Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

13 March 2013

Risk perception, ARV-based prevention strategies and grassroot conversations – a preview of the upcoming Mapping Pathways monograph

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

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