Communicating health risk in a context of uncertainty

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.

Continue reading “Communicating health risk in a context of uncertainty”

Shining a light on campaign strategy

Who knew it could be so controversial calling for HIV prevention campaigns tailored for gay men under thirty?

I’m saying gay men under thirty have different prevention information needs, and good campaign strategy shouldn’t wait until infection rates begin rising before investing in campaigns tailored to meet those needs.

That’s just common sense, and not a very exciting news story, until the AIDS Council disagrees — and then there’s a fight and quick, everybody, gather round! Place your bets and let’s get ready to rumble… In yesterday’s edition of MCV, by Rachel Cook, I read:

‘”Anyone who understands anything about health promotion wouldn’t attempt to blame the ads,” Kennedy said. “We do not agree with Daniel’s analysis and his claim that VAC does nothing for young, gay men is just demonstrably false.”‘

I don’t blame the ads for rising infection rates, and I don’t claim VAC does nothing for young gay men. Putting words in my mouth doesn’t help Mike’s credibility in responding to my concerns.

The hostile response does illustrate why I don’t place much weight on the feedback VAC quotes in support of the porn image campaign’s relevance to men under thirty. When they react with such hostility to criticism, it’s little wonder they don’t hear it much.

In my case, it’s a massive overreaction, since I am broadly supportive of that campaign: infection rates have steadied in the age brackets it was designed for. I’m concerned about a lack of campaigns targeted for men under thirty, and the porn image campaign doesn’t cover them.

Apparently, when they’re not in the country, Mike Kennedy, Colin Batrouney (health promotion manager) and Jason Asselin (health educator) are happy to agree with me. For example:

Kennedy M, Batrouney C, Asselin J (2008) “Shining a light on gay anal sex: community reactions to an explicit campaign promoting condom use for anal sex with casual partnersAIDS 2008 XVII International AIDS Conference (Abstract THPE0387).

They describe holding “focus groups with the campaign’s target population, men in their 30s and 40s” and later conclude “prevention campaigns will need precise targeting and generalised campaigns will be less effective”.

In their own words, the campaign was not developed for (or focus tested with) men under thirty, campaigns need precise targeting, and you can’t rely on a single campaign to fit everybody.

Again, quoting Mike’s own words, the porn image campaign achieved only 40% recognition among men under thirty at Midsumma Carnival. (Okay, the “only” part is mine.)

Coming back to how VAC receives critical feedback: the abstract states “Community responses were generally very positive but an interesting subset of negative responses was demonstrably tapping into internalised homophobia triggered by images of gay sex in public media.”

This makes it clear the authors interpret positive feedback as the general rule and critical feedback as the exception. It concerns me that the Executive Director of an organisation that provides counselling feels it’s okay to diagnose internalised homophobia in men he’s never met, simply because they don’t identify with images/themes in a campaign, and to dismiss their responses on that basis.

Some audience members do experience internalised homophobia; in fact, it’s something we all struggle to overcome. Research by the American psychologists Michael Ross, Simon Rosser and colleagues (2008) in AIDS Education & Prevention has shown a strong connection between internalised homonegativity and increased rates of unsafe sex.

Kennedy, Batrouney & Asselin’s abstract admits the porn image campaign does not meet the needs of those men.

Continuing the theme of VAC not taking critical responses seriously, the abstract suggests “Campaign design should include draft responses to such negative criticism”. In other words, community debate is met with message management and canned public relations messages.

I’m going to conclude with a question: if Mike is right and there was no lack of campaigns targeting young men specifically, why did they just accept Department of Health funding to develop one?

vacgmhc_under30_campaign

More bad advice from the Manhunt “Cruise Director” Michael Alvear

You have to be a Manhunt member to read the Cruise Director posts, so I’m including it here – apologies for the long excerpt!

How Do I Overcome My Fear Of Having Sex?
By transferring your irrational fear of safe sex into a rational fear of unsafe sex.

Yo, Mike!
I had my first HIV test about two-and-a-half years ago. I’m sorry to say that I had it done because I was a bit “irresponsible” in my teen years. Glad to say my test came back NEGATIVE and ever since, promised myself I’d never have unprotected sex again. Unfortunately, that has not been 100% the case. I’ve had two more HIV tests since, both of which were a requirement at the companies I’ve worked at. I am once again thankful to say they were both negative.

However, the whole HIV-test process has taken a real emotional toll on me, since I have become terrified of having sex. Every time I meet I guy I’m scared to go near his dick, for fear I might catch something. The fact that condoms are not 100% safe makes me terribly uneasy and incapable of having a good, nice fuck.

Continue reading “More bad advice from the Manhunt “Cruise Director” Michael Alvear”

Prop 8 and Gay vs Black voters

The sting in the tail of last week’s Obama election happiness was the news that California had passed Proposition 8, a special ballot to amend the state constitution to abolish same sex marriage.  Almost immediately, social news sites like Reddit and blogging communities like Daily Kos focused their attention on CNN exit polling showing that 70% of black voters surveyed had voted to deny same sex couples the right to marry.

Apart from some thoughtful coverage this news unleashed a torrent of racist recrimination, mostly from gay men, some of it seriously ugly.  In response, DKos diarist Shannika [via Trevor] has offered a laundry list of demographic reasons why black voters couldn’t have carried Prop 8 to victory.  However, I feel this doesn’t really contradict the underlying misconception — that blacks somehow held the balance of power in the first place.

Now, my hero Rachel Maddow has bought into the debate in her own irreducibly intelligent style, inviting Princeton political scientist Melissa Harris-Lacewell on the program to discuss the issue.  (From 3:30 in the video.)  Harris-Lacewell makes the important point that anti-Prop 8 campaigners failed to reach out to communities of colour, where they could have argued the similarity between Prop 8 and the legislative ban on inter-racial marriage (which was only overturned by a court case in 1967).  She suggests it was an opportunity left begging: “African[-American]s understand the language of ‘separate but equal'”, and says one of the nice things about Obama’s resoundingly-effective grassroots strategy is that no demographic can henceforth be safely neglected.

Vodpod videos no longer available.

There’s one question that isn’t being asked much:  should we be fighting for marriage rights in the first place?  My heart goes out to queer Californians whose marriages have been left in legal limbo, and I sympathise with gay men and women who believe marriage is the last bastion of legal inequality.  Except that it isn’t.  I agree with Michael Warner’s analysis in The Trouble With Normal (1999) where he argues marriage is the tentpole for a social hierarchy that regulates everybody from the top (white middle-class married couples with children) down to the bottom (gay men and sex workers).

There’s something deeply unseemly about climbing on the heads of those sex workers to scrabble up to win access to the marriage club.  There’s something similar going on when 27% of GLBTI voters go for McCain, as if by endorsing a conservative they can put some distance between themselves and the bottom of that pile.  And there’s something really sad about some poor 19-year old kid who’s ashamed of sex and his sexuality thinking it will all just evaporate if he could  promise forever to someone equally-deluded with the State nodding its legal blessing.

The Nuns Didn’t Do It

For years, there has been a robust counter-dialogue against the official position that HIV started to spread among humans following a single transmission event between an infected ape and a jungle butcher.

Skeptics point to the smallpox and polio vaccination missions conducted all throughout the Congo by nuns and nurses who used the same needle to vaccinate entire villages of people.

A new study published in the Proceedings of the National Academy of Sciences (USA) suggests the nuns didn’t do it.  Or they did no more than 0 to 6% of it. The rest, it says, either can’t be explained by the vaccination theory or is better explained by sexual or vertical (mother-child) transmission.  (Press release, 3 Jun 07)