Pulling it Together: As The International AIDS Conference Convenes, Some Positive News About Public Opinion and HIV

The American people are busy trying to make ends meet and take care of their families and they are constantly bombarded by messaging and spin. They rarely have a full understanding of policy issues and debates. Often it is their strongly held beliefs, whether based on accurate or inaccurate perceptions, which color what they think about issues.  The classic case is the public’s perception of foreign aid, something they don’t like and that they believe consumes a far larger share of the federal budget than it actually does. (If people are given a specific and more popular purpose for aid, such as funding for global health or to alleviate hunger and poverty, their views flip and they are much more positive.)

So it is something of a surprise, and more than a little bit heartening, to see in our new Kaiser Family Foundation-The Washington Post survey published in the paper this week that the American people get most of the essentials about the HIV epidemic right (but not necessarily all of the details). On the eve of the first International AIDS Conference in the U.S. since 1990 (the year we started the modern day Kaiser Family Foundation and made HIV one of our core priorities), there is a lot that is positive about public opinion on HIV. The state of public opinion on HIV, once an issue marked by great fear and misperception, contrasts sharply with the much more toxic environment on many other health issues we poll on, such as health reform, where we see much higher levels of confusion, misperception and division in public opinion.

• Half of Americans (51%) see progress in combating the domestic epidemic, with 18% saying we are losing ground. Blacks (41%) are less likely than whites (52%) to believe progress is being made, which, of course, reflects the reality in the black community which has been much harder hit by HIV/AIDS.  The public has it right; there has been great progress, although there is still a long way to go.
• Most Americans (58%) think the world is making progress on HIV/AIDS, with 18% saying we are losing ground.  Again, right on target.
• People from communities who are most affected by the epidemic are the most likely to say they are worried about it.  For example, blacks are five times as likely as whites to worry about a family member getting HIV.
• People know where the epidemic is now hitting hardest.  For example, over half the public (54%) – and even a larger share of blacks (63%) – recognize that the epidemic has had a greater impact on blacks than whites in the U.S.
• Most people know that providing access to treatment is a problem in developing countries, with 87% percent of the public saying most people in developing countries don’t have access to HIV medications. This has been a theme in media coverage of the global epidemic. New data just out from UNAIDS finds recent gains have been made, although still almost half of people in low and middle income countries who need HIV medications are not getting them.
• A majority (56%) says that more spending on HIV treatment will lead to meaningful progress in slowing the epidemic here at home, something experts would certainly assert.  (About a third – 34% – say it won’t make much difference.)
• Recent research has shown the important benefits of treatment as prevention – that those with HIV on treatment can reduce the chances of spreading the virus to sexual partners by as much as 96%.  Half of Americans (49%) are aware of this link between treatment and prevention, a surprisingly high number for a fairly recent research finding that will not affect most of the public.

Still, there are misconceptions about HIV that stubbornly persist.  About a third of the American people still harbor some misunderstanding about a basic fact related to HIV such as thinking you can transmit the virus by sharing a drinking glass with an HIV positive person.  Thirty percent think Magic Johnson has been cured or are unsure.  Only 17% of the public knows that HIV drugs can lower the risk of people who are HIV negative but at high risk of contracting HIV (our poll was conducted just before the high profile FDA approval of the first drug for this purpose). This will be critical information to get to high risk groups.

So why does the public grasp at least the essential contours of the epidemic?  One factor may be the cumulative effect over many years of media coverage, because the news media is by far the public’s top source of information on HIV.  But that cannot be the only explanation.  News coverage of HIV has been falling off for years, and this year only 14% of the public say they have seen, heard, or read “a lot” about HIV in the U.S. (22% say the same about HIV in Africa). That’s down from 34% and 51% respectively in our 2004 survey.

Another factor, I suspect, is that people have learned about the epidemic because, sadly, many know someone with HIV.  Forty-five percent of the American people now say they have a family member or close friend (22%) or know someone else (another 23%) who has HIV.  People are likely to learn more about the epidemic when they have personal contact with it.  Still another factor is that significant shares of people are talking to doctors about HIV.  For non-elderly whites the percentage talking to doctors is up to 40%; for blacks it is now 64%.  No doubt the tireless efforts of HIV advocacy groups and advocacy campaigns have also played a significant, if hard to measure, role in the public’s general grasp of the epidemic.

It is likely a combination of all of these factors and others that are responsible for the American people grasping the essentials of the epidemic.  While some share of the public will always get basic facts and details wrong, it is most important now to make sure people understand the significance of recent scientific advances, particularly for high risk groups, who can act on what has been learned about the benefits of early detection and treatment to protect themselves and others.

Even so, knowledge of basic facts – like whether HIV can be transmitted from toilet seats or drinking glasses –  can be beneficial because it helps to reduce the persistent stigma directed towards those who are HIV positive, which contributes to the spread of the epidemic when people delay testing and treatment because of worries about how they will be viewed.  In fact, while the percentage of people who say they would be very comfortable working with someone with HIV has been rising, from 32% in 1997 to 48% this year, and the share of parents saying they would be comfortable if their kids had an HIV positive teacher is up, until attitudes like these are more universal, stigma will persist.

The public’s grasp of the essentials (if not all the details) is important for future efforts to halt the HIV epidemic.  Despite progress and new breakthroughs in research on the role of treatment as a prevention tool, there is a long way to go in the effort to end the epidemic here and abroad.  There is still stigma and discrimination and new funding is exceedingly hard to come by in today’s weak domestic and global economies.  But there is a foundation of basic public knowledge and support which will serve the HIV effort well in years ahead.