Credit score: Unsplash/CC0 Public Area
The variety of new HIV infections has fallen through the years—it declined by 39% from 2010 to 2023. However HIV’s devastating affect on world well being persists. In 2023, 1.3 million individuals acquired HIV—thrice greater than the 370,000 goal set by UNAids. In sub-Saharan Africa, HIV incidence amongst younger ladies aged 15–24 is lowering—however they accounted for 27% of all new infections in 2023, and had been thrice extra more likely to purchase HIV than male counterparts.
There are a selection of efficient, user-centered HIV prevention choices. They embody oral pre-exposure prophylaxis (PrEp, a day by day capsule that incorporates antiretroviral medicine), condoms, vaginal rings (which will be inserted and launch medicine), and long-acting injectables.
These are vital within the struggle in opposition to HIV, however an individual must determine to make use of them. It’s this person choice course of which is key in understanding find out how to stop new HIV infections.
My colleagues in public well being analysis and I suggest a brand new, structured approach of understanding individuals’s thought processes when deciding whether or not to make use of condoms, drugs, or different HIV prevention strategies. We name this framework the “decision cascade.” It is based mostly on behavioral science—the examine of how individuals suppose, really feel and act.
To maintain and speed up the struggle in opposition to HIV, we should do not forget that persons are on the coronary heart of the HIV pandemic. Individuals’s selections will probably be influenced by their private judgment of whether or not they really want and may entry the strategies and instruments obtainable, based mostly on their particular person circumstances and priorities.
We hope that the choice cascade will present researchers, public well being interventionists and coverage makers with a information to understanding individuals’s selections. We additionally counsel approaches that might work.
The choice cascade
Constructing on earlier work, the cascade identifies varied forms of decision-makers who want HIV prevention merchandise however do not use them. In contrast to many frameworks, it contains those that do not think about using the providers, do not see a necessity for them, or face boundaries for private, social, or structural causes.
The choice cascade focuses on the particular person and the elements that affect their selections to behave. Individuals undergo steps when making selections. The thought behind the cascade is to assist them full every step with a view to act.
The steps are:
Step 1: triggers and cues
People are cued, or triggered, to think about an motion, akin to utilizing a vaginal ring. Triggers will be exterior (like getting a flyer about HIV providers) or inner (nervousness about having had unprotected intercourse).
Present interventions typically depend on health-focused cues. They deal with rational explanations about well being advantages (for instance, “using condoms reduces your risk of HIV”). They assume that if persons are given logical, clear details about find out how to shield themselves, they are going to act accordingly.
The issue is that folks could not course of info. They could be overwhelmed with different considerations (like monetary stress or relationships), or really feel that HIV is just not a priority for them. They may not deal with HIV prevention, even when the data is offered.
One other downside is that folks are likely to deal with what feels pressing, related or necessary to them in the meanwhile. If somebody would not see HIV as a right away risk or precedence, they could ignore prevention messages, no matter how logical or useful these messages appear.
Step 2: response
As soon as cued or triggered, individuals typically react instantly. Their reactions are sometimes unconscious and formed by what they already affiliate with HIV. If they’ve adverse emotions or discomfort in regards to the matter, they may ignore the message or react poorly to it.
The mind will make selections shortly based mostly on biases, like: “I don’t know anyone with HIV, so it’s not a risk for me,” “HIV only affects promiscuous people” or “I’m healthy, so I don’t need prevention.”
These computerized processes could make it more durable for individuals to interact with selections about prevention efforts, even whether it is related to them.
Step 3: analysis of motion
People weigh the prices and advantages of appearing. This analysis is advanced, subjective, and influenced by biases, private beliefs, and the trustworthiness of knowledge sources.
As an example, if an individual perceives utilizing PrEP as a danger to necessary relationships, she or he could desire various actions that keep these relationships.
Step 4: capability evaluation
After deciding that motion is worth it, people assess their capability to behave on it. This includes sensible concerns like realizing how and the place to entry providers or having the mandatory sources.
Some boundaries embody entry points, useful resource constraints, and a insecurity of their capability to make use of the product.
Step 5: timing of motion
Timing is an often-overlooked aspect in HIV prevention. Even when a person decides that utilizing prevention providers is necessary and possible, they need to nonetheless determine when to behave. They could delay if taking motion would not appear pressing.
If an individual takes all these steps, they are going to probably act to stop HIV an infection.
Designing profitable interventions
The choice cascade framework highlights the necessity for interventions that help people all through the complete decision-making course of. Primarily based on this, we now have some suggestions to assist design profitable interventions:
Set off engagement: Interventions ought to use various and interesting triggers to seize consideration and interact a large person base.
Tackle reactions: Concentrate on optimistic messaging.
Assist evaluations: Present clear, reliable info and spotlight the worth of appearing. Assist individuals weigh the non-public prices in opposition to the advantages to make knowledgeable, lifelike selections.
Improve capability: Assist people to take sensible steps in the direction of HIV prevention. Examples embody prolonged clinic hours, adolescent pleasant providers, improved selection of merchandise, digital well being approaches, neighborhood based mostly providers and cash-incentive applications.
Encourage well timed motion: Interventions ought to discover methods to scale back delays and help constant use of prevention providers. It might be via making commitments to going for check-ups, for instance, or motivating individuals by linking prevention providers with different objectives.
Interventions which might be designed for the best way individuals really make selections are more likely to be simpler.
Offered by
The Dialog
This text is republished from The Dialog below a Inventive Commons license. Learn the unique article.
Quotation:
HIV infections will be prevented—why some individuals act to guard themselves, and others do not (2024, December 1)
retrieved 1 December 2024
from https://medicalxpress.com/information/2024-11-hiv-infections-people-dont.html
This doc is topic to copyright. Aside from any truthful dealing for the aim of personal examine or analysis, no
half could also be reproduced with out the written permission. The content material is supplied for info functions solely.
