HIV infections can be prevented—why some people act to protect themselves, and others don’t

The variety of new HIV infections has fallen over time—it declined by 39% from 2010 to 2023. However HIV’s devastating affect on international 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 have been thrice extra more likely to purchase HIV than male counterparts.

There are a number of efficient, user-centered HIV prevention choices. They embrace oral pre-exposure prophylaxis (PrEp, a each day tablet that incorporates antiretroviral medicine), condoms, vaginal rings (which might be inserted and launch medicine), and long-acting injectables.

These are crucial within the battle towards HIV, however an individual must determine to make use of them. It’s this person resolution 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 manner of understanding individuals’s thought processes when deciding whether or not to make use of condoms, medicines, or different HIV prevention strategies. We name this framework the “resolution cascade.” It is primarily based on behavioral science—the examine of how individuals assume, really feel and act.

To maintain and speed up the battle towards HIV, we should keep in mind that individuals are on the coronary heart of the HIV pandemic. Individuals’s decisions shall be influenced by their private judgment of whether or not they actually want and might entry the strategies and instruments accessible, primarily based 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 decisions. We additionally counsel approaches that would work.

The choice cascade

Constructing on earlier work, the cascade identifies numerous sorts 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 components that affect their choices to behave. Individuals undergo steps when making choices. The thought behind the cascade is to assist them full every step in an effort to act.

The steps are:

Step 1: triggers and cues

People are cued, or triggered, to contemplate an motion, corresponding to utilizing a vaginal ring. Triggers might 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 give attention to rational explanations about well being advantages (for instance, “utilizing condoms reduces your danger of HIV”). They assume that if individuals are given logical, clear details about find out how to defend themselves, they’ll act accordingly.

The issue is that folks might not course of info. They could be overwhelmed with different considerations (like monetary stress or relationships), or really feel that HIV isn’t a priority for them. They may not give attention to HIV prevention, even when the knowledge is obtainable.

One other downside is that folks are inclined to give attention to what feels pressing, related or vital to them for the time being. If somebody does not see HIV as a right away menace or precedence, they might ignore prevention messages, no matter how logical or helpful 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 subject, they could ignore the message or react poorly to it.

The mind will make choices rapidly primarily based on biases, like: “I do not know anybody with HIV, so it isn’t a danger for me,” “HIV solely impacts promiscuous individuals” or “I am wholesome, so I do not want prevention.”

These automated processes could make it more durable for individuals to have interaction with choices 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 complicated, subjective, and influenced by biases, private beliefs, and the trustworthiness of knowledge sources.

For example, if an individual perceives utilizing PrEP as a danger to vital relationships, she or he might choose different actions that keep these relationships.

Step 4: means evaluation

After deciding that motion is worth it, people assess their means to behave on it. This includes sensible concerns like figuring out how and the place to entry providers or having the mandatory assets.

Some boundaries embrace entry points, useful resource constraints, and a insecurity of their means to make use of the product.

Step 5: timing of motion

Timing is an often-overlooked factor in HIV prevention. Even when a person decides that utilizing prevention providers is vital and possible, they have to nonetheless determine when to behave. They may delay if taking motion does not appear pressing.

If an individual takes all these steps, they’ll doubtless act to forestall HIV an infection.

Designing profitable interventions

The choice cascade framework highlights the necessity for interventions that assist people all through the complete decision-making course of. Primarily based on this, we’ve got some suggestions to assist design profitable interventions:

Set off engagement: Interventions ought to use various and interesting triggers to seize consideration and have interaction a large person base.
Handle reactions: Deal with constructive messaging.
Help evaluations: Present clear, reliable info and spotlight the worth of appearing. Assist individuals weigh the private prices towards the advantages to make knowledgeable, life like choices.
Improve means: Assist people to take sensible steps in direction of HIV prevention. Examples embrace prolonged clinic hours, adolescent pleasant providers, improved alternative of merchandise, digital well being approaches, group primarily based providers and cash-incentive packages.
Encourage well timed motion: Interventions ought to discover methods to cut back delays and assist constant use of prevention providers. It might be by way of making commitments to going for check-ups, for instance, or motivating individuals by linking prevention providers with different objectives.

Interventions which are designed for the way in which individuals really make choices are more likely to be simpler.

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