Four years ago, Gwen Ifill stumped vice presidential candidates Dick Cheney and John Edwards when, during their debate, she asked them to address the spread of HIV in the United States and the stark disparities that define the epidemic—including the fact that “black women between the ages of 25 and 44 are 13 times more likely to die of the disease than their [white] counterparts.”
Black women are now almost 15 times as likely to be infected with HIV and 23 times more likely to be diagnosed with AIDS as white women. For black women between the ages of 25 and 34, AIDS is the number one killer.
The day before this year’s International AIDS Conference, the Centers for Disease Control and Prevention announced startling news: A total of 56,300 people in the United States were newly infected with HIV in 2006, a number 40 percent higher than previously estimated. This is no blip—the numbers have been this high for the past decade. We simply keep ignoring the scale of the crisis.
Two communities in particular bear the greatest share of the U.S. HIV/AIDS epidemic: men who have sex with men and African Americans. Fifty-three percent of new HIV infections in 2006 occurred in gay and bisexual men of all races and ethnicities, while African Americans, who make up only 12 percent of the U.S. population, now make up more than 45 percent of new infections.
In fact, according to the Black AIDS Institute, if African Americans in the United States constituted their own country, that country would rank 16th in the world among those with the highest number of individuals living with HIV. The number of African Americans infected with HIV now exceeds the number of HIV-positive people in 7 of the 15 countries targeted by the President’s Emergency Plan for AIDS Relief, or PEPFAR. The HIV rate in Washington, D.C., our nation’s capital, is 1 in 20—the same as the overall rate in sub-Saharan Africa.
Earlier this summer, the United States increased its PEPFAR commitment to $48 billion over five years for international HIV/AIDS prevention and treatment. This is a crisis-sized response to a global crisis. Unfortunately, we have yet to do the same for the crisis in our own backyard.
The United States has admirably addressed the epidemic abroad, but where is the political response to the crisis at home? What ideological predispositions allow us to care for Africans but not African Americans?
We expect this year’s vice presidential—and presidential—hopefuls to be more aware and better prepared to answer questions about HIV/AIDS in the United States. More important, we hope they are ready to make a commitment to address the situation on a scale commensurate with the crisis.
Currently, the majority of domestic HIV funding is designated for treatment and care for people living with HIV/AIDS. Prevention programs receive a mere 4 percent of domestic funding—and this share of the budget has fallen over time. At a recent hearing of the House Committee on Oversight and Government Reform, CDC officials stated that their agency would need an additional $4.8 billion dollars over the next five years to reduce the annual number of new HIV infections in the United States. A significant investment, yes, but this amount is only one-tenth of our PEPFAR commitment.
An adequate policy response from the next administration would take into account treatment and prevention, and it would be funded at the level necessary to reach all those affected by and vulnerable to HIV.
An ideal approach would fully integrate HIV/AIDS prevention, testing, treatment, and care with health care in general and with reproductive health services in particular. It would be evidence-based and remove ideological barriers that restrict federal funds from supporting strategies with proven effectiveness, such as comprehensive sex education, condom distribution, and needle exchange programs.
Finally, an effective policy response would be developed with the full participation and leadership of the communities most in need, namely the African-American and gay and bisexual communities. It would address the taboo issues surrounding HIV/AIDS to get to the root causes of unsafe sexual practices, which include poverty, discrimination, and violence. And it would address the stark racial and gender inequities that allow the epidemic—and the stigma attached to it—to persist and flourish.
We have an HIV/AIDS crisis in the United States, and we need a crisis-sized plan from a new administration to address it. We don’t want our candidates debating this again four years from now.
Shira Saperstein is a Senior Fellow with the Center for American Progress Action Fund. Stephanie Gross worked with the Women’s Health & Rights Program at the Center for American Progress Action Fund during the summer of 2008.