PUBLIC OPINION DISPARITIES & PUBLIC OPINION DATA NOTE A joint product of the Disparities Policy Project and Public Opinion and Survey Research October 2011 BLACK RESIDENTS VIEWS ON HIV/AIDS IN THE DISTRICT OF COLUMBIA When it comes to HIV/AIDS, the District of Columbia is particularly hard hit, with one of the highest AIDS rates in the nation. 1 A recent survey 2 of District residents by the Kaiser Family Foundation (KFF) and The Washington Post found this fact reflected in concern about the disease: DC residents identified AIDS as the top health problem facing the area (36 percent said so), whereas nationally, AIDS ranks 7 th. But the impact of HIV/AIDS is not evenly spread across the city: As is true nationally, black residents in DC are disproportionately affected by HIV/AIDS. While they make up about 50 percent of the DC population, they account for about three quarters of people living with HIV/AIDS in the District. 3 And, because the black community is not uniform, experiences and attitudes about HIV/AIDS also differ greatly across various groups of black residents. This data note focuses on the nuances in opinion towards HIV/AIDS among DC s black residents as reflected in the May 2011 Washington Post/KFF survey, taking into account the way views and concerns differ by age, education and geography. Selected Demographics Of District By Race Annual Household Income Black White Less than $35,000 42% 3% $35,000 to $49,999 15 8 $50,000 to $64,999 13 11 $65,000 to $99,999 14 20 $100,000 or more 16 59 Age 18 29 21% 25% 30 44 27 39 45 64 35 24 65+ 17 12 Education Less than high school 17% 1% Graduated high school 33 5 Some college 26 7 Graduated college 13 42 Post graduate 10 45 Child under 18 living at home 26% 17% When examining these views, it s important to begin by noting the vast socio economic differences between the black and white segments of the population in the nation s capital. In general, black adults living in the District are disproportionately lower income and have less education than the population of white residents. For example, the survey suggests that 42 percent of black adults live in households making less than $35,000 per year, compared to 3 percent of white adults. On the flip side, roughly six in ten white residents report their household income as over $100,000 per year, compared to 16 percent of black residents. When it comes to education, nearly nine in ten white adults report having a college degree, compared to roughly two in ten black adults. 1 Kaiser Family Foundation, Fact Sheet, The HIV/AIDS Epidemic in the United States, August 2011. http://www.kff.org/hivaids/3029.cfm. 2 The Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia (conducted May 10 31, 2011), http://www.kff.org/kaiserpolls/8199.cfm. 3 District of Columbia Department of Health, District of Columbia HIV/AIDS, Hepatitis, STD, and TB Annual Report 2010, http://www.dchealth.dc.gov/doh/frames.asp?doc=/doh/lib/doh/services/administration_offices/hiv_aids/pdf/2010_annual_report_final.pdf.
BLACK DISTRICT RESIDENTS MORE LIKELY THAN WHITES TO VIEW AIDS AS SERIOUS PROBLEM, WORRY ABOUT INFECTION Concern about becoming infected with HIV is a particularly pervasive worry for the District s black residents. They are four times as likely as whites to say they are concerned about becoming infected with HIV (44 percent vs. 10 percent). And, when it comes to worrying about a family member becoming infected, black residents are eight times as likely to worry: 65 percent do, compared to 8 percent of white residents. More generally, half of blacks in the District say HIV/AIDS is a very serious problem in their local community, compared to about a quarter of whites. However, similar shares of white and black residents list HIV/AIDS as the most urgent health problem facing the city (42 percent and 36 percent, respectively). Blacks More Likely to Express Concern About HIV Infection for Selves, Families Percent who say they are very concerned or somewhat concerned about DC all adults DC White adults DC Black adults personally becoming infected with HIV In addition to being concerned about infection, black adults living in the District are somewhat more likely to report a personal connection to the epidemic. Fully 65 percent of black residents personally know someone who has HIV/AIDS or has died from AIDS, compared to 54 percent of whites. Given their worry and personal ties to the disease it is perhaps not surprising that black adults are about twice as likely as whites to say the subject of HIV/AIDS comes up in conversation with family and friends at least sometimes: 49 percent say so, compared to 26 percent among whites. 10% 29% 44% Source: The Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia (conducted May 10 31, 2011) an immediate family member becoming infected with HIV 8% 40% 65% Black District More Likely to Know Someone Who Has Dealt with HIV/AIDS Percent who say yes they personally know someone who now has AIDS, has died from AIDS, or has tested positive for HIV: DC all adults 58% DC White adults 54% DC Black adults 65% NATIONAL all adults 41% Source: National results from Kaiser Family Foundation 2011 Survey of Americans on HIV/AIDS (conducted April 4 May 1, 2011); DC results from The Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia (conducted May 10 31, 2011) 2
Despite the fact that black residents are more likely to know someone with the disease, they are somewhat less likely than white residents to report being comfortable working with someone who has HIV/AIDS (76 percent vs. 91 percent). But, on an individual basis, having a personal connection to the disease does seem to be related to feeling comfortable around those with HIV/AIDS. Blacks in the District who say they know someone who is HIV positive or has AIDS are more likely to report being comfortable working with an HIV positive person: 81 percent do, compared to 66 percent of black residents who say they don t know someone with HIV/AIDS. Perceptions Of HIV/AIDS Among DC, By Race Percent who All DC Black White Think AIDS is a serious problem in their local community 59% 68%* 50% Say the subject of HIV/AIDS comes up in discussions with family and friends often/sometimes 40 49* 26 Say they are very or somewhat comfortable working with someone who has HIV 81 76* 91 Say they are very comfortable working with someone who has HIV 55 47* 71 * Statistically significant difference from white residents (p<0.05) KNOWLEDGE AND PERCEPTIONS OF HIV/AIDS AMONG BLACK RESIDENTS DIFFERS BY AGE: YOUNG BLACKS MORE KNOWLEDGEABLE AND MORE LIKELY TO ACKNOWLEDGE SEVERITY OF EPIDEMIC; PERSONAL CONCERN EQUALLY HIGH ACROSS ALL AGE GROUPS In part a reflection of life experiences and the age of the epidemic, 73 percent of the black District residents living with HIV/AIDS are 40 or older. 4 Still, those under 40 are an important target of prevention efforts and are more likely to perceive HIV/AIDS as a serious problem (83 percent, including 63 percent who say it s a very serious problem) than older blacks (60 percent, including 43 percent who say it s a very serious problem). Perhaps a result of younger blacks growing up in the age of AIDS 39 year olds today were only 9 or 10 when AIDS was first discovered younger blacks in DC are also less likely to harbor misperceptions about the disease. 4 District of Columbia Department of Health, District of Columbia HIV/AIDS, Hepatitis, STD, and TB Annual Report 2010, http://www.dchealth.dc.gov/doh/frames.asp?doc=/doh/lib/doh/services/administration_offices/hiv_aids/pdf/2010_annual_report_final.pdf. 3
They are more likely than older blacks in DC to correctly answer that a pregnant woman with HIV can reduce the risk of transmission to her baby by taking certain drugs (81 percent vs. 57 percent), that there is no vaccine to prevent AIDS (73 percent vs. 61 percent), and that Magic Johnson has not been cured of AIDS (76 percent vs. 62 percent). But for other measures, younger black residents are similar to older black residents. For example, concern about personally becoming infected or a family member becoming infected crosses generational lines, as does the likelihood of knowing someone with HIV/AIDS. Knowledge And Perceptions Of HIV/AIDS Among Black DC, By Age Black Ages 18 39 Black Ages 40 or Older Listed HIV/AIDS as most urgent health problem facing the District 38% 35% How serious a problem HIV/AIDS is in their local community Very serious 63%* 43% Somewhat serious 20 16 Not too serious 8 12 Not a problem 5* 14 The subject of HIV/AIDS comes up in discussions with family and friends Often 26% 19% Sometimes 28 28 Rarely 32 27 Never 13* 26 Personal concern about becoming infected with HIV Very concerned 30% 28% Somewhat concerned 19 14 Not too concerned 25 20 Not at all concerned 26* 37 Concern about family member becoming infected Very concerned 41% 46% Somewhat concerned 21 21 Not too concerned 17 14 Not at all concerned 21 18 Know a pregnant woman who has HIV can take certain drugs to reduce the risk of her baby being born infected 81%* 57% Know there is no vaccine for HIV 73%* 61% Know that Magic Johnson has not been cured of AIDS 76%* 62% Comfortable working with someone who has HIV Very comfortable 49% 46% Somewhat comfortable 30 28 Not too comfortable 10 15 Not at all comfortable 9 9 Know someone with HIV/AIDS or has died of AIDS 64% 66% * Statistically significant difference from black residents age 40 or older (p<0.05) 4
ATTITUDES VARY BY EDUCATIONAL ATTAINMENT: LESS EDUCATED MORE CONCERNED ABOUT INFECTION, MORE LIKELY TO HARBOR MISINFORMATION ABOUT THE DISEASE In DC, there are large differences in educational attainment within the black community that may shape public opinion towards AIDS. Black residents with less education stand out as considerably more likely than those with more than a high school diploma to say they are very concerned about personally becoming infected (41 percent vs. 17 percent) or about family members contracting the disease (60 percent vs. 29 percent), even as similar shares of both groups acknowledge that the problem is a very serious one for the city (52 percent vs. 49 percent). When it comes to familiarity with basic facts about the disease, more educated black adults are more likely to correctly answer that there is no vaccine for HIV/AIDS (75 percent vs. 56 percent) and that Magic Johnson has not been cured of AIDS (76 percent vs. 58 percent). Those with more education also are more likely to name HIV/AIDS as the most urgent health problem facing the district (41 percent vs. 30 percent) and to report knowing someone with the disease (70 percent vs. 61 percent). Knowledge And Perceptions Of HIV/AIDS Among Black DC, By Educational Attainment Black High School or Less Black More Than High School Listed HIV/AIDS as most urgent health problem facing the District 30% 41%* How serious a problem HIV/AIDS is in their local community Very serious 52% 49% Somewhat serious 15 20 Not too serious 10 10 Not a problem 11 11 The subject of HIV/AIDS comes up in discussions with family and friends Often 24% 19% Sometimes 28 27 Rarely 22* 37 Never 26* 17 Personal concern about becoming infected with HIV Very concerned 41%* 17% Somewhat concerned 14 16 Not too concerned 15* 29 Not at all concerned 29* 37 Concern about family member becoming infected Very concerned 60%* 29% Somewhat concerned 16* 25 Not too concerned 7* 23 Not at all concerned 16 22 Know a pregnant woman who has HIV can take certain drugs to reduce the risk of her baby being born infected 62% 69% Know there is no vaccine for HIV 56%* 75% Know that Magic Johnson has not been cured of AIDS 58%* 76% Comfortable working with someone who has HIV Very comfortable 43% 51% Somewhat comfortable 29 29 Not too comfortable 15 13 Not at all comfortable 12* 6 Know someone with HIV/AIDS or has died of AIDS 61% 70%* * Statistically significant difference from black residents with more than a high school diploma (p<0.05) 5
KNOWLEDGE AND PERCEPTIONS ALSO VARY BY GEOGRAPHY: RESIDENTS OF WARDS 7/8 MORE LIKELY TO SAY AIDS IS A SERIOUS PROBLEM, MORE LIKELY TO EXPRESS CONCERN ABOUT INFECTION Looking at the District as a whole, or even dividing it by District of Columbia sociodemographic groupings, in some ways misses the reality of opinion on the ground, which can often differ by neighborhood. When dealing with an epidemic such as HIV/AIDS, the social networks and relationships that exist within geographic communities are particularly important to understanding and preventing transmission of the disease. As in many cities, divisions by race and class in Washington often fall along geographic lines, and in this section we examine views toward HIV/AIDS through this lens. 5 The eight official, political wards that divide the city vary considerably in terms of racial make up, income level, and education. For example, 7 and 8, which lie east of the Anacostia River, are roughly 95 percent black and have high rates of poverty. In contrast, 1 and 4, generally more affluent areas, are more racially mixed and have fewer people living in poverty, while 5 and 6 are racially mixed with higher poverty rates. 2 and 3, meanwhile, have a significantly higher proportion of residents who are white, welleducated and have much higher incomes. These differences come in to play in the views of residents from different communities. Source: Neighbhorhood Profiles, Washington DC, http://www.neighborhoodinfodc.org/wards/wards.html Demographics By DC Council Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8 Population, 2010 76,197 79,915 77,152 75,773 74,308 76,598 71,068 70,712 Children, 2005 09 (%) 12 6 13 20 17 13 25 30 Black, non Hispanic, 2010 (%) 33 13 6 59 77 42 96 94 White, non Hispanic, 2010 (%) 41 67 78 20 15 47 1 3 Unemployment rate, 2005 09 (%) 7 4 3 8 13 8 19 17 Without high school diploma 2005 09 (%) 19 8 3 17 19 12 20 21 Poverty rate, 2005 09 (%) 16 15 7 10 19 18 26 35 Average family income, 2005 09 ($) 98,485 190,692 257,386 116,668 78,559 120,526 54,677 44,076 Source: Neighborhood Info DC, Neighborhood Profiles, Council http://www.neighborhoodinfodc.org/wards/wards.html Meanwhile, HIV/AIDS prevalence rates are well above epidemic level in all but one of DC s eight wards. According to data reported by the District s Department of Health in 2008, 5, 6 and 8 had the highest HIV/AIDS prevalence rate in the District, at 2.7 percent, 2.8 percent and 2.8 percent respectively. 6 Ranking closely behind those were Ward 1 at 2.5 percent and Ward 7 at 2.4 percent. Ward 1 also has the highest overall number of persons living with HIV/AIDS. 2 (2.1 percent) and 4 (1.7 percent) were slightly lower than the previous group, and Ward 3 was the only District neighborhood that had a prevalence rate below epidemic status, at 0.3 percent. Looking at reported concern about HIV/AIDS in the KFF/Washington Post survey data, we find that worries are highest among those black residents living in 7 and 8, which, as is true for other wards, are shown combined in the table below due to sample size limitations. [Note also that due to the smaller shares of blacks living in 2 and 3 13 percent and 6 percent, respectively there is insufficient sample to present results for these wards.] As noted above, this 5 The Washington Post, Interactive: Mapping the Census http://www.washingtonpost.com/wp srv/special/nation/census/2010/. 2010 data, accessed Sept. 2011. 6 District of Columbia HIV/AIDS Epidemiology Update 2008, http://doh.dc.gov/doh/lib/doh/pdf/dc_hiv aids_2008_updatereport.pdf. 6
area east of the river stands out not just for its high prevalence rate but for its strikingly high poverty rates, with roughly one in four living in poverty in Ward 7 and one in three in Ward 8. Three out of four black residents east of the river (75 percent) say that HIV/AIDS is a serious problem in their community compared to closer to six in ten blacks living in 1/4 or 5/6. And about half of blacks living in 7/8 say they are personally concerned about becoming infected with HIV, compared to one third in 5 and 6. This heightened level of concern in 7/8 extends to their immediate family members as well, with 72 percent expressing concern for family members (including 53 percent who are very concerned ). Perceptions Of HIV/AIDS Among DC s Black, By Ward Among Black DC Percent who 1/4 5/6 7/8 Say that HIV/AIDS is a problem in their local community (NET) 64% 62% 75% a,b Very serious 47 47 56 Somewhat serious 17 15 19 Are personally concerned about becoming infected with HIV (NET) 44% 34% 51% b Very concerned 30 b 19 34 b Somewhat concerned 14 15 17 Are concerned about an immediate family member becoming infected with HIV (NET) 62% 58% 72% b Very concerned 38 38 53 a,b Somewhat concerned 23 20 19 Say HIV/AIDS comes up often/sometimes in discussions with their family and friends (NET) 54% b 43% 54% b Often 19 17 28 b Sometimes 35 c 26 25 Know someone who has AIDS or has died from AIDS 62% 64% 69% a Statistically significant difference from 1/4 (p<0.05); b Statistically significant difference from 5/6 (p<0.05) Blacks living in 5/6 are somewhat less likely than those living east of the river to report being concerned about themselves or a family member becoming infected, and are somewhat less likely to report talking about HIV/AIDS with friends and family, despite the fact that they live in areas with equally high prevalence rates. Still, rates of concern are quite high. Overall, one in three black residents of 5 and 6 do express concern about their own vulnerability, and nearly twice as many (58 percent) say they worry about a family member contracting the disease. In terms of their concern about themselves or a loved one becoming infected, black residents of 1/4 generally fall somewhere in between those living in other wards, but are just as likely as blacks in 7/8 to say they talk about HIV/AIDS with family and friends. Overall, 44 percent say they personally worry about HIV infection. As further evidence of the extent to which the HIV/AIDS epidemic has touched people across the District, at least 6 in ten black residents in each of the ward clusters examined above report knowing someone who has AIDS or has died from AIDS. 7
Levels of basic HIV knowledge are similar among black adults across the different wards. Between 60 and 70 percent were able to correctly answer true or false questions about preventing mother to child transmission of HIV, the lack of a vaccine to prevent HIV infections, and if Magic Johnson has been cured of AIDS. However, a somewhat higher share of black residents in 7/8 report being comfortable working with someone who is HIV positive than blacks living in 1/4 (81 percent vs. 71 percent). Blacks living in 5/6 fall in between with 77 percent reporting they would be comfortable having an HIV positive coworker. As previously noted, sociodemographic characteristics vary from ward to ward. Yet, even when comparing the opinions of those with similar educational attainment, ward differences remain. Across wards, the perception of HIV/AIDS as a serious problem for the local community is shared across education levels. But, when it comes to concern about becoming infected, black residents of 7/8 are more likely to express concern about infection than residents of 5/6 regardless of education level. Among black adults in DC who have attended at least some college, four in ten residents of 7/8 are personally concerned about becoming infected compared to 27 percent of their similarly educated peers in 5/6. Similarly, among black adults with a high school education or less, 57 percent in 7/8 report being concerned about infection, compared with 43 percent of those in 5/6. Levels Of HIV Knowledge Among Black DC, By Ward Among Black DC Percent who know 1/4 5/6 7/8 A pregnant woman who has HIV can take certain drugs to reduce the risk of her baby being born infected 63% 63% 66% There is no vaccine to prevent people from becoming infected with HIV 63 68 62 Magic Johnson has not been cured of AIDS 67 68 65 Black of 7/8 Slightly More Comfortable with HIV Positive Coworker In general, how comfortable would you be, personally, working with someone who has HIV or AIDS? Very comfortable 1/4 5/6 7/8 Somewhat comfortable AMONG BLACK DC RESIDENTS 41% 48% 49% Note: Don t know/refused answers not shown. Source: The Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia (conducted May 10 31, 2011) Somewhat uncomfortable 30% 29% 32% 15% 15% 12% 6% 10% 8% Very uncomfortable Personal Concern About Becoming Infected With HIV, by Educational Attainment Percent who say they are very or somewhat concerned about personally becoming infected with HIV AMONG BLACK DC RESIDENTS Those with a high school education or less 5/6 7/8 Those with more than a high school education 5/6 7/8 27% 43% 40% 57% Source: The Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia (conducted May 10 31, 2011) 8
DC IN NATIONAL CONTEXT The Kaiser Family Foundation also recently conducted a broader, national survey on Americans views of HIV/AIDS. 7 Many of the results from the DC survey reflect the findings at the national level, however higher shares of DC residents say AIDS is the most urgent health problem for their city than Americans report at the national level (36 percent vs. 7 percent). Results by race in some ways reflect the national numbers, though the District s black residents are more likely than black adults nationally to report a personal connection with the disease (65 percent vs. 57 percent). Given the diversity of the city and the disproportionate impact on the black community, a more localized look at how opinions vary is important for understanding the impact and response to HIV/AIDS. Along with differences by race, there are also differences within the black community correlated with where they live and other socioeconomic factors. Awareness of these disparities can help the city government and local stakeholders better understand the challenges in preventing and treating HIV/AIDS in the District. It can also help the community better understand and reflect the heterogeneity of the black community. Methodology The Washington Post/Kaiser Family Foundation Survey Project is a partnership and an experiment in combining survey research and reporting to better inform the public. The 2011 Survey of DC, the 22 nd in this partnership series, was conducted by telephone from May 10 to May 31, 2011 among a representative random sample of 1,342 adults ages 18 and older living in the District of Columbia. The full sample includes additional interviews with randomly selected African Americans, for a total of 812 black respondents. The added interviews (commonly referred to as an oversample ) were completed to ensure there were enough respondents for separate analysis. Results for all groups have been weighted to reflect their actual distribution in Washington, D.C. Telephone interviews conducted by landline and cell phone were carried out in English and Spanish by Social Science Research Solutions (SSRS). The margin of sampling error for results based on the total sample is plus or minus 3.5 percentage points. The error margin is 4 percentage points for the African American sample and 6.5 points for the white sample. For results based on other subgroups, the margin of sampling error may be higher. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Table percentages may not add to 100% due to rounding. Full information about the survey is available at http://www.kff.org/kaiserpolls/8199.cfm 7 Kaiser Family Foundation, HIV/AIDS at 30: A Public Opinion Perspective June 2011. http://www.kff.org/kaiserpolls/8186.cfm. This publication (#8231) is available on the Kaiser Family Foundation s website at www.kff.org. The Henry J. Kaiser Family Foundation: Headquarters 2400 Sand Hill Road, Menlo Park, CA 94025 Phone: 650.854.9400 Fax: 650.854.4800 Washington Offices and Barbara Jordan Conference Center: 1330 G Street N.W., Washington, DC 20005 Phone: 202.347.5270 Fax: 202.347.5274 www.kff.org The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.