Assessing behavioral economic biases among young adults who have increased likelihood of acquiring HIV: a mixed methods study in Baltimore, Maryland

AIDS Research and Therapy

Research

Larissa Jennings Mayo-Wilson¹  Sarah MacCarthy²  Jessica Coleman Lewis³  Sebastian Linnemayr⁴ 

[1] Department of Health Behavior, Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 310 Rosenau Hall CB #7400, 135 Dauer Drive, 27599, Chapel Hill, NC, USA;Department of Health Behavior, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AL, USA;Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205, Baltimore, MD, USA;RAND Corporation, 1776 Main Street, 90401, Santa Monica, CA, USA;

关键词: Behavioral economics;    Young adults;    Baltimore;    African-American;    HIV;    Prevention;    Qualitative;    Homelessness;    Mixed methods;   

DOI  :  10.1186/s12981-023-00521-3

 received in 2023-01-27, accepted in 2023-04-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundBehavioral economic (BE) biases have been studied in the context of numerous health conditions, yet are understudied in the field of HIV prevention. This aim of this study was to quantify the prevalence of four common BE biases—present bias, information salience, overoptimism, and loss aversion—relating to condom use and HIV testing in economically-vulnerable young adults who had increased likelihood of acquiring HIV. We also qualitatively examined participants’ perceptions of these biases.Methods43 participants were enrolled in the study. Data were collected via interviews using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses.Results56% of participants were present-biased, disproportionately discounting future rewards for smaller immediate rewards. 51% stated they were more likely to spend than save given financial need. Present-bias relating to condom use was lower with 28% reporting they would engage in condomless sex rather than wait one day to access condoms. Most participants (72%) were willing to wait for condom-supported sex given the risk. Only 35% knew someone living with HIV, but 67% knew someone who had taken an HIV test, and 74% said they often think about preventing HIV (e.g., high salience). Yet, 47% reported optimistically planning for condom use, HIV discussions with partners, or testing but failing to stick to their decision. Most (98%) were also averse (b = 9.4, SD  ±.9) to losing their HIV-negative status. Qualitative reasons for sub-optimal condom or testing choices were having already waited to find a sex partner, feeling awkward, having fear, or not remembering one’s plan in the moment. Optimal decisions were attributed qualitatively to self-protective thoughts, establishing routine care, standing on one’s own, and thinking of someone adversely impacted by HIV. 44% of participants preferred delayed monetary awards (e.g., future-biased), attributed qualitatively to fears of spending immediate money unwisely or needing time to plan.ConclusionMixed methods BE assessments may be a valuable tool in understanding factors contributing to optimal and sub-optimal HIV prevention decisions. Future HIV prevention interventions may benefit from integrating savings products, loss framing, commitment contracts, cues, or incentives.

【 授权许可】

CC BY   
© The Author(s) 2023