Original content from our Mapping Pathways blog team
Risk perception and the consequent behavioral responses has been a
theme that has fascinated Philip Smith throughout his professional career.
Smith, a Ph.D. candidate at the Desmond Tutu HIV Foundation
(DTHF), a Mapping Pathways partner organisation, first encountered the subject
of risk perception as he was completing his masters degree in social science
and psychology at the University of Cape Town. Smith realised that scaring
people with death as part of a prevention strategy may actually end up leading
people to deny their own vulnerability.
“Smoking is an example where a key prevention strategy involves
subjecting people to images of death. My research indicates that this kind of
messaging actually leads to a psychological tension that can lead to
risk-denial or even an increase in self-esteem boosting risky behavior to
relieve that tension,” says Smith.
Smith’s interest in risk and the HIV field led him to DTHF and
subsequently to a key role in the Mapping Pathways project; writing up the
results of the 2011 Online Survey as part of a monograph to be published this
spring by project partner, RAND.. The online survey is one of four data
collection mechanisms of the Mapping Pathways project: the other three being
the ExpertLens, the Literature Review and the Stakeholder Interviews.
“The Online Survey, which happened in India, South Africa, and the
U.S. in 2011, seeks to understand what people at the grassroots were thinking about
implementation and what the specific challenges are on successfully
implementing ARV-based prevention strategies, such as PrEP and TLC+, also known
as treatment as prevention, in their communities,” says Smith
The methodology involved first creating a questionnaire with two
different sections: a multiple choice section and a qualitative section where
respondents were asked about information they wanted and concerns they may have
about ARV-based prevention strategies.
Over 1,000 individuals participated in the survey across the three
countries. Among other questions, participants were asked how important they
thought ARV-based prevention strategies were and what would they find useful in
their work. In addition to asking participants to quantify how important they
believed the different strategies are in preventing HIV infection in their
communities, they were also given the opportunity to share their perspectives
of the barriers to implementing successful ARV-based prevention strategies.
Lastly, participants were asked to suggest what kinds of
information they would find helpful in implementing community friendly,
impactful, ARV-based prevention strategies.
“Most participants felt positively about ARV-based prevention
strategies and their implementation. TLC+ was the most favoured strategy and
some valid concerns were raised about cost and the lack of access to
healthcare, especially in South Africa and India but also in the U.S.,” says
Smith.
Smith says that a key conversation that developed revolved around
how healthcare systems around the world, currently tailored towards treatment,
would have to adapt with a twin focus on prevention to successfully implement
ARV-based prevention strategies.
Consequently, participants wanted to know how best to raise awareness
about the different prevention strategies, with some participants requesting
that information be made available comparing the different strategies to maximise
informed choices in communities. Participants also expressed interest in understanding
what policy-makers thought about ARV-based prevention methods because this
would act as a useful guide for implementation.
Besides data collection and gathering an evidence base, the key
mission of the Mapping Pathways project is to disseminate findings and liaise
with the global HIV-treatment and prevention community at large around the use
of ARVs for prevention. The upcoming monograph, “Developing evidence-based, people-centered strategies for the use of
antiretrovirals as prevention”
will touch on all these themes and more, including the theme of risk that has
so intrigued Smith throughout his professional career.
Stay tuned for the Mapping Pathways monograph, coming soon
