DOCSLIB.ORG

CIRCUMCISION, INFORMATION, and HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton*

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
CIRCUMCISION, INFORMATION, and HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton* RESPONDING TO RISK: CIRCUMCISION, INFORMATION, AND HIV PREVENTION Susan Godlonton, Alister Munthali, and Rebecca Thornton* Abstract—Understanding behavioral responses to changes in actual or per- In this paper, we study asymmetric responses to informa- ceived risk is important because risk-reduction goals can be undermined by risk-compensating behavior. This paper examines the response to new tion about personal risk in which new information informs information about the risk of HIV infection. Approximately 1,200 circum- individuals of their type, either high or low risk. Individuals cised and uncircumcised men in rural Malawi are randomly informed that learning their type should revise their beliefs about personal male circumcision reduces the HIV transmission rate, predicting asym- metric behavioral responses. We find no evidence that the information risk either upward or downward, predicting opposite beha- induces circumcised men to engage in riskier sex while uncircumcised vioral responses. While the new information may be used men practice safer sex in response to the information. There were no sig- beneficially by one risk type, the same information may nificant effects of the information on child circumcisions after one year. cause the other type to engage in potentially harmful risk- compensating behavior. The theoretical predictions of the behavioral responses to information about risk are straight- I. Introduction forward, yet testing these predictions empirically is more difficult. Access to information about risk is typically corre- EGINNING with the seminal work of Peltzman lated with unobserved characteristics that introduce bias to (1975), economists have sought to understand beha- B causal inference. Moreover, it is difficult to identify a set- vioral responses to changes in actual or perceived risk. ting in which information is likely to induce an asymmetric Much of the empirical literature has focused on measuring response. The most common strategy within the economics behavioral responses to the introduction of risk-reducing re- literature is to measure how information about risk interacts gulations such as mandatory seat belt laws or risk-reducing with ex ante beliefs (Gong, 2014; Boozer & Philipson, technologies including protective sports gear, sunscreen, 2000; Wilson, Xiong, & Mattson, 2014).2 treatment for high cholesterol, or vaccines.1 Although these The specific context of risk examined in this paper is the innovations strictly decrease personal risk, the net impact of risk of HIV infection. We estimate the response to learning their introduction is ambiguous because risk-compensating new information—that male circumcision is partially pro- behavior may offset their positive technological effects. In tective against HIV infection—among two types of men: contrast to the introduction of risk-reducing technologies men who are circumcised (low risk) and men who are uncir- where the effects of risk compensation may be offset by cumcised (high risk). We expect both low- and high-risk safety benefits, the net behavioral effect of the introduction men to change behavior in response to learning their type of information about risk relies exclusively on the direction by practicing either safer or riskier sex. This context is and extent to which individuals change their behavior. uniquely suitable to analyze asymmetric responses to infor- mation about risk in that the information is newly available, Received for publication February 6, 2012. Revision accepted for publi- cation August 20, 2014. Editor: Philippe Aghion. highly relevant, and provides clear theoretical predictions * Godlonton: Williams College and IFPRI; Munthali: University of of behavior change. Ultimately, the net impact of the disse- Malawi; Thornton: University of Illinois at Urbana-Champaign. mination of this information is an empirical question. Funding for this study was provided by Michigan Center for Demogra- phy of Aging (MiCDA), OVPR, and Rackham at the University of Michi- As background, recent randomized control trials in South gan, as well as the Institute for Research on Women and Gender. We Africa, Kenya, and Uganda find that male circumcision is acknowledge the extensive contributions of the field team, including up to 60% effective in reducing HIV transmission risk James Amani, Sheena Kayira, Collins Kwizombe, Denise Matthijsse, Ern- 3 est Mlenga, and Christopher Nyirenda. We also thank the assistance of (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007). Kondwani Chidziwisano, Jessica Kraft, Erica Marks, Julie Moran, Jason Shortly after the release of the results of these trials, organi- Stanley, and Kondwani Tomoko. For helpful comments, we thank seminar zations such as WHO and UNAIDS set an ambitious goal participants at the Development Day Conference at University of Michigan, NEUDC, Population Association of America, University of Illinois, Chi- to circumcise 80% of men ages 15 to 49 in fourteen priority cago, Princeton University, Yale University, University of Georgia, Georgia State University, DePaul, University of California Berkeley, University of Illinois Urbana–Champaign, the CSWEP CeMENT Workshop, and the 2 Other examples of studies that examine behavioral responses to infor- anonymous referees. mation about risk are Dupas (2011) and Bennear et al. (2013). Dupas A supplemental appendix is available online at http://www.mitpress (2011) finds that after an information session on the relative risk of HIV journals.org/doi/suppl/10.1162/REST_a_00516. infection by partner’s age, teenagers substitute away from older partners 1 Blomquist (1988) provides an extensive review of the literature on toward same-age partners. In the context of water source choices, Bennear safety belt regulations and car safety technologies (other recent examples et al. (2013) examine how learning the level of arsenic in one’s well include Evans & Graham 1991, and Cohen & Einav, 2003). Other papers affects the decision to change water sources. examine the use of protective gear in risky sports (Walker, 2007; Braun 3 Across the three trials, there were 11,054 HIV negative men who were & Fouts, 1998; Williams-Avery, & MacKinnon, 1996), increased sun willing to be circumcised. Approximately half of these were randomly exposure with the availability of sunscreen (Autier et al., 1998; Dickie & assigned to be offered circumcision surgery, while the others remained Gerking, 1997), poor eating habits and increased BMI with the introduc- uncircumcised. All participants were extensively counseled in HIV pre- tion of high cholesterol treatment (Kaplan, 2012), and risky sexual beha- vention. The studies found 61% reduction in risk in the South African vior in response to receiving the HPV vaccination (Lo, 2006; Kapoor, trial, a 53% reduction in the Kenyan study, and a 48% reduction in the 2008). Ugandan study. The Review of Economics and Statistics, May 2016, 98(2): 333–349 Ó 2016 by the President and Fellows of Harvard College and the Massachusetts Institute of Technology doi:10.1162/REST_a_00516 Downloaded from http://www.mitpressjournals.org/doi/pdf/10.1162/REST_a_00516 by guest on 28 September 2021 334 THE REVIEW OF ECONOMICS AND STATISTICS countries by 2015, making voluntary medical male circum- Our sample consists of approximately 900 circumcised and cision one of the key components of HIV prevention strate- 300 uncircumcised men who are unlikely to have had prior gies. While the medical evidence points to male circumci- exposure to the information. We randomize information sion as a viable HIV prevention strategy, one concern that about male circumcision and HIV transmission risk to has prevented the rapid scale-up of male circumcision pro- causally estimate behavioral responses. Information was vision in several African countries is the potential beha- randomized across villages to limit information spillovers vioral responses to learning that male circumcision is par- within villages. Approximately one year after the informa- tially protective against HIV infection. Some policymakers tion intervention, the project revisited respondents to mea- have noted the need to ‘‘proceed with caution’’ (Namangale, sure sexual behavior and whether the uncircumcised men or 2007) and researchers have noted that risk compensation any young male dependents had been circumcised in the may reduce the overall estimated benefit of male circumci- previous year. sion (Kalichman, Eaton, & Pinkerton, 2007; Cassel et al., We find that uncircumcised men who receive the infor- 2006). More recently, a panel of Nobel Prize economists mation about circumcision and HIV transmission risk prac- ranked ‘‘scaling up male circumcision’’ as priority 7 out of tice safer sex with approximately two fewer sexual acts in eighteen other HIV prevention strategies, ranked low the past month (a 26% reduction) and one additional con- mainly due to concerns of disinhibition behaviors. The dom used in the past month (an increase of 65%). These panel noted ‘‘Circumcision is protective, but only to a cer- results are consistent across marital status of the respondent, tain extent. It is possible that, as a consequence of large- albeit stronger for nonmarital sexual encounters. We docu- scale male circumcision with an accompanying information ment an asymmetric response to the information by circum- campaign about its protective effect, males and their part- cision status; however, we find no evidence of risk compen- ners opt for less safe sexual practices and for example sation on average among
Load more

Recommended publications
  • Biomedical Interventions
    Ch03.qxd 3/5/07 5:11 PM Page 60 3 Biomedical Interventions Stuart Berman, M.D., Sc.M., and Mary L. Kamb, M.D., M.P.H. Biomedical interventions for STD are not new. In fact, the 19th century discoveries related to syphilis in large part presaged the biomedical model of intervention. Three major discoveries at the dawn of the 20th century set the stage for subsequent medical advances: the identification of Treponema pallidum as organism responsible for syphilis; a complement fixation blood test that could diagnose the presence of the organism; and the identification by Paul Ehrlich of an arsenical, salvarsan (though not the magic bullet hoped for), that could kill the organism (1). Subsequently, the availability of penicillin and the publication of Surgeon General Thomas Parran’s “Shadow on the Land” con- tributed to the national effort to control syphilis transmission, supported by the National Venereal Disease Control Act (1938), the model for modern public health interventions based on the biomedical model. However, as this book demonstrates, the array of available interventions aimed at preventing and con- trolling sexually transmitted infections (STIs) now include many other non- medical approaches. Nevertheless, in many ways biomedical interventions are still the critical mainstay of prevention, and new biomedical approaches are constantly being evaluated and added to the armamentarium. In considering biomedical interventions, we have found that the Anderson- May equation, R = bcd, serves as a useful framework (2). In this construct, R, the reproductive number, is the average number of secondary cases associated with an index case; b is the measure of transmissibility, given exposure; c is the average number of susceptibles exposed during the period of infectivity; and d is the average period of infectivity.
    [Show full text]
  • Male Circumcision and HIV in Lesotho: Is the Relationship Real Or Spurious? Analysis of the 2009 Demographic and Health Survey
    DHS WORKING PAPERS Male Circumcision and HIV in Lesotho: Is the Relationship Real or Spurious? Analysis of the 2009 Demographic and Health Survey Tiisetso Makatjane Thandie Hlabana Emmanuel Letete 2016 No. 125 DEMOGRAPHIC AND August 2016 HEALTH This document was produced for review by the United States Agency for International Development. SURVEYS Male Circumcision and HIV in Lesotho: Is the Relationship Real or Spurious? Analysis of the 2009 Demographic and Health Survey Tiisetso Makatjane1 Thandie Hlabana2 Emmanuel M. Letete3 ICF International Rockville, Maryland, USA August 2016 1 Department of Statistics and Demography 2 Department of Sociology, Anthropology and Social Work 3 Department of Economics All three are based at the National University of Lesotho Corresponding author: T. J. Makatjane, Department of Statistics and Demography, National University of Lesotho; E-mail: [email protected] or [email protected] Acknowledgments We would like to extend our heartfelt gratitude to ICF International and USAID for considering us for this opportunity and for funding us to be part of the 2016 DHS Fellows program. We are greatly indebted to our facilitators Dr. Wenjuan Wang, Dr. Shireen Assaf, Dr. Elizabeth Nansubuga, Simona Simona, and Damian Damian for their guidance and patience during this process. Our reviewer, Joy Fishel at ICF, is appreciated for valuable insights about this work. We are also grateful to our DHS Program co-fellows for their support, feedback, and humor. This has been an opportunity for growth, and we see ourselves as ambassadors of The DHS Program in Lesotho and beyond. We also want to extend our gratitude to our institution, the National University of Lesotho, Faculty of Social Sciences, for affording us the opportunity to participate in the 2016 DHS Fellows Program.
    [Show full text]
  • Male Circumcision As Strategy for HIV Prevention and Sexually Transmitted
    ANN IST SUPER SANITÀ 2010 | VOL. 46, NO. 4: 349-359 349 DOI: 10.4415/ANN_10_04_02 ES Male circumcision as strategy I OLOG for HIV prevention and sexually transmitted D diseases. The potential role of traditional ETHO M birth attendants in neonatal male circumcision D N A Catia Dini RCH Direzione Generale per la Cooperazione allo Sviluppo, Ministero degli Affari Esteri, Rome, Italy A ESE R Summary. In developing countries, it would be advisable to give priority to human immunodeficiency virus (HIV) prevention strategies, because of the high mortality caused by the rapid spread of the pan- demic. Furthermore, HIV prevention could contribute to the mitigation of tuberculosis (TB) propaga- tion, which is tightly correlated to acquired immune deficiency syndrome (AIDS). As demonstrated, male circumcision (MC) confers protection against HIV and sexually transmitted diseases (STD). The suggested strategy considers the neonatal MC advantageous, since it is safer, feasible, culturally more acceptable and less costly than adult MC. This approach is based on the assumption that, if newborn males are circumcised, within the next 15-20 years the sexually active population will be almost entirely circumcised and, consequently, the HIV transmission will be reduced. The employment of retrained traditional birth attendants is considered in order to implement the MC after the child birth and to facilitate its acceptance in those contexts where it is not traditionally performed. Key words: HIV, acquired immunodeficiency syndrome, sexually transmitted diseases, male circumcision, tuber- culosis, traditional birth attendants. Riassunto (La circoncisione maschile come strategia di prevenzione dell’HIV e delle malattie sessualmen- te trasmissibili. Il ruolo potenziale delle ostetriche tradizionali nella circoncisione maschile neonatale).
    [Show full text]
  • Male Circumcision, Sexual Behavior, and HIV Status in Uganda [WP100]
    DHS WORKING PAPERS Male Circumcision, Sexual Behavior, and HIV Status in Uganda Simon P.S. Kibira Elizabeth Nansubuga Nazarius M. Tumwesigye 2013 No. 100 DEMOGRAPHIC AND August 2013 HEALTH This document was produced for review by the United States Agency for International Development. SURVEYS Male Circumcision, Sexual Behavior, and HIV Status in Uganda Simon P.S. Kibira 1 Elizabeth Nansubuga 2 Nazarius M. Tumwesigye 3 ICF International Calverton, Maryland, USA August 2013 1 Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University 2 Department of Population Studies, School of Statistics and Planning, Makerere University 3 Department of Epidemiology and Biostatistics, School of Public Health, Makerere University Corresponding author: Simon P.S. Kibira, Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Uganda; Email: [email protected] ACKNOWLEDGEMENTS The authors are very grateful to USAID and ICF International for their financial and technical support in writing and producing this working paper. This work would not have been possible without the valuable contribution, input, comments, reviews and suggestions made by Wenjuan Wang, Sarah Staveteig, Helen Nviiri, and Kerry MacQuarrie. In a special way, we are grateful to Wenjuan Wang for the constant advice she provided us and to Joy Fishel for reviewing our paper and providing invaluable comments. In addition, we would like to extend our sincere appreciation to all the 2013 DHS Fellows and facilitators for their support throughout the Fellows Program. ABSTRACT After a series of studies that revealed the protective effect of male circumcision against HIV infection, WHO/UNAIDS in 2007 recommended the adoption of safe male circumcision as one of the effective strategies in reducing heterosexually acquired HIV.
    [Show full text]
  • Safety Regulations, Risk Compensation, and Individual Behavior
    82 Injury Prevention 2000;6:82–90 HADDON MEMORIAL LECTURE Inj Prev: first published as 10.1136/ip.6.2.82 on 1 June 2000. Downloaded from Risky business: safety regulations, risk compensation, and individual behavior James Hedlund Editors comment: We are Government regulations and industry practices paper, behavioral adaptation describes all be- proud to be able to bring to constrain our behavior in many ways in an havioral change in response to perceived our readers this full text version of the Haddon attempt to reduce injuries. Safety features are changes in risk and risk compensation describes Memorial Lecture delivered designed into products we use: cars now have the special case of behavior change in response at the recent Fifth World airbags; medicine bottles have “childproof” to laws and regulations. The distinction Conference on Injury Pre- vention and Control in caps. Laws require us to act in a safe manner: we becomes murky at times: if a new safety feature New Delhi, India. James must wear seat belts while driving and hard hats appears on all chain saws, any behavioral reac- Hedlund oVers a brilliant in construction areas. But do these measures tion won’t depend on whether the feature is review of one of the most important areas of debate influence our behavior in other ways? Risk com- required by government regulation or adopted in the entire field of injury pensation theory hypothesizes that they do, that voluntarily by all manufacturers. The risk control. This is the most we “use up” the additional safety though more compensation definition adopted here focuses complete, most perceptive, and well balanced apprais- risky actions.
    [Show full text]
  • August 2020 Preventing Hiv Through Safe Voluntary Medical Male
    GUIDELINES PREVENTING HIV THROUGH SAFE VOLUNTARY MEDICAL MALE CIRCUMCISION FOR ADOLESCENT BOYS AND MEN IN GENERALIZED HIV EPIDEMICS RECOMMENDATIONS AND KEY CONSIDERATIONS 2020 AUGUST GUIDELINES PREVENTING HIV THROUGH SAFE VOLUNTARY MEDICAL MALE CIRCUMCISION FOR ADOLESCENT BOYS AND MEN IN GENERALIZED HIV EPIDEMICS AUGUST 2020 AUGUST RECOMMENDATIONS AND KEY CONSIDERATIONS Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations ISBN 978-92-4-000854-0 (electronic version) ISBN 978-92-4-000855-7 (print version) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/ igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/ mediation/rules/).
    [Show full text]
  • Amherst Multimodal Master Plan Utilizing Systematic Safety Principles to Develop a Town-Wide Multimodal Network
    Amherst Multimodal Master Plan Utilizing Systematic Safety Principles to Develop a Town-wide Multimodal Network Amherst Bicycle & Pedestrian Advisory Committee Amherst Multimodal Master Plan Multimodal Master Plan Version 9.2.1 June 1, 2019 Amherst Bicycle & Pedestrian Advisory Committee Amherst, New Hampshire Principal Authors Christopher Buchanan and Simon Corson Amherst Bicycle & Pedestrian Advisory Committee Members George Bower Christopher Buchanan, chairman Patrick Daniel, recreation commission ex-officio Richard Katzenberg, vice chair Wesley Robertson, conservation commission ex-officio Judy Shenk Christopher Shenk Alternate Members Mark Bender Jared Hardner, alternate conservation commission ex-officio John Harvey Carolyn Mitchell Wendy Rannenberg, alternate recreation commission ex-officio With the Assistance of Bruce Berry Susan Durling Matthew Waitkins, Senior Transportation Planner, Nashua Regional Planning Commission Page i Amherst Multimodal Master Plan Table of Contents 1 A Town-Wide Multimodal Network ......................................................................................................... 1 1.1 The Amherst Bicycle and Pedestrian Advisory Committee .......................................................... 1 1.2 Purpose ............................................................................................................................................... 1 1.3 Plan Outreach & Engagement .......................................................................................................... 1 1.4
    [Show full text]
  • Information Package on Male Circumcision and Hiv Prevention Insert 5
    InformatIon package on male cIrcumcIsIon and HIv preventIon Insert 5 Implications for women Background Observational and epidemiological data have long suggested an association between male circumcision and reduced risk of HIV infection in men. Results from three randomized controlled trials have provided evidence that male circumcision reduces the risk of HIV acquisition in men through heterosexual sex, demonstrating at least a 60% reduction in risk.1-3 This is a significant breakthrough in HIV prevention, and the international public health community and countries are therefore translating these research findings into public health policy and practice. In 2007, WHO and UNAIDS recommended that male circumcision be added to current comprehensive HIV prevention strategies. Appropriate tools and guidelines have been developed and work is in progress with national governments to develop policy, programmes and services in this field.4 HIV-negative men can be expected to benefit directly from male circumcision but the implications for women are less clear. Although it is expected that male circumcision programmes will have indirect beneficial effects on women’s health, there are concerns about possible negative effects on women. This document builds on the conclusions and recommendations of a meeting of women’s health advocates, researchers, policy-makers, pro- gramme managers and providers which was convened by WHO and UNAIDS in June 2008 in Mombasa, Kenya, to examine the implications of male circumcision for women. Benefits for women There are currently no known direct benefits of male circumcision for women. The available data suggest that there are important indirect health benefits of male circumcision for women, in particular a reduced risk of expo- sure to HIV and other sexually transmitted infections.
    [Show full text]
  • Male Circumcision Does Prevent HIV Infection
    Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection Richard G Wamai, Brian J Morris, Jake H Waskett, Edward C Green, Joya Banerjee, Robert C Bailey, Jeffrey D Klausner, David C Sokal and Catherine A Hankins* A recent article in the JLM (Boyle GJ and Hill G, ″Sub-Saharan African Randomised Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns″ (2011) 19 JLM 316) criticises the large randomised controlled trials (RCTs) that scientists, clinicians and policy-makers worldwide have concluded provide compelling evidence in support of voluntary medical male circumcision (VMMC) as an effective HIV prevention strategy. The present article addresses the claims advanced by Boyle and Hill, demonstrating their reliance on outmoded evidence, outlier studies, and flawed statistical analyses. In the current authors’ view, their claims portray misunderstandings of the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular. At the same time they ignore systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs. Denial of the evidence supporting lack of male circumcision as a major determinant of HIV epidemic patterns in sub-Saharan Africa is unsubstantiated and risks undermining the evidence- based, large-scale roll-out of VMMC for HIV prevention currently underway. The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners.
    [Show full text]
  • Analysis of Legislation to Change to Primary Enforcement of Seat Belt Law for the Health District of Northern Larimer County Board of Directors
    Analysis of Legislation to Change to Primary Enforcement of Seat Belt Law For the Health District of Northern Larimer County Board of Directors Issue Summary: Legislation would allow police officers to stop a car if the driver and front-seat passengers were not wearing seatbelts. This is known as primary enforcement. Sponsors: Senate – Peter Groff House – Joe Rice History: Bill is expected to be filed by Senator Groff in late January or early February Date of Analysis: January 16, 2007 Prepared by: Carrie Cortiglio Bill Summary The bill is expected to be a refile of a bill from last session, HB 06-1125. (Last year the Health District Board voted to strongly support HB06-1125.) The bill will make it a primary offense for a driver to operate a vehicle if the driver and/or front-seat passengers are not wearing seat belts. This means a police officer may stop a vehicle solely because the driver or front-seat passenger is not wearing a seat belt. The bill will likely contain a provision specifically noting that it is the intent of the general assembly that the statutory prohibition against profiling should be strictly observed by each law enforcement officer who stops a driver for an alleged restraining device violation. Current Law Under current Colorado law, both drivers and front-seat passengers are required to wear a seat belt. Colorado is currently a secondary enforcement state meaning that officers can only cite drivers for non-use of seat belts if they are stopping the vehicle for another vehicle or traffic offense.
    [Show full text]
  • Risk Homeostasis in Information Security: Challenges in Confirming Existence and Verifying Impact
    Risk homeostasis in information security: challenges in confirming existence and verifying impact Karen Renaud Merrill Warkentin © the authors 2017. This is the author's version of the work. It is posted here for your personal use. Not for redistribution. The definitive Version of Record was published in Proceedings of the 2017 New Security Paradigms Workshop (NSPW’17), http://dx.doi.org/10.1145/3171533.3171534 Risk Homeostasis in Information Security: Challenges in Confirming Existence and Verifying Impact Karen Renaud Merrill Warkentin School of Arts, Media and Computer Games College of Business Abertay University, Scotland Mississippi State University University of South Africa MS, USA [email protected] [email protected] ABSTRACT CCS CONCEPTS The central premise behind risk homeostasis theory is that • General and reference → Empirical studies; • Secu- humans adapt their behaviors, based on external factors, to rity and privacy → Social aspects of security and pri- align with a personal risk tolerance level. In essence, this vacy; means that the safer or more secure they feel, the more likely it is that they will behave in a risky manner. If this KEYWORDS eect exists, it serves to restrict the ability of risk mitigation Risk Homeostasis, Challenges techniques to eect improvements. The concept is hotly debated in the safety area. Some ACM Reference Format: authors agree that the eect exists, but also point out that Karen Renaud and Merrill Warkentin. 2017. Risk Homeostasis in it is poorly understood and unreliably predicted. Other re- Information Security: Challenges in Conrming Existence and Ver- searchers consider the entire concept fallacious. It is impor- ifying Impact.
    [Show full text]
  • Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV
    AJPH PREEXPOSURE PROPHYLAXIS Individual Versus Community-Level Risk Compensation Following Preexposure Prophylaxis of HIV We analyzed the concept of risk Martin Holt, PhD, and Dean A. Murphy, PhD compensation and how it has been applied in HIV prevention, See also Landers and Kapadia, p. 1534. to consider the impact of PrEP on paying particular attention to community norms and practices the strategy of HIV preexposure and not only on the immediate reexposure prophylaxis and safety and recalibrate their prophylaxis (PrEP). In risk com- recipients of the intervention. P (PrEP) is one of the most actions if they perceive that pensation, reduced perceptions Risk compensation theory significant developments in HIV they are exceeding their target of risk after the introduction relies on a rational actor model prevention, providing an al- or acceptable level of risk. A of a preventative intervention of human behavior, which is ternative and supplement to pre- key part of risk compensation derived from classic economic lead to more frequent risk- vention methods such as theory is that the benefits of an theory and has not been without taking behavior. Such a change condoms. PrEP involves intervention (e.g., seatbelts) can its critics.9,10 The idea that risk may undermine the interven- HIV-negative people regularly be outweighed over time as compensation is inevitable is tion’sprotectivebenefits. taking antiretroviral drugs to people begin to feel safer and contested, particularly when We found that many studies prevent HIV infection.1,2 It has then increase their risk-taking highly effective interventions purporting to investigate risk been found to be highly effective behavior (e.g., driving faster or are introduced.
    [Show full text]