In the past few months, support for HIV pre-exposure prophylaxis (PrEP; Truvada) has grown substantially. The CDC and WHO now endorse it, as does New York State Governor Cuomo who recently announced a multi-pronged plan to reduce the rate of new HIV infections in the state by 75% before 2020. However, the role of PrEP in curbing HIV transmission is still hotly debated – who should take it, who should pay for it, and whether or not it will work on a population level. Its price tag is about $10,000/year to insurers, it requires daily adherence for maximum benefit, and involves periodic testing to monitor a patient’s HIV status. Part of the concern is that PrEP’s effectiveness may be affected by two behavioral phenomena often experienced in health promotion: self-selection and risk compensation. (more…)
Though significant improvements to health can be achieved through policy change (making healthier choices the default option) and through the smart use of behavioral economic principles (like rewards and incentives), many health promotion programs suffer from an inherent bias: they primarily help only those who are ready to help themselves. People who are “pre-contemplative” and not yet considering behavior change are overlooked.
This is a troublesome situation. Any program or organization committed to health should make a conscious effort to “recommit to serving the most vulnerable” people, as Project Renewal recently did. By constantly striving to reach the toughest and most recalcitrant of cases, we as a society will avoid the complacency and poundage associated with simply “cream-skimming.”
How can we realize this goal? (more…)