Are we PrEPared to eradicate HIV?

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.

“Follow me: I’m a role model”

Source: Keepcalm-o-matic.co.uk

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?

Live for the Healthy Now, Pepsi

In 2012, Pepsi kicked off a global “Live for Now” campaign, which promoted the idea of living “each moment to the fullest” and “embrac[ing] the ‘now’” particularly as it related to pop culture. In addition to TV, radio, and outdoor advertising, it promoted its new “Pepsi Pulse” digital and social media platform to connect with users and their experiences on-the-go. Last month, Pepsi furthered this campaign with a “Global Fashion Capsule Collection” – branding the “Live for Now” mantra on clothing and accessories.

Source: Google

The #YOLO (“you only live once”) generation will almost certainly eat this up, but Living for Now has the potential for sending the message that one should make decisions made “in the now” without worrying about future consequences. This sort of thinking has deleterious effects, leading to everything from rising credit card debt to unhealthy diet or lifestyle behaviors.

The Opportunity Cost of Healthy Behavior

After a long day at the office or the hospital, when I am mentally wiped out, going for a bike ride or lifting weights at the gym is often the last thing that I want to do. I also don’t want to go grocery shopping, make dinner, or plan lunch for the next day. I definitely don’t want to take the time to floss. Happy hour, sitting on the couch and watching Netflix, or trying out a new restaurant with friends sound much more appealing.

This problem is shared by all – we are constantly bombarded with messages and forced to make short-term decisions that may conflict with long-term health goals. Eat healthy, but try the KFC Double Down. Go to the gym, but have you marathon-watched that new season of House of Cards yet?

Living a “healthy” lifestyle – however defined – takes work and energy.