Tens of millions of people have died of AIDS-related causes since the beginning of the epidemic. As the most serious epidemic in living memory, AIDS has necessarily been a campaign platform in presidential races for the last 20 years. The US plays the most crucial role in funding the response to the global pandemic, and with current available treatments, the next president of the United States has a historic opportunity to be the one who ends the AIDS pandemic. And yet, until last weekend, not a single presidential candidate had an official strategy for the global AIDS response.
This past Friday, Hillary Clinton caused an uproar when she miscredited Nancy Reagan as a "very low-key, effective" advocate, claiming the Reagans had started the public conversation about AIDS in the 1980s. Although Clinton apologized immediately, her mistake has illuminated something much more concerning -- presidential candidates weren't making plans to end AIDS.
On Sunday, Bernie Sanders became the first candidate to offer a policy plan entirely focused on HIV/AIDS, both on the domestic and global epidemics. Before that, the only mention of HIV existed as an entirely domestic and underwhelming nod in Clinton's LGBT policy plan. Not a single Republican has discussed it.
The AIDS crisis is far from over -- today, nearly 37 million people are HIV-positive, and only 15.8 million are currently on treatment. Antiretroviral treatment dramatically extends the lifespan of people living with HIV and effectively prevents HIV transmission to uninfected partners. And yet, there were 2 million new HIV infections in 2015, and over one million people died of AIDS.
The World Health Organizations and UNAIDS have shown that if we close the gap in treatment access, and double the number of people on HIV treatment by 2020, we will stop new infections by 2030. If we don't scale-up to this level, the AIDS epidemic will continue to outrun our response. Without scale-up, we will increase the long-term need for HIV treatment, increase future costs to health systems, and most importantly, countless people will die.
What will it take to scale-up access to HIV treatment and care to this level? For starters, it will take leadership from the United States. The US is by far the largest donor to global AIDS programs. Although over half of AIDS treatment budgets now come from African countries, an increase in funding from donor countries is necessary to achieve the end of this crisis.
For the US, this means providing an estimated annual increase of $450 million per year for our bilateral HIV programs for the next 4 years. These programs have been flat-funded since 2011, resulting in decreased expansion of critical lifesaving programming. To make this happen, we need visionary leadership in the White House that is committed to ending AIDS.
So how do the candidates stack up on the global AIDS response?
To date, none of the republican candidates have presented a plan for ending AIDS. In fact, none of them bothered to answer the two surveys about AIDS that have been sent to them from leading HIV/AIDS organizations. Republicans have long been champions of the global AIDS response - President George W. Bush started PEPFAR, the U.S.-funded global AIDS program, and global AIDS efforts have long had bipartisan support. This partisan stonewalling of HIV is not typical, and it is absolutely egregious.
Currently, Hillary Clinton has a minimal commitment to HIV in her LGBT policy plan, which is focused entirely on the domestic epidemic. The day after her remarks on the Reagans, she published a more involved apology in which she stated, "We should increase global funding for HIV and AIDS prevention and treatment," falling short of making a solid promise. Clinton also belatedly responded to a survey from AIDS advocacy organizations in the United States that Sanders had already responded to. You can read Clinton's and Sanders' full answers here. When asked, "will you commit to ensuring the necessary funding to double the number of people directly supported by the U.S. on life-saving HIV medicine by 2020?", Secretary Clinton talked at length on her record, but did not address the 11% drop in PEPFAR funding that occurred when she was Secretary of State, and failed to actually make a campaign promise.
Concerning access to medicines issues relating to trade and intellectual property rules, Clinton has been silent. Although she has opposed the Trans Pacific Partnership (TPP), she has not cited access to medicines as a reason behind her opposition.
Senator Sanders on the other hand responded to community calls over the weekend to present a plan on AIDS. Among his commitments to the global AIDS response, he officially committed to double the number of people on HIV treatment globally by 2020 by increasing support for the President's Emergency Plan for AIDS Relief (PEPFAR). Sanders also cites his opposition to the TPP as part of his AIDS platform, saying, "a major reason why Bernie is leading the fight against the disastrous Trans-Pacific Partnership (TPP) is because it would significantly increase prices for HIV/AIDS drugs for some of the most desperate people in the world. At a time when prescription drug prices are skyrocketing, the TPP would make a bad situation even worse by granting new monopoly rights to big pharmaceutical companies to deny access to lower cost generic drugs to millions of people."
Right now, Senator Sanders is the only candidate who has offered any sort of vision for ending AIDS in the form of solid campaign commitments. Although Hillary Clinton has a record on global AIDS programs, it is time for her to move past citing her resume and present her plan for the future. And it is long overdue for the republican candidates to do the same.
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