Modeling the Exchange of AIDS Prevention and Treatment Strategies in Hong Kong

Richard CallahanLinder & Associates

Consultant, Los Angeles Police Department

1-443-677-7800

Richard.J.Callahan.03@alum.Dartmouth.org

This research was conducted with a grant from the Goodman Foundation at Dartmouth College and in collaboration with Dr. Joel Levine and

Dr. Robert Welsch at Dartmouth College.

Outline

Problem, scope, and methods of research

Description of the mathematical tools used in this research

Hong Kong’s response to AIDS

Findings and context for the network models from the ethnographic research

Policy implications and areas for future research

The Problem

To what extent do non-government organization (NGO) workers in Hong Kong discuss their prevention or treatment programs with their colleagues?

How does this sharing of information relate to the strategies the NGOs use to fund and implement their programs?

Scope of the study

Organizations that provide prevention, care or program support related to HIV/AIDS in Hong Kong

Full-time and part-time workers for the NGOs that applied to the AIDS Trust Fund (ATF) for funding

Methodology

Ethnographic research: Participant observation and key

informant interviews

Network analysis: Quantitative questionnaire about how people

perceived the risk groups they targeted with their outreach efforts and with whom they discussed their strategies

SNA and Agent-Based Modeling

Actor-based algorithms for network analysis do not assign to actors the ability to use information from their environment to pursue a set of goals

Sociocentric network models can add detail to the environment for an agent-based model and give researchers a benchmark for evaluating the accuracy of simulations

A Multidimensional Scaling Algorithm for Network Analysis

/1dim

1

),(

kjkik yxjid

Distance is defined according to a metric with Minkowski

parameter

A Multidimensional Scaling Algorithm for Network Analysis

Distance is then converted to a table of observed frequencies

The power p affects the degree to which frequencies attenuate as distance from a vertex increases

pijd

jiij ecarF ˆ

A Multidimensional Scaling Algorithm for Network Analysis

The expected frequency table is compared to the observed frequencies of communication using a sum of chi-squared errors

Vertices are then moved to minimize the error between the two tables, using a downhill simplex method with simulated annealing

Because the algorithm is a heuristic, finding a global minimum is not guaranteed, but results are reproducible

HIV/AIDS Prevalence in Hong Kong

Reported HIV/AIDS Statistics (updated 31 March 2002)

HIV AIDStotal Q1 2002 total Q1 2002

Gender male 1469 34 499 8female 329 9 71 2

Ethnicity Chinese 1248 34 446 10non-Chinese 550 9 124 0

Transmissionheterosexual 1026 23 376 7homosexual 340 5 98 1bisexual 87 2 29 1injecting drug use 46 2 9 0blood/bl products 68 0 19 0perinatal 14 0 6 0undetermined 217 11 33 1

TOTAL 1798 62 570 10Source: Special Preventive Programmes, Department of Health, Hong Kong SAR Government

The NGOs

Organization Full-time staff Part-time staff Target groupsTeenAIDS 2 2 Youth

Hong Kong AIDS Foundation 16 0 All sixSt. John's Cathedral HIV Education Centre 1 1 Travelers, Women

Action for REACH OUT 6 0 CSW*, IDUs*Caritas AIDS project 1 1 Youth, Travelers

Hong Kong Council on Social Services (HKCSS) AIDS Project 1 1 Health workersChi Heng Foundation 3 0 MSM*

Society for AIDS Care 10 0 PatientsAIDS Concern 13 11 MSM, Travelers, Youth

*CSW: Commercial Sex Workers. IDU: Intraveneous drug users. MSM: Men who have sex with men.

Hong Kong Coalition of AIDS Service Organizations (HKCASO)

The NGO response to their social position

NGO leaders meet bimonthly, usually discuss how to get funders and policy makers to listen to them

While the NGOs were writing their proposals for the AIDS Trust Fund (ATF), even convincing members to discuss their target groups was difficult

HKCASO was able to get the ATF to extend their application deadline one month

Most important mechanism for sharing ideas

Hong Kong NGOs Relative to their Target Groups

Competition Shapes the Overall Structure

This study gives evidence that competition for funding (“survival”) affected the actions and discussions of the NGO workers at the time of the study

Communication takes place mostly through strong ties, and according to a hierarchical structure

Competition for funding is a key factor affecting the strategies used by each NGO

Policy Implications Information about prevention strategies currently travels slowly betw

een NGOs if at all, and change is likely to be implemented in a top-down manner

The social structure that we have seen provides the potential for policy makers to implement a management and accountability system that gives the NGOs latitude to develop and implement their own initiatives, yet holds them accountable by directly evaluating effectiveness in terms of affecting HIV transmission and prevalence in Hong Kong

“Engineer the funding and the so-called Advisory committees. I think you possibly have to merge them into one.” Create an advisory board "which can make decisions or can influence the funding directly. And then you need that group [to have] a good...working relationship with the NGOs.” Get people with different backgrounds represented on such a board. “Reactivate the community planning process, and… have a good surveillance system.”

-a former chairperson of HKCASO

Further avenues for research With baseline indicators for NGO performance in place, it is now

possible to relate position in a communications network to an NGO’s overall performance in preventing or treating HIV in Hong Kong

A network study conducted at a less competitive moment in time could be useful

An agent-based model predicting how NGOs would respond to spikes in HIV transmission within specific target groups could use data from network surveys to accurately state how much information each agent would have

The missing piece to the puzzle is how to relate NGO prevention work to a decline in HIV transmission

Acknowledgements This research was supported by a grant from the Goodman Foundation at D

artmouth College

Dr. Joel Levine at Dartmouth College developed the algorithm for this study

Professors Joel Levine and Robert Welsch at Dartmouth College were my advisers for this research

Dr. Bian Yanjie (Hong Kong University of Science and Technology) gave me valuable insight into the questionnaire development while I was in Hong Kong

Dr. Gina LAI and Dr. Danching RUAN (Hong Kong Baptist University) proofread the questionnaire for content, and Elijah Fung (St. John’s Cathedral HIV Education Centre) proofread the questionnaire for accuracy in translation

This study could also not have been completed without assistance from the staff of the AIDS-related NGOs in Hong Kong