Vulnerability and risk perception in the management of HIV/AIDS: Public priorities in a global pandemic

Abstract

Understanding the way perception of risk is shaped and constructed is crucial in understanding why it has been so difficult to mitigate the spread of HIV/AIDS. This paper uses the Pressure and Release (PAR) model, used to predict the onset of natural disasters as the conceptual framework. It substitutes vulnerability and risk perception as the trigger factors in the model, in making the case that HIV/AIDS can be characterized as a slow onset disaster. The implications are that vulnerability must be managed and reduced by addressing root causes, dynamic pressures, and unsafe conditions that contribute to the HIV/AIDS pandemic. HIV/AIDS programs must be culturally appropriate and work toward influencing risk perception, while addressing social norms and values that negatively impact vulnerable populations. By impacting cultural and social expectations, individuals will be able to more readily adopt safer sex behaviors. The development of policies and programs addressing the issues in context, as opposed to individual behaviors alone, allows for effective public health intervention. This may have implications for public health measures implemented for combating the spread of HIV/AIDS.

Place and practice: Sexual risk behaviour while travelling abroad among Swedish men who have sex with men

“…Risk within the epidemiological field commonly refers to risk of illness 52 , making risk something that rationally should be avoided 53,54 . Giesecke (2002) 55 (p.29) clarifies that in epidemiology the word exposure is used "to denote having met with a risk factor for the disease, which may or may not be the cause" reminding us that risk factors or determinants, "denote anything that could be associated with risk for disease".…”

“…Risk perception has been defined as "individual responses to a threat or hazard" 61 . Public and global health ideals and health communication often act according to the idea that information about risk awareness and risk reduction strategies lead to behaviour change among individuals 54 . Such a view expects people to be rational and uniformly act in accordance with knowledge provided by society and researchers e.g.…”

“…that individuals should get tested for HIV to benefit public health 56 . Nevertheless, this individualisation of health risks and risk reduction has been shown to fail when tested in practice 54,63 . Douglas & Calvez (1990) 64 argue that such a view is narrowly based on the majority society's view on risk, neglecting that society consists of many different cultures and subcultures that do not all have the same perception of risk or assessment of different kinds of risk.…”

“…Scott (2014) 56 shows that certain groups are perceived as "risky" while others are seen as "at risk", implying differentiation in responsibilities in relation to HIV transmission. Structural aspects such as perspectives on power and position related to race, ethnicity, socioeconomic status, age, disability and religion must therefore also be acknowledged when studying and understanding how individuals and groups relate to risk 54,65,66 .…”

Comportamentos sexuais de risco e preventivos masculinos: resultados de uma amostra recolhida através da internet em Portugal

“…Aplicada ao VIH, a vulnerabilidade percepcionada face à possibilidade da ocorrência da infeção, conjugada com fatores como a avaliação da severidade da mesma ou a eficácia percepcionada do comportamento protetor -por exemplo, usar o preservativo -, podem determinar o comportamento do indivíduo, colocando-o ou não em maior risco de contrair o vírus (Tsasis;Nirupama, 2008). Avanços no tratamento do VIH trouxeram também novos desafios ao nível da percepção de vulnerabilidade em relação à infecção, por exemplo, por parte de indivíduos VIH positivos cujos níveis "indetectáveis" de vírus no sangue podem levar a comportamentos menos seguros (Joseph et al, 2010) Outro conceito complementar na compreensão dos comportamentos problemáticos em relação ao VIH, e intimamente relacionado com a percepção de vulnerabilidade, é a percepção de risco.…”