African American and HIV/AIDS Survey - Kaiser Family Foundation

The Kaiser Family Foundation Survey of African Americans on HIV/AIDS

African American Women and HIV/AIDS

African American women have been particularly impacted by HIV/AIDS. They represent the highest percentage (56 percent) of all AIDS cases reported among women and an increasing proportion of new cases (60 percent).¹⁷ This represents three times the number of new cases reported for white women. When standardized to population size, the disproportionate impact of HIV/AIDS on African American women is even more striking: the AIDS case rate per 100,000 population for African American women is 16 times that of white women (61.9 cases per 100,000 compared to 3.8 cases per 100,000).¹⁸ While new cases among white women appear to be leveling off, new cases among African American women are still on the rise. African American women represent a little more than half of the survey sample (55 percent). Major findings are highlighted below:

African American women share a sense of urgency with African Americans in general about HIV/AIDS in the country today.

African American women rate AIDS as the most urgent health problem facing the nation today (53 percent).
In fact, they are more likely than men to say that AIDS is a more urgent problem for the country today than it was a few years ago (62 percent compared to 53 percent).
Most say that AIDS is a major threat to public health in this country today (88 percent).

In addition, African American women express this sense of urgency for their communities and people they know:

Almost half (46 percent) say that AIDS is a more urgent problem today for their local community than it was a few years ago;
A majority (55 percent) of African American women say that AIDS is a very serious problem for people they know; and
Fifty percent knows someone personally who has AIDS, has died of AIDS, or has tested positive for HIV.

African American women are very concerned about their children becoming infected with HIV:

Sixty nine percent of African American mothers a re very concerned about their children becoming infected with HIV, and this concern has increased more among women (52 percent) than men (45 percent) in recent years.
A majority of African American women (60 percent) cite the need for information about discussing AIDS prevention with children. This is the information which African American women rate the most important (36 percent).

However, African American women are less concerned about becoming infected with HIV themselves:

Less than half (47 percent) are " very concerned" about becoming infected with HIV compared to 54 percent of men, although an additional 17 percent are " somewhat concerned " compared to an additional 15 percent of men.

A majority of African American women have been tested for HIV:

Fifty-eight percent re port ever having been tested, including 36 percent within the past year.
One third of African American women (34 percent) have talked with a provider about HIV testing. Of these women, 53 percent say they brought up the topic .
Two thirds (69 percent) of African American women who have tested for HIV report discussing the results with a provider.
However, one in five African American women (21 percent) incorrectly state that today's HIV tests can determine infection within one month of exposure and 21 percent state that they do not know when the tests can determine, with confidence, whether or not someone has been infected with HIV.

Why have 2 out of 5 African American women (40 percent) not been tested for HIV?

A third (35 percent) say it is because they are married or in a monogamous relationship.
A third (32 percent) say it is because they are not sexually active.
Fourteen percent see no need or reason to suspect a problem.
Only a third (35 percent) has ever talked with a health care provider about the risks of being infected with HIV.

Young Adult African Americans and HIV/AIDS

Despite some of the recent advances in HIV treatment, HIV infection is still increasing among young people and young people of color may even be at higher risk for HIV infection. One in every four Americans newly infected with HIV is under the age of 22.¹⁹ Thirty-five percent of cases among 20-24 year old males and 55 percent of cases among 20-24 year old females are among African Americans. We know that young people engage in risky sexual and drug using behavior. For example, 53 percent of American high school students report having had sexual intercourse. Among African American students, 73 percent report ever having had sexual intercourse and more African American students than students in general report current sexual activity.²⁰ What are young African Americans attitudes towards HIV/AIDS? What is their knowledge of HIV/AIDS and where do they get their information about HIV/AIDS? We defined young African Americans as those between the ages of 18-24 (we did not survey anyone younger than age 18). Young African Americans made up 16 percent of the sample. Highlights from our findings include:

Young African Americans have a greater sense of urgency and worry about the HIV/AIDS epidemic than African Americans overall.

They are slightly more likely to say that AIDS is the most urgent health problem facing the nation today (57 compared to 52 percent of all African Americans).
And they are much more likely to say that AIDS is a more urgent problem for the country today than it was a few years ago (70 compared to 58 percent) and in their communities (49 percent compared to 44 percent).
To young people, AIDS is perceived as a major threat to public health in this country (93 percent).

Young African Americans' sense of personal concern about becoming infected with HIV is higher than African Americans overall.

Young people are more likely to say they are very worried about becoming infected with HIV (62 percent compared to 50 percent of all African Americans).
They report greater worry over the last few years. Over half says they are more worried about becoming infected (55 percent) compare d to 40 percent of all African Americans.

Knowledge about HIV/AIDS among young people is similar to that of African Americans overall as are their information needs:

More young people would like information about what to discuss with partners about sex (48 compared to 40 percent of all African Americans).
Twenty-two percent would like information about using condoms.
Forty-six percent would like information about getting tested for HIV.
And half (51 percent) would like information about where to go for help if exposed to HIV.

Young African Americans rely on different sources for HIV/AIDS information than all African Americans:

They are much more likely to have received information in the last month about HIV/AIDS from television, street signs/billboards, health care providers, or friends, family and acquaintances.

Young people are particularly supportive of TV programs including more information about HIV/AIDS:

More young people are in support of major TV networks accepting advertising from condom manufacturers (89 percent compared to 74 percent) and including more condom references on TV shows which deal with sexual relationships (78 percent compared to 69 percent) than African Americans in general.

Have young African Americans been tested for HIV?

Yes. As with African Americans overall, 56 percent of young people have been tested for HIV, most in the last year.
But 28 percent of young African Americans incorrectly state that today's HIV tests can determine infection within a month after exposure and 10 percent state that they do not know when the test can determine, with confidence, whether or not someone has been infected with HIV.

HIV/AIDS and Local Opinion Leaders in the African American Community

What makes them local opinion leaders?

They are opinion leaders because in the past 12 months, they have participated in at least three of the following activities:

Who are local opinion leaders?

African American opinion leaders represent 21 percent of the African American sample.

Attended a public meeting on town or school affairs (84 per-cent);
Served as an officer of some club or organization (74 percent);
Helped organize a group or event in support of a cause (70 percent);
Served on a local committee, such as a school board or community council (45 percent)
Made public speeches (43 percent);
Contacted members of Congress or a US Senator (33 percent);
Worked on a political campaign (26 percent);
Were interviewed or quoted by the media about an important issue (20 percent);
Wrote a letter to a newspaper that was published (14 percent).

They are somewhat older than African Americans in general. Half of all opinion leaders are in the 30-49 age group (52 percent).
They are more educated than African Americans overall (and Americans overall); almost 2 out of 3 (62 percent) African American opinion leaders have some college education or more.
Opinion leaders also earn significantly more than African Americans as a whole, with 30 percent reporting family incomes of $40,000 or more in 1996. Only 19 percent of African Americans are in this category.
Most opinion leaders, like African Americans in general, are from urban areas and from the South.
Finally, most opinion leaders are Democrats (70 percent) which is slightly higher than African Americans overall (63 percent) and much higher than Americans overall (33 percent)

Given the role of local opinion leaders in African American communities, how do their attitudes toward and knowledge of HIV/AIDS compare to African Americans in general?

African American Opinion Leaders view AIDS as an urgent health problem.

Like all African Americans, opinion leaders view AIDS as the most urgent health problem today (54 percent).
At the same time, they are less likely to say that AIDS is a more urgent problem for the country today (47 compared to 58 percent of all African Americans) than it was a few years ago.
And a higher percentage of opinion leaders believes that the country is making progress in the fight against AIDS (52 compared to 45 percent).
Like African Americans in general, they believe that AIDS is a more urgent problem for their local community (45 percent) than it was a few years ago or about as urgent (23 percent).
Only a quarter of opinion leaders (24 percent), and of African Americans overall (25 percent), believe that their local communities are making progress in the fight against AIDS.
When asked, however, if their local community was making progress against AIDS, opinion leaders were more likely than African Americans overall to say that AIDS has never been a problem for their local communities (32 compared to 24 percent).

African American opinion leaders report more personal experience with people with HIV and AIDS.

Opinion leaders perceive the epidemic as slightly more serious for people they know (61 compared to 56 percent of African Americans overall).
And they are much more likely to know people who have AIDS, have died from AIDS, or have tested positive for HIV (63 compared to 49 percent)
At the same time, they are personally less concerned about becoming infected with HIV. Only 38 percent of opinions leaders, com pared to half (50 percent) of all African Americans ar e very concerned.
Unlike African Americans in general and all other subgroups of the African American population in this survey, opinion leaders' concern about becoming infected is more likely to have decreased than increased over the last few years.

African American opinion leaders' overall impressions of the response of government and community leaders to the AIDS epidemic are similar to those of African Americans overall.

Most African American opinion leaders (70 percent) think that the government spends too little on AIDS.
Opinion leaders are more likely to say that federal spending for AIDS, relative to other health problems, is too low (62 percent compared to 54 percent of all African Americans).
Opinion leaders are as or m o re supportive of federal spending on HIV and AIDS education and other prevention activities (98 percent), making new treatments available to more people infected with HIV (99 percent), and researching more effective treatments (97 percent).
Like African Americans overall, African American opinion leaders rank AIDS vaccine research as the top priority for federal spending (41 percent of opinion leaders and 47 percent of all African Americans).

African Americans Support Federal Spending On AIDS/HIV

African Americans show significant support for more government efforts in the fight against AIDS. Most believe that the government is not spending enough money on AIDS (66 percent). Even when compared to the amount of money the federal government spends on other health problems, such as heart disease or cancer, a majority (54 percent) still says spending on AIDS is too low. The support of African Americans for spending not only stands out above that of all Americans (40 percent says the federal government spending is too low in the context of other health problems) but also has endured over time. In 1995, 58 percent said spending was too low, even in light of spending on other health problems.

African Americans advocate spending in a range of areas. More than nine in ten African Americans support federal spending on: HIV/AIDS education and other prevention activities; improve access to new combination drug therapies (including helping lower income HIV infected people pay for these new d rugs); and continued research to find more effective treatments. Research to find an AIDS vaccine is rated as the top federal spending priority; prevention and education efforts rank number two.

Needle Exchange

A majority (59 percent) of African American respondents favor "needle exchange programs, which offer clean needles to IV drug users in exchange for used ones, to help stop the spread of HIV" (as compared to 58 percent of all Americans). Offered an argument voiced by opponents of needle exchange, namely that these programs may send the message that it's okay to use illegal drugs, support drops among African Americans: 40 percent favors, 55 percent opposes.

Knowledge Levels High Among African Americans About HIV/AIDS, But Misperceptions Exist

Overall, there was a high level of general knowledge about AIDS among African Americans:

97 percent of African Americans knows that HIV can be transmitted during sexual intercourse;
84 percent of African Americans know that there are drugs available to treat HIV which can lengthen life of a person infected with HIV;
91 percent of African Americans knows that a pregnant woman with HIV can pass it to her baby, 59 percent knows that she can take steps to reduce the risk of infecting her child.

While a majority (67 percent) of African Americans knows that a vaccine is not available at present to protect people from getting AIDS, one in three (33 percent) incorrectly believes there is a vaccine available or isn't sure. And although most African Americans know that there is no cure for AIDS, 21 percent thinks there is a cure.

Similar to all Americans, African Americans are knowledgeable about HIV and AIDS. While we know that knowledge does not necessarily translate into behavior change, information is an important first step. ²³

Income, Education and Attitudes Towards Knowledge of HIV/AIDS Among African Americans

Individuals with lower incomes and less education may be at greater risk of HIV infection. In addition, there is some indication that those with less education are significantly less likely to have access to important and cost effective drugs needed to prevent AIDS related opportunistic infections such as Pneumocystis Carinii Pneumonia, which is preventable yet still accounts for a significant number of new AIDS cases.²¹ We examined the survey data of those with incomes less than $20,000 (34 percent of the sample) and those with less than high school education (23 percent of the sample). There is some overlap between these two subgroups; those with less education are also likely to have lower incomes (60 percent).²²

African Americans with lower incomes and less education share the same sense of urgency about HIV/AIDS in the country today:

Over half (52 percent) of those with lower incomes rate AIDS as the most urgent health problem facing the nation today.
Those with less education also rate AIDS as the most urgent health problem (45 percent).

AIDS appears to be a more serious problem for people they know, compared to African Americans overall.

Sixty-one percent of those with lower incomes say that AIDS is a very serious problem for people they know compared to 56 percent of the overall sample.
Seventy percent of less educated African Americans say that AIDS is a very serious problem for people they know.

At the same time, however, they are less likely to say that they personally know someone who has AIDS, has died fro m AIDS, or has tested positive for HIV.

Whereas almost half of all African Americans say they know someone, only 33 percent of those with less than a high school education and 44 percent of those with less than $20,000 income say they know someone in these categories. Both groups are very concerned about becoming infected with HIV and more so than African Americans in general.
Almost three in five of those with less education (58 percent) and those with lower incomes (60 percent) are very concerned about becoming infected with HIV compared to one in two (50 percent) of African Americans overall.
Compared to all African Americans, they are more likely to say their concern has grown over recent years .

African Americans with less education and lower incomes express slightly greater information needs than African Americans overall.

They want more information about condom use, discussing sex with partners, talking about AIDS prevention with children, getting tested, and where to go for help if exposed to HIV.
When asked to rank information needs, those with lower incomes, like African Americans in general, cite the need for information about discussing AIDS prevention with children as their greatest information need.
Those with less education cite information about where to go for help if exposed to HIV as their greatest information need (those with less education a re less likely to have children, reflecting in part their younger age).
Those with less education also express the greatest information needs.

African Americans with lower incomes and less education get information about HIV/AIDS from different sources:

Those with lower incomes rely more on TV news, TV entertainment, and health care providers for HIV/AIDS information than African Americans overall.
Those with less education state less of a reliance on these sources than African Americans overall.

There are somewhat different levels of knowledge among those with less education and lower income compared to African Americans in general.

Although most correctly state that there is no vaccine available to protect a person from getting AIDS, greater proportions of those with less education (22 percent) and those with lower incomes (17 percent) thought there was a vaccine compared to 13 percent of African Americans overall.
Similarly, a greater proportion of those with less education (30 percent) and those with lower incomes (27 percent) incorrectly believe there is a cure for AIDS; this is greater than the proportion of African Americans overall (21 percent).

Those with less education are less likely to have received information about HIV and AIDS from a doctor or health care provider.

Only 37 percent of those with less education, compared to 48 percent of all African Americans and 51 percent of those with lower income levels, have talked to their health care provider about HIV and AIDS.
Less (25 percent) have talked to their providers about the risks of being infected with HIV, compared to 35 percent of all African Americans and 38 percent of those with lower incomes.
Finally, they are much less likely (19 percent) to have talked with a provider about getting tested for HIV comp a red to 33 percent of all African Americans and 35 percent of those with lower incomes.

African Americans with less education are also less likely to have been tested for HIV.

Whereas 56 percent of all African Americans and 61 percent of those with lower incomes have been tested, 45 percent of those with less education have ever been tested.
Twenty-two percent say they did not get tested because they do not suspect a problem (compared to 13 percent of African Americans overall and 12 percent of those with lower incomes who gave this as a reason for not getting tested).