Todd Heywood's blog

Orphan's Visit Sheds Harsh Light on US HIV/AIDS Efforts

2008-12-17T08:00:00-05:00

EAST LANSING, Mich. — Alan has an almost cherubic face, but like any 13-year-old, there is an impish twinkle in his eyes. His throaty laughter and smile are nearly constant as he sits eating a Cobb salad. It is difficult to tell that he has endured more tragedy in his short life than most Americans can dream of.

Alan is an orphan of the HIV/AIDS epidemic that is ravaging Africa. In his native Uganda, he is considered an orphan because his father died. On top of dealing with the stigma of having a father who died as a result of HIV, he is also suffering from cerebral palsy, which leaves him unable to walk, and has the tendons in his right hand strung so tight he can’t use his thumb.

He is in Michigan as a guest of his school, the Nyaka AIDS Orphan School, to receive surgery in hopes of gaining some use of his right hand. The surgery is only the latest benefit the teenager is getting from his five-year relationship with the school in Uganda.

Nyaka, which operates out of Michigan, has been offering primary education to “the most at-need” youth since 2001 and was authorized by the Ugandan government in 2003. The average class size is 32, whereas the average class size for public schools in Uganda is 60 to 120. The students get hours of instruction in math, English and other basic subjects, as well as free breakfast and lunch.

“Most of our students are orphans from HIV and AIDS,” said Chris Singer, communications manager for Nyaka.

“A lot of our kids live with host families we have identified or grandmothers or family. We have almost 300 children and only five are [HIV] positive.”

The school focuses on HIV/AIDS prevention efforts. The school’s choir goes out and sings and puts on skits about HIV.

“The skits are amazing because they are so in your face. It’s very different than here,” Singer said. “There they have billboards all over the place. …

“There are lot of men who prey on young girls, and they call them sugar daddies,” said Singer. “And they have billboards that say ‘No Sugar Daddies.’”

The messaging from the youth and the government is working. New cases are declining, Singer said, noting that the HIV infection rate has gone from 18 percent to seven percent. He said this is because the government uses so-called ABC’s education on HIV prevention — Abstinence, Be Faithful and Condoms.

Although it is working, the program limits the country’s access to U.S. funds because it is not abstinence-only education. Nonetheless the program’s success has made Uganda a model for fighting HIV, even without U.S. resources.

“This disease is a litmus test for our society, and we are failing,” Singer said.

He says he sees a different response for his work in Africa than he does for his service as a board member on the Lansing Area AIDS Network (LAAN).

“I work for this school in Uganda and I get all this attention about how great it is. Why doesn’t LAAN get that attention?”

Stigma around the disease remains as dangerous in Africa as it does in the U.S., Singer added.

Alan said before he began attending Nyaka, he was teased for being in a wheelchair and for being an AIDS orphan, but not anymore. Going to school with others impacted by HIV has helped him connect.

Singer said he thinks it is time for American HIV/AIDS service organizations to work together.

“I think we can all work together for the same thing,” Singer said.

“What bothers me is that there is stigma surrounding it from all sides. We all want the same thing. I don’t think the kids there are any more deserving than the kids here … It is the biggest global injustice going around. No matter what side you are on, if you fit in one of those areas you are suffering from the injustice. We still have a large population infected here and nobody cares.”

AIDS and Silence: The Stigma Is Killing Us

2008-12-02T08:00:00-05:00

We have a problem in the gay men’s community. Our silence about the epidemic slowly eating us away is killing us. As much as this might sound like it is some ancient diatribe written in the ’80s, sadly it remains the reality today.

HIV has not gone away, and, in fact, there is an increase in the reported cases of men who have sex with men in Michigan. We can blame a lot of things, but before we look very far, we have to blame ourselves.

Yes, the Bush administration’s fixation on abstinence-only education has hurt us. Gay sex has not been figured into that formula, so our lives were ignored. That does not mean we did not have a responsibility to teach each other how to be safe.

In the early ’90s when I came out, you could not go to a gay-related event or bar without finding a big bowl full of free condoms. I have been to dozens of queer events, including Creating Change, in the last year, and the free condoms seem to be gone. If we aren’t putting them out there at our events, we are pretending that the epidemic is gone.

Barebacking or raw sex — sex without condoms — is real. It is happening. Maybe it’s a backlash against the condom messaging that was hammered home in the ’90s. Maybe it’s because barebacking feels good. Maybe its because people are getting tweaked out on meth and screwing their brains out. But until we talk about it, it will continue. I am not saying barebacking has to end. I am saying we need to give people the tools to talk about engaging in it in a safer manner. And that means conceding it is real.

It also means being real about our options. Abstinence is the only 100-percent sure-fire way to make sure you don’t get infected. But it’s also an irrational expectation to place on a community that is told on one hand that it should abstain and on the other that its relationships don’t matter so don’t ask the state to recognize you. Sometimes, consciously or not, the gay community replaces intimacy with sex. All kinds of people replace intimacy with sex. It’s part of human nature.

Condoms are certainly an effective option, but realistically, they are not being used regularly or consistently. That’s why we are seeing increased rates of HIV and other STIs in the gay men’s community.

There are other options. Post-Exposure Prophylaxis or PEP; and Pre-Exposure Prophylaxis, or PrEP; work. PEP is the long-held secret of the medical community and is used when a health care worker is exposed to HIV. Promptly the person is put on a course of anti-HIV medications. The course is 30 days. It has also been shown to prevent infection if taken within 72 hours of exposure through sex. PrEP is used as a long-term option by some and requires the use of anti-retrovirals before and after exposures. It has been shown effective in studies.

But we don’t talk about PEP and PrEP as real options for HIV prevention. Why aren’t gay men being given PEP options through HIV education and prevention outreach efforts? Why aren’t doctors with HIV-positive patients discussing with those patient’s partners the PrEP option? Do most doctors even know about these options? Do HIV educators?

And finally we have to get real about how HIV is impacting all of us, infected and uninfected. Rejecting a guy merely because he is HIV positive sends the message that he should not disclose his status again. Not getting tested and trusting your partner to be honest with you is not safe, it’s reckless. And choosing partners who claim to be HIV negative but can not name the date time and place they were last tested is not reducing your risk, it’s burying your head in the sand. Our ignorance is killing us and we are aiding it by pretending we are not ignorant.

If you have not been tested for HIV, you are hurting the community. If you are not talking about HIV with your partner, you are hurting the community. If you are gossiping about someone and labeling them as HIV positive to ostracize them, you are making HIV a bigger, nastier monster than it already is. If you are rejecting some one who is HIV positive, you are damaging yourself.

Syphilis Outbreak in Michigan County Claims More Patients

2008-12-01T08:00:00-05:00

An outbreak of the sexually transmitted bacterial infection syphilis continues to claim more patients, the Genessee County Health Department confirmed in an interview.

In August with the number of confirmed cases at 70, GCHD spokesman Mark Valacak told RH Reality Check the outbreak was waning.

But now, nearly three months and 39 cases later, the department is ramping up education and outreach again. At least five of the newly diagnosed cases were congenital cases — found in newborns — Valacak said.

“We went for a little while and we saw no cases,” Valacak said of the outbreak. “Then we saw cases in a younger population. Syphilis tends to be in an older demographic. And now we have these congenital cases.”

The number of confirmed cases now puts Genessee County above Detroit as the place with the highest number of reported cases of syphilis in Michigan.

“Very serious,” Valacak said when asked how serious the outbreak was. “In terms of our rates for a community of our size it is of extreme concern.”

Valacak said the department is working hard to raise awareness. It is doing this through a combination of public relations moves, such as posters and signs on buses, as well as outreach to the ob-gyns. The department has also trained outreach workers to go out and work with sex workers.

Valacak said that people should learn the signs and symptoms of syphilis and get tested. “People need to be making sure they understand syphilis is a simple blood test and a treatable disease. If you are putting yourself at risk you need to be tested.”

More information on syphilis can be found here and here.

Condom Ad in Michigan State University Newspaper Arouses Controversy

2008-11-25T08:00:00-05:00

EAST LANSING, Mich. - An advertising insert placed in the Michigan State University (MSU) student newspaper, The State News, on Thursday, Nov. 13, is raising eyebrows among health educators.

Durex condoms initiated a national advertising campaign called Durex U with an insert that encouraged students to "major in sex and you could score $25,000." The ad promoted a sweepstakes with prizes that included "trips, entertainment and other diversions to heighten your education." It also prominently featured a drawing of a man and two women in the back seat of a convertible with strawberries, whipped cream and banana.

The advertisement directed readers to a web site, DurexU.com, which requires certification that the visitor is 18 or older and includes the illustration pictured in the ad, along with depictions of couples, covered by sheets, having sex in bed and on a football field.

"We believe that such an overt stereotype of college students engaging in casual sex does little to help us educate our population about healthy sexuality. The overt sexism is also not conducive to the environment we work to create on campus - one that is inclusive of all genders and sexual orientations," said a statement released by MSU Olin Health Center's educators, Dr. Dennis Martel and Erica Phillipich.

"This ad and Web site provide only clearly heterosexual scenarios and the physical act of having sex; while allowing for no discussion, no communication, and no education regarding consent between partners or safer sex strategies," the statement continued.

"It always disappoints us when a condom company has an opportunity to promote comprehensive and responsible sexual health information," said Lori Lamerand, CEO of Planned Parenthood of Mid and South Michigan, in a phone interview. "It's too bad when that is missed. It seems like it wouldn't have been hard to catch attention and include responsible messages."

But Durex representatives challenge the health educator's characterization of the advertisement.

"This campaign is not for the faint of heart, and it definitely was created to speak to a certain target audience - one with a definite sense of humor and an appreciation for out-of-the-box creative," said Steve Mare, brand manager for Durex Consumer Products.

Mare declined an interview, opting instead to issue the statement in a release through the company's public relations contractor, Jennifer Grizzle.

"We gave our agency, Youthography, the freedom to develop an ad campaign that, while a bit edgy, speaks directly to this audience and gets them thinking about their sexual well-being which is a balance of physical, emotional and sociological factors."

The Los Angeles-based Youthography is also defending the ad.

"The Durex U campaign was developed to talk to those men and women who seemingly get bombarded with suggestive and often irresponsible messages in movies, TV and online mediums," said Jeff Roach, vice president of strategy for Youthography.

Roach's statement was also included in the release from Durex. "The ad was clearly an outrageous and exaggerated situation that doesn't exist in everyday life. It was meant to be thought-provoking and invoke reactions regarding the consequences of irresponsible behavior."

"I think there are other ways to invoke conversations and get people to talk about responsible and healthy sexuality than to do outrageous ads that border not getting people to talk at all," said Martel, the MSU health educator. He said the ads are difficult to understand and thus inhibit full conversation. "These ads create misperceptions about sex and sexuality. I don't see how this creates dialogue."

Martel said Olin relies on "evidence-based" education practices.

"We use cutting-edge and funny sides too, but they are based on data, and we use effective interventions that are proven," he said. "We don't go to an ad agency and say how do we promote our product. We have a philosophical difference in how to promote condoms."

Martel points out the advertisement implies the use of whipped cream with condoms is OK. However, whipped cream contains oil, which has been shown to degrade latex condoms, causing failure which can lead to infections and unintended pregnancy.

"Whatever their strategy in thinking outside the box, everyone has a responsibility to promote responsible behavior," Martel said in a phone interview.

Craig Covey, CEO of the Midwest AIDS Prevention Project (MAPP) said he found nothing wrong with the advertisement.

"I find the ad kinda fun and cute. Since it is for condoms, I would support the ad. [MAPP is] not anti-sex, but rather pro-safer sex," he said in an email.

New Obama Appointee Understands Connections Between Health and Economy

2008-11-25T08:00:00-05:00

President-elect Barack Obama yesterday announced his new economic team, which includes Melody Barnes, a former Senior Domestic Policy Adviser to Obama during his bid for the presidency. Although she is well-known within the progressive community, the public is not as familiar with Barnes or her position on key domestic issues. Barnes is a former Executive Policy Director at the Center for American Progress; she's also served as chief counsel to Senator Edward Kennedy on the Senate Judiciary Committee.

During the presidential campaign, I had an opportunity to have a one-on-one with Barnes during which she talked at length about the importance of addressing the HIV/AIDS epidemic as a key to addressing urban renewal programs.

Barnes said:

"Barack sees an urban agenda that tries to help people with [the] disease have access to health care," Barnes said. "He recognizes a larger hole in that strong families make up strong communities, and if you are sick and struggling, you are not going to have a strong family."

Barnes said Obama has also been vocal about HIV testing and about challenging the African-American community to address the HIV epidemic.

"This is a matter of life and death," Barnes said.

In a powerful piece published in 2007 on the Washington Post, the day before President Bush's State of the Union speech, Barnes also said:

Domestically, no need is more urgent than fixing our broken health care system. Today, nearly 47 million Americans have no health insurance. And those lucky enough to be insured are seeing the cost of their premiums soar. At the same time, the uninsured cannot afford screening for heart disease, diabetes, cancer, or even get a flu shot - and our health care system as a whole places far more emphasis on treatment than it does on preventing disease in the first place. As a nation, we dedicate only three percent of our health dollars to health promotion, but over 20 percent of our health care dollars to care in the last year of life. We must guarantee affordable coverage for all Americans. At the same time, we must also overhaul our health care system so that we make wellness and disease prevention a national priority. The Wellness Trust will create incentives for health care providers, employers, schools and individuals to focus on prevention, and preventative care will be available to people outside of a doctor's office. Preventive services will be covered whether they are delivered in pharmacies, supermarkets, on the job, at senior centers, or elsewhere in the community.

By appointing policy leaders like Barnes who see the connections between health and the economy, Obama appears to have pulled together an economic team that reflects many of the goals he set out during his campaign.

Wall Street Journal Says "Cure" for AIDS Stumbled Upon

2008-11-11T08:00:00-05:00

Doctors in Berlin, Germany, are reporting that a 42-year-old American living in that city may have eliminated the virus from his body after a bone marrow transplant.

According to the Wall Street Journal report, the man was suffering from leukemia and AIDS, and while he continues to receive treatment for the leukemia, the virus has not reappeared in his blood in 600 days.

Traditionally, when a person on antiretroviral medication to treat HIV stops taking the pills, the virus bursts back with a flurry of activity. But this unidentified patient stopped taking the medication and has not had any evidence of the virus in his blood since.

The report explains that doctors believe this is due to the man’s leukemia doctor's use of bone marrow from a donor who had genetic immunity to HIV infection.

The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren’t sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning.

So what does this case indicate to experts? The Journal reports:

While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it “a very good sign” and a virtual “proof of principle” for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy.

“Sounds like good news so far — I’d be hesitant to call it a cure,” Mark Peterson of the Michigan Positive Action Coalition, or MI-POZ, a group of politically active HIV-positive people in Michigan, said in an e-mail. Peterson went on to say that the news underscored the importance of research into a specific class of drugs that stop the virus from invading human cells in the first place.

This is possibly very important news in the fight against HIV.

When antiretrovirals were first introduced, and viral loads (the number of viral particles in the blood) were found to have been suppressed to undetectable, doctors thought that eventually cells harboring HIV would die off and the person would be HIV-free. That did not happen. Researchers discovered that the virus incorporated itself into the genetic makeup of the infected person and waited for the opportunity to reignite the infection.

But in 1996, researchers also made another startling discovery, the Journal reports:

…researchers discovered that some gay men astonishingly remained uninfected despite engaging in very risky sex with as many as hundreds of partners. These men had inherited a mutation from both their parents that made them virtually immune to HIV.

The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 acts as a kind of door for the virus. Since most HIV strains must bind to CCR5 to enter cells, the mutation bars the virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc., doesn’t attack HIV itself but works by blocking CCR5.

Craig Covey, executive director of the Midwest AIDS Prevention Project based in Ferndale, said he had not heard anything about the case or the reports, and was unable to comment.

McCain Flip-Flops on HIV Prevention

2008-10-07T08:00:00-04:00

John McCain changed his stance on several key issues of concern to HIV prevention and sexual health advocates, according to an interview published this past Wednesday in the District of Columbia's gay newspaper, The Washington Blade.

McCain called for a national strategy to deal with HIV/AIDS:

I am committed to supporting the development of a National AIDS Strategy. Countries receiving PEPFAR aid are required to develop a national plan; but we don't have one in our country. It's important to settle on a national strategy - with input from state, local and federal government officials; along with the private sector, doctors, drug companies and AIDS advocates. Let's roll up our sleeves and put together a National AIDS Strategy for more effectively addressing the domestic challenges. Recent CDC statistics show that gay men continue to be strongly impacted by the disease, and the disease is disproportionately affecting people of color. Our prevention and treatment efforts must be improved to address these challenges.

Barack Obama has championed as part of his platform a national strategy to address HIV/AIDS. In contrast, McCain has never voiced support for a national strategy until this interview, let alone advocated for prevention measures that address the needs of gay youth. You can read RH Reality Check's comparison of both candidate's views on this issue of HIV/AIDS here.

In fact, McCain has supported abstinence-only education mandates as part of sex education - a strategy that many experts have faulted as aiding in the increased rates of infections among gay youth. Those programs, which focus on abstinence until marriage, ignore a significant issue: Gay youth are well aware that they can't get married in most states. Government evaluations of the abstinence-only education programs have all determined the programs are failures. Yet McCain and Palin continue to support the programs.

In the Blade interview, McCain had the following exchange with the interviewer:

Blade: How would a McCain administration approach abstinence-until-marriage sex education initiatives? What is your view regarding programs that provide safe-sex messages specific to gay youth?

McCain: I have supported including abstinence as a component of sex-education programs. Decisions regarding programs targeted specifically at gay youth should be made based on a review of the scientific data to determine what works and what doesn't, but they must encourage responsible individual behavior.

Given an opportunity to support the claim that programs addressing the issue of prevention be scientifically sound, McCain voted against the measure, according to Planned Parenthood Action Fund:

McCain opposed legislation requiring that abstinence-only programs be medically accurate and scientifically based. McCain voted NO on legislation that would help reduce the number of teen pregnancies by providing funding for programs to teach comprehensive, medically accurate sexuality education and other programs to prevent unintended teen pregnancies.

So the question is, what does John McCain actually believe when it comes to HIV/AIDS prevention?

Understanding the Issues: The Candidates on HIV/AIDS

2008-09-29T08:00:00-04:00

While both candidates for president have made statements that they want to combat HIV/AIDS, a comparison of the voting records, public statements and other actions shows John McCain has very few specifics to address the crisis and has a history of supporting legislation that damages and impedes the process of addressing the HIV epidemic in America.

First, here are what Barack Obama and McCain, respectively, have said about the HIV/AIDS crisis in general statements:

"We are all sick because of AIDS - and we are all tested by this crisis. It is a test not only of our willingness to respond, but of our ability to look past the artificial divisions and debates that have often shaped that response. When you to go places like Africa and you see this problem up close, you realize that it's not a question of either treatment or prevention - or even what kind of prevention - it is all of the above. It is not an issue of either science or values - it is both. Yes, there must be more money spent on this disease. But there must also be a change in hearts and minds, in cultures and attitudes. Neither philanthropist nor scientist, neither government nor church, can solve this problem on their own - AIDS must be an all-hands-on-deck effort." - Obama; Lake Forest, Calif.; World AIDS Day 2006; Dec. 1, 2006.

"The spread of HIV/AIDS, and the efforts of the international community to combat it, will be remembered by history as one of the defining issues of our time. The ethical implications of not doing everything in our power to slow the spread of this disease are severe. The most basic morality requires that we commit ourselves to combating HIV/AIDS everywhere." - McCain in a 2003 speech on the floor of the U.S. Senate.

Obama's plans to combat HIV/AIDS can be found here.

McCain's plan to combat HIV/AIDS is not available on his Web site.

National Strategy on HIV/AIDS in America

Currently the United States requires that all foreign countries receiving HIV funding provide a comprehensive HIV/AIDS strategy that outlines specific outcome-based measures for the success or failure of funded programming and prevention of transmission of HIV in the grant country. However, the United States itself, 27 years after the cases of this epidemic were identified, still does not have a national strategy on HIV/AIDS in America.

McCain has never addressed the issue of whether or not he would support a comprehensive HIV/AIDS strategy for America.

Obama has stated that in the first year of his administration he will develop a comprehensive HIV/AIDS strategy for America that will specifically encompass every department of the federal government.

Needle Exchange Programs

In 1989, marking the "war on drugs," Congress and President George H.W. Bush created a law preventing the funding of needle exchange programs. However, studies have shown time and again that providing clean needles does not increase drug abuse, and more importantly they prevent the transmission of HIV, Hepatitis B and C, and other diseases among intravenous drug users. Some of the studies even indicated that needle exchange programs funnel drug users into treatment and out of the addiction cycle.

Congress has authorized the president to lift the needle exchange ban if the Department of Health and Human Services certifies that needle exchange programs do not contribute to drug abuse. The DHHS made that certification in 1998, but no president has used his congressionally authorized power to lift the ban.

McCain has never stated whether or not he would use the congressional power afforded presidents in 1998 to lift the ban on needle exchange programs to address the spread of HIV/AIDS in the intravenous drug using population in America.

Obama has stated he would lift the ban on needle exchange programs, and he has made it part of his HIV/AIDS platform on his Web site.

HIV Testing

One of the most crucial impacts on prevention of HIV transmission is found in the simple acting of widespread testing for the virus. The Centers for Disease Control has recommended routine testing as part of an annual physical, but as with millions of Americans without basic health insurance, very few are getting the annual physical. As a result, testing has fallen onto community organizations who provide anonymous or confidential testing. Any comprehensive HIV/AIDS strategy must address the issue of access to testing within impacted communities.

McCain has not made public statements about testing.

In a show of support for the idea of HIV/AIDS testing, Obama and his wife, Michelle, have both taken HIV tests publicly in 2006 in a trip to sub-Sahara Africa and have called on others to follow suit.

Access to Treatment

In addition to testing, it is imperative from a public health perspective to make sure that those persons testing positive for HIV have access to adequate medical care, including access to anti-retroviral medications, which have made HIV a manageable, chronic disease in the United States, rather than the death sentence it used to be. However, many HIV-positive Americans die without access to these necessary medications because of wait lists for AIDS drug assistance programs, which are funded only a certain amount to provide HIV medications to patients.

McCain voted against a federal program titled Early Treatment with HIV Act. ETHA would expand Medicaid coverage to low-income persons who are living with HIV but have not been diagnosed with AIDS. McCain was a co-sponsor of the original Ryan White CARE Act, which authorized funding to states to assist in treating HIV. McCain did not sponsor the 2000 Ryan White CARE Act reauthorization. In 2003 McCain voted against increasing funding to the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis by $940 million. He also voted against increasing treatment worldwide by $800 million that same year.

Obama has co-sponsored ETHA as well as the Ryan White CARE Act legislation. He also has outlined a concise plan, within his larger health plan, to assure access to health care for those infected with HIV.

Confronting Stigma

In all the issues surrounding HIV/AIDS, nothing is as painful and important as the need to address the stigma of being HIV-positive. Many people would rather never get tested than to hear the words "YOU ARE-- HIV-positive" from a medical care provider. The reasons for this are overwhelming. They run the gamut of issues from family prejudices on sexuality to taboos about sexuality in American culture, fear of disease and death, and simple ignorance about how HIV is spread.

While McCain has made comments about how terrible the epidemic is, he has also taken serious actions as a senator to support legislation that adds to the stigma of being HIV-positive in America. Among the things McCain has supported is a 1993 ban preventing HIV-positive individuals from coming to the United States as tourists, students or on other visas. He also voted in 1991 to involuntarily test all patients going in for surgery and to imprison any health care worker who is HIV-positive and participates in surgery.

In a debate at Howard University, Obama said the following:

"One of the things we've got to overcome is a stigma that still exists in our communities. We don't talk about this. We don't talk about it in the schools. Sometimes we don't talk about it in the churches. It has been an aspect of sometimes a homophobia, that we don't address this issue as clearly as it needs to be."

Obama also supports the lifting of the ban on immigration and other visas to persons with HIV, a ban passed in 1987 with the assistance of McCain.

Science or Dogma to Drive HIV Prevention Programs?

Since George W. Bush became president, the United States has been aggressively supporting abstinence-only education programs. Those programs have been shown to fail, but it has not stopped the president and his supporters from pushing this broken agenda on this country and the world. The recently passed President's Emergency Plan For AIDS Relief (PEPFAR) included a provision that demanded that 33 percent of all HIV prevention programs presented in other countries and funded under PEPFAR be abstinence-only programs.

Comprehensive prevention programs include development of new modes of prevention as well as education programs targeting groups most at risk for HIV infection with effective programs.

Obama is the Democratic sponsor of the Microbicide Development Act, which would fund a program at the National Institutes of Health to develop a topical anti-HIV agent to use in conjunction with other activities to prevent the spread of HIV. Obama also supports the JUSTICE Act, which would assist in the prevention of HIV transmission in U.S. prisons by allowing the distribution of condoms to prisoners. Current law makes possession of condoms in federal prison a crime. Obama also supports the end of abstinence-only-until-marriage prevention programs and replacing them with programs based on proven comprehensive reproductive health education.

Obama is also a co-sponsor of the Prevention First Act, which would provide young Americans with information about abstinence, contraception and condom use to reduce unintended pregnancies, disease transmission and abortions. The bill would also lift the 33-percent abstinence-only education component of PEPFAR. Obama has said the United States should "rewrite much of the bill to allow best practices - not ideology - to drive funding for HIV/AIDS programs."

Obama also is opposed to federal funding of abstinence-only programs.

"We can't ignore the fact that abstinence and fidelity, although the ideal, may not always be the reality - that we're dealing with flesh and blood men and women and not abstractions, and that if condoms and, potentially, things like microbicides, can prevent millions of deaths, then they should be made more widely available." - Obama to Los Angeles Times

McCain in March 2007 was unable to tell reporters on board his "Straight Talk Express" bus if he thought condoms were effective in preventing the spread of HIV. The New York Times ran the following transcript of the conversation on its blog:

Reporter: "Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?"

Mr. McCain: "Well I think it's a combination. The guy I really respect on this is Dr. Coburn. He believes - and I was just reading the thing he wrote- that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn't succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I'm not very wise on it."

(Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)

Mr. McCain: "I haven't thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don't know if I would use taxpayers' money for it."

Q: "What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush's policy, which is just abstinence?"

Mr. McCain: (Long pause) "Ahhh. I think I support the president's policy."

Q: "So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?"

Mr. McCain: (Long pause) "You've stumped me."

Q: "I mean, I think you'd probably agree it probably does help stop it?"

Mr. McCain: (Laughs) "Are we on the Straight Talk express? I'm not informed enough on it. Let me find out. You know, I'm sure I've taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception - I'm sure I'm opposed to government spending on it, I'm sure I support the president's policies on it."

Q: "But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: ‘No, we're not going to distribute them,' knowing that?"

Mr. McCain: (Twelve-second pause) "Get me Coburn's thing, ask Weaver to get me Coburn's paper that he just gave me in the last couple of days. I've never gotten into these issues before."

The Veep Choices on HIV/AIDS

Sen. Joe Biden of Delaware, Democratic nominee for vice president, has a mixed record on HIV/AIDS issues. While campaigning for the nomination for president this year, he would not commit to a national strategy on HIV/AIDS, but he did sponsor the Prevention First Act, ETHA, and Ryan White CARE Act and the reauthorization. He has also stated that he supports needle exchange programs and supported the funding of research for microbicides, which would prevent the transmission of HIV. Biden also supports a move toward science-based education programs and away from the ideological programs such as abstinence-only. While he has supported such legislation, he has also supported the ban on HIV-positive people traveling to the United States and supported a 1991 bill that would have imprisoned health care workers with HIV who participated in surgeries.

Alaska Gov. Sarah Palin, Republican nominee for vice president, on the other hand, has a scant history on HIV/AIDS issues. While in March she declared a Native HIV/AIDS awareness program, she has stated that she is opposed to "explicit" sex-ed programs. She later amended her statements in a 2006 governor's debate, by saying:

"I'm pro-contraception, and I think kids who may not hear about it at home should hear about it in other avenues."

In February of this year, RH Reality Check published answers to a reproductive health questionnaire we distributed to all of the presidential candidates at that time including information on their HIV/AIDS positions and strategy. Senator John McCain's campaign did not respond. You can find Senator Obama's published answers here.