305270
Applying Choice Architecture Principles to Understand HIV/AIDS Testing: Findings from Malawi and Zimbabwe
In sub-Saharan Africa, improvements in HIV testing from 2004 to 2011 have seen a parallel increase in antenatal visit-based HIV/AIDS counseling. To what extent do these improvements follow individual-level factors (e.g., demographics and knowledge improvements), relative to structural-level support (e.g. availability of opt-out testing for mothers during antenatal visits)? We explore whether structural-level support can predict HIV/AIDS testing above and beyond individual-level attitudes and cognitions, such as stigma towards people living with HIV/AIDS and knowledge about HIV transmission and prevention.
Methods
We analyzed DHS data collected between 2004 and 2011 from Zimbabwe (N=1330) and Malawi (N=4043)—countries where over 10% of the adult population has HIV/AIDS. We tested the influence of demographic variables, various modes of knowledge about HIV/AIDS, stigma towards people living with HIV/AIDS, attitudes about spousal abuse, and whether or not HIV/AIDS counseling had been offered during antenatal visits on AIDS testing.
Results
Logistic regressions supported our hypothesis—structural-level change (OR: Malawi=12.127, Zimbabwe=286.016) was the strongest predictor of AIDS testing above and beyond individual-level attitudes and cognitions. When receipt of antenatal HIV/AIDS counseling was taken into account in Zimbabwe, the effect of individual and social level variables no longer had a significant impact on testing behavior and the influence was significantly reduced in Malawi.
Conclusion
People can be nudged to make healthy decisions through “choice architecture,” where the healthier option is presented as the default. This principle supports a structural, rather than an individual-focused, approach for promoting AIDS testing, particularly when addressing stigmatized health issues.
Learning Areas:
Protection of the public in relation to communicable diseases including prevention or controlPublic health or related laws, regulations, standards, or guidelines
Public health or related public policy
Learning Objectives:
Identify potential barriers to successful implementation of an opt-out approach to AIDS testing.
Differentiate the relative influence of individual and social level variables from structural level support on AIDS testing.
Assess the benefits of implementing structural level interventions that create an opt-out HIV/AIDS testing environment.
Keyword(s): HIV/AIDS, HIV Interventions
Qualified on the content I am responsible for because: I am a post-doctoral scientist in the School of Public Health at George Washington University. I have worked on the development of R01 and R021 NIH grant proposals, and have written several articles addressing HIV/AIDS stigma in Sub-Saharan Africa. I am a published author in top-tier journals and I have presented my work at international conferences. My primary interest is understanding how to reduce health stigma, particularly in the context of HIV/AIDS.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.