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HIV/AIDS at 30: A Public Opinion Perspective

Section 5: Conclusions and a Look Ahead

What do trends in public opinion on HIV/AIDS tell us about future progress and roadblocks in the fight against AIDS going forward? The survey data point to several hopeful signs, as well as some areas for concern.

In one troubling sign, visibility of the domestic epidemic and the public’s sense of urgency about it continue to decline. Fewer and fewer people say they are hearing about HIV/AIDS, in the media or otherwise. And in an environment in which HIV is increasingly regarded by the public as a chronic, manageable problem rather than an urgent threat—and in which other health problems like cancer, obesity, and access to health care often take center stage—public health officials and advocates may need to work even harder to keep the problem of HIV on the public’s radar screen. Still, after years of slow but steady decline, personal concern about becoming infected ticked up among young adults for the first time in this year’s survey.  And many adults—including substantial majorities of blacks and Latinos—express a desire for more information about HIV, suggesting that there is a receptive audience for those looking to educate the public and increase awareness about the disease.

It is impossible to look at survey data on HIV/AIDS and not be struck by the extent to which the disease’s impacts are disproportionately felt in the black community. For example, compared with white Americans, blacks are much more likely to know someone living with HIV or who has died from AIDS, to express worry about becoming infected themselves, and to view HIV as the nation’s most urgent health problem. Blacks are also more likely to report taking certain actions that can help reduce the spread of HIV, including talking with their doctors and partners about the disease, and getting tested. And blacks, with their closer ties to the epidemic, are more likely than whites to perceive discrimination against those with HIV/AIDS, and to see AIDS as a more urgent problem for their community now than it was a few years ago. Still, many key measures of visibility and concern are either flat or trending down over time among blacks, when we might hope they’d be going up, given the disproportionate burden that HIV continues to place on the black community.

One of the survey trends that may be most disappointing is the lack of change in self-reported testing rates, which have remained stubbornly flat for more than a decade. And while it’s a positive sign that blacks, Latinos, and younger adults are more likely to report having had an HIV test, overall testing rates for these groups have also been flat since 1997. Though the CDC now recommends routine HIV testing for patients ages 13-64 in all health care settings, just about half of non-elderly adults say they’ve ever been tested, with one in five saying they were tested in the past year. Still, those looking to increase testing may take hope in the fact that the share of adults under 65 saying a doctor has ever suggested they be screened for HIV ticked up from 19 percent in 2009 to 29 percent in 2011. Although this has not yet translated into an increase in reported rates of actually getting an HIV test, it’s an important finding nonetheless, given that it comes just a few years after the CDC’s recommendation for routine screening.

Finally, it’s worth noting that thirty years into the epidemic, substantial shares of the public continue to express discomfort at the idea of interacting in various situations with people with HIV. With expressed discomfort linked to knowledge about transmission, it’s also a disconcerting sign that a third of Americans continue to be misinformed on some basic facts about how HIV is transmitted. Still, over several decades, the trend has been towards a decline in reports of attitudes that may stigmatize people with HIV, such as the view that AIDS is a punishment—which has dropped 27 percentage points since 1987—and that it’s people’s own fault if they contract the disease—down 22 percentage points over the same time frame.

In 2011, then, there continues to be incremental movement in public opinion on HIV/AIDS. And of course, the public itself changes, as new generations come to an age where they must learn about and grapple with the realities of the disease. But looked at in the context of three decades of opinion change, it seems we are in a period of relative stability in terms of Americans’ views of HIV/AIDS. Whether and when we will see big shifts in attitudes depends on the reach and effectiveness of ongoing educational efforts, the timing of scientific and medical discoveries that are no doubt in our future, the extent to which the media focuses on HIV/AIDS, and the daily individual actions that add up to the spread of an epidemic.

Section 4: Americans Talk About Testing Survey Methodology