JUST OUT: Sample Congressional Questionnaire

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Congressional Candidate Questionnaire

Candidate Name:_______________________________________________________
Congressional District:  ______ Party: _____________________________________
Campaign Address:_____________________________________________________
City, State & Zip:  _____________________________________________________
Campaign Phone:______________________________________________________
Web Site Address: _____________________________________________________
E-mail Address: _______________________________________________________

Please complete the questionnaire below by circling the answers that most closely matches your position. 

1. In the last year, the government of the United States (along with the G8 countries and United Nation) committed to assuring universal access to AIDS prevention, treatment, care and support by 2010.  If elected, will you support policies that will make this commitment a reality in the U.S. and around the world?

(a)   Yes                               (b)   No                        (c)   Undecided

2. Do you support the Early Treatment for HIV Act, which expands Medicaid for HIV-positive people who would otherwise need to become completely disabled in order to qualify for Medicaid-covered services?

        (a)   Yes                               (b)   No                        (c)   Undecided

3. Do you support full funding for the AIDS Drug Assistance Program to end the waiting lists that prevent uninsured and low-income people living with HIV/AIDS from getting the HIV medications they need to survive?

(a)   Yes                               (b)   No                        (c)   Undecided

4. Do you support efforts to increase the amount of federal funding appropriated for science-based HIV prevention programs to no less than $1 billion annually in order to respond to growth and changes in the HIV/AIDS epidemic?

(a)   Yes                               (b)   No                        (c)   Undecided


5. Do you support the Microbicide Development Act, which creates an office within the National Institutes of Health dedicated to research and development of topical agents—known as microbicides—capable of preventing sexual transmission of HIV?

(a)   Yes                               (b)   No                        (c)   Undecided

6. Given the overwhelming body of evidence demonstrating the efficacy of needle exchange as HIV prevention, do you support legislation to lift the ban on federal funding for needle exchange as a strategy to reduce HIV transmission among injection drug users, their partners, and children?

(a)   Yes                               (b)   No                        (c)   Undecided

7. Do you support an end to federal funding for “abstinence-only-until-marriage” programs, which have been proved not only ineffective but actually harmful to young people by contributing to higher rates of STDs, risky sexual behaviors, and lower rates of protected sexual contact?

(a)   Yes                               (b)   No                        (c)   Undecided

8. Do you support increased funding for the Housing Opportunities for People With AIDS (HOPWA) program, which provides desperately needed housing assistance for disabled people with AIDS?

(a)   Yes                               (b)   No                        (c)   Undecided

9. Do you support the repeal of the ban against people living with HIV from entering the United States as travelers or immigrants, and bars those in the U.S. from legalizing their immigration status?

(a)   Yes                               (b)   No                        (c)   Undecided

10. Since the world will need over $23 billion per year to fight AIDS globally by 2010, will you support an increase in U.S. funding to contribute one-third of this amount?

(a)   Yes                               (b)   No                        (c)   Undecided

11. Will you support a commitment by the U.S. to fund its full one-third “fair share” contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria--$1.2 billion in 2007?

(a)   Yes                               (b)   No                        (c)   Undecided


12.     As part of its global AIDS funding, should the U.S. increase spending for HIV prevention programs that are scientifically proven to halt the spread of HIV including needle exchange and comprehensive and age-appropriate sexuality education programs that include but are not limited to the promotion of abstinence?

(a)   Yes                               (b)   No                        (c)   Undecided

13.     Would you support ratification of free trade agreements, like those being negotiated by the U.S. with the governments of Thailand and South Korea, which would increase intellectual property protections for big drug companies while preventing the development of low-cost, life-saving generic HIV medications?

(a)   Yes                               (b)   No                        (c)   Undecided

14.     Do you support the removal of the requirement that one-third of U.S. global AIDS funding for prevention (services aimed at reducing sexual transmission of HIV) go to “abstinence only” programs?

(a)   Yes                               (b)   No                        (c)   Undecided

15.     Should the U.S. invest $8.6 billion in new funding over five years for training, retention, and support of the skilled healthcare workforce needed to tackle the HIV/AIDS crisis on the African continent? 

(a)   Yes                               (b)   No                        (c)   Undecided

16.     Will you support legislation requiring the U.S. to give 100% debt cancellation without harmful economic conditions attached for every impoverished nation that needs it to boost their fight against AIDS?

(a)   Yes                               (b)   No                        (c)   Undecided




Completed by (print candidate name): _________________________________________

Candidate Signature: _________________________________  Date:_________________



[Include a cover page with instructions on where to fax or mail completed questionnaires, deadlines, and the names and contact information for candidates to direct their questions.]