How Obama, McCain Differ On HIV/Aids

Where They Stand
To help you make an informed decision in the presidential election, CBS News is devoting a large part of our broadcasts until Nov. 4 to telling you where the candidates stand on major issues - from the war in Iraq to health insurance to education … and a lot more. Each piece will be an in-depth look at the issues facing the 44th president. In this installment, CNN's Sanjay Gupta, a CBS News contributor, reports on how the proposed HIV/AIDS policies of Barack Obama and John McCain would affect your community.

The Issue

It was a sight seldom seen in Washington - bi-partisan praise for President Bush's re-authorization of a plan for global AIDS relief. It's called PEPFAR (President's Emergency Plan for AIDS Relief), and it's the largest international health initiative ever for a single disease.

"The legacy of this administration will certainly be the work that this president has done regarding the global AIDS epidemic," said Phill Wilson, executive director of the Black AIDS Institute.

But while we as a nation spend almost $10 billion annually to fight AIDS abroad, we spend less than 10 percent of that here at home.

"There's tremendous irony that while we're showing leadership on the global epidemic, we're showing complete neglect on the domestic epidemic," Wilson said.

And, estimates by the Centers for Disease Control and Prevention reveal African Americans in particular are disproportionately affected. In the year 2006, blacks accounted for 45 percent of new HIV infections - more than 22,000.

The reasons why?

"One of them is shame - people are ashamed to have the infection. The other is stigma - they're punished if someone else finds out they have it," said Dr. Julie Geberding of the CDC, in testimony. "And then the third is ignorance."

It's a pandemic that's spreading right under our nation's nose.

The CDC estimates that one in 20 people living in Washington, D.C., is HIV positive. Astoundingly, in the capital of the world's wealthiest country, the incidence of HIV/AIDS is two-and-a-half times that of Port au Prince, the capital of Haiti, one of the world's poorest countries.

C. Russell, 31, is HIV-positive, having been diagnosed nine years ago after having unprotected sex.

"Eighty percent of the HIV cases in this city - your city - are in blacks," Gupta said.

"They are," Russell said.

"What is going on here?" Gupta said.

"Apathy in our community. Apathy possibly maybe from the government," he said. "People not going and getting tested and getting treatment once they're diagnosed."

Luckily, Russell's been able to keep the virus at bay, without the need for medication. But if he did get sick, care and treatment costs over his lifetime could easily top $275,000.

"If it came to that, I'd want to know that I'd be taken care of. I'd want to know that I'd be able to get health care," he said.

But it's not just men.

The incidence rate for black women like Danielle, who is 42 and HIV-positive, is nearly 15 times that of whites - making AIDS a leading killer of African-American women ages 25 to 34.

Danielle contracted HIV through sexual intercourse 15 years ago, and passed the virus onto one of her five children during pregnancy.

"A lot of people are in the mindset that well, because we have medication we can take, it's OK if I become HIV positive," she said.

But Danielle has no health insurance. So she'll be in trouble should she ever develop AIDS.

"You couldn't get all the medications that you need, you couldn't get the sub-specialty care that you need. What would happen to someone like you?" Gupta said.

"I'd probably get sicker. And possibly even die," she said.

The Candidates

So where do the candidates stand? For starters, they both fully support President Bush's PREFAR program - but that's focused on the epidemic overseas. So, what if you're one of the 1.2 million Americans living with HIV/AIDS?

"We have to have a more effective AIDS policy. Studies have shown we may have undercounted the incidence of AIDS in this country," Barack Obama said.

Obama's plan begins with his promise to sign universal health care legislation by the end of his first term as president.

He wants to prevent HIV through sex education and by promoting HIV testing in minority communities.

But the cornerstone of the Obama plan calls for a national HIV/AIDS strategy involving all federal agencies.

"When we give money to developing countries to fight AIDS, we demand they have a national strategy. And yet we don't have a national AIDS strategy in this country," Wilson said.

"I think we need a domestic plan," Sen. John McCain said.

McCain's prescription to prevent HIV: Emphasize abstinence programs. For those with pre-existing conditions such as AIDS, he wants to establish "guaranteed access plans" for affordable insurance.

His prescription for rising drug costs? Greater competition among drug companies. But the centerpiece of the McCain blueprint? A $2,500 tax credit for individuals to purchase the health care coverage of their choice.

The Impact

"How does that affect you?" Gupta asked Russell.

"It sounds like I'd get a tax credit for money that I would spend on health care, which is okay, but I'd rather have the health care," he said.

"You also have to have to have a health insurance company that accepts you," Gupta said.

"Exactly," Russell said.

For now, Russell may not benefit more from either candidate's plan, because he already has health insurance through his employer. On the other hand, Danielle would have a better chance with either candidate than she does now to find affordable coverage. But there was one thing that Obama said that captured her attention.

"Especially in the African-American and Latino communities, it is skyrocketing," Obama said.

"Just the fact that, I guess Senator Obama speaks specifically to the community of which I belong," she said. "It makes me know that he cares about the African-American community."

Nevertheless, both Danielle and Russell are hopeful that the leadership America has shown overseas will inspire the next president to show leadership on the AIDS epidemic here at home.