Clinton’s Mistake on Reagan Is an Opportunity for Action on HIV/AIDS

Angelica Tome does a chalk drawing of a red AIDS ribbon on Castro Street on December 1, 2015 in San Francisco, California.

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If there is an upside to Hillary Clinton’s recent misstatement regarding the Reagans’ record on HIV/AIDS, it’s the opportunity the incident offers to point out that many of the problematic Reagan-era policies related to HIV are still on the books, endangering thousands of lives. Despite progress in medical research and community advocacy, HIV persists as a significant threat to public health. HIV-related stigma remains high and attention and resources devoted to treating and preventing the disease are still inadequate.

The Reagan administration was notoriously slow in aggressively combatting the disease. Today we have effective treatments but struggle to get them to the people who need them. According to the Centers for Disease Control and Prevention, roughly 1.2 million people are living with HIV in the United States, and roughly 50,000 people are newly infected each year. Of these 1.2 million people, only 87 percent are diagnosed.  

Even more alarming,  according to recent estimates, only 40 percent of those living with HIV are engaged in care, only 37 percent have access to lifesaving anti-retroviral drug therapy (ART), and only 30 percent are virally suppressed—meaning that drugs have reduced the amount of virus in their blood to “undetectable” levels.

Ensuring widespread drug treatment for HIV is critical to preventing the spread of the disease, because as the amount of virus in an individual’s body decreases, so too does the ability of the disease to spread to another person. Our failure to more widely treat those that already are living with HIV contributes to its spread. President Obama’s National HIV/AIDS Strategy recognizes this reality—that treatment and prevention are linked.

But HIV-related stigma is pervasive, contributing to a high life-time risk of becoming HIV positive for gay and bisexual men. Stigma acts as a barrier to testing, consistent engagement in care, and treatment. Many counterproductive policies instituted during the 1980s linger, perpetuating inaccurate information regarding how HIV is transmitted, and continuing to stigmatize those living with HIV.

For example, dozens of states have laws that criminalize sexual or other behaviors by HIV positive people. Such laws are problematic because they may actually discourage individuals from obtaining testing and determining their HIV status: If you do not know you are HIV positive, you cannot be prosecuted under HIV specific criminal laws.

These laws almost always fail to account for whether an individual is virally suppressed or using a condom, in which case the likelihood of transmission is significantly reduced. In fact, some of these laws criminalize activities, such as spitting that pose no risk of transmission, fuel stigma, and foment irrational fears over how HIV is spread.

Many of these laws are a product of the early years of the epidemic, when fear and misunderstanding guided policy responses. For example, a 1988 report issued by President Reagan’s Commission on the Human Immunodeficiency Virus Epidemic suggested that HIV-specific criminal statutes for intentional transmission could reduce the spread of the disease. Fortunately, the CDC and the White House National HIV/AIDS Strategy have begun to question the efficacy of such laws. Nonetheless, they remain in force in many states.

Similarly, beginning in 1985, the Food & Drug Administration began recommending that any man who had ever had sex with another man since 1977 be indefinitely barred from donating blood out of fear that the person would donate blood infected with HIV. It was not until 2015 when the FDA finally issued a minor revision to this policy, prohibiting donations from any man who has had sex with another man in the year prior to donating. But this policy continues to bar gay and bisexual men from donating even if they are in a long term monogamous relationship and both parties are seronegative.

Perhaps even more significantly, by focusing on certain sexual identities, rather than risk behavior, the policy fails to educate that everyone—regardless of demographics—is at risk of HIV if they engage in unprotected anal or vaginal sex with partners of unknown HIV status.  

Put succinctly, while critics of Clinton were right to point out that the Reagans’ record on HIV was extremely poor, equally troubling is that 30 years later America still operates under some of those problematic policies. Action is needed to revise laws and policies that stigmatize those living with HIV and send inaccurate messages regarding how HIV is transmitted, and resources must be devoted to treating those currently afflicted with the disease.

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