Applying Cascading Behavior to HIV prevention: a case for Nigeria
Article Link:
https://www.dovepress.com/hiv-prevention-cascade-theory-and-its-relation-to-social-dimensions-of-peer-reviewed-article-HIV
When analyzing the role Cascade theory and clusters play in the real world, we are shown the multifaceted nature of the possible applications that can come from this rapid dissemination of information. Though applications of cascade theory are wide ranging, the article I chose focuses on the HIV/AIDS prevention efforts in Nigeria (country currently with the second largest HIV epidemic in the world). This continuing epidemic, despite multiple separate efforts for resolution, has led researchers to advocate for an HIV Prevention Cascade (HPC) theory; this theory ensures a continuous sophisticated interrelationship that stretches beyond the biomedical interventions of treatment. Essentially, applying the HPC theory in this setting of HIV/AIDS prevention illustrates the set of actions a set of individuals could take to improve their health services and outcomes. Researchers broke down the possible applications of cascade theory to improving health outcomes into three categories: “demand-side interventions that improve risk perception, awareness and acceptability of prevention approaches; supply-side interventions that make prevention products and procedures more accessible and available; and adherence interventions that back current adoption of prevention behaviors, including those with or without prevention products”. Focusing specifically on the demand-side interventions, the effectiveness of many of the possible solutions like information and education campaigns delivered in schools, health settings, and communities are all subject to how well the information spreads and the rate at which the ideas are actually adopted when they do spread. As applied from ideas we learned in class, the presence of clusters within many of these social groups in Nigeria, whether that be villages or large towns and cities with particular ideologies or societal rules, lead to certain efforts being rendered completely ineffective in particular areas while fairly successful in others. For example, the researchers write that “the background of cultural and gender appropriateness will influence the effective usage of HIV preventive services by the population”; the culture around women in Nigeria is still influenced heavily by the lack of many personal rights afforded to women, so some of these practices did not cascade at all due to the dominating Patriarchy/the lack of a strong voice prescribed to women in the country. However, as progress continues both socially and technologically, other factors such as the increasing use of social networking give more likelihood for future iterations of HPC theory to work.
These applications of Cascade theory do not deviate heavily from the core concepts we have previously learned through class and the textbook. As discussed above, a cascade comes to a stop when it runs into a dense cluster (like a village or social group with strong beliefs or values). This is right along the lines of our course teachings as we learned that clusters are the only thing that causes cascades to stop, saying essentially that otherwise the cascade would continue to “wash over” those affected. Applied to this article, when certain new information or practices about prevention methods deviate heavily from the societal norms of a town or village that holds fervent beliefs, it is much less likely to be adopted by any individual within this group. The researchers in the article highlighted that the focus of this cascading effect would be measured through community-wide opportunities for teaching, including information and education campaigns delivered in schools, health settings, and communities; therefore, the effect they would be measuring is the extent to which the information provided in these forms actually impacts the rate at which people are contracting the disease (within regional distinctions). Measuring this difference allows them to see the presence or lack of a cascading behavior regarding the dissemination of knowledge and practices across groups.