Health education and the AIDS epidemic

How individuals' opinions influence society's resistance to epidemics: an agent-based model approach

BACKGROUND

Protecting public health from infectious diseases often relies on the cooperation of citizens, especially when self-care interventions are the only viable tools for disease mitigation. Accordingly, social aspects related to public opinion have been studied in the context of the recent COVID-19 pandemic. However, a comprehensive understanding of the effects of opinion-related factors on disease spread still requires further exploration.

METHODS

We propose an agent-based simulation framework incorporating opinion dynamics within an epidemic model based on the assumption that mass media channels play a leading role in opinion dynamics. The model simulates how opinions about preventive interventions change over time and how these changes affect the cumulative number of cases. We calibrated our simulation model using YouGov survey data and WHO COVID-19 new cases data from 15 different countries. Based on the calibrated models, we examine how different opinion-related factors change the consequences of the epidemic. We track the number of total new infections for analysis.

RESULTS

Our results reveal that the initial level of public opinion on preventive interventions has the greatest impact on the cumulative number of cases. Its normalized permutation importance varies between 69.67% and 96.65% in 15 models. The patterns shown in the partial dependence plots indicate that other factors, such as the usage of the pro-intervention channel and the response time of media channels, can also bring about substantial changes in disease dynamics, but only within specific ranges of the dominant factor.

CONCLUSIONS

Our results reveal the importance of public opinion on intervention during the early stage of the pandemic in protecting public health. The findings suggest that persuading the public to take actions they may be hesitant about in the early stages of epidemics is very costly because taking early action is critical for mitigating infectious diseases. Other opinion-related factors can also lead to significant changes in epidemics, depending on the average level of public opinion in the initial stage. These findings underscore the importance of media channels and authorities in delivering accurate information and persuading community members to cooperate with public health policies.

Psychological and Behavioral Factors Predicting Attendance at a Community-based HIV Prevention Intervention

To date, virtualiy no research has addressed individuals' characteristics which influence their participation in prevention interventions targeting the human immunodeficiency virus (HIV). Identification of these characteristics is important, for no intervention is effective if not attended. This study explored stage of condom adoption and selected other psychological and behavioral factors, to determine which of these predicted attendance at a clinic-based HIV intervention. Stage of condom adoption ( p = .03) and frequency of drunkenness ( p = .05) were significant predictors of attendance for persons with more than one sex partner. For persons with only one sex partner, self-efficacy and outcome expectations were identified. The implications of these findings are discussed.

Social policy and child health

Under the rubric of social policy and child mental health are two overlapping but conceptually different areas. The first set is the social policy questions with direct relevance to child mental health programs per se; that is, decisions about whether a given child mental health proposal merits the investment of community resources. The second category of social forces is that which has important secondary consequences for child mental health although child mental health per se may never enter the discussion; for example, policy decisions which have a major impact on family life (women's rights, tax policy, divorce law, employment policy, etc.). This paper will review the first category, the overt policy issues, before moving on to the second category, the "convert" child health debate.

HIV education for youth: the importance of social consensus in behaviour change

Most theories of health education focus on change in the knowledge, beliefs, and skills of individuals as causes of behaviour change. We argue that this neglects the important contribution of the social environment in supporting healthier behaviour, and we describe a model of social consensus that allows alternative routes for educational influence at both individual and social levels. This model assumes that basic knowledge and skills for avoiding health threats may not be sufficient for behaviour change unless socially-mediated influences that can inhibit behaviour change are addressed. This is especially crucial given the nature of HIV infection and the controversy surrounding its discussion. We illustrate the potential for social influences to have played a role in inhibiting the adoption of safer sexual behaviour in young people, and use our model to analyse young people's responses to the epidemic as documented in available research. The analysis also suggests possible educational strategies to overcome social obstacles in the future.

Truancy and illegal drug use, and knowledge of HIV infection in 932 14-16-year-old adolescents

In a sample of 932 4th & 5th year comprehensive school adolescents, 41% had truanted in the current term. The truants, compared with their non-truanting peers, had three times the level of solvent misuse (14% compared with 4%), thrice the soft drug misuse (19% compared with 6%), and four times the involvement with hard drugs (9% compared with 2%). Truants were significantly more involved with other problematic behaviour and were found to score higher on all negative social indices, including parents who smoked. Despite the sample's relatively accurate knowledge about drugs and HIV infection, truants scored less well on these and other HIV-related issues. An extrapolation of the results indicates a significant number of adolescents at risk demanding urgent policy initiatives.

There's no quick fix for AIDS

The epidemiology of AIDS reflects interactions among biological, psychological and social factors. The immune response to the infectious agent is relatively ineffectual; the course of the disease it produces is chronic. The long interval between HIV infection and the appearance of clinical disease maximizes "silent" transmission. The infection is transmitted behaviourally; that is, primarily via specific sexual acts and contaminated paraphernalia employed by IV drug users. The virus entered human populations in an era when such behaviours had become very much more prevalent in response to social change. The public health response to the epidemic was seriously compromised by the stigma attached to the persons victimized by the disease; thus, the mobilization of adequate resources was markedly delayed. Irrational fears of contamination led to proposals for mandatory population-wide screening, in utter disregard of the high false to true positive ratio in screening tests when prevalence is low. Welcome as a vaccine to prevent HIV infection would be, it is not likely to be available, if it can be produced at all, before the end of the century. Control of the epidemic demands that stigma be vigorously combated and that all groups of the population be educated about ways to minimize the likelihood of becoming infected and of transmitting the virus.

Drug and solvent misuse and knowledge of HIV infections in 14-16-year-old comprehensive school students

This study of drug and solvent misuse and knowledge of the HIV link amongst 934 secondary school students, completes a third survey concerned with prevalence of drug misuse. Drug and/or solvent misuse was found in 16% of the sample including 5% who use hard drugs, which since 1985 represents a 3% decline, but a 1% increase in the use of hallucinogens. The misusers were compared with the non-users with regard to their social characteristics, other illegal behaviour and their knowledge of HIV and other public health concerns. There were some surprises concerning the gender results. Misusers were found to be more socially disadvantaged and more involved in other negative behaviour. Despite reasonable knowledge about HIV-related matters, the misuser group were less accurate on all public health issues, appearing to 'deny' the potential risks associated with drug misuse.

Prejudice and AIDS: the views and experiences of people with HIV infection

Discrimination against people on the basis of physical or mental infirmity is common and creates a considerable burden for sufferers. There has been considerable debate about the prejudice against people with disease resulting from human immunodeficiency virus (HIV) infection. This study reports on the views and experiences of stigmatization by 192 outpatients with HIV infection interviewed at two London teaching hospitals. Despite reticence about discussing their infection, one quarter of patients had received negative reactions from confidants. The implications for health and social policies are discussed.