AIDS and the Clinton Presidency: The Persistence of Stigma

The Reagan administration was vilified for AIDS policies that reflected (at best) indifference and (at worst) hostility towards people diagnosed. Little changed in the H.W. Bush administration, even though he promised a “kindler, gentler America.” Provisions for care and codification of rights expanded under the Bush administration, chiefly through court decisions and the reluctantly signed Ryan White Care Act of 1990, the enduring foundation for federal support for people with AIDS.

The Clinton administration promised a breath of fresh air yet ultimately left a mixed legacy. He showed interest in HIV/AIDS and welcomed gay people to the White House but caved on gays in the military and signed the Defense of Marriage Act. He benefitted from the mid-1990s discovery of anti-retroviral drugs that transformed AIDS from a usually fatal to a chronic disease and lessened the epidemic’s political sting for politicians wanting to avoid discussions of sex and drugs. But when faced with federal funding for needle exchange programs, which would save thousands of lives, he retreated. Clinton responded with cautious support to funding to combat AIDS in Africa, laying a path for George W. Bush’s PEPFAR (President’s Emergency Program for AIDS Relief), which saved millions of lives, primarily in Africa.

Our paper assesses Clinton’s decision making about HIV in comparison with his Republican predecessors. We analyze new evidence based on previously unexploited materials at the Clinton Presidential Library, including records opened in response to our Freedom of Information Act requests. We argue that, while there was undoubted evolution in cultural and political responses to AIDS, the politics of stigma remained potent for Clinton and many liberals. Reagan’s surgeon general, C. Everett Koop, lamented Reagan’s failure to exercise presidential leadership about HIV/AIDS – an absence that shadowed the first twenty years of the epidemic, regardless of ideology or political party.