Treatment as Prevention is the idea of treating PLHIV early and en masse, based on the slowly emerging consensus among medical researchers that HIV treatment reduces infectiousness. That consensus is an interesting story in its own right, since there’s not yet any new evidence to support it.
Based on a wildly unrealistic mathematical model — set in South Africa of all places — public health practitioners have been planning experimental trials of the TAP concept, and a recent post on Peripheries blog takes aim against stigma, cited as a major objection against treatment as prevention.
Intriguingly, the post states a couple of times that it’s not about stigma. Over the past three years I’ve been doing a fair bit of training and writing about how we conceptualise stigma in HIV prevention work, so I contacted the author to find out what he thought it really was about.
An intensive policy and practical panel discussion about the possibility of rapid HIV tests being rolled out in Australia
In my writing about criminalisation and HIV stigma I have been strongly critical of the rational-individual ‘model’ (assumption) that underpins the health psychology and economics upon which so much of public health practice is based. I’ve argued we can learn a lot instead from behavioural economics and bounded rationality.
One of the biggest bounds (limits) on human rationality is the finite nature of what we know, especially with respect to what’s likely to happen in the future or about some newly-emerged and previously unknown problem or technology.
Nobel prize-winning research by Kahneman and Tversky (1979) developed ‘prospect theory’, which shows that in economic decisions, rather a lot depends upon how a prospect is framed — in particular in terms of whether it involves possible loss or gain.
There have been some rather clunky attempts to incorporate this insight into health promotion, such as by framing condom use in terms of what someone has to lose. It’s an important insight but it involves translating health behaviour into economic terms, which as Dan Ariely points out has a suppressive effect on social norms like altruism — not ideal!
Today and tomorrow, I’m attending the NCHSR Social Research Conference at the University of New South Wales. At this morning’s opening plenary, Alan Peterson from Monash University is presenting on communicating health risk in a context of uncertainty. He argues early framing of risks is influential upon subsequent responses: think about the panic about the high death rate in the early days of H1N1 flu in Mexico.
This week, an American public health practitioner posted on the US national AIDS blog about a new program starting up in the States. The program is called TLC-Plus, short for “Enhanced Testing, Linking into Care, Plus Treatment” for PLHIV. Here’s how the author, Carl Dieffenbach PhD, explained the need for that middle component, “linking into care” –
“Unfortunately, many people don’t make it to their follow-up medical visits for a variety of reasons. Yet these individuals can continue to spread the virus in their communities until we entice them to step through the door, whether it’s giving them a pat on the back or offering financial incentives.”