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  • Title: Unsafe sex: decision-making biases and heuristics.
    Author: Kaplan BJ, Shayne VT.
    Journal: AIDS Educ Prev; 1993; 5(4):294-301. PubMed ID: 8297709.
    Abstract:
    This paper suggests that continued high-risk behavior is the result of the heuristics used to make judgments under uncertainty, and that the same heuristics may be mobilized to increase the use of safer-sex practices. In order to explain why it is that individuals fail to make effective use of the information they may have concerning rates of infection, consequences of infection and their own at-risk status, theory and research in several areas will be considered. Developments in the breadth of areas to which basic research on decision-making has been applied continue to provide new approaches toward understanding and overcoming the processes by which we reason (Kahnemann, 1991). It is worth reminding ourselves that public health campaigns in other areas have led to changes in behavior. Reasoning, even with its biases, is still the route by which we make decisions, most of them effective and self-protective. This paper focuses on the heuristics of decision making, which reflect the reasons why and how it is that information alone on the risks and prevalence of HIV/AIDS is insufficient to change behavior toward safe sex. High risk behavior is assumed to be the result of heuristics used to make judgments under uncertain conditions. Heuristic reasoning has the potential for being mobilized for increasing use of safer sex practices. Mass media messages should portray AIDS and HIV infections as dangerous to people who are sexually active and have multiple partners or have a partner who is sexually active and has multiple partners. The reasoning is that the appearance of more mainstream AIDS conditions will make AIDS more apparent, representative, and come to mind during decision making about safe sex practices. Lottery ticket buying follows this reasoning, where the chances are slim for winning but many engage in buying tickets. The parallel to safe sex is that many people use safe sex even though the chances are low of contracting the AID virus. Another approach is to publicize the probability of having an HIV positive sexual partner, if there are multiple sexual contacts. This approach reinforces the statistic about the number of AIDS cases out of the total population. Optimistic reasoning is the culprit in high risk decision making, and it allows for relapses in safe sex behavior or lack of safe sex practices. Proposals are made to mainstream HIV/AIDS cases and to establish a safer sex norm. The aim is to eliminate individual decision making which poses a threat of rejection for bringing up the topic of safe sex or desexualizing a spontaneous or unplanned experience. The discussion of motivated reasoning relies on the theories of Kunda on motivated reasoners and behavior change and Fineberg's evidence of dramatic declines in sexually transmitted diseases during World War II due to appropriate public health campaigns. Decision making heuristics is also presented in the discussion the studies by Kahnemann, Slovic, and Tversky on judgment under uncertainty. Illness susceptibility and optimistic bias reasoning is represented in the studies by Weinstein on undue optimism in the judgment of risk.
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