Numbers and behaviour

There's an article on The Conversation by a health researcher John de Witt entitled To curb rising HIV rates, we must target our human flaws, talking about the vexed issue of the increasing rate of HIV.

Every year now, it seems there is angst about the number of new cases of HIV, and how the education methods are clearly not working.   de Witt notes:

Much of what we currently do is based on common sense and past experience, which is problematic because people do not necessarily behave in their own best interests. People are, in fact, often motivated, well intentioned and well informed but suffer from the common so-called “new year’s resolution” effect; they do genuinely want to change but just don’t quite manage to get started or fail to maintain new behaviour.

We are also, rightly, reluctant to lecture or play on people’s fears because we want them to make their own informed choices. So we assume that if we give people all the information they need they will put it together and act accordingly. But most people have more on their minds than staying healthy, and most assume they are healthy anyway.

He suggests a couple of things, such as "opt out" inclusion of HIV testing at sexual health clinics (seems odd that this is not already the case for anyone who turns up worried about an STD.)  He also talks about  "simple action plans" which sound like people being reminded on their phone to get tested, etc.

These may be well and good, but he still seems to be reluctant to go to the obvious place - telling gay men to stop having so much casual sex.   Here's a novel idea:  tell guys that if they meet someone, get to know them over dinner, talk about if they ever get tested for HIV, then decide if you want to have sex with them.   The same thing could be applied to heterosexuals too - after all, a recent study on the rate of chlamydia showed how high it is getting too, particularly amongst younger people:

Prevalence of chlamydia was 5.2 per cent in men and 4.4 per cent in women. Among men, prevalence was highest in those aged 20-24 years (6.6 per cent) and in women, it was highest in those aged 16-19 years (8.0 per cent).

One figure which I realised I had no idea about when reading the article was the proportion of gay men who are HIV positive.  Just reading about 1,000 new cases every year (or talking about a 10% rise in the rate of new diagnoses) gives readers no idea about that.

But Google being our friend, it appears de Witt himself has estimated that for Australia about 10% of gay men are HIV positive, but with many of them not knowing.

Why is that figure not more widely discussed in education to the gay community?    Have ten casual lovers in a year, and there's a pretty good chance one of them will be HIV positive.  The figure is, I'm pretty sure, not often featured in the media, but then do they talk about it in their sexual health campaigns aimed at gay men?

de Witt will probably argue that this is an attempt to scare people, which doesn't work.  And certainly, as I have wondered before in this blog, it would appear that knowledge of the risk of syphilis (when it was untreatable even) did not deter men from having sex with prostitutes for hundreds of years.  Or is it thought that the figure is not high enough to scare people?   Has any research ever been done on that, I wonder, in both the gay or heterosexual community of people who have lots of partners in any given year? 

But the thing that I thought is obvious, is that if you don't talk about the rate of HIV amongst your target population, so to speak, you aren't helping at least some people who can take a rational approach to their sex life.   

An addendum:   de Witt, along with everyone else who ever writes about the increasing rate of new HIV cases, talks about  part of the problem is the fact that anti viral treatments mean people are not scared of HIV in the way they used to be.  But he notes:

Every new infection comes with a lifetime of medical treatment, significant risk of medical complications and considerable lifelong costs; about A$18,000 each year for ARTs for one person in Australia.

Again, I really wonder whether in their education attempts, how much effort do they put in to explaining why HIV is not a good thing to have even when treated?   And certainly, regardless of life expectancy (and some reports of studies might be giving exactly the wrong impression on this), the government has got fantastic financial motive to make education work.