Americans on AIDS in Africa: Help and Discipline Needed

Americans on AIDS in Africa: Help and Discipline Needed

Epidemic Blamed On Africans for Unsafe Practices


By Richard Morin and Claudia Deane

Washington Post Staff Writers

Saturday, July 6, 2002


Most Americans favor modest and targeted increases in spending on the global AIDS crisis but many believe any additional money likely will do little to slow the spread of AIDS in Africa and elsewhere in the developing world, according to a survey by The Washington Post, the Henry J. Kaiser Family Foundation and Harvard University.


Nearly three in four -- 74 percent -- members of the public support a proposal by President Bush to spend an additional $500 million mostly in Africa over the next three years to help combat the transmission of the AIDS virus from mothers to their unborn children.


But this compassion is tempered by caution. Other poll findings and interviews with survey participants suggest that few

Americans believe that inadequate funding is the major problem. Instead, the public blames the deepening AIDS emergency in the region on factors it feels are largely immune to a quick financial fix: The stubborn reluctance of many Africans to abandon unsafe sex practices, crippling poverty and governments that are either too corrupt, too incompetent or too overwhelmed to deal effectively with the disease.


"I think it's a matter of people there understanding they need to stop the actions they're doing," said Elizabeth Stokesberry, 26, of Barre, Mass., a homemaker who is expecting her first child at the end of this month. "I don't think the United States should be the world's parent."


But Stokesberry also believes the United States has a "duty to help countries that don't have the resources" -- and then to keep a watchful eye on how its assistance is used.


AIDS experts from around the world will gather in Barcelona for the 14th International AIDS Conference on Sunday. The Barcelona meeting comes as the AIDS crisis continues to worsen in Africa and elsewhere in the developing world. Seventy percent of all individuals infected with the AIDS virus live in sub-Saharan Africa, home to about 11 percent of the world's population. In some African nations, nearly a third of the population is infected.


United Nations Secretary General Kofi Annan recently proposed collecting as much as $10 billion a year from wealthier nations for a global fund aimed at fighting AIDS, as well as malaria and tuberculosis. The presumed U.S. share of the fund would be in excess of $2 billion, about double U.S. spending on AIDS abroad.


Few Americans are ready to endorse such a large increase, the Post/Kaiser/Harvard survey suggests. Not even a third 31 percent of those polled -- believes the United States is spending "too little" to deal with AIDS in developing countries. Half of those interviewed said this country was spending the "right amount" (34 percent) or "too much" (16 percent) and the remainder were unsure.


And twice as many respondents opposed increasing U.S. support to $2 billion as favored it. But a clear majority -- 59 percent -- acknowledged that they needed to know more before making up their minds, suggesting that many Americans have not yet ruled out a more generous U.S. assistance package. And Americans are far less likely to oppose U.S. assistance to fight global AIDS than they are to object to foreign aid in general.


Bush's proposal to spend $500 million internationally came on the heels of a well-publicized trip by Treasury Secretary Paul H.

O'Neill and rock singer Bono to Africa to study the AIDS crisis. Assistance to Africa for AIDS relief was a major focus of the recent Group of Eight meetings in Canada.


The Post/Kaiser/Harvard survey found that Americans clearly recognize the magnitude of the global AIDS crisis. Two-thirds

agreed that AIDS had reached epidemic proportions throughout the world. Eight in 10 correctly believe that Africa has been

hardest hit by the disease. Two-thirds say they expect that "the worst is yet to come" in Africa, a fear universally shared by the

world's AIDS experts.


"I think the worst of the problem [in Africa] is still out there," said Gary James, 42, who works with the mentally handicapped and

is a deacon at his church in Columbia, S.C. "I think it's worse than people really perceive."


James believes the AIDS crisis in Africa will eventually harm the United States. "Eventually it will spread. . . . It has already

impacted the United States. To just sit back and cover it up, I think it's kind of wrong."


James is not alone. Eight in 10 believe that AIDS in other countries threatens the quality of life in the United States, and 43

percent rate it as a "very serious" threat, though it ranks well behind terrorism and nuclear proliferation. Nearly half of those

surveyed said it was "very likely" that the global AIDS crisis could loose a flood of refugees into the United States. And one in five

thought the epidemic abroad probably would weaken the U.S. economy.


At the same time, many question the wisdom of spending more money to combat AIDS in Africa and other developing countries. Nearly half -- 47 percent -- said they doubted that additional assistance will lead to meaningful progress while 40 percent said it would.


Behind those numbers are fundamental disagreements between blacks, Latinos and whites over the merits of spending more on global AIDS. Barely a third of all whites -- 34 percent -- said more money would significantly help, a view expressed by 62 percent of all blacks and 60 percent of Latinos. More blacks (47 percent) than whites (30 percent) or Latinos (37 percent) ranked AIDS as the most urgent health problem facing the world today. Blacks and Latinos also were more likely to say that prevention programs would make "a lot" of difference in combating AIDS in developing countries.


The survey suggests that many Americans doubt that more money will help because they don't believe that money -- or the lack of it -- is a major reason the disease has spread so far, so fast across sub-Saharan Africa.


Eight in 10 say a major reason that AIDS has been so hard to control in Africa is the "unwillingness of people to change their unsafe sexual practices." Three in four blame African governments that "are not doing enough themselves to fight AIDS." Two in three -- 65 percent -- said poverty was a big reason.


But only one in four -- 25 percent -- said the lack of financial support from the United States and other developed countries was a

big reason it has been difficult to control the spread of AIDS in Africa.


"We send them money and the government takes it and the money doesn't reach the people that need it," said Bill Stalfa, 65, a

retired firefighter who lives in Forked River, N.J. "And they've got to curb themselves. They're the leading population with AIDS.

Stop having sex if they're going to get AIDS. Then ask us for help. We got enough problems in this country right now. Forget

about Africa."


Many Americans question whether AIDS is the biggest health problem facing Africans. When asked what the priorities of the

United States should be to deal with health-related problems in Africa, the public ranked the lack of access to clean water and widespread hunger ahead of AIDS, a priority list that precisely echoes the views of Treasury Secretary O'Neill after his Africa trip.


Ronald Mann, 44, of Sanderson, Fla., a sales representative for a steel manufacturer, said he does not think the United States has a responsibility as the richest and most powerful country to spend more to fight global AIDS, an argument that Annan and other world leaders have made. "Until people are willing to help themselves, and that includes their government and their leadership, we can't lead them with American dollars," Mann said.


According to the survey, 51 percent of the public shares his belief that the United States has no more obligation than other wealthier countries to fund AIDS programs in Africa or elsewhere in the developing world. Slightly more than four in 10 44 percent -- believe this country does have a special role.


"I think we do have that responsibility," said Nancy Graham, 69, a dog breeder and retired nurse who lives in Damariscotta, Maine. "It is an advantage in terms of world opinion, and I would hope that we care about that . . . I would hope that it would hold us up as standard-bearers that we care about our fellow man."


Is she worried that the money might be squandered? "Maybe it will go down the drain," she allowed. "But you can hope."


2002 The Washington Post Company