Despite the city’s efforts to prevent the spread of the disease and make treatment available, HIV/AIDS tops the list as the District’s most urgent health problem, according to a new survey by The Washington Post and the Kaiser Family Foundation.

More than a third of city residents single out HIV/AIDS — first identified 30 years ago — as the city’s biggest health concern. Nationally, cancer and obesity get far more mentions.

And the scourge of HIV/AIDS weighs particularly heavily on the minds of African American residents, who suffer from the disease in disproportionate numbers, are far more likely than white residents to raise it as a concern in discussions and more often fret over whether they or their family members will become infected.

More than four in 10 African Americans — 44 percent — say they personally are concerned about contracting HIV, compared with 10 percent of white residents, according to the poll.

“It’s spreading so rapidly in the black community,” said Ahwaneda Brown, reflecting the concern of the 65 percent of African American respondents who fear a family member might get the virus. Only 8 percent of white residents are similarly worried.

Although Brown has not discussed the issue with her adult grandchildren, the 82-year-old retired school counselor said: “I know my daughter has. I have the type of family that will talk with their children because I have talked to mine. We are very open about talking.”

The District has what is considered to be one of the highest rates of HIV/AIDS in the nation. More than 3 percent of residents older than 12 — about 16,000 people — are stricken, high enough to be categorized as an epidemic under to a standard set by the Centers for Disease Control and Prevention and the World Health Organization.

Fully three-quarters of residents living with the virus are African Americans, according to the city’s latest annual epidemiology report. It found that 17 percent are white and 5 percent Hispanic.

The disease’s impact is widely noted: nearly seven of 10 African American residents say the spread of HIV/AIDS is a problem in their communities, versus just half of white residents.

About two-thirds of blacks say they know someone directly affected by HIV or AIDS. Across the city, 58 percent of residents say someone they know has the disease or has died of it — far higher than the 41 percent who said so in a national survey from the Kaiser Family Foundation.

Potentially contributing to the challenge for the city’s black residents is that they are far less likely than whites to have private health insurance. More than 90 percent of white residents say they get coverage through an employer or another private source, but only 47 percent of black residents say they do.

The D.C. government provides free health care and medicine to residents who have the HIV virus.

But financial difficulties affect the health care of many District residents. Fully 25 percent of African Americans with incomes under $20,000 say they have delayed medical care in the past year because they couldn’t afford it.

Among blacks in households with income under $100,000, 19 percent say they recently have had trouble paying medical bills, compared with 8 percent of whites in that income group.

Calvin Jackson, a 58-year-old building engineer and registered nurse, has private health insurance through his employer, but it does not cover all of the care he and his wife need to treat their Type II diabetes.

The couple have gone to the District’s free clinics twice in the past eight months to supplement their medical and dental care. Jackson’s insurance does not cover his wife’s primary care, so she goes to a hospital emergency room when she becomes sick.

“I have to budget very wisely,” said Jackson, who saves loose change in jars to help pay for part of his health care and who moved from Prince George’s County to a smaller, cheaper home in Northwest Washington. “It’s the only thing I can do to keep my health and my wife’s health going.”

The health coverage divide also extends to dental care, with 80 percent of whites saying they went to a dentist in the past year, while 40 percent of blacks say it’s been a year or more since their last visit. Jackson, who pays for dental care, said six fillings recently cost him $3,300.

A 2004 study on dental care by the health institute of the Joint Center for Political and Economic Studies, a black think tank, concluded that lack of care had an impact on appearance, which affected the ability of job seekers to obtain or keep employment.

But worries over medical and dental coverage do not rise to the level of concern over HIV/AIDS. In the poll, nearly half of African Americans say HIV/AIDS comes up in conversations with family and friends at least sometimes. That’s about double the proportion among whites.

Concern about becoming infected with HIV/AIDS is significantly higher among lower-income and less-educated blacks than it is on the higher ends of the socioeconomic scale.

Leon Williams, 56, a retired machine operator, said he is “very concerned” about AIDS. It’s not so much a personal concern (“I’m in a very strong relationship. I have a person in my life, and we trust each other,” he says) but a matter of frightening statistics.

“This is very serious in the District,” said Williams, who lives in Northeast. “I have a friend personally that has it, and I’ve seen all the drugs he takes to stay alive.”

When African Americans in the District first began to die from the infection, black church ministers often declined requests from relatives to preside over their funerals, a result of the disease’s homosexual stigma, black gay rights activists have said.

But Williams said he continues to respect his friend and would work beside him without reservation. Overall, 76 percent of African American residents and 91 percent of white residents said they would be “very” or “somewhat” comfortable working with someone with HIV or AIDS. Nationwide, 78 percent of Americans felt the same.

The poll was conducted by telephone between May 10 and 31, with a total random sample of 1,342 adults in the District. The margin of error is plus or minus 3.5 percentage points for the full survey, 4 percentage points for the black sample and 6 percentage points for the white sample.

Polling analyst Scott Clement contributed to this report.