by Alecia McGregor–Opinion courtesy of TheGrio.com
Two years ago, the nation’s oldest civil rights organization and oldest university formed a partnership to investigate the persistent racial disparity in HIV/AIDS in the United States.
With the help of national partners from academia, the non-profit sector, government, and medicine, Harvard University’s Center for AIDS Research and the NAACP held a symposium in Boston to offer explanations for why African-Americans make up a startling share of Americans dying of HIV/AIDS.
When this group of experts reviewed the research literature, they verified what AIDS activists have clamored for since the 1980s—that the U.S. needs increased access to care and a comprehensive response to social inequalities to successfully fight AIDS. Although the U.S. has made important steps toward this type of policy response, the current threat of across-the-board budget cuts in Washington threatens to reverse progress toward ending the epidemic and reducing this disparity.
In many respects, African-Americans bear the brunt of the HIV/AIDS epidemic in this country. Accounting for only 14 percent of the population in 2009, black Americans represent a disproportionate 44 percent of new HIV infections. Black Americans are also much more likely to die of the disease than their white counterparts, with blacks making up 57 percent of all HIV-related deaths in 2007. Even more troubling is that the gap in HIV-related mortality rates between blacks and whites has increased more than two-fold since 1985, reflecting continuing inequalities in access to treatment and stark differences in socioeconomic status across races.
Recognizing this, participants in the symposium generated policy recommendations that ranged from including African-Americans in clinical trials for new medicines to integrating African-American studies into public school curricula as a means of empowerment.
By and large, these proposals emphasized that social determinants — such as poverty, lack of insurance, discrimination, and inequalities in education — work to create the gap in HIV infection and HIV-related mortality in blacks versus other groups.
For instance, participants highlighted that black Americans are currently more likely to be uninsured than white Americans (20 percent versus 11 percent), making access to HIV/AIDS medications more difficult for African-Americans.
Black young people are also much more likely to attend public schools, where sex education is neither required nor guaranteed to be funded in more than half of all U.S. states.
These social determinants may contribute to the reasons why black Americans are more likely to be “late testers,” or to learn of their HIV status only months before developing full-blown AIDS. Notably, factors like widespread stigma, inadequate access to primary care, and the inability to reveal one’s sexuality to their primary care physician were cited as barriers to diagnosis and treatment for HIV. Ultimately, participants in this symposium — along with several other public health experts and AIDS service providers — have made the case that the role of social and economic inequalities in HIV transmission calls for a broader social policy response to the epidemic.
However, in today’s political environment, where the dramatization of a fiscal cliff and the terror of sequestration keep many policy wonks in the grip of suspense, it is hard to imagine the possibility of fully-funded social policies that begin to truly address the complexity of HIV/AIDS. In fact, with domestic discretionary spending very much on the chopping block — and both Democrats and Republicans responsible for placing it there — the heads of community programs all across the country move forward in a precarious circumstance, not knowing whether the work they do to keep HIV-positive-persons in safe and affordable housing, for example, will exist in the next fiscal year.
However, what is distinct, and hopeful, in the current political landscape is the unprecedented level of institutional and legislative commitment to combating HIV/AIDS and the mesh of social factors driving the epidemic. To their credit, the White House’s Office of National AIDS Policy issued the first National HIV/AIDS Strategy in 2010, explicitly highlighting the need to address disparities in HIV/AIDS, and noting the role of stigma and discrimination in the spread of HIV. With past administrations paying considerable attention to the AIDS epidemic outside of the United States, this marks a major shift in executive-level commitment to the domestic epidemic.
Additionally, as we approach full implementation of the Affordable Care Act (“Obamacare”) in 2014, we can move forward with greater confidence that people living with HIV will no longer be discriminated against by insurers because of their pre-existing condition, and that this barrier of access to care will be removed.
However, other vital federal and state-level public health programs—including Medicaid, the AIDS Drug Assistance Program and the Housing Opportunities for Persons with AIDS program—currently face the threats of cuts with the impending fiscal cliff and require protection from members of Congress.
Following the re-election of a president who understands the social determinants of HIV, we must not forget to address the root causes of the epidemic. Given the evidence of such strong connections between poverty, discrimination and other social inequalities and HIV, this is perhaps the only sure way to combat the spread of the virus and to end AIDS. Even at the edge of this fiscal cliff, the U.S. must keep its commitment to the social policies that will prevent those of us most at risk from falling off.
Alecia McGregor is a Ph.D. candidate in Health Policy at Harvard University. (*Disclaimer: This article does not reflect the opinions and views of the NAACP or Harvard University, only those of the author herself.)
by Bryce Covert
Is the 2012 election going to hinge on voters’ beliefs about the government workforce? It seems that at least this week’s news cycle will. It’s an important conversation to have. Public sector job loss is at the heart of our stagnant economy and is a big reason why the recovery can’t get real lift-off. Yet this isn’t a coincidental phenomenon or a bipartisan issue. Republican lawmakers are to blame for the bulk of these job losses, and their solutions to the problem will only add fuel to the fire.
To recap for those who don’t watch the Sunday talk shows: In a press conference on Friday, President Obama said, “The private sector is doing fine.” The full quote shows that he was talking about private sector job creation versus public sector job loss, but the pundits began a-punditing and soon his quote had become synonymous with “the economy is doing fine,” as if the private sector is all that matters.
Never one to sit on an opportunity to muddy his own message, Mitt Romney jumped in later in the day to take it further. Instead of confining his attack to Obama’s (purported) suggestion that things are hunky-dory in the private sector while the economy is still clearly suffering, Romney maligned some of the most beloved public sector workers. He said of Obama: “He wants another stimulus, he wants to hire more government workers. He says we need more fireman, more policeman, more teachers.… It’s time for us to cut back on government and help the American people.”
Both soundbites are likely to get so bent out of shape by the media game of telephone that they’ll eventually end up unrecognizable. But at the heart of each statement lies a fundamental difference in how the two candidates — and the two parties — view the nature of the jobs crisis. From Obama’s point of view, we’re not being dragged down by job loss in the private sector but by losses in the public sector. Romney sees exactly the opposite: We should cut even more jobs in the government and invest more heavily in private sector job creators. (He even explicitly called for government job cuts just a week ago.) So which view is right?
Evidence backs Obama’s perspective. Since the recovery officially began, the number of local government jobs has fallen by 3 percent, while the private sector has actually been able to add jobs — 4.3 million, to be exact. And it’s worth comparing those numbers to recent recessions to get the full effect of just how bad, and abnormal, this trend is. Romney is at least partly right in that the private sector isn’t doing as well as it could be. At this point in the recessions experienced in 1992 and 2003, it had added 5 million and 4.5 million jobs, respectively.
But the public sector looks far, far worse now than it did then. As Ben Polak and Peter K. Schott write in the New York Times today, “In the past, local government employment has been almost recession-proof. This time it’s not.” Local government employment actually grew in the past two recessions by 7.7 percent and 5.2 percent for each respective period. This time around, it’s hemorrhaging jobs.
So it seems that while both candidates’ exaggerations were a bit off — Obama misspoke in suggesting that the private sector is completely shielded from pain — he gets closer to the heart of the problem than Romney. The huge fall in public sector employment really is dragging down the economy. As we wonder how to get out of this economic mess, it’s good to keep in mind another point Polak and Schott make: “If state and local governments had followed the pattern of the previous two recessions, they would have added 1.4 million to 1.9 million jobs and overall unemployment would be 7.0 to 7.3 percent instead of 8.2 percent.” That’s a huge difference.
But it’s also extremely important to remember why we’re in this situation. Polak and Schott hypothesize that it could be an electorate that is no longer willing to stomach paying for a growing government workforce. Or perhaps, they say, it’s that state and local governments have run out of ways to handle their extremely crunched budgets. But as Mike Konczal and I showed not too long ago, the massive job loss we’ve been experiencing in the public sector is no random coincidence or unfortunate side effect. It is part of an ideological battle waged by ultra conservatives who were swept into power in the 2010 elections. Republicans seized control of eleven states, and of those, five were at the top of the list for public sector job loss. Only seven states lost more than 2.5 percent of their government workforce from December 2010 to December 2011, and those five newly Republican states were among them. All others fared far better: They lost an average of .5 percent of their government employees.
This means that the eleven states that went red two years ago were responsible for 40 percent of these public sector job losses in 2011. If we add in Texas, a massive red state, we can pinpoint the source of 70 percent of those losses. And these losses were the result of deliberate decisions: Even in the face of tight budget constraints, many of these states cut taxes for corporations and top earners while slimming down the public payrolls. It was part and parcel of a new agenda that came in with Tea Party-esque Republican legislators.
All of this is even more important when we switch from discussing the causes of the jobs crisis to the solutions. Romney’s plan looks very similar to those being played out in these ultraconservative states: he wants to further eviscerate the public workforce — including, apparently, policemen and teachers, who are desperately needed right now — while continuing tax breaks and creating even more for top earners and corporations.
On the other side of the aisle, Obama is still demanding — even if the demand is falling on deaf ears — that Congress pass his American Jobs Act, which would spend $35 billion in federal funds to keep those very government workers in their jobs. Guess who opposes that plan? Congressional Republicans and Mitt Romney.
There are still some remaining questions when it comes to Obama’s plan. Where’s the money to put public employees back to work after so many lost their jobs? Even more troublesome, if these job losses are due to ideologically driven decisions, will more federal spending really make a dent? Will these ultraconservative Republicans even accept the money? But it is clear that under a President Romney that money won’t even be offered and even less may be extended. Whether employed by the government or a private business, any voter should be nervous about a candidate that is threatening to further a trend that’s already holding our economy back.
Bryce Covert is the Editor of the Roosevelt Institute’s New Deal 2.0 blog. She lives and works in New York City.
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