Mandatory HIV/AIDS Testing: An Ethical Issue

Should HIV/AIDS testing be required for health care workers and patients? This study compared the perceptions of 64 health care professionals and 97 nursing students on mandatory HIV testing, the risk of accidental infection, the appropriate industry response to infection, and the placement of costs. Significant differences were found between the two groups. While health care professionals favored testing for patients, students favored mandatory testing for both health care workers and patients. Students also viewed the risk of HIV/AIDS infection by a patient as significantly higher than did health care workers. Overall younger respondents tended to favor mandatory testing and also thought that hospitals should bear the cost.     

Concern About HIV and AIDS Among Older People in the Slums of Nairobi,Kenya

The article explores the way that social networks and personal experiences affect perceived HIV‐related concerns among people aged 50 years or older living in a low resource neighborhood with high HIV prevalence in Nairobi, Kenya. Multiple logistic regression is used to model the association between the reporting of an HIV‐related concern and individual‐level characteristics, personal experiences, and social interaction. The main concerns regarding HIV reported by older people in the study included caring for orphaned children (65%), caring for people with AIDS (48%), and losing material and social support from adult children (36%). Interestingly, 38% of respondents voiced concerns about HIV infection among older people. Respondents who had been individually affected by HIV and AIDS, who were part of a wide social network, or who participated in community activities were frequently more likely to report a concern. The findings highlight the significance of the role of social interaction and social networks in the diffusion of information and knowledge. These findings have implications for HIV and AIDS policy and programs, highlighting the potential for social networks and community‐level interventions to educate and increase awareness about HIV and AIDS among older people. Community leaders can make good peer educators and communication agents for HIV/AIDS campaigns. Additionally, the recognized high level of personal vulnerability to HIV infection among older people suggests the need for targeted sexual behavior change programs among this often neglected group.     

Corporate Responses to HIV/AIDS: Experience and Leadership from South Africa

HIV/AIDS harms the viability and competitiveness of African businesses. As a consequence, companies increasingly subscribe to the view that taking a proactive role to combat HIV/AIDS is not simply a question of compassion and good corporate citizenship. Rather, these firms see assertive action against HIV as critical to their long‐term profitability, and some have concluded that it is cost effective even in the short term. The article discusses how South African companies are taking action against HIV in ways that set new benchmarks, enhance the effectiveness of international AIDS advocacy efforts, and spur businesses across Africa and beyond to strengthen their corporate responses to HIV/AIDS.     

A Cross‐Cultural Study of Perceived Benefit Versus Risk as Mediators in the Trust‐Acceptance Relationship

Several recent studies have identified the significant role social trust in regulatory organizations plays in the public acceptance of various technologies and activities. In a cross‐cultural investigation, the current work explores empirically the relationship between social trust in management authorities and the degree of public acceptability of hazards for individuals residing in either developed or emerging Latin American economies using confirmatory rather than exploratory techniques. Undergraduates in Mexico, Brazil, and Chile and the United States and Spain assessed trust in regulatory authorities, public acceptance, personal knowledge, and the risks and benefits for 23 activities and technological hazards. Four findings were encountered. (i) In Latin American nations trust in regulatory entities was strongly and significantly (directly as well as indirectly) linked with the public's acceptance of any activity or technology. In developed countries trust and acceptability are essentially linked indirectly (through perceived risk and perceived benefit). (ii) Lack of knowledge strengthened the magnitude and statistical significance of the trust‐acceptability relationship in both developed and developing countries. (iii) For high levels of claimed knowledge, the impact on the trust‐acceptability relationship varied depending upon the origin of the sample. (iv) Confirmatory analysis revealed the relative importance of perceived benefit over perceived risk in meditating the trust‐acceptability causal chain.     

A necessary dialogue: a South African case study exploring the role of national HRD in HIV/AIDS non-government organizations

This article makes the case for a coordinated and multi-faceted national level response to the HIV/AIDS crisis in South Africa from the field of human resource development (HRD), arguing that national policy debate on this issue must include the development of human resources in HIV/AIDS non-governmental organizations (NGOs). An exploration of potential connections between HIV/AIDS and HRD was conducted with a qualitative case study in Port Elizabeth, South Africa. Through this study, four major thematic categories emerged in connection to the work of NGOs involved in the management of HIV/AIDS, government policy, and the emerging theory and practice of national human resource development (NHRD). In addition, findings pointed to the need for HRD research to be conducted in HIV/AIDS related NGOs given their front-line roles in both policy and practice. Initial suggestions for dialogue between NGOs involved with managing HIV/AIDS and the HRD research and practice community are made along with recommendations for stronger linkages between NHRD and HIV/AIDs.     

Perception and control of occupational injury risks in fishery--a pilot study

The frequency of occupational accidents in fishery is high in most fishery nations. Implementation of safety measures has, however, been limited. The purpose of the present cross-sectional study was to explore Swedish fishermen's attitudes towards occupational risks and accident control. Information was acquired through a questionnaire distributed to a convenience sample of 92 fishermen. Indices were built, containing variables relevant to perceived risk levels in connection with work, perceived manageability of risks, activity in safety work, technical knowledge and individual attitudes towards risks. The results did not support earlier findings of low risk awareness and risk acceptance among fishermen. Perceived manageability of risks but not perceived risk level, accident experience or risk acceptance, were significantly associated with activity in safety work. The results suggest that safety work might benefit from efforts to develop fishermen's understanding of how the development of hazardous situations can be prevented or managed. The results do not support strategies for accident control in fishery based solely on increasing risk awareness.     

Perception and control of occupational injury risks in fishery--a pilot study

The frequency of occupational accidents in fishery is high in most fishery nations. Implementation of safety measures has, however, been limited. The purpose of the present cross-sectional study was to explore Swedish fishermen's attitudes towards occupational risks and accident control. Information was acquired through a questionnaire distributed to a convenience sample of 92 fishermen. Indices were built, containing variables relevant to perceived risk levels in connection with work, perceived manageability of risks, activity in safety work, technical knowledge and individual attitudes towards risks. The results did not support earlier findings of low risk awareness and risk acceptance among fishermen. Perceived manageability of risks but not perceived risk level, accident experience or risk acceptance, were significantly associated with activity in safety work. The results suggest that safety work might benefit from efforts to develop fishermen's understanding of how the development of hazardous situations can be prevented or managed. The results do not support strategies for accident control in fishery based solely on increasing risk awareness.     

Bureaucratic Autonomy in the U.S. Separation of Powers: Evidence from Cabinet Departments

Theories of delegation posit that politicians have the incentive to decrease discretion when ideological conflict with an administrative agency increases. Yet agencies can use their expertise to appropriate informational benefits from delegation helping to increase bureaucratic autonomy. Such theories only indirectly address the impact of ideological conflict on bureaucrats’ perceptions about the extent of the discretion they are afforded on the job. Does the perception of discretion by bureaucrats depend on ideological conflicts between the legislative and executive branches? Statistical results from dynamic panel models provide evidence that that closer ideological alignment with the U.S. Congress than the president increases perceived discretion; that a negative relationship emerges between confirmation times and perceived discretion, but a small and opposite relationship exists among supervisory levels; that variance in the ideological portfolio of cabinet secretaries decreases perceived discretion overall, but has no effect on supervisory cadres; and that divergence between the goals and legal context of an agency and the president’s policy orientation are associated with lower perceived discretion.     

Artifactual Uncertainty in Risk Analysis

The field of comparative risk analysis of electrical energy alternatives has traditionally been plagued by highly uncertain estimates of risk rates, and consequently by conflicting judgements of relative risk. To the extent that this uncertainty arises from traditional sources–imperfect observations or actual variance in the data–it can be brought within a Bayesian statistical framework which allows policy conclusions to be formulted and tested at different levels of confidence. It is shown that there are important methodological or "artifactual" sources of uncertainty, however, that cannot be treated by statistical means; these require conceptual advances for their resolution. By identifying these sources of uncertainty in simple thought experiments and examples, it is shown in what ways the concept of attributable risk, which is the policy-maker's chief concern, must be sharpened and refined to have unambiguous meaning. The conventional "multilinear" formula for calculating risk indices is challenged as a measure of attributable risk, and directions for further research to improve the methodological foundations of comparative risk analysis are identified.     

Knowledge,Risk Perceptions,and Xenophobic Attitudes: Evidence from Italy During the Ebola Outbreak

The purposes of the current study were twofold: (1) to investigate affective and cognitive responses and social‐contextual factors related to Ebola and their intercorrelations in a developed country without widespread Ebola transmission; and (2) to examine the relationships among risk perception of Ebola, levels of knowledge about Ebola, and (blatant and subtle) prejudice toward African immigrants. Between January 2015 and March 2015, an anonymous cross‐sectional survey was conducted among a convenience sample of 486 Italian adults. Results showed that most participants were not particularly concerned about Ebola and did not feel at risk of acquiring the virus. Cognitive dimensions of risk perception of Ebola (i.e., perceived severity of illness, perceived personal impact, perceived coping efficacy, and likelihood of infection), affective response (or worry) to Ebola, and social‐contextual factors (i.e., perceived preparedness of institutions, family members’ and friends’ levels of worry) were interrelated. Prejudice toward African immigrants was positively related to risk perception of Ebola and negatively related to levels of knowledge about Ebola even when controlling for sociodemographic variables including political preference.     

The "Trust Gap" Hypothesis: Predicting Support for Biotechnology Across National Cultures as a Function of Trust in Actors

Using results from the 1999 Eurobarometer survey and a parallel telephone survey done in the United States in 2000, this study explored the relationship between levels of knowledge, educational levels, and degrees of encouragement for biotechnology development across a number of medical and agricultural applications. This cross-cultural exploration found only weak relationships among these variables, calling into question the common assumption that higher science literacy produces greater acceptance (whether or not mediated by lower perceived risk). The relationship between encouragement and trust in specific social institutions was also weak. However, regression analysis based on "trust gap" variables (defined as numerical differences between trust in specific pairs of actors) did predict national levels of encouragement for several applications, suggesting an opinion formation climate in which audiences are actively choosing among competing claims. Differences between European and U.S. reactions to biotechnology appear to be a result of different trust and especially "trust gap" patterns, rather than differences in knowledge or education.     

Collaborative Governance of HIV Health Services Planning Councils in Broward and Palm Beach Counties of South Florida

This study uses the collaborative governance concept to examine efforts of HIV Health Services Planning Councils in two South Florida Counties. The study employs qualitative methods such as interviews and document reviews in collecting data from various relevant sources. The results reveal more similarities than differences in the Councils?? efforts toward addressing the HIV/AIDS problem. The Councils are similar in all variables of collaborative governance with few exceptions relative to facilitative leadership and institutional design. Collaborative governance of stakeholders thereby enhances efforts in effectively managing and/or addressing complex problems.     

Differences in Perception of Risk Between People Who Have and Have Not Experienced Salmonella Food Poisoning

It is believed that food hygiene precautions in domestic kitchens are an important strategy in efforts to reduce the incidence of sporadic food poisoning, but recent research has shown that people who have suffered food poisoning handle the same types of foods and adopt similar food hygiene precautions in their kitchens to the rest of the population. This suggests the need to examine other factors. A case-control study of sporadic Salmonella food poisoning was conducted to investigate several domestic kitchen risk factors. Measures of perception of risk, knowledge, and control associated with food poisoning in case and control respondents are reported here. It was found that perceived personal risk from food poisoning in the home was less than perceived risk to other people. In contrast, ratings of personal knowledge about food poisoning and personal control over food poisoning in the home were seen to be greater than other people's knowledge and control. There were no differences between the cases and the controls in their ratings of knowledge about food poisoning or their control over food poisoning. However, cases perceived their personal risk from food poisoning to be higher than controls. Both case and control samples exhibited optimistic bias but this was reduced in the case sample, suggesting that experience with food poisoning may reduce optimistic bias.     

Dose-Response and Risk Assessment of Airborne Hexavalent Chromium and Lung Cancer Mortality

This study evaluates the dose-response relationship for inhalation exposure to hexavalent chromium [Cr(VI)] and lung cancer mortality for workers of a chromate production facility, and provides estimates of the carcinogenic potency. The data were analyzed using relative risk and additive risk dose-response models implemented with both Poisson and Cox regression. Potential confounding by birth cohort and smoking prevalence were also assessed. Lifetime cumulative exposure and highest monthly exposure were the dose metrics evaluated. The estimated lifetime additional risk of lung cancer mortality associated with 45 years of occupational exposure to 1 microg/m3 Cr(VI) (occupational exposure unit risk) was 0.00205 (90%CI: 0.00134, 0.00291) for the relative risk model and 0.00216 (90%CI: 0.00143, 0.00302) for the additive risk model assuming a linear dose response for cumulative exposure with a five-year lag. Extrapolating these findings to a continuous (e.g., environmental) exposure scenario yielded an environmental unit risk of 0.00978 (90%CI: 0.00640, 0.0138) for the relative risk model [e.g., a cancer slope factor of 34 (mg/kg-day)-1] and 0.0125 (90%CI: 0.00833, 0.0175) for the additive risk model. The relative risk model is preferred because it is more consistent with the expected trend for lung cancer risk with age. Based on statistical tests for exposure-related trend, there was no statistically significant increased lung cancer risk below lifetime cumulative occupational exposures of 1.0 mg-yr/m3, and no excess risk for workers whose highest average monthly exposure did not exceed the current Permissible Exposure Limit (52 microg/m3). It is acknowledged that this study had limited power to detect increases at these low exposure levels. These cancer potency estimates are comparable to those developed by U.S. regulatory agencies and should be useful for assessing the potential cancer hazard associated with inhaled Cr(VI).     

Worry and Risk Perception

Risk perception is sometimes measured by means of judgments about worry, sometimes as perceived risk more directly. However, perceived level of risk calls for a more intellectual judgment and worry tends to refer to emotional reactions. These two are therefore not the same and need not be strongly correlated. Results reported here show that perceived risk and worry are indeed weakly correlated, both for generalized worry and for more specific measures of worry matched with the same hazard as risk ratings. A distinction is suggested between cognitive, abstract hazards and concrete, sensory hazards, with implications for the worry-perceived risk relationship. It was furthermore found by means of cluster analysis that there were groups of subject displaying different dynamics of risk and worry.     

Patterns of Strategic Change in Health Care: District Health Authorities Respond to AIDS*

The literature on strategic change is based mostly on research in the private sector. This paper suggests that change in public sector organizations is equally worthy of study and can offer novel insights. Findings from research into the development of services for HIV/AIDS in NHS health districts are used to illustrate six generic themes in strategic change processes. The first theme concerns the role of context in potentiating change, and in promoting a diverse response in different localities despite unifying government guidelines. A second theme introduces the initiators of change, the ‘product champions’, a less homogeneous group than is sometimes suggested. Although personal status, energy and pro-activity were shared characteristics, individuals differed in style and methods used to attain goals. Theme three highlights social movements as mediators of change. Consumerism has affected both private and public sector industry, but for HIV/AIDS the process has been particularly visible. The mobilising role of crisis comes next. A three phase model is suggested, linking ‘crisis-as-threat’ and ‘crisis-as-opportunity’ theories. A fifth theme concerns changes in organizational culture provoked by HIV/AIDS, and the role played by symbolism - often unpredictable and not easily manipulated by management. The last theme is organizational learning; how learning about HIV/AIDS diffused through the districts, and how well learning generalizes to other issues. In conclusion, it is argued that the study of processes of change in a public sector organization can contribute to general models of strategic change and help to develop organizational theory.     

Understanding Risk Information Seeking and Processing during an Infectious Disease Outbreak: The Case of Zika Virus

This study draws on the Planned Risk Information Seeking Model (PRISM) to assess Zika virus information seeking and systematic processing, paying particular attention to the relationship between perceived knowledge and knowledge insufficiency. Novel risks, such as Zika, provide an interesting context for examining whether information-seeking models, such as PRISM, are able to predict information seeking when available information is limited or scarce. A cross-sectional, online study of men and women of childbearing age (N = 494) residing in the state of Florida was conducted. Our results provide some support for the PRISM for predicting Zika information seeking intention, as well as systematic processing of information. We also found that individuals with high levels of perceived knowledge were more likely to report high level of knowledge insufficiency, illustrating that contextual factors may impact the fit of risk information seeking models.     

Risk Perception and the Value of Safety

This paper examines the relationship between perceived risk and willingness-to-pay (WTP) for increased safety from technological hazards in both conceptual and empirical terms. A conceptual model is developed in which a given household's WTP for risk reductions is a function of traditional socioeconomic variables (i.e., income and base level of risk) and perceived characteristics of the hazards (i.e., dread, knowledge, and exposure). Data to estimate the model are obtained through a combined contingent valuation and risk perception survey that considers 10 technological hazards, five of which are well-defined (e.g., death rates are known and the risks are relatively common) and five are less well-defined. Econometric results, using TOBIT estimation procedures, support the importance of both types of variables in explaining WTP across all 10 hazards. When the risks are split into two groups, the results show that WTP for well-defined hazards is most influenced by perceived personal exposure, while WTP for less well-defined risks is most influenced by levels of dread and severity.     

What Risks Are Chinese People Concerned About?

The aim of this study is to investigate public perceived risk on various issues in present-day China. Two surveys were conducted in urban China in 1996 and 1998. In the first survey, risk perceptions of different occupational groups are compared. Gender differences within each occupational group are also analyzed. In the second survey, participants with diverse employment status were recruited. The overall risk rankings of both surveys indicate great concern with risks that threaten national stability and economic development, and less concern with high-technology risk such as threat from a nuclear power plant. It is also found that employees from high-profit firms are more concerned about macroscopic catastrophic risks, whereas laid-off workers and employees from money-losing enterprises are more concerned about daily life or self-concerned risks. The importance of actual exposure to risk, mass media coverage, culture, and psychometric dimensions are discussed.     

Fuzzy-Trace Theory, Risk Communication, and Product Labeling in Sexually Transmitted Diseases

Health care professionals are a major source of risk communications, but their estimation of risks may be compromised by systematic biases. We examined fuzzy-trace theory's predictions of professionals' biases in risk estimation for sexually transmitted infections (STIs) linked to: knowledge deficits (producing underestimation of STI risk, re-infection, and gender differences), gist-based mental representation of risk categories (producing overestimation of condom effectiveness for psychologically atypical but prevalent infections), retrieval failure for risk knowledge (producing greater risk underestimation when STIs are not specified), and processing interference involving combining risk estimates (producing biases in post-test estimation of infection, regardless of knowledge). One-hundred-seventy-four subjects (experts attending a national workshop, physicians, other health care professionals, and students) estimated the risk of teenagers contracting STIs, re-infection rates for males and females, and condom effectiveness in reducing infection risk. Retrieval was manipulated by asking estimation questions in two formats, a specific format that "unpacked" the STI category (infection types) and a global format that did not provide specific cues. Requesting estimates of infection risk after relevant knowledge was directly provided, isolating processing effects, assessed processing biases. As predicted, all groups of professionals underestimated the risk of STI transmission, re-infection, and gender differences, and overestimated the effectiveness of condoms, relative to published estimates. However, when questions provided better retrieval supports (specified format), estimation bias decreased. All groups of professionals also suffered from predicted processing biases. Although knowledge deficits contribute to estimation biases, the research showed that biases are also linked to fuzzy representations, retrieval failures, and processing errors Hence, interventions that are designed to improve risk perception among professionals must incorporate more than knowledge dissemination. They should also provide support for information representation, effective retrieval, and accurate processing.