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América 101: Por que temos debates presidenciais?

América 101: Por que temos debates presidenciais?


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Hidden H.I.V. da América Epidemia

Por que os homens negros gays e bissexuais da América têm um H.I.V. taxa do que qualquer país do mundo?

Jermerious Buckley, um homem positivo para H.I.V. em Jackson, senhorita. Crédito. Ruddy Roye para The New York Times

Cedo, em uma manhã amena de outubro passado, Cedric Sturdevant começou suas rondas ao longo das ruas esburacadas e estradas secundárias de Jackson, Srta. Sturdevant, 52, acumulou quase 300.000 milhas dirigindo em loops e círculos alargados ao redor de Jackson em seu papel improvisado de visitante enfermeira, treinador motivacional e figura paterna para um número crescente de jovens gays e mulheres transexuais que sofrem de HIV e AIDS. Sturdevant é coordenador de projetos da My Brother’s Keeper, uma organização local sem fins lucrativos de serviços sociais. Se ele não faz essas rondas, ele aprendeu, muitos desses pacientes não vão às consultas médicas, farmácias, bancos de alimentos e sessões de aconselhamento que podem fazer a diferença entre a vida e a morte.

Negociando um labirinto de estradas não pavimentadas em Jackson no carro da empresa, uma Ford Expedition de 13 anos com bancos rachados e pintura lascada, ele parou para deixar o H.I.V. medicação na casa de um casal. Um dos homens era H.I.V. positivo, o outro negativo eles viviam no bairro que os moradores locais chamam de Bottom, onde cada cinco ou seis casas são abandonadas, com janelas quebradas, portas penduradas nas dobradiças, galhos caídos e folhas secas cobrindo os jardins da frente. Sturdevant bateu na porta de uma casinha, com o quintal coberto de mato que ele sabia não deixar o pacote na soleira da porta, onde poderia ser roubado. Depois de um tempo, um jovem apareceu, sem camisa, encolhendo os ombros para dormir. Ele tinha acabado de sair da prisão. Sturdevant entregou-lhe o pacote, apertou sua mão e disse-lhe para "ficar longe de problemas".

Sturdevant dirigiu por mais 15 minutos para pegar Marq (uma versão abreviada de seu nome para proteger sua privacidade), um adolescente que ainda estava se recuperando do H.I.V. diagnóstico que recebeu na primavera anterior. Enquanto eles iam e voltavam de uma consulta médica e de uma reunião com um conselheiro, Sturdevant, de fala lenta e paciente, com olhos que desaparecem em suas maçãs do rosto quando ele sorri e uma barba branca como a neve, grelhou-o suavemente, lembrando-o de ficar com os remédios . O adolescente afundou no banco de trás, meio ouvindo, meio verificando seus textos. Ele olhou para cima brevemente quando Sturdevant disse a ele: "Você percorreu um longo caminho. Estou orgulhoso de você." Mas Marq mal se despediu ao saltar do carro em frente a uma loja de conveniência em uma avenida repleta de uma casa de penhores, uma loja de bebidas e várias igrejas batistas, e quase admitiu que planejava passar a tarde fumando maconha e procurando no Instagram. "Knucklehead," Sturdevant sussurrou, enquanto o adolescente batia a porta. Tirando seu boné de beisebol favorito do Dallas Cowboys e passando a mão sobre a cabeça careca, Sturdevant acrescentou suavemente: "Parte meu coração."

Esses pacientes de Sturdevant são as faces de uma das crises de saúde pública mais preocupantes da América. Graças ao sucesso da medicação anti-retroviral que salva vidas, lançada há 20 anos e anos de pesquisa e educação, a maioria das pessoas HIV positivas hoje pode levar uma vida longa e saudável. Em cidades como Nova York e São Francisco, que já foi o marco zero da epidemia de AIDS, o vírus não é mais uma sentença de morte e as taxas de infecção despencaram. Na verdade, nos últimos anos, as autoridades de saúde pública defenderam a ideia de que uma geração sem AIDS poderia estar ao nosso alcance - mesmo sem uma vacina. Mas em certos bolsões do país, desconhecido para a maioria dos americanos, o H.I.V. ainda está devastando comunidades em taxas surpreendentes.

No ano passado, os Centros de Controle e Prevenção de Doenças, usando as primeiras estimativas nacionais abrangentes de risco ao longo da vida de H.I.V. para várias populações-chave, prevê-se que, se as taxas atuais continuarem, um em cada dois homens afro-americanos gays e bissexuais será infectado com o vírus. Isso se compara ao risco ao longo da vida de um em 99 para todos os americanos e de um em 11 para homens gays e bissexuais brancos. Para oferecer mais perspectiva: a Suazilândia, uma pequena nação africana, tem a maior taxa de H.I.V. do mundo, com 28,8% da população. Se homens afro-americanos gays e bissexuais constituíssem um país, sua taxa ultrapassaria a desta empobrecida nação africana - e de todas as outras nações.

A crise é mais aguda nos estados do sul, que detêm 37% da população do país e em 2014 representavam 54% de todos os novos H.I.V. diagnósticos. O Sul também abriga 21 das 25 áreas metropolitanas com o maior H.I.V. prevalência entre homens gays e bissexuais. Jackson, a capital do Mississippi, o estado mais pobre do país, é mais conhecida por blues, churrasco e "The Help". Ele também tem a maior taxa do país - 40 por cento - de homens gays e bissexuais vivendo com HIV, seguido por Columbia, SC El Paso Augusta, Geórgia e Baton Rouge, Louisiana. Em Jackson, uma pequena cidade de pouco mais de 170.000, meio a dezenas de homens negros gays ou bissexuais recebem o choque de um diagnóstico todos os meses, e mais de 3.600 pessoas, a maioria deles homens negros, vivem com o vírus.

O Sul também tem o maior número de pessoas vivendo com H.I.V. que não sabem que foram infectados, o que significa que não estão envolvidos em tratamento e cuidados que salvam vidas - e correm o risco de infectar outras pessoas. Um número excessivo deles está morrendo: em 2014, de acordo com uma nova análise da Duke University, 2.952 pessoas no Deep South (Alabama, Flórida, Geórgia, Louisiana, Mississippi, Carolina do Norte, Carolina do Sul, Tennessee e Texas) morreram com H.I.V. como causa subjacente, com as maiores taxas de mortalidade no Mississippi e na Louisiana. Entre os homens negros nesta região, a taxa de mortalidade relacionada a H.I.V. foi sete vezes maior do que a da população dos Estados Unidos em geral.

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Sturdevant, nascido e criado em Metcalfe, uma pequena cidade de cerca de 1.000 habitantes no Delta do Mississippi, entende muito bem o medo, o estigma e o isolamento que podem advir de ser um homem negro gay no sul. “Enquanto eu crescia, fui ensinado que Deus não estava planejando perdoar uma pessoa que era homossexual”, disse Sturdevant. “A Bíblia supostamente disse que você está indo direto para o inferno, automaticamente, não há perdão. Várias vezes pensei em suicídio. Várias vezes eu quis ficar doente e morrer. Finalmente, meu pensamento foi, eu só quero sair daqui. ” Ele se mudou para Dallas e depois para Memphis.

Quando soube que tinha H.I.V. em 2005, Sturdevant sabia pouco sobre o vírus e estava muito deprimido e envergonhado para contar a alguém no início. Quando seu parceiro morreu no ano seguinte, ele deixou que a doença o consumisse. “Eu estava fraco, tive uma febre de 103, não conseguia nem conter a água”, lembrou ele. Sturdevant compartilhou sua história muitas vezes para contar, para que os rapazes saibam que ele também esteve lá e para ajudá-los a compreender que podem sobreviver a esta praga. Ele também sabe que muitos homens negros gays e bissexuais foram rejeitados e descartados, e envolveu seus braços em torno de tantos quanto pode agarrar, tratando-os como família. Sturdevant tem duas filhas de um casamento precoce e três netos, mas ele diz que sente a mesma coisa por seus 16 ou mais “filhos” não aparentados, a maioria deles vivendo com H.I.V. Ele os alimenta, às vezes os abriga, mas principalmente os ouve. “Jovens negros se sentem abandonados e precisam de alguém em quem possam acreditar e que acredite neles”, disse Sturdevant enquanto dirigia por campos de algodão fofo, com as mãos apoiadas levemente no volante. “Eu disse a Deus que queria poder ajudar caras como eu, que não cresceram com o pai, e eles começaram a vir até mim, querendo conversar. Depois de um tempo, eles traziam outras pessoas até mim e diziam: ‘Pai, você também pode ajudá-lo?’ ”

Sturdevant moveu seu assento para trás, preparando-se para uma longa viagem, e ajustou o rádio para 107,5, o R. & ampB local. estação dos antigos. O lamento de Toni Braxton - "Gostaria que você me segurasse em seus braços como aquele violão espanhol" - encheu o carro. Ele estava indo para uma pequena cidade 90 milhas a leste da cidade para visitar Jordon, um H.I.V. positivo de 24 anos de idade. Quando o próprio Sturdevant estava em seu ponto mais baixo, ele disse: "Eu parecia algo como esse menino que vamos ver."

Ele atendeu a uma ligação de De’Bronski, um dos "filhos" de quem ele cuidou e com quem se relacionou. Sturdevant conheceu o jovem em 2009 e o acolheu, mais tarde o ajudou a lidar com seu H.I.V. diagnóstico. "Eu também te amo", disse Sturdevant. Então ele virou em uma rua sem saída e parou em frente à casa de tijolos de um andar onde Jordon morava. "Estou muito preocupado com ele", disse Sturdevant, baixando a voz enquanto caminhava pela calçada rachada da garagem em direção à porta da frente. Jordon postou recentemente uma foto de sua moldura esquelética no Facebook, pedindo aos amigos que “orem por mim”.

Como ele pisou no quarto abafado de Jordon, os olhos de Sturdevant varreram de uma cadeira de rodas encostada na parede até uma lata de Garantia na mesa de cabeceira antes de se fixar no jovem. Ele estava esfregando os pés, estremecendo com a neuropatia relacionada a H.I.V. que causou o que ele descreveu como "dor ímpia". Os olhos redondos e encobertos de Jordon estavam afundados em seu rosto. Calça de moletom cinza acumulava-se em torno de suas pernas finas como um palito, tão frágeis que pareciam como se você pudesse parti-las em duas. Seus braços estavam marcados com cicatrizes de visitas ao hospital e IVs. Com mais de um metro e oitenta de altura, ele pesava apenas 45 quilos. Ele sorriu levemente quando viu Sturdevant, covinhas se formando em suas bochechas encovadas. "Ei, Sr. Ced", disse ele, com a voz rouca.

Em fevereiro de 2016, Jordon de repente se viu muito fraco e cansado para frequentar as aulas da faculdade comunitária em que se matriculou, mal conseguia levantar a cabeça do sofá de sua mãe. Ele não estava acostumado a ficar doente e seu teste deu negativo para H.I.V. apenas cinco meses antes, pensando que estava com um forte resfriado, ele esperou semanas antes que sua família o obrigasse a ir ao pronto-socorro de um hospital em sua pequena cidade, onde ele foi testado novamente. “O médico disse-me:‘ O seu H.I.V. é tão ruim - como você poderia não saber? '”Jordon contou em meio às lágrimas. Ele acabou na UTI por três semanas. "Sinceramente, não acreditei." Ele fez uma pausa e acrescentou baixinho: "Foi o pior dia da minha vida."

Com esforço, Jordon sentou-se ligeiramente, desembaraçando-se de uma confusão de lençóis. Sturdevant perguntou como ele estava e catalogou uma longa lista do que chamou de suas doenças do “velho”. “Eu tive de tudo - diarreia, hemorróidas, agora essa neuropatia”, disse ele. "Meu corpo me odeia." Uma vez por mês, sua mãe ou avó o levava a consultas médicas em Jackson, para receber cuidados de profissionais experientes no tratamento de pessoas que vivem com H.I.V. e para evitar o olhar de uma cidade pequena nas instalações locais, não há crise de saúde dos gays para ele visitar em sua pequena cidade, como haveria se ele vivesse em Nova York. “Todo mundo conhece todo mundo aqui”, disse Jordon. “No hospital, eles conhecem minha mãe, meu irmão e minha avó. Prefiro estar perto de pessoas que não me conhecem. ” Envergonhado demais para admitir que tinha o vírus, Jordon contou a poucos amigos sobre seu diagnóstico.

"Você está tomando seu remédio?" Sturdevant perguntou. Para muitos jovens, o H.I.V. o diagnóstico e a doença são tão devastadores que pode ser difícil manter um regime de medicação novo e desconhecido. Jordon baixou os olhos. "Não com a frequência que deveria." Quando ele viu o brilho de Sturdevant, ele continuou, parecendo um garotinho. “Odeio tomar remédio, odeio. Tenho que tomar seis comprimidos, agora sete, oito, mais uma injeção - ”

Sturdevant o interrompeu. “Todos nós temos que fazer isso, Jordon. Você não quer melhorar? ”

Jordon deixou sua cabeça cair no travesseiro. "Eu sei que posso melhorar, Sr. Ced", disse ele, massageando os pés. “Eu simplesmente não sei como tudo ficou tão ruim.”

Dados os avanços na pesquisa, informação e tratamento, parece inconcebível que alguém que vive com o vírus hoje, como Jordon, possa parecer que saiu dos primeiros anos da epidemia. No entanto, uma série de decisões e omissões fatídicas, que remontam à descoberta da doença, levaram a um presente que se parece com o passado - mas apenas para alguns.

A história marca o início da epidemia de AIDS americana em 5 de junho de 1981, quando uma edição do Relatório Semanal de Morbidez e Mortalidade do CDC - a voz autorizada da agência - destacou cinco casos de pneumonia por pneumocystis (PCP) em homens previamente saudáveis ​​em Los Angeles. Pessoas saudáveis ​​não contraem doenças como o PCP, que até então era restrito a pacientes sob medicação para suprimir o sistema imunológico para um transplante de órgão ou pacientes com câncer em quimioterapia. Embora não declarado explicitamente, a linguagem do relatório, ao omitir raça, implicava que seus “cinco jovens, todos homossexuais ativos”, eram brancos, o que de fato eram. Mas havia mais dois casos documentados, não mencionados no aviso, e esses sexto e sétimo casos eram negros - um deles um afro-americano gay, o outro um haitiano heterossexual.

O Dr. Michael Gottlieb, o principal autor do relatório e um renomado médico especializado em H.I.V./AIDS, tratou Rock Hudson antes de morrer de complicações da AIDS em 1985 e ainda pratica em Los Angeles. Gottlieb disse que frequentemente perguntam por que não incluiu naquele primeiro relatório o caso documentado do homem gay afro-americano, que tinha PCP e citomegalovírus, um vírus que ataca os órgãos de pacientes com sistema imunológico comprometido. Ele explica que descobriu o caso após a finalização do laudo. “Até recentemente, eu não teria pensado que isso importasse”, disse Gottlieb, que disse que ele e outros na linha de frente estavam lutando com um mistério médico sem precedentes e assustador e trabalhando em grande parte no escuro. “Mas, em retrospecto, acho que pode ter feito diferença entre homens negros gays.”

Incluir homens negros gays na literatura e compreensão das origens da doença e seu tratamento poderia ter significado um alcance anterior, mais uma voz e uma posição nas organizações de defesa da HI.V./AIDS e acesso ao poder cultural e financeiro do L.G.B.T. comunidade que se levantaria para exigir ação do governo. Mas 35 anos de negligência, agravados pela pobreza e infraestrutura local inadequada de saúde, deixaram muitos homens negros gays e bissexuais caindo em uma série de redes de segurança.

Isso tem acontecido até mesmo com os avanços mais recentes. Em 2010, o governo Obama revelou a primeira Estratégia Nacional de HIV / AIDS, um plano ambicioso que priorizou pesquisas e recursos do governo para as chamadas populações-chave, incluindo homens e mulheres negros, homens gays e bissexuais, mulheres transexuais e pessoas que vivem no sul . Com o mandato de “acompanhar a epidemia”, várias empresas farmacêuticas e organizações filantrópicas também iniciaram projetos para ajudar homens negros gays, principalmente nos estados do sul. Naquele mesmo ano, o Affordable Care Act e, posteriormente, a expansão do Medicaid em mais da metade dos estados do país vincularam significativamente mais americanos HIV positivos a tratamentos e cuidados que salvam vidas.

Em 2011, HPTN 052, um estudo com 1.763 casais em 13 cidades em quatro continentes financiado pelo Instituto Nacional de Alergia e Doenças Infecciosas, descobriu que as pessoas infectadas com H.I.V. são muito menos propensos a infectar seus parceiros sexuais quando colocados em tratamento imediatamente, em vez de esperar até que seu sistema imunológico comece a desmoronar. Essa estratégia de “testar e tratar” também reduz significativamente o risco de doença e morte. Os dados foram tão convincentes que o governo federal começou a promover novas diretrizes de tratamento de H.I.V./AIDS para os profissionais de saúde no ano seguinte. E em 2012, a Food and Drug Administration aprovou o uso preventivo de Truvada, na forma de um comprimido diário para ser tomado como profilaxia pré-exposição (comumente chamado de PrEP). Foi descoberto que é até 99 por cento eficaz na prevenção de pessoas que não foram infectadas com H.I.V. de contrair o vírus, com base nos resultados de dois grandes ensaios clínicos, estima-se que 80.000 pacientes receberam prescrições nos últimos quatro anos.

Mas essas medidas não se estenderam à maioria dos homens negros gays e bissexuais. A C.D.C. Um relatório de fevereiro observou que apenas 48% dos homens negros gays e bissexuais suprimem efetivamente o vírus com medicamentos consistentes, e os números são ainda mais baixos para esses homens no final da adolescência e aos 20 anos. Em 2014, quase um em cada cinco homens negros gays que receberam o diagnóstico de H.I.V. já haviam progredido para AIDS quando souberam da infecção - o que significava que, em geral, estavam muito doentes quando começaram o tratamento. Apenas uma pequena porcentagem de negros usa a PrEP para evitar a contração do vírus, respondendo por apenas 10% das prescrições, a grande maioria dos usuários são brancos. Muitos homens negros gays e bissexuais não podem pagar a PrEP ou não sabem sobre isso - eles podem não consultar um médico regularmente, e muitos provedores de serviços médicos nem mesmo ouviram falar da PrEP.

Inverter as coisas significaria expandir os testes e fornecer tratamento acessível para aqueles que são positivos - para impedir a doença e a morte e também para bloquear a transmissão do vírus. Também exigiria obter informações e medicamentos, incluindo PrEP, para aqueles que estão em maior risco. Ainda mais desafiador seria reduzir o estigma, a discriminação e a vergonha que levam os homens gays e bissexuais a esconder sua sexualidade e evitar o sistema de saúde - e garantir que os provedores tenham recursos adequados e entendam como cuidar de H.I.V. pacientes.

“É profundamente preocupante quando se espera que 50 por cento dos homens gays afro-americanos contraiam H.I.V. durante sua vida, mas também foi um toque de clarim para que todos nós melhorássemos o que estamos fazendo ”, disse o Dr. Jonathan Mermin, diretor do Centro Nacional de C.D.C. para H.I.V./AIDS, Hepatite Viral, S.T.D. e Prevenção de TB. “O que temos tentado fazer é garantir que estamos tendo o melhor efeito com os recursos que recebemos.”

Poucos acreditam que haja o tipo de energia, liderança, dinheiro e vontade política no clima político atual para consertar a situação na comunidade que caiu por terra por tanto tempo. E os especialistas na área estão cada vez mais preocupados com o compromisso do novo governo com o combate à doença. Logo após a posse do Presidente Trump, a página web do Escritório de Política Nacional de AIDS, o arquiteto da Estratégia Nacional de H.I.V./AIDS, foi desativada no site da Casa Branca. O orçamento proposto pelo presidente inclui um corte de US $ 186 milhões no financiamento do C.D.C. para serviços de prevenção, teste e apoio de H.I.V./AIDS. A luta no Congresso sobre a revogação do Affordable Care Act e as declarações do presidente de que "Obamacare está morto" criaram um retorno desastroso a condições ainda mais alarmantes, como listas de espera para medicamentos. Recentemente, em 2011, a lista de estado a estado do Programa de Assistência a Medicamentos da AIDS de pessoas esperando por H.I.V. a medicação cresceu para mais de 9.000 pessoas, a maioria homens negros e pardos pobres nos estados do sul.

“A chave para acabar com a epidemia de AIDS exige que as pessoas tenham tratamentos terapêuticos ou preventivos, revogando assim o A.C.A. significa que qualquer impulso que tivermos estará morto na chegada ”, disse Phill Wilson, executivo-chefe e presidente do Black AIDS Institute, uma organização sem fins lucrativos com sede em Los Angeles. “Para os mais vulneráveis, acabamos voltando em uma época em que as pessoas tinham apenas atendimento de emergência ou nenhum atendimento e estavam literalmente morrendo nas ruas? Não sabemos ainda, mas temos que pensar sobre isso. ”

June Gipson, presidente e executiva-chefe da My Brother’s Keeper, a organização sem fins lucrativos para a qual Cedric Sturdevant trabalha em Jackson, acredita que a revogação do Affordable Care Act não teria um efeito catastrófico imediato em seu estado - mas apenas porque as coisas já estão tão terríveis. Como a maior parte do Sul, o Mississippi recusou a expansão do Medicaid e quase metade de seus cidadãos que vivem com H.I.V. conte com o programa Ryan White H.I.V./AIDS para permanecer vivo. Nomeado em homenagem a um adolescente de Indiana que contraiu H.I.V. por meio de uma transfusão de sangue nos anos 80, este programa federal fornece financiamento para H.I.V. tratamento e cuidados para quem não tem outra forma de financiar a medicação. Se o A.C.A. é revogada, disse Gipson, "isso significa apenas que todo o país se torna o Mississippi."

Por quase dois décadas, os Estados Unidos concentraram dinheiro e atenção na epidemia de H.I.V./AIDS em outros lugares. Barbara Lee, a representante de longa data dos Estados Unidos do norte da Califórnia, assinou seu nome como patrocinadora de todas as principais peças da legislação federal sobre HIV / AIDS desde que foi eleita pela primeira vez em 1998. Em 2003, ela foi co-autora da legislação que levou ao Plano de Emergência do Presidente para Combate à AIDS (Pepfar). A estratégia global de cinco anos e US $ 15 bilhões forneceu serviços de prevenção, tratamento e cuidados aos países mais afetados pela doença, quase exclusivamente na África. A maior iniciativa internacional de saúde da história para combater uma única doença, Pepfar é considerada uma história de sucesso em qualquer medida e uma realização culminante da presidência de George W. Bush.

A América negra, no entanto, nunca recebeu um Pepfar. Embora os números brutos fossem muito mais baixos do que na África, partes de nosso país pareciam o continente para o qual o programa foi criado. No entanto, embora baldes de dinheiro fossem para o exterior, o financiamento interno para H.I.V./AIDS permaneceu estável e os esforços para combater a doença aqui foram reduzidos a uma colcha de retalhos mal coordenada. “Quando vimos que a epidemia estava fora de proporção na comunidade negra, começamos a clamar por uma Pepfar doméstica que trouxesse novos recursos para o esforço, criasse objetivos claros e ambiciosos e reconstruísse a infraestrutura de saúde em todo o país”, disse Lee. “Mas simplesmente não conseguimos que o governo se concentrasse em um plano doméstico.”

Greg Millett, um cientista sênior do C.D.C. por 14 anos e um conselheiro sênior de política do Escritório de Política Nacional de AIDS da Administração Obama, para colocá-lo de maneira mais franca. “Durante os anos Bush, o governo abandonou todas as pretensões de que se importava com a AIDS neste país”, disse Millett, que agora é vice-presidente e diretor de políticas públicas da amfAR, a Foundation for AIDS Research. “A Casa Branca disse H.I.V. é um problema apenas na África Subsaariana, e essa mensagem foi filtrada para o público. Embora o governo Bush tenha feito um trabalho maravilhoso no combate ao H.I.V. globalmente, a destruição que causou na epidemia doméstica foi duradoura ”.

A partir do final dos anos 90, o governo dos Estados Unidos canalizou bilhões de dólares federais para programas de abstinência até o casamento aqui e no exterior. No lugar de uma educação sexual eficaz, esses programas muitas vezes desencorajam o uso de preservativo enquanto ensinam a abstinência como a única forma de prevenir a propagação da AIDS - mesmo quando pesquisas bem conceituadas estabeleceram que esse tipo de educação sexual não diminui o risco de contrair H.I.V. e outras doenças sexualmente transmissíveis.

Durante esse tempo, muitos cientistas, pesquisadores e administradores governamentais ficaram com medo de falar abertamente sobre preservativos, troca de seringas e L.G.B.T. questões por medo de represálias e perda de financiamento. Organizações comunitárias tornaram-se alvos de cruzadas anti-homossexuais, submetidas a intenso escrutínio, incluindo auditorias exaustivas, por agências federais. “Não é por acaso que as novas taxas de H.I.V. infecção entre gays, especialmente homens negros gays, começou a aumentar drasticamente a partir de 2000, por causa de uma campanha anticientífica que permitiu que pouco ou nada fosse feito por uma comunidade difamada simplesmente devido à ideologia e intolerância ”, disse Millett. “O ambiente hostil tornou o financiamento de programas, mensagens ou pesquisas eficazes de prevenção de H.I.V. impossível para as comunidades dos EUA mais afetadas por H.I.V.”

A eleição de Barack Obama trouxe atenção renovada à epidemia doméstica e afrouxou o controle conservador da agenda de prevenção e pesquisa do governo federal. Na primeira conferência nacional de prevenção do HIV pós-Bush em 2009, Christopher Bates, então diretor de política de HIV / AIDS para Saúde e Serviços Humanos e diretor executivo interino do Conselho Consultivo Presidencial sobre HIV / AIDS, deu início ao evento em Atlanta pulando no palco com fita adesiva na boca, arrancando-a e gritando: "Finalmente, posso falar!" No Dia Mundial da AIDS em 2011, Obama se dirigiu diretamente ao H.I.V. crise entre gays negros em um discurso na George Washington University: “Quando novas infecções entre jovens negros gays aumentam em quase 50% em três anos, precisamos fazer mais para mostrar a eles que suas vidas são importantes”.

Mas as boas intenções não se traduziram em financiamento e recursos suficientes - do governo ou de organizações filantrópicas. Boas intenções também não neutralizaram a infraestrutura médica deficiente em estados como Mississippi, que o Commonwealth Fund, uma fundação independente de pesquisa de políticas de saúde, classifica em último lugar em mais de 40 medidas de desempenho do sistema de saúde. Um estudo de 2014 conduzido pelo Dr. David Holtgrave da Escola de Saúde Pública Johns Hopkins Bloomberg descobriu que para fazer qualquer progresso real na crise de HIV / AIDS entre homens negros gays e bissexuais nos Estados Unidos, o governo precisaria investir mais $ 2,5 bilhões para atender às necessidades não atendidas de testes, cuidados, tratamento e prevenção. Apesar do maior H.I.V. diagnóstico e taxas de mortalidade no Deep South, a região recebeu US $ 100 a menos em financiamento federal por pessoa vivendo com H.I.V. do que os Estados Unidos em 2015.

Como o centro da epidemia mudou de Nova York e São Francisco para as cidades menores do Sul, e de gays brancos com posses para pessoas de cor mais pobres, L.G.B.T. a defesa e a arrecadação de fundos mudaram para a igualdade no casamento. Em 2013, H.I.V. ativistas persuadiram 35 L.G.B.T. líderes assinem uma declaração e criem um vídeo implorando à grande comunidade gay para se comprometer novamente com a luta contra a AIDS. A mensagem: “Precisamos que você volte”. Mas dos US $ 168 milhões em dólares filantrópicos de H.I.V./AIDS gastos nos Estados Unidos em 2015, US $ 31 milhões foram desembolsados ​​para o Sul, apenas 19 por cento do total de H.I.V. filantropia nos Estados Unidos, apenas US $ 26 milhões visavam diretamente os afro-americanos e apenas US $ 16 milhões iam diretamente para homens gays e bissexuais, de acordo com a organização Funders Concerned About AIDS.

Durante as décadas de Millett no governo e em organizações sem fins lucrativos, ele vasculhou montes de dados sobre H.I.V./AIDS e homens negros gays e bissexuais. Dois anos atrás, ele e seus colegas da amfAR publicaram um relatório abrangente intitulado “H.I.V. e a comunidade negra: as vidas #Black (gay) importam? ” Quando o calmo e geralmente ensolarado Millett, conhecido por seus óculos azuis e seu sorriso pronto, fala sobre o que ele chama de “tempestade perfeita”, sua voz fica mais dura. “Vamos acabar eventualmente com a AIDS nos Estados Unidos, mas temo que isso não aconteça com os negros M.S.M.”, disse ele, referindo-se aos homens que fazem sexo com homens. “Nós esperamos muito tempo. Com tantos negros gays já infectados, o cavalo já saiu do celeiro. ”

Nas noites de sábado, homens de cor em Jackson e arredores vão até o clube gay Metro. O prédio sem janelas com tinta azul royal descascando do revestimento de alumínio fica na Rodovia 80 ao lado de uma loja de automóveis decadente e não tem nenhuma placa na frente, você só precisa saber. Uma noite em outubro, Cedric Sturdevant caminhou pela sala escura da frente com Regi Stevenson e James Watson, dois colegas de 20 e poucos anos do My Brother’s Keeper. Um punhado de caras estava dançando no estilo exuberante que homenageia os J-Settes - o famoso esquadrão feminino de dança da Universidade Estadual de Jackson - combinado com um toque de moda vindo direto da cena do salão de baile do Harlem. Os três homens observaram os dançarinos realizando movimentos fortemente coreografados usando cadeiras como adereços, antes de cumprimentar seu amigo Jermerious Buckley, 30, resplandecente em lentes de contato verdes e saltos altos vermelhos de dez centímetros, encostado no bar.

Em uma sala dos fundos com painéis de madeira muito iluminados, Sturdevant e os homens mais jovens montaram uma mesa, exibindo brochuras, preservativos, lubrificante e alguns pirulitos. Stevenson e Watson, ambos abertos, amigáveis ​​e bonitos, atraíram alguns caras para a mesa, mas principalmente aqueles que já tinham ouvido o proteja-se-contra-H.I.V. discurso. Stevenson apontou que a multidão era esparsa - talvez 50 homens e algumas mulheres transexuais - porque muitos residentes de Jackson estavam participando da feira estadual anual. “De qualquer forma, é sempre difícil fazer contato no clube”, disse ele. “Eu prefiro um a um. Assim não é, ‘estou tentando educar você’, estamos apenas conversando e nos divertindo. Eu digo a eles o que faço, e eles se sentem à vontade para fazer perguntas ”.

Stevenson pegou seu telefone e abriu o Jack'd, um aplicativo de conexão popular entre os homens de cor. Ele puxou seu perfil "profissional" - no qual ele está sorrindo, limpo e abotoado em meio a um mar de peitos nus e fotos na virilha. Na parte inferior, ele colocou um link para um site com informações sobre a PrEP ao lado, ele escreveu: "Inbox-me se você quiser saber mais." “Recebi um monte de mensagens perguntando sobre os efeitos colaterais, quanto custa e como funciona”, disse Stevenson. Ele e Watson disseram que tomam o medicamento "para garantir".

Depois de uma hora, eles dobraram a mesa e enfiaram os preservativos e brochuras de volta em uma sacola de ginástica, largaram-na ao lado de Sturdevant, que estava tomando um coquetel meloso de uma lata, e se dirigiram para a pista de dança. Um remix de "Where Have You Been" de Rihanna tocou, tão alto que as paredes tremeram. Como todos os outros, Stevenson e Watson, que são treinadores de dança e coreógrafos, aperfeiçoaram seus movimentos ao assistir a vídeos dos J-Settes no YouTube. Stevenson se curvou e empurrou, ao mesmo tempo explosivo, angular e preciso. O rosto de Watson ainda estava como uma pedra quando ele virou o pescoço para o lado, seus dreadlocks na altura da cintura chicoteados em torno de sua cabeça. Depois de algumas canções, a música terminou enquanto o clube se preparava para um drag show à 1 da manhã. Stevenson, suado e sem fôlego, começou a conversar com outros dançarinos.

Todo mundo conhece todo mundo na pequena e unida comunidade gay negra de Jackson, e a maioria dos homens encontrará seus parceiros sexuais nesta rede. A maioria dos cientistas agora acredita que o risco de contrair H.I.V. Resume-se a um jogo de números em vez de um jogo de culpa: se o vírus não estiver presente em sua rede sexual, você pode fazer sexo desprotegido e não ser infectado. But if you are in a community, like Jackson, where a high percentage of gay and bisexual men are infected with H.I.V. — and many don’t know it and go untreated — any unprotected sexual encounter becomes a potential time bomb. This explanation of “viral load” helps dispel the stubbornly held notion that gay and bisexual black men have more sex than other men, a false perception embedded in the American sexual imagination and fueled by stereotypes of black men as hypersexual Mandingos dating back to slavery.

“Black men are not just out here having unprotected sex willy-nilly the science disproves that,” said Terrance Moore, deputy executive director of the National Alliance of State and Territorial AIDS Directors in Washington. He pointed to stacks of studies over the years, including a groundbreaking, exhaustive 2006 data dive led by Greg Millett that was published in The American Journal of Public Health. In this and other studies, Millett and his colleagues found that gay black men engage in risky sexual practices no more frequently, are as consistent about condom use and have fewer sex partners than their nonblack peers. “It’s that the viral load in communities of black gay men is higher, which puts them at disproportionate risk,” Moore explained. “Plus, these are the same individuals that are dealing with structural barriers around lack of employment, lack of education and opportunities, transportation and, of course, very, very overt institutional racism.”


Lazy narrative

Democratic candidate John F. Kennedy looked tanned and youthful during the first televised presidential debates in 1960, while then Vice-President Richard Nixon, who ill-advisedly applied a product called Lazy Shave to cover up his five oɼlock shadow, looked wan and sweaty.

It's a great story, but according to political science professors Christopher Wlezien and Robert Erikson, Kennedy's polling average at the beginning of the first debate was commensurate with the support he got in the election.

WATCH | Kennedy shines, Nixon flops in first televised debate:


How Presidential Debates Have Changed Over the Past 60 Years

Even though the ability for the forum to make or break a candidate's campaign has remained the same.

It wasn't until 1960 that America witnessed a political standoff between Democratic and Republican presidential candidates during the first televised debate. Since then, a lot has evolved and changed&mdashbut the ability for the forum to make or break a candidate's campaign has remained the same. Ahead of the 2020 election, take a look back at the past 60 years of political face-offs.

It was during the 1960 presidential campaign that candidates John F. Kennedy and Richard Nixon took part in the first debate that was broadcasted on TV to the public.

Kennedy and Nixon sit in their respective chairs, while getting instructions about the broadcast from CBS news producer Don Hewitt.

The first debate took place on a closed set, was shot at the CBS studios in Chicago, Illinois, and drew in 66 million viewers.

Jacqueline Kennedy watches her husband from backstage. Up until this point, Nixon was favored to win the election. But the historic debate came out in the young Senator's favor and boosted him in the polls.

Viewers across America gathered around their television sets and tuned in to see the Democratic and Republican candidates discuss issues facing the country with moderator Howard K. Smith and news reporters from NBC, ABC, and CBS.

NBC set the stage differently for the second debate. Held in the news broadcaster's studios, each candidate had a podium, which was separated by the moderator, Frank McGee.

For the third debate, the candidates participated from different studios&mdashNixon was in Los Angeles while Kennedy was in New York&mdashand appeared on a split screen.

Kennedy and Nixon faced off a total of four times throughout their race. Kennedy overwhelmingly won the first, while Nixon reclaimed victories in the second and third. The fourth debate was considered a draw between the candidates.

After his debate against the Democratic candidate, Nixon opted out of debates during both his 1968 and 1972 presidential campaigns. As a result, general election debates weren't held again until 1976.

Despite not having general election debates from 1960 to 1976, the Democratic candidates engaged in interparty debates. Here, Senator Robert F. Kennedy debates Eugene McCarthy during a television interview with Robert Clark, Bill Lawrence, and Frank Reynolds.

NBC prepares for the first presidential debate since 1960 between sitting President Gerald Ford and Democratic nominee, Jimmy Carter. Unlike the Kennedy-Nixon debates, where television studios hosted the broadcasts, the 1976 broadcast was sponsored by the League of Women Voters.

Newscasters Tom Jarriel, Sam Donaldson, and Frank Reynolds prepare to cover the debate at the Walnut Street Theatre in Philadelphia.

President Gerald Ford, who took over as President after Nixon resigned 1974, allowed for three debates against his opponent. The first one (pictured) focused on domestic policy issues.

The debate was held, for the first time, in front of a studio audience. As a result, crowds flocked to the debate's venue in downtown Philadelphia.

A hoard of protestors lined the entrances of the debate.

Governor Jimmy Carter was said to have won the second Carter-Ford debate, which was broadcasted from San Francisco. The debate covered the topic of foreign policy, in which Ford made blunders when discussing the Soviet Union.

Republican vice presidential candidate, Robert Dole, watches his running mate face off against Carter in the second debate.

While prepping for the third and final debate, First Lady Betty Ford leaves a note on Jimmy Carter's podium. Ford wished her husband's opponent good luck and that the best man may win, although she remains biased. The debate's producers later removed it from the podium and instead delivered it by hand to Carter.

Students at Harvard University gather in a common room to watch the third Ford-Carter debate.

In 1980, candidates began participating in debates during the presidential primary race. Here, the seven Republican candidates&mdashincluding Governor Reagan and George H. W. Bush (far right)&mdashpose before the debate in Manchester, Vermont.

The rise in popularity of Independent candidate, John Anderson, made the debates difficult. President Carter refused to debate with Anderson and Reagan refused to debate without him. The first debate went on as scheduled without Carter. The second debate, as well as the vice presidential debate, were cancelled.

Carter and Reagan made a compromise and debated alone for the third and final debate.

Per Carter's demands, Independent Party candidate Anderson was not allowed to participate in the live debate. Instead, he was filmed separately and his responses were cut into the coverage.

As a former actor, Reagan had a command presence on screen. This resulted in a huge victory in the candidate's debate against President Carter and helped him gain momentum for his election win.

Politicians competing for the Democratic nomination prepare for the primary debate.

George H. W. Bush shakes hands with his opponent, Geraldine Ferraro, before the vice presidential debate. After 1984, vice presidential debates became a regular event in the campaign.

Former heavyweight boxing champion, Joe Frazier, candidly throws Vice President Bush's hands in the air, proclaiming him the champion after his debate against Walter Mondale's running mate, Geraldine Ferraro.

First Lady Nancy Reagan greets her husband after his second debate against Democratic candidate Walter Mondale. After losing the first debate, the incumbent President secured a victory in their second matchup.

Candidates for the Democratic nomination prepare for a debate at the University of North Carolina.

There were three debates during the 1988 presidential election. Here, Vice President Bush and his opponent, Michael Dukakis, are seen debating onstate.


The History of the Town Hall Debate

Here’s one question you didn’t hear Barack Obama or Mitt Romney answer during the 2012 presidential election. “Do you prefer pepperoni or sausage on your pizza?”

The question was the brainchild of Pizza Hut, which promised free pizza for life to any patriot willing to ask the question at the audience-driven presidential town hall debate that year.

The marketing ploy, offered a week before the debate, quickly turned into a PR disaster as people panned the offer. UMA Gawker headline articulates the general reaction to the pitch: "Want Free Pizza Hut Pizza for Life? Just Make a Mockery of the American Democratic System on Live TV."

At first blush, the corporate stunt might seem entirely inappropriate for a tradition that dates all the way back to 17th-century New England meeting houses. But in a certain way it’s fitting: The modern town hall presidential debate, like its predecessor, was built on informal, populist discourse that invites everyone to the table, even those who perhaps shouldn’t be given the mic. & # 160

The very first town hall in the United States was established in Dorchester, Massachusetts, in 1633. Per the town’s court records, every Monday at the sound of an 8 a.m. bell, townspeople held a meeting to settle and establish “such orders as may tend to the generall good as aforesayd.” The decisions made at these meetings were honored as law and “every man to be bound thereby, without gaynesaying or resistance.”

The practice soon spread throughout New England as an effective means for citizens to decide on important issues of the day. Town hall meetings gave locals a way to have their say in local affairs. The informal, majority-rules forum became a foundation of early American democracy and they are still used throughout the country today. The longest continuously functioning one, held in Pelham, Massachusetts, has been run out of a two-story wooden structure since 1743.

Early presidential hopefuls didn’t participate in town halls. They didn’t even openly campaign for votes. Rather, in the spirit of George Washington, elected officials were supposed to simply present themselves as civil servants. On-the-sly politicking and newspaper editorials were expected to do the campaign work for them—no debates needed.

Over time, this sentiment changed. When Abraham Lincoln made a run for Stephen Douglas’ senate seat, he persuaded the senator to agree to a series of debates in 1858—the first electoral debate of note in the country. Decades later, the advent of new technologies like radio and television offered even more ways for candidates to use the debate format to make an impression on would-be voters.

However, these debates were more stylistically formal and were moderated only by established journalists from established news outlets. But with each change came new risk and new reward—as with the famous first televised general election debate in 1960, in which John F. Kennedy’s camera-ready looks helped the Democratic senator score a win against Vice President Richard Nixon, a coup that eventually pushed him all the way to the Oval Office.

Since the 1920s, all presidential debates had been moderated by the League of Women Voters, but in the years after Nixon-Kennedy, campaigns have sought to exert more control, ideally to present their candidates in a more favorable light. From that emerged a secret, backdoor memo in the 1980s crafted by Republican and Democrats to give their candidates more leverage. Among their suggestions were to ban follow-up questions from moderators and an ability to seed the audience with supporters.

When the League caught wind that the parties were trying to strong-arm the debate format, it issued a searing statement from its president, Nancy M. Neuman.

"On the threshold of a new millennium, this country remains the brightest hope for all who cherish free speech and open debate," Neuman wrote. "Americans deserve to see and hear the men who would be president face each other in a debate on the hard and complex issues critical to our progress into the next century."

She challenged the candidates, Vice President George H.W. Bush and Governor Michael Dukakis, to "rise above your handlers and agree to join us in presenting the fair and full discussion the American public expects of a League of Women Voters debate."

The League ultimately withdrew its sponsorship. In its place, the nonpartisan Commission on Presidential Debates was established. It proved more open to changes in the once-honored debate format.

That next presidential season, Arkansas governor Bill Clinton would put the new committee to the test. A skilled public speaker who prided himself on his ability to engage with crowds, Clinton had successfully used town hall forums, where he spoke one-on-one with voters, to his advantage in the primaries. Seeing a town hall debate as an easy way to shine in the general election, his campaign reached out to see if President Bush would be open to a change.

“Boy, I really wanted that, because I'd done a lot of town meetings,” Clinton later told PBSNewshour anchor Jim Lehrer.

The incumbent president initially seemed against the idea. As the president  told Bernard Shaw on CNN, "I thought when you and others asked tough questions at the 1988 debates, it livened things up. I saw nothing wrong with the former format.”

But his campaign agreed to it during a phone call with Clinton. As Northeastern University journalism professor  Alan Schroeder points out in his book on the perils of the presidential campaign trail, the Bush team believed that since the debate was being held in conservative Richmond, Virginia, undecided voters would be impressed enough by a chance to speak to the president that they wouldn’t ask him hard questions. Bush himself had fared well in small groups in the past, even hosting a successful “Ask George Bush” forum during his own campaign, which was analogous to Clinton’s own forums. The new Commission on Presidential Debates put the forum in motion and the town hall format for presidential debates was born.

Despite the country’s historic embrace of  town halls, allowing everyday voters to question the candidates on a national stage revamped the original model and gave it a turn-of-the-21th-century twist.  PARADE magazine called it “one more populist touch in a campaign marked by bus tours, talk shows and MTV—and capped by huge voter turnout.”

The new format meant that candidates couldn’t easily stick to their talking points and instead had to react to questions culled from the crowd. It also created a way for the public to see how candidates performed in a more informal environment. Clinton, for one, was ready: His practiced Southern charm played to his advantage, helping him regain an edge from independent candidate H. Ross Perot, who was considered the winner of the first, more formal, debate.

“Since the town hall format was a novelty it received far more attention than the other more conventional debates,” wrote University of Maryland professor Kathleen E. Kendall in her  book on presidential candidates and the media. “Clinton was able to generate substantial political capital because he could showcase his relational style in the most highly publicized and popular of the debates.”

That October, 209 undecided voters were selected by the Gallup Organization to serve as the studio audience for the 90-minute debate. Carole Simpson of ABC News served as moderator. When she came on stage, she commented first on the novelty of the night: “Tonight's program is unlike any other presidential debate in history—we're making history now and it's pretty exciting.”

Though Bush got some barbs in, like saying the Arkansas governor’s flip-flopping would turn the “ White House into the Waffle House,” he was criticized for looking too formal, staying behind his lectern for the debate, and looking at his watch. Visuals meant everything, as Clinton knew.

As  one paper published in the Journal of Communication in 2007 argues, “While the Bush team simply practiced verbal arguments and rebuttals leading up to the town hall debate, Bill Clinton’s staff also laid out a grid, complete with fake cameras and doubles for his opponents and the audience, to train their candidate to utilize space effectively.”

That meant whenever the camera was on him, Clinton was ready and posed accordingly. The future president also knew how to keep Bush and Perot in the camera’s view so that they might be caught with “bad facial expressions."

Bush would later express his frustration with how the town hall had gone to Lehrer: “You look at your watch and they say that he shouldn't had any business running for president. He's bored. He's out of this thing, he's not with it and we need change. It took a little incident like that to show that I was you know out of it. They made a huge thing out of that. Now, was I glad when the damn thing was over. Sim. And maybe that's why I was looking at it, only 10 more minutes of this crap, I mean."

But Bush took arguably more heat for being unable to field a question from one of the voters in the audience. When  Marisa Hall Summers asked how the candidates had been personally affected by America's economic downturn, Bush was perceived as being out of touch, saying, “it has a lot to do with interest rates.”

According to a Times Mirror Center poll conducted at the end of October 1992, the debate was a success. Forty-six percent of the public preferred that candidates be questioned by voters compared to 28 percent who preferred to stick with a single-moderator format. Simpson chalked up the town hall’s success to its popular appeal. “I think voters who are used to the overabundance of talk shows want to see those people reacting with others like them,” she said. “I think they want that connectedness.”

Since 1992, the town hall format has continued to evolve. In 2008, it included several questions submitted online for the first time. The “pepperoni or cheese” question was actually introduced there first, but because it wasn't asked, Pizza Hut ended up  making its bold promise the following election cycle. & # 160

This Sunday, for the first time ever, a town hall debate will be considering the top 30 questions submitted and selected by viewers at PresidentialOpenQuestions.com. Currently leading with more than  42,000 votes is a question asked by Richard M. from California: “ Would you support requiring criminal background checks for all gun sales?”

The town hall debate is now seen as part of the American political tradition. And in a way, it is—a modern innovation cribbed from a much older way to include everyday people in the political process.

“It’s the democratic process in its most amiable state: earnest Americans asking serious questions about the issues,” a  New York Times opinion piece wrote in 2004.

Perhaps the questions aren’t always so earnest. But they likely weren’t back in 1633 either—unless colonists needed to decide which kind of pizza to order.  ​

About Jackie Mansky

Jacqueline Mansky is a freelance writer and editor living in Los Angeles. She was previously the assistant web editor, humanities, for Smithsonian revista.


Worst. Debate. Sempre. (And let’s definitely do it again)

President Trump and former vice president Joe Biden debated on Tuesday. You know how it went. Pool/Photographer: Morry Gash-Pool/Ge

If there is one thing that President Trump and former vice president Joe Biden did in their 90-minute debate on Tuesday night, it was to bring a deeply polarized nation together to say, collectively, “that debate was really horrible.”

And it was easily the worst presidential general election debate in American history. There were so many interruptions and candidates talking over each other that the word “crosstalk” appeared 140 times in the debate transcript.

And it was so unwatchable that the Commission on Presidential Debates, the North Star of nonpartisan organizations, released a statement saying that they will have to put in new structures in place so that next time it is, you know, an actual debate.

Immediately after the 90-minute hot mess ended, there were calls to just end the debate season. After all, for those who felt this was a national embarrassment and looked on with horror as one candidate, namely Trump, didn’t let his opponent speak, what was the point of doing two more?

They ask a good question. But here is the answer: of course we should have two more debates. Here are three quick reasons why:

1. To cancel the debates is to let Trump win

Debate moderator Chris Wallace of Fox News didn’t have to say that Trump was the main problem during the debate, but he did anyway. Trump has shown that he likes to disrupt political institutions and he did so again Tuesday.

To simply call off the rest of the debates is to let him destroy an American institution that serves a very important purpose. Most people in both parties and independents, too, believe that it is a good thing that a nonpartisan, nonmedia organization works to find the neutral ground and organize all television networks to simultaneously broadcast meetings of national importance.

2. The town hall debate is a chance for everyday Americans to interact with the next leader of the free world

We are living in serious times when regular people want answers from their potential leaders about the economy, the coronavirus, and the movement for racial justice. The antidote to all the poisonous shouting in the first debate might be the format of the next one, a town hall.

There are no guarantees that Trump won’t try to hijack that debate either. And in 2016, Trump used the lack of podiums in that year’s town hall debate to get into Hillary Clinton’s space in a way that was commented on for weeks. That said, in the age of COVID, there are basically no chances for everyday people to ask the next leader of the free world a question. We should not deny them that.

3. More questions and dialogue is always better

Without these debates, the nation will never stop and consider issues or the candidates at all. It would just simply end with commercials, Zoom meetings, whatever campaign rallies Trump decides to have, and limited media interviews that tend to only allow for soundbite answers.

America should not scrap opportunities for candidates to actually give full answers to complicated, nuanced questions on the major issues of the day, from COVID-19 to taxes, foreign policy to health care.

And, really, America deserves a chance for its presidential candidates to redeem themselves.


Presidential debate 101: Is Romney right about $716 billion in Medicare cuts?

In Wednesday's presidential debate, the GOP's Mitt Romney cited ill effects from $716 billion in cuts to Medicare contained in Obama's health-care reform law. Here's a look at what fact-checkers say.

Medicare has been a hot topic this campaign cycle, and it came up again during Wednesday’s debate between President Obama and Republican challenger Mitt Romney.

Mr. Romney brought up a point he’s hit hard before – that with the passage of his health-care reform law, the Affordable Care Act, Mr. Obama is responsible for $716 billion in cuts to Medicare.

"If the president were to be reelected you're going to see a $716 billion cut to Medicare," Romney said. "You’ll have 4 million people who will lose Medicare Advantage. You’ll have hospitals and providers that’ll no longer accept Medicare patients. I’ll restore that $716 billion to Medicare."

Decoder has taken on this claim before, but with the dollar number in the spotlight again, let's take a look at how other news outlets are decoding this claim.

After the debate, the Tampa Bay Times’ PolitiFact rated Romney’s claim as “half true.” It explains exactly where the number, $716 billion, comes from: A Congressional Budget Office report determined that between 2013 and 2022, the Affordable Care Act would reduce the amount of federal spending on Medicare by $716 billion.

As Kamala Harris’ portfolio grows, so does the scrutiny

But PoltiFact clarifies that those spending reductions would come at the expense of insurance companies and hospitals, not Medicare beneficiaries. Obama’s goal, it says, is to slow the growth in the program's expenditures, not cut the current budget.

The Washington Post has a nifty pie chart that shows how the $716 billion in Medicare cuts is divvied up. The Post reports that 34.8 percent of cuts are attributed to hospital reimbursement rates, though it predicts hospitals should be able to make up some of that loss. Some of the cuts will be funds for hospitals to encourage them to see more uninsured patients. Because the Affordable Care Act expands insurance coverage to all Americans, the number of uninsured patients hospitals must treat will be reduced.

The next slice of the chart shows 30.2 percent of the cuts coming from Medicare Advantage payments, which addresses Romney's debate-night claim that 4 million people will lose Medicare Advantage under the Affordable Care Act. This is the often-mentioned scale-back of payments to private insurers.

The Post and PolitiFact both point out that Medicare Advantage, a program in which the government pays for seniors to have private health insurance, on average costs more than private insurance, rather than keeping costs low. The National Committee to Preserve Social Security and Medicare reports that, on average, the US government pays 14 percent more per beneficiary per year for seniors in the Medicare Advantage program. It says payments to Medicare Advantage will not be eliminated entirely, but reduced gradually to bring them more in line with traditional Medicare.

The last third of the cuts, 35 percent, the Washington Post labels "everything else."

The Kaiser Family Foundation elaborates. "Other Medicare spending reductions include $39 billion less for skilled nursing services, $66 billion less for home health, and $17 billion less for hospice." The website points to additional benefits the Affordable Care Act will provide, such as an increase in prescription drug coverage.

Perhaps Mother Jones sums it up best with its quick Q&A on the $716 billion in cuts.

Are America's seniors getting the short end of the stick? "No probably not," it says hospitals and insurance companies are. But does that mean Medicare beneficiares have nothing to worry about?

"It's possible that the cuts to providers could lead to slight cuts in quality or even, via some unintended backdoor mechanism, to some doctors dropping out of Medicare," Mother Jones writes. "And the cuts to Medicare Advantage might prompt insurance companies to reduce some of the extra benefits they've provided." However, it cautions, all predictions at this point are speculative.

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In the end, Obama really is cutting $716 billion from Medicare, that's true. While the long-term effects of the cuts will benefit seniors by extending the life of Medicare, the effects on a doctor-by-doctor, hospital-by-hospital level are unpredictable.

As Mother Jones puts it, "There's no way to cut a bunch of money out of anything and guarantee that it will have no effect whatsoever."


The Purpose of Presidential Debates

U.S. President Barack Obama (R) debates with Republican presidential candidate Mitt Romney as moderator Bob Schieffer (L) of CBS looks on at the Keith C. and Elaine Johnson Wold Performing Arts Center at Lynn University on October 22, 2012 in Boca Raton, Florida.

Monday night's presidential foreign policy debate probably won't change the opinion of many voters. Proponents of President Barack Obama are still convinced that Mitt Romney is a fool and a liar. Proponents of former Gov. Romney have the same view of the president.

Of course, this is normal in any American presidential race. Along with the eternal conviction that the party in power is destroying the country, we have regarded Abraham Lincoln, during the 1860 election, as a simple-minded country bumpkin with a touch of larceny Franklin Roosevelt as a rich dilettante and socialist and Dwight Eisenhower as a bumbling fool who is lazy and incapable of understanding the complexity of the world &mdash this about the man who, during World War II, led the most complex military coalition on the planet to victory.

We like to think that our politics have never been less civil than they are today. Given that Andrew Jackson's wife was accused of being a prostitute, Grover Cleveland was said to have illegitimate children and Lyndon Johnson faced the chant "Hey, hey, LBJ, how many kids did you kill today?" I will assert that the Obama-Romney campaign doesn't even register on the vilification scale.

The founders wouldn't have minded this culture of contempt for politicians. In founding the republic, their fundamental fear was that the power of the state would usurp the freedoms of the states and individuals. They purposefully created a political regime so complex that it is, in its normal state, immobilized. They would not have objected if professional politicians were also held in contempt as an additional protection. Ironically, while the founders opposed both political parties and professional politicians, preferring to imagine that learned men take time from their daily lives to make the sacrifice of service, many became full-time politicians and vilified one another. Thomas Jefferson's campaign said of John Adams that he had a "hideous hermaphroditical character, which has neither the force and firmness of a man, nor the gentleness and sensibility of a woman." Adams' campaign stated that Jefferson was "a mean-spirited, low-lived fellow, the son of a half-breed Indian squaw sired by a Virginia mulatto father." And Jefferson and Adams were friends. I would suggest suspending the idea that we have never had so vicious a politics.

Let me move to a more radical thought. Both Mitt Romney and Barack Obama are capable men, as well intentioned as ambitious men seeking power can be. Just as I doubt that Jefferson and Adams were as stupid and malicious as their campaigns tried to portray one another, the same can be said of Romney and Obama. I am not suggesting for a moment that the circus of accusations stop, however. To the contrary, seeing how one endures slander is an outstanding measure of a leader's character and an opportunity to learn how the candidate will react to the sorts of unreasonable and unfair conditions that the president is sure to encounter.

At their best, debates test a candidate's coolness under pressure and ability to articulate some thought at least vaguely connected to the question while convincing the viewers that he or she is both personable and serious.

A president will face a world that does not wish the United States well in all cases and an opposition that will try anything, fair or foul, to make the president fail. A president who breaks down when he is mistreated &mdash as Edmund Muskie, a senator running for president in 1972, did over charges made against his wife &mdash is a non-starter. Muskie's campaign immediately collapsed, as it should have. A president who expects to be treated fairly is an immediate liability.

The True Objective of Debates

A debate is not about policy. It is impossible to state a coherent policy on any complex matter in 90 seconds. The debates between Lincoln and Steven Douglas did go far in that direction, but then it wasn't on national television, and it was for senator of Illinois, not the presidency. That left room for contemplation. It should be remembered that prior to the Kennedy-Nixon race of 1960, there were no debates, partly because there was no television and partly, perhaps, because the ability to debate was not seen as the appropriate measure of a president.

Debates test one thing: the ability to quickly respond to questions of numbing complexity that are impossible to answer in the time available. They put a premium on being fast and clever but don't say much about how smart a candidate is. Nor are they meant to, in part because being smart, in an academic sense, is not essential to be president &mdash as many have demonstrated. At their best, debates test a candidate's coolness under pressure and ability to articulate some thought at least vaguely connected to the question while convincing the viewers that he or she is both personable and serious.

That is, after all, what leadership is about. We have had enormously intelligent presidents who simply couldn't lead. Here, I think of Herbert Hoover and Jimmy Carter, both of whom had substantial and demonstrable intellects but neither of whom, when confronted by the disastrous, could rapidly contrive both a response and a commanding and reassuring presence in public. In that sense, their intellects betrayed them. Each wanted the right answer, when what was needed was a fast one. Each was succeeded by someone who could provide a fast answer. FDR's famous first 100 days did not solve the Depression, but they did give the sense that someone was in charge. FDR and Ronald Reagan could reassure the country that they knew what they were doing while they rapidly tried things that might work.

Therefore, the question of who won Monday's debate is not one that a viewer who spends his time focused on foreign policy can answer. The candidates weren't speaking to those who make their livings involved in or watching foreign affairs. Nor can we possibly extract from the debate what either candidate intends to do in foreign policy, because conveying that was not what they were trying to do. They were trying to show how quickly and effectively they could respond to the unexpected, and that they were leaders in the simplest sense of being both likeable and commanding, which is the incredibly difficult combination the republic demands of its presidents.

Technology's Impact

It is important to remember that for most of our history there were no televisions and no debates. Knowledge of the candidates filtered through speeches and letters. The distance between the president and the public was even greater than today. In a sense, the imperial presidency &mdash the president as first among equals of the three branches of government &mdash really began with FDR, who used radio brilliantly. But there were no debates or public press conferences in which to challenge him.

The distance collapsed with television and rapid-fire interplays, yet at the same time increased in another way, as the president became the most public and pseudo-known character in government. I say pseudo-known because, in fact, the president's greatest skill lies in revealing himself selectively, in a way and to the extent that it enhances his power.

What could be sensed in debates were things like meanness of spirit, ability to listen, willingness to improvise and, ultimately, there was a chance to look for humor and good will. There was also a danger. The debate put a premium on articulateness, but it is not clear that the well-spoken candidate &mdash or at least the candidate who could speak most clearly most quickly &mdash also thought more clearly. There are many people who think clearly but speak slowly while acting quickly. They are not meant for Bob Schieffer or Candy Crowley's meat grinder.

The subject of the debate and the specific answers in the debate are doubly unimportant. The winner of the debate will be the one whose soul, when glimpsed, appears able to withstand the burdens of the presidency.

The point of this is to continue a previous argument I have been making. The issues-based candidacy is a fallacy, especially because events determine the issues, and the most important events, such as 9/11 and the financial crash, are not always expected. Therefore, reality divides the candidate's policy papers from the candidate's policies.

I am arguing that the subject of the debate and the specific answers in the debate are doubly unimportant. First, the nature of these debates makes coherent presentation impossible. Second, the stated policies, such as they are, have little to do with the results of the debate. Nor will the better debater win. The winner of the debate will be the one whose soul, when glimpsed, appears able to withstand the burdens of the presidency. Romney's surge had less to do with Obama's performance and more to do with what the viewer learned of Romney.

This has always been what American presidential campaigns are about. All that has happened is that television intensified it and the debate purified it. A debate is a 90-minute opportunity to see a candidate under pressure. What the viewer determines he saw will be critical.

I am also making a parallel argument that our perception of today's political campaigns as uniquely vicious is untrue. We have always been brutal to our candidates, but this served a purpose. We may not know what his policy on trade reform is, but we need to know what kind of person he is for the unexpected issues that will come faster and be more deadly than any moderator's questions. I think this is the purpose debates serve. They are not some public policy review but a dissection of the soul of someone who wants to be president. It is not necessarily a good one, or always an accurate one. It is, however, why we have them.

The question may come up as to who I think won the debate. My opinion on that is no better than anyone else's, nor, as I pointed out, do I think it really matters. The winner of the debate may or may not have persuaded enough voters of his virtue to be elected. But in the end, our response to the debate is idiosyncratic. What moved me may not have moved others. After all, the country appears divided down the middle on this election, so obviously we are seeing different things. Therefore, who I think won the debate is as irrelevant as who I think should be president. Besides, there are more important questions than our own opinions on the candidates. For me, one of those is trying to understand what we are doing when we elect a president.


What is Super Tuesday?

Since at least 1976, journalists and political commentators have stressed the importance of “Super Tuesday” to the complexion of presidential campaigns. Super Tuesday is the day in late February or early March when the largest number of U.S. states hold their primary elections and caucuses. Since each state selects its election day separately, the list of states holding their Super Tuesday primaries differs from year to year.

About 33% of all delegates to the presidential nominating conventions are up for grabs on Super Tuesday. As a result, the outcomes of the Super Tuesday primaries have historically been a key indicator of the likely eventual presidential nominees.


Interview Highlights: Julian Zelizer

On Monday's debate

"I think it's going to be a big debate. Social scientists often say debates don't make that big a difference. But the number of people who are going to watch this and the kind of fireworks that we can expect on this stage, given what we saw in the Republican primaries, might make this more significant than they otherwise would be. And I'm sure they're going to be very aggressive with each other.

The most important thing in debates is to not make a mistake. And certainly Hillary Clinton who's very seasoned will be doing that, trying to avoid any semblance of an error. Donald Trump is more freewheeling and we don't know exactly what he will do. But he will be provocative and I'm not sure he's going to calm himself down that much. So I think each has a very different strategy. Obviously, Hillary Clinton wants to use this to communicate to the public more about herself, what she stands for, and to respond to this ongoing concern that some Democrats seem to have with her."

On how the first debate impacted the 1960 presidential election

"It used to be said that it was pretty decisive, and when people saw John F. Kennedy, how he looked and how he sounded, it was such a dramatic contrast with Nixon, who had his five o'clock shadow, who didn't look into the camera, who really seemed uncomfortable, that was why the election ultimately went one way or another. It's not clear that's true. People have responded that it's an exaggeration. But it did confirm a basic impression that had developed about the two candidates and some of the excitement that have been generated about John F. Kennedy."

On what really matters in presidential debates

". Substance really isn't at the heart of these debates &mdash it's your style it's your mannerism. Carter just gave this long speech about how Reagan was this radical and he had been against Medicare in the 1960s and he was going to go after Medicare again, and just was with a smile and a laugh and the humor that Reagan was very good at display. He basically, for many Americans, knocked out the seriousness of what Carter was saying, and that was something he was skilled at. Again, did it alter the debate? Carter thought it did, but I'm not convinced because of that line that's why we got a Reagan presidency. There were many other factors at work that moved the campaign in Reagan's direction."

On what kind of role moderators ought to play in 2016

"I think they have to [fact check]. I think we're in a moment in political history where there's a lot of fuzziness as some people are saying with the truth [and] facts. And I think it's incumbent on the moderators in this day and age to push back against candidates with what they say &mdash they can't just let the candidates to use this as a 90-minute opportunity to tell us their campaign ads. I think it'd be a better event if the moderators are tough with the candidates."


Assista o vídeo: André Ventura totalmente exposto (Julho 2022).


Comentários:

  1. Nikolkis

    Eu entro. Assim acontece. Podemos nos comunicar sobre este tema.

  2. Aden

    Na minha opinião, você está errado. Eu posso defender minha posição.



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