AIDS and Campaign 2008

As the 2008 election draws closer, the questions of candidates and campaign issues occupy more and more space in print media, minutes on radio and television, and bandwidth in the ubiquitous blogs and spam messages that have become the modern equivalent of brochures hung on the doorknob. Computer-dialed phone calls with prerecorded messages from elected officials, would-be elected officials, friends of elected officials, would-be friends of would-be elected officials, ad nauseam, add to the din. The political junkies among us hang on every word-from our favorites, to find more reasons to lend support, and from the opposition, to find the slips of the tongue or pronouncements that justify voting the other way. Unfortunately, many voters have long since tuned out the whole process, with their minds made up long ago during the primary season; or they have become so tired of the endless noise that voting will only be a blind jab at the candidate who has the less offensive ads; or perhaps they will not vote and just ignore election day altogether.

But-and there is always a “but”-it’s too important to let today’s “all election, all the time” blitz get in the way of serious questions about what will happen to HIV-sensitive issues over the next 4 years. Does anyone have the political will to tackle universal coverage and access to care? How much money will a new administration be willing to invest in improvements in our “non–health medical care system,” given the low probability of rapid, comprehensive reform? Will we be assertive in opposing discrimination, on any grounds? Will we move to support access to treatment for addicts as well as a full range of prevention for this challenging population? Will we return to the support of comprehensive health education that includes sex education (ie, real sexual education, not just the “say no” approach to safe sex)? Will our rhetoric about a global concern for health translate into sustained support for successful programs, whatever the politics of the countries in need? Will we sort out the differences between testing students beyond their patience and a true “no child left behind” process that provides all children and adolescents with excellent teachers and learning for a chance at a lifetime of success?

PRESIDENTIAL CAMPAIGNS
A quick look at the official campaign Web sites for the Democratic and Republican candidates for president suggests that both candidates are far from clear on meaningful action in many arenas that have been of great interest to the HIV/AIDS advocacy community. Both are preoccupied in the health care area with the question of affordable insurance coverage, with the Obama Web site somewhat clearer on steps to be taken to achieve universal coverage. The addition of Hillary Clinton supporters and policy staff to the Obama campaign may push this even further. Both candidates make clear their commitment to international AIDS action.

It is no surprise that HIV/AIDS is not the same issue it was 15 years ago: programs do exist; there is less blatant discrimination; and the investment in research has held, even if the findings in some areas, such as vaccines, have yet to produce success. But it would be nice if the candidate who seems to have the greatest affinity for the actions requested by the HIV activist community, ie, Barack Obama, were committed to a US policy with the same level of clarity we expect from other nations responding to HIV. He may have made clearer references to those steps between the time of writing this column and publication; I hope so.

Neither candidate has adopted a slogan resembling “it’s the economy, stupid,” but it would be wise for whoever moves ahead in the polls to do so; if the polling numbers remain close, then both should do so. All of the community organizing and hope will not produce the funds needed to reduce our national debt and achieve a truly balanced budget. Without such a move, there will be no money to invest in any programs at all. It’s also worth remembering that the election will determine who makes the next appointments to the Supreme Court, a nonet that is teetering on the edge of completely reversing many important precedents. Obama’s interests and history support a more optimistic view of where we might end up by 2012.

THE OTHER RACES
As has been the case in other election years, however, this column takes a strong stand that while the presidential election is extremely important-given the failed policies of the current Administration-it is not only the presidential election that matters. The current Congress has had to struggle to keep a focus on progressive legislation in the face of a stubbornly recalcitrant president. If the margin of seats occupied by senators and representatives willing to move forward is not increased, the chance for real change is slim. Many of us recall how difficult it was for a president and Congress from the same party (in this case, the Democratic Party) to move health reform and other issues forward in 1993 and 1994, and how the clashes of that period seemed to lead directly to party turnover in Congress and less action. National policy is a team effort; we need to pay attention to all of the races that influence the team’s makeup.

Finally, much of what we want to have for every member of our society, whether currently infected or uninfected, depends on not only the national political leadership but also the governors and mayors; members of state legislatures, county commissions, and city councils; school boards; and public health and hospital boards. When wearing my academic hat, I’ve been known to suggest to students that I’d like a grading system in which they could be penalized for failure to vote. If such a system were extended to the grading of each of us as citizens, I’d also grade on one’s degree of attention to those “lesser” races, ie, those at the state and local levels. The decisions by a governor and legislature on whom to appoint and confirm as state health or Medicaid officials and how to budget funds to carry out state-adopted policies on access to care, access to health insurance, access to quality education, antidiscrimination, and equal opportunity all matter. They can make even a weak federal program work reasonably well-or undermine a strong one. Local decisions about land use, building codes, enforcement of health regulations, and school curriculum matter enormously.

The AIDS epidemic made policy watchers and policy wonks of the many who had ignored or avoided any engagement in the political life of the community. The activists of the 1980s and 1990s made a difference in both policies and elections. Many of those early activists have moved inside the policy world, in jobs that extend to developing or carrying out policies regarding AIDS, health care in general, education, and more. The political world seems a bit calmer now than it was 20 years ago. Maybe too calm. The enthusiasm of many younger and first-time voters for a campaign with change and hope as its central themes suggests a readiness to jump forward, to make up for lost time, to make a real difference. All of those sentiments are good; can we back them with solid policy proposals, disciplined negotiation that recognizes real economic constraint, and elected officials at all levels who are prepared to fight for a society we have been dreaming of? It’s our vote. Let’s use it well.