Intention-Behavior Gaps in HIV Care

Last week at the bi-annual Ryan White Program Conference on HIV Care and Treatment, HIV care providers from across the country heard from the U.S. Secretary for Health and Human Services (DHHS), the head of the Health Resources and Services Administration (HRSA), and the head of the National Institute for Allergy and Infectious Diseases at NIH. These experts highlighted a central fact of the HIV epidemic, which is that it has for the past 20 years been as much a result of gaps between intention and behavior as it has been a medical crisis. The HIV treatment cascade shown here illustrates the patient behaviors needed to successfully manage this chronic disease. First, people at risk for HIV can avoid infection through appropriate prevention behaviors, like using condoms or taking pre-exposure prophylaxis (PrEP) medications. Once people are infected with HIV, they need to be tested in order to initate treatment. Then they must be linked to the care system, a barrier for younger people who may never have been involved with routine health care for a chronic condition. Once engaged in care, they must remain in care over time, and in order to gain the benefits of treatment they must stay adherent to medication. Each of these steps in the treatment cascade is one where patients' intentions may not match their behaviors, resulting in unnecessary health problems, gaps in care, or even treatment failure. Successfully supporting patients with each of these behaviors also requires health care practitioners to change behaviors, such as always testing for HIV or following up intensively when patients miss an appointment. Behavior change is a key to successful treatment in HIV and other chronic diseases.

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