted earlier this year. Although it is unlikely that Republicans will be able to muster the votes needed to repeal the bill so long as a Democrat occupies the White House and control the senate, G.O.P. critics of health care reform may well seek to withhold the funding needed to implement key provisions of the legislation.

Health care reform has the potential to dramatically broaden and strengthen the safety net for low-income Black people living with HIV. Studies show that Black Americans are far more likely than other Americans to lack health coverage and that associated access barriers are a major reason why HIV-positive Blacks are less likely to receive life-preserving antiretroviral treatments. By expanding Medicaid, establishing new mechanisms to broaden private coverage, and prohibiting discriminatory practices by the private insurance industry, the health care reform bill will enable many currently uninsured Black people living with HIV to obtain the coverage they need.

The legislation contains additional provisions that of particular value to the AIDS response in Black America. The bill authorizes community transformation grants to build capacity in underserved communities to address AIDS and other health priorities. And the legislation also establishes a major new public health fund that will train and deploy community health workers to address key health care gaps, such as inadequate HIV testing rates, insufficient linkage to care for people who test HIV-positive, and support services to help patients adhere to treatment.

For those of us who have long worked on the front lines of the epidemic, these new challenges are disheartening. But AIDS advocates have never given up the fight, even in the face of long odds.

The new political landscape merely underscores the need for focused investments in efforts to educate the new Congressional majority about the urgency of the AIDS fight. The truth is that America’s health shouldn’t be a political football. Americans of all political persuasions – Democrat, Republican, independent, and tea party – should be able to unite around the conviction that all people deserve a fighting chance to live and to contribute to their community.  It is our job to lead that effort.

It is vital that we avoid making assumptions about members of the new majority in the House. Those of us who have been around for a while have crossed this bridge before. After the 1994 elections, when Republicans swept away a Democratic majority in Congress, AIDS advocates took to work and helped educate the new Congressional majority about the AIDS crisis. Some of the most enduring successes of the AIDS movement occurred when a Democrat occupied the Oval Office and Republicans controlled Congress.

Indeed, Tuesday’s election results point the way toward opportunities to educate the new Republican majority. For example, the South is a region where Republicans made some of their greatest gains in the 2010 elections. The South also happens to be the region where HIV/AIDS rates among Black people are rising the fastest. It is vital that we help new members of Congress and new Congressional leaders from the South understand what the epidemic is doing to their districts and work together to devise new solutions to these challenges.

In short, our work has never been more important. The challenges appear daunting at first glance, but our agenda is one that transcends political divisions.  I remember the days of emergency rooms full of people with AIDS, death beds and weekly memorial services.  And no matter what happened yesterday, I’m not going back.   It is time for all of us to roll up our sleeves, get to work, and insist on national solidarity to address the needs of the most vulnerable among us.

Phill Wilson is the president and CEO of the Black AIDS Institute.