[Editor’s note: 2016 Presidential candidate Hillary Clinton recently praised the Reagans’ record on AIDS; she quickly claimed she “misspoke” after advocates criticized her. Revisit our April 2005 cover story interview with then-Senator Clinton for her stances at that time.]
Capital Hill
Senator Hillary Rodham Clinton is closely associated with many issues, and healthcare is close to the top of the list. In an interview with A&U’s B. Andrew Plant. She addresses how HIV/AIDS is interrelated to so many facets of our lives, from education and healthcare delivery to information technology. Most importantly, the Senator restates her deep and passionate commitment to people living with AIDS
In Living History, her bestselling autobiography, Senator Hillary Rodham Clinton relates anecdotes about HIV/AIDS in ways only a true participant in modern history can. She talks of visiting the countries of sub-Saharan Africa as they were realizing the catastrophic devastation of AIDS. She remembers early on in the Clinton Presidential administration working for better testing and labeling of pediatric drugs, inspired by her friend, AIDS activist Elizabeth Glaser.
And that’s just the tip of the iceberg. Suffice to say that now-Senator Hillary Rodham Clinton—who views AIDS from many perspectives, including those of mother, attorney, diplomat, and politician—is informed and compassionate about the pandemic.
In one of her previous books, It Takes A Village, published during her tour of duty as First Lady, Senator Clinton posited that it takes a community working collectively to raise a child. So, it made sense to ask her what it would take to beat AIDS.
“It will take a lot more than a village to beat AIDS,” she says. “It will take the entire world. It will require the government to pledge funding and resources not only to battling domestic epidemics, but toward multilateral efforts like The Global Fund, which has been seriously underfunded since it was founded.”
And she doesn’t stop there. “It will require scientists and research institutions to continue investigating scientific advancements in vaccines, microbicides and treatments,” she adds. “[And] it will require our medical professionals to seek out the opportunities to go to the places where AIDS is most critical, and provide treatment and the health infrastructure which simply does not exist.”
The Senator also has a charge for those beyond the medical community, saying, “it will [also] require the commitment of religious leaders, who can deliver spiritual sustenance to people with HIV and their loved ones, and help lead the efforts to reduce stigma.”
Arguably, this healthcare advocate knows of what she speaks. She was First Lady of Arkansas when the Ryan White CARE Act, which distributes federal funding related to HIV/AIDS, was first enacted. Later, as First Lady of the United States, she championed Ryan White funding and other AIDS initiatives. This year, as Ryan White is up for reauthorization before Congress (as it is every five years), Senator Clinton says the process is an opportunity to bring national attention to the pandemic [see Sidebar below].
“In my role as a U.S. Senator, I am able to fight for increased HIV/AIDS services, particularly for those that affect New York City, an epicenter of the epidemic in the United States,” she says. “In the city, 66,000 people are living with HIV/AIDS, and I am committed to helping them get the medications and care that will allow them to continue participating in their lives to the fullest extent possible.”
She notes that, fortunately, there are many wonderful providers and social service agencies in New York City that work at the neighborhood level to address the concerns of people living with HIV.
Of course, her concern extends beyond New Yorkers. “I’m concerned about all persons with this disease across the globe,” she says. “I think that we need to improve care for everyone with HIV, and I am very proud of my legislative record on AIDS issues. I’ve introduced several bills to benefit people with AIDS, including the Early Treatment for HIV Act, which would allow states to expand their Medicaid programs to provide treatment services for low-income individuals living with HIV (who have not yet developed full-blown AIDS).”
The Senator proudly notes that her husband was the first President to establish the position of AIDS “czar”—Director of the White House Office on National AIDS Policy (which coordinates domestic efforts to reduce the number of new HIV infections). “I think that during his time in the White House, [Bill Clinton] was able to focus a lot of resources and attention on the epidemic,” she says. Likewise, she acknowledges her own opportunity, while in the White House, to make AIDS more of a focal point.
“While First Lady, I was active in bringing attention to the impact of AIDS on women and children,” she says. “I advocated increased counseling and testing for pregnant women, especially after we learned of the effects that AZT could have on preventing mother-to-child transmission. Our government’s early action on promoting testing has helped thousands of mothers during their pregnancies.”
But just as she is hopeful, touting improvement in AIDS treatment, she also recognizes the work ahead. “While we have made much progress, we are still a long way from resolving this epidemic,” she says.
From her perspective as Arkansas’ First Lady when the Ryan White CARE Act was enacted, she recalls, “I was able to see what assistance this program could be to states…like Arkansas, which, at that time, had a very small number of reported AIDS cases. With the state grants [it] provided, Arkansas was able to have some resources dedicated to AIDS to help the people in the state who would otherwise not have access to programs that tend to their unique needs.”
Undoubtedly, Clinton has worked to better the healthcare system, above and beyond HIV and AIDS. So, I asked how an overhauled U.S. health system could most benefit people with AIDS, as well as how the unique threat of the pandemic might still continue to be a special challenge for us. Her answer is characteristically straightforward.
“We have the most advanced medical system in human history—the finest medical institutions, the newest treatments, the best-trained healthcare professionals,” Senator Clinton says. “But in spite of the best intentions of clinicians, patients, and policy makers, our system is plagued with underuse, overuse, and misuse.”
Clearly, that is something the junior Senator from New York would like to change. “Because of this crisis, I have introduced legislation to modernize our healthcare system, reduce errors, and lower costs,” she says, “By building a fully interoperable information technology infrastructure, we can share information and empower patients to become active participants in maintaining their health while ensuring their privacy.”
By using information technology in a way that protects privacy but reduces duplication, Senator Clinton says, “it would make the healthcare system infinitely easier for a person with HIV to navigate.” Instead of having to pass records from primary caregivers to specialists, for example, a streamlined healthcare system would make it easier and quicker for a provider to access test results and treatment information.
“Having more information about drug interactions and possible treatment resistance will make it easier to adjust regimens and improve the health of people living with HIV,” she adds.
She also notes that, as we make improvements to the overall healthcare system, “we must be particularly vigilant to ensure that better management of AIDS does not lead us to become complacent about the threat that the disease poses.” And, as you might expect, the Senator has specific ideas as to just where that vigilance is needed.
“While we want to make sure that everyone will have access to medications and treatment,” she says, “we cannot lose sight of the fact that we still need increased research on AIDS. Slowing the progression of HIV is certainly no substitute for a cure, and we cannot allow our progress in improving the health of many to distract us from the overall goal of complete eradication….”
In terms of balancing education and prevention resources, I just had to ask Senator Clinton her “take” on the recent resurgence of abstinence-only or abstinence-centric programs. Her answer envelops sound science—and compassion.
“As educators have been saying since the beginning of the AIDS epidemic, abstinence is the only sure method of prevention,” she says. “And for so many of America’s teenagers, abstinence is really the right choice. There is a lot of pressure from society to have sex….But so many of our teens just aren’t ready, and know they are not ready to accept the emotional and physical responsibilities involved with having sex for the first time.”
At the same time, she is realistic about the necessary breadth of education and prevention programs. “I think that an abstinence-only curriculum—a ‘Just Say No’ program—does a great disservice to our youth,” she says. “At some point, when they do make the choice to have sex, they are going to need to know how to protect themselves against HIV and other sexually transmitted infections. It’s not a matter of sending a mixed message to our youth…it’s a matter of giving them information that could save their lives.”
As always, the informed worldview of this long-time policy maker is apparent in her answers to my questions.
“One other reason that I do not support abstinence-only programs, especially on the international level, is that, far too often, avoiding sex is not just a matter of saying ‘no,’” she says. “Many women and girls cannot make the choice of when to have sex. They are forced into situations where they have to have sex with partners to avoid abuse, and in addition to trying to help them get out of these situations, we have to give them the information they need to protect themselves.”
Make no mistake, Senator Clinton is ready to mobilize to ensure sound education and prevention policy has the footing it needs, all the while staying the course with AIDS treatment. “I fully support increasing funding for HIV education and prevention,” Clinton says. “But I do not think that we should be [forced to choose between funding] prevention or treatment. We need to understand that prevention and treatment are linked. Treatment offers us an opportunity to continue education and counseling with people who are HIV-positive, to reduce the possibility that they might pass the virus to others.”
With international AIDS efforts seemingly more in vogue now than domestic efforts to battle the pandemic, I ask the Senator how we might strike a balance between the two. Her approach to the topic is both philosophical and practical. “It is clear that AIDS has had a devastating effect not only for our nation, but for many developing countries,” she says. “The toll of HIV/AIDS has reached catastrophic proportions around the world, and it would be inexcusable for our government to sit on the sidelines any longer.” She continues, saying, “We have experience in fighting AIDS domestically, and it’s our duty to use this knowledge to help other nations deal with their own epidemics.”
Now, as for a focus on the AIDS crisis closer to home, she says, “I think that the recent UNAIDS theme of ‘women and girls around the world’ offered an excellent way to draw attention to the domestic AIDS epidemic. In the United States, AIDS cases among women have tripled since 1985, and in New York, about one-third of new AIDS cases occur among women.”
“We can no longer afford to ignore the rampant epidemic among African-American women, who represent an overwhelming seventy-two percent of new HIV diagnoses among women,” the Senator says.
“We need to examine the factors behind the increasing rates of HIV infection among women, learn what the barriers are that keep women from protecting themselves, and develop programs that will address those barriers. Since women are also traditionally caregivers of children and family members, we need to ensure that our programs are flexible enough to recognize the dual role of women as both provider and patient.”
And, because she is indeed a sitting member of the U.S. Senate, Clinton again notes opportunities Congress has to effect AIDS change. “I…think that when reauthorization of [Ryan White] comes before Congress, we will be able to bring national attention to the domestic epidemic, and the shortfalls that currently exist in our HIV/AIDS care,” she says. “Too many people are on ADAP [AIDS Drug Assistance Program] waiting lists. Too few people are able to access treatment at the early stages of HIV disease, and too many people are still becoming infected with HIV. I’m hopeful that when we discuss Ryan White, we will gain an understanding of AIDS in America that will allow us to provide a higher standard of care and support to people living with HIV/AIDS.”
Finally, I wondered what words of encouragement one of the most recognized and powerful women in America might offer to people with HIV/AIDS who may be wondering if help is on the way. “They should know that there are many of us in government, both Democrats and Republicans, who are working to confront and eradicate this disease and support those living with this virus,” she says. “[They should know that] we support increased funding for treatment, more research on vaccines, and additional social services for people infected with and affected by HIV.”
Obviously, Clinton is well-aware of the unprecedented nature of the pandemic—and the role she can play in battling it. “The profound human tragedy of HIV/AIDS has already exacted an incalculable economic and human toll, and we will continue to devote our energy and resources to seeking solutions for the epidemic,” she says.
In closing, the Senator reflects on both the progress and the plight of individuals living with HIV/AIDS, saying, “we have so far to go in the fight against this pandemic, but I am encouraged by the significant progress that we have made so far. I know that, someday, we will be able to ensure that, no matter where you live, AIDS will cease to be the terrifying killer it is today.”
B. Andrew Plant is an Atlanta-based freelance writer and formerly the Editor at Large of A&U.