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1.
Proc Natl Acad Sci U S A ; 120(50): e2312242120, 2023 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-38055736

RESUMO

The evolution of cooperation is a major question in the biological and behavioral sciences. While most theoretical studies model cooperation in the context of an isolated interaction (e.g., a Prisoner's Dilemma), humans live in heterogeneous social environments, characterized by large variations in fitness interdependence-the extent to which one's fitness is affected by others. Theoretical and experimental work indicates that humans can infer, and respond to, variations in interdependence. In a heterogeneous ancestral environment, these psychological mechanisms to infer fitness interdependence could have provided a selective advantage, allowing individuals to maximize their fitness by deciding when and with whom to cooperate. Yet, to date, the link between cognitive inference, variation in fitness interdependence, and cooperation remains unclear. Here we introduce a theoretical framework to study the evolution of inference and cooperation in heterogeneous social environments, where individuals experience interactions with varying levels of corresponding interests. Using a combination of evolutionary game theory and agent-based modeling, we model the evolution of adaptive agents, who incur a cost to infer interdependence, in populations of fixed-behavior agents who always cooperate or defect. Our results indicate that natural selection could promote the evolution of psychological mechanisms to infer fitness interdependence, provided that there is enough variation in fitness interdependence to offset the cost of inference. Under certain conditions, the fixation of adaptive agents results in higher levels of cooperation. This depends crucially on the type of inference performed and the features of the interdependence landscape.


Assuntos
Evolução Biológica , Comportamento Cooperativo , Humanos , Teoria dos Jogos , Modelos Teóricos , Seleção Genética
2.
Proc Natl Acad Sci U S A ; 120(24): e2303546120, 2023 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-37285394

RESUMO

Individual and societal reactions to an ongoing pandemic can lead to social dilemmas: In some cases, each individual is tempted to not follow an intervention, but for the whole society, it would be best if they did. Now that in most countries, the extent of regulations to reduce SARS-CoV-2 transmission is very small, interventions are driven by individual decision-making. Assuming that individuals act in their best own interest, we propose a framework in which this situation can be quantified, depending on the protection the intervention provides to a user and to others, the risk of getting infected, and the costs of the intervention. We discuss when a tension between individual and societal benefits arises and which parameter comparisons are important to distinguish between different regimes of intervention use.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Comportamento Cooperativo , Pandemias/prevenção & controle , Teoria dos Jogos , SARS-CoV-2
3.
J Neurosci ; 44(22)2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38649270

RESUMO

In competitive interactions, humans have to flexibly update their beliefs about another person's intentions in order to adjust their own choice strategy, such as when believing that the other may exploit their cooperativeness. Here we investigate both the neural dynamics and the causal neural substrate of belief updating processes in humans. We used an adapted prisoner's dilemma game in which participants explicitly predicted the coplayer's actions, which allowed us to quantify the prediction error between expected and actual behavior. First, in an EEG experiment, we found a stronger medial frontal negativity (MFN) for negative than positive prediction errors, suggesting that this medial frontal ERP component may encode unexpected defection of the coplayer. The MFN also predicted subsequent belief updating after negative prediction errors. In a second experiment, we used transcranial magnetic stimulation (TMS) to investigate whether the dorsomedial prefrontal cortex (dmPFC) causally implements belief updating after unexpected outcomes. Our results show that dmPFC TMS impaired belief updating and strategic behavioral adjustments after negative prediction errors. Taken together, our findings reveal the time course of the use of prediction errors in social decisions and suggest that the dmPFC plays a crucial role in updating mental representations of others' intentions.


Assuntos
Córtex Pré-Frontal , Interação Social , Estimulação Magnética Transcraniana , Humanos , Córtex Pré-Frontal/fisiologia , Masculino , Feminino , Adulto Jovem , Adulto , Eletroencefalografia , Dilema do Prisioneiro , Cultura , Potenciais Evocados/fisiologia
4.
Emerg Infect Dis ; 30(13): S56-S61, 2024 04.
Artigo em Inglês | MEDLINE | ID: mdl-38561865

RESUMO

Increasing vaccination knowledge is effective in addressing hesitancy and is particularly important in populations deprived of liberty who may not routinely have access to health information, ensuring health equity. RISE-Vac is a European Union-funded project aiming to promote vaccine literacy, offer, and uptake in prisons in Europe. We consulted persons living in prisons in the United Kingdom (through the Prisoner Policy Network), France, and Moldova to determine their vaccination knowledge gaps, the information they would like to receive, and how they would like to receive it. We received 344 responses: 224 from the United Kingdom, 70 from France, and 50 from Moldova. Participants were particularly interested in learning about the effectiveness, side effects, and manufacturing of vaccines. Their responses guided the development of educational materials, including a brochure that will be piloted in prisons in Europe. Persons with experience of imprisonment were involved at every stage of this project.


Assuntos
Prisioneiros , Vacinas , Humanos , Prisões , Reino Unido , França
5.
Proc Biol Sci ; 291(2025): 20232493, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38889792

RESUMO

Direct reciprocity is a mechanism for the evolution of cooperation in repeated social interactions. According to the literature, individuals naturally learn to adopt conditionally cooperative strategies if they have multiple encounters with their partner. Corresponding models have greatly facilitated our understanding of cooperation, yet they often make strong assumptions on how individuals remember and process payoff information. For example, when strategies are updated through social learning, it is commonly assumed that individuals compare their average payoffs. This would require them to compute (or remember) their payoffs against everyone else in the population. To understand how more realistic constraints influence direct reciprocity, we consider the evolution of conditional behaviours when individuals learn based on more recent experiences. Even in the most extreme case that they only take into account their very last interaction, we find that cooperation can still evolve. However, such individuals adopt less generous strategies, and they cooperate less often than in the classical setup with average payoffs. Interestingly, once individuals remember the payoffs of two or three recent interactions, cooperation rates quickly approach the classical limit. These findings contribute to a literature that explores which kind of cognitive capabilities are required for reciprocal cooperation. While our results suggest that some rudimentary form of payoff memory is necessary, it suffices to remember a few interactions.


Assuntos
Evolução Biológica , Comportamento Cooperativo , Memória , Animais , Humanos
6.
J Theor Biol ; 595: 111955, 2024 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-39349162

RESUMO

Species frequently engage in both competitive and cooperative interactions, delicately balancing these dynamics to optimize their chances of survival and reproduction. While competition drives individuals to compete for limited resources, cooperation can emerge as a strategic response, mitigating risk and enhancing collective payoff. To bridge theoretical game approaches such as payoff, cooperation, and defections in ecological systems, we propose a two-species predator-prey model inspired by the principles and variations of the prisoner's dilemma game. We comprehensively address and analytically verify all stable strategic states, exploring the role of payoff parameters both individually and collectively. Additionally, we investigate the effect of free space. Beyond ecological contexts, we present a model of rumor propagation within a social system to establish connections with the prisoner's dilemma game. In both systems, our primary focus is to discuss strategies and enhance the cooperative factor within the system, given its crucial importance across diverse environments.

7.
J Theor Biol ; 595: 111946, 2024 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-39271052

RESUMO

Explaining the evolution of cooperation in the strong altruism scenario, where a cooperator does not benefit from her contribution to the public goods, is a challenging problem that requires positive assortment among cooperators (i.e., cooperators must tend to associate with other cooperators) or punishment of defectors. The need for these drastic measures stems from the analysis of a group selection model of temporarily formed random groups introduced by Hamilton nearly fifty years ago to describe the fate of altruistic behavior in a population. Challenging conventional wisdom, we show analytically here that strong altruism evolves in Hamilton's original model in the case of biparental sexual reproduction. Moreover, when the cost of cooperation is small and the amplified contribution shared by group members is large, cooperation is the only stable strategy in equilibrium. Thus, our results provide a solution to the 'problem of origination' of strong altruism, i.e. how cooperation can take off from an initial low frequency of cooperators. We discuss a possible reassessment of cooperation in cases of viral co-infection, as cooperation may even be favored in situations where the prisoner's dilemma applies.

8.
J Theor Biol ; 592: 111891, 2024 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-38945472

RESUMO

We investigate conditions for the evolution of cooperation in social dilemmas in finite populations with assortment of players by group founders and general payoff functions for cooperation and defection within groups. Using a diffusion approximation in the limit of a large population size that does not depend on the precise updating rule, we show that the first-order effect of selection on the fixation probability of cooperation when represented once can be expressed as the difference between time-averaged payoffs with respect to effective time that cooperators and defectors spend in direct competition in the different group states. Comparing this fixation probability to its value under neutrality and to the corresponding fixation probability for defection, we deduce conditions for the evolution of cooperation. We show that these conditions are generally less stringent as the level of assortment increases under a wide range of assumptions on the payoffs such as additive, synergetic or discounted benefits for cooperation, fixed cost for cooperation and threshold benefit functions. This is not necessarily the case, however, when payoffs in pairwise interactions are multiplicatively compounded within groups.


Assuntos
Evolução Biológica , Comportamento Cooperativo , Teoria dos Jogos , Humanos , Densidade Demográfica , Modelos Biológicos
9.
BMC Med Res Methodol ; 24(1): 68, 2024 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-38494501

RESUMO

BACKGROUND: The challenging nature of studies with incarcerated populations and other offender groups can impede the conduct of research, particularly that involving complex study designs such as randomised control trials and clinical interventions. Providing an overview of study designs employed in this area can offer insights into this issue and how research quality may impact on health and justice outcomes. METHODS: We used a rule-based approach to extract study designs from a sample of 34,481 PubMed abstracts related to epidemiological criminology published between 1963 and 2023. The results were compared against an accepted hierarchy of scientific evidence. RESULTS: We evaluated our method in a random sample of 100 PubMed abstracts. An F1-Score of 92.2% was returned. Of 34,481 study abstracts, almost 40.0% (13,671) had an extracted study design. The most common study design was observational (37.3%; 5101) while experimental research in the form of trials (randomised, non-randomised) was present in 16.9% (2319). Mapped against the current hierarchy of scientific evidence, 13.7% (1874) of extracted study designs could not be categorised. Among the remaining studies, most were observational (17.2%; 2343) followed by systematic reviews (10.5%; 1432) with randomised controlled trials accounting for 8.7% (1196) of studies and meta-analysis for 1.4% (190) of studies. CONCLUSIONS: It is possible to extract epidemiological study designs from a large-scale PubMed sample computationally. However, the number of trials, systematic reviews, and meta-analysis is relatively small - just 1 in 5 articles. Despite an increase over time in the total number of articles, study design details in the abstracts were missing. Epidemiological criminology still lacks the experimental evidence needed to address the health needs of the marginalized and isolated population that is prisoners and offenders.


Assuntos
Criminosos , Prisioneiros , Humanos , Mineração de Dados , Projetos de Pesquisa
10.
J Exp Child Psychol ; 241: 105858, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38310663

RESUMO

Adults are more likely to cooperate with in-group members than with out-group members in the context of social dilemmas, situations in which self-interest is in conflict with collective interest. This bias has the potential to profoundly shape human cooperation, and therefore it is important to understand when it emerges in development. Here we asked whether 6- to 9-year-old children (N = 146) preferentially cooperate with in-group members in the context of a well-studied social dilemma, the iterated Prisoner's Dilemma Game. We assigned children to minimal groups and paired them with unfamiliar same-age and same-gender peers. Consistent with our predictions, children were more likely to cooperate with in-group members than with out-group members in this minimal group context. This finding adds to the current literature on group bias in children's prosocial behavior by showing that it affects decision making in a context that calls on strategic cooperation. In addition, our analyses revealed an effect of gender, with girls more likely to cooperate than boys regardless of the group membership of their partner. Exploring this gender effect further, we found an interaction between gender and age across condition, with older girls showing less sensitivity to the group membership of their partner than younger girls and with older boys showing more sensitivity to the group membership of the partner than younger boys. Our findings suggest that risky cooperation in the face of social dilemmas is shaped by group bias during childhood, highlighting the potentially deeply rooted ties between cooperation and parochialism in humans.


Assuntos
Comportamento Cooperativo , Dilema do Prisioneiro , Masculino , Adulto , Criança , Feminino , Humanos
11.
J Adolesc ; 96(3): 485-500, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37661443

RESUMO

INTRODUCTION: Disparities in evaluating readiness to change and recidivism risk across diverse cultural groups can profoundly affect rehabilitation program efficacy. This study examines readiness to change and recidivism risk disparities between Israeli-Arabs and Israeli-Jews entering a re-entry program by the Prisoner Rehabilitation Authority postrelease. METHOD: The University of Rhode Island Change Assessment Scale questionnaire gauged readiness to change, whereas the Ohio Youth Assessment System-Residential tool assessed recidivism risk. The sample included 151 participants: 98 Israeli-Arabs and 53 Israeli-Jews. Mean differences in change readiness and recidivism risk were statistically assessed through t tests. RESULTS: Significant differences emerged in change readiness levels between Israeli-Arabs and Jews upon rehabilitation program entry, with Israeli-Jews exhibiting higher readiness. Additionally, a noteworthy divergence in recidivism risk was noted, indicating elevated average risk for Israeli-Jews. CONCLUSIONS: Findings underscore the vital need for cultural sensitivity during admission. Bias potential in assessing risk for Arab participants emphasizes the necessity of a comprehensive culturally sensitive approach. While focusing on admission, the Risk-Need-Responsivity model application could enhance risk evaluation and guide culturally tailored treatments.


Assuntos
Criminosos , Etnicidade , Adolescente , Humanos , Masculino , Israel , Árabes , Judeus
12.
Artigo em Inglês | MEDLINE | ID: mdl-39073751

RESUMO

In the United States, a disproportionately high number of incarcerated individuals suffer from serious mental illnesses, substance use disorders, chronic medical conditions, infectious diseases, and traumatic brain injuries. Correctional facilities are often ill-equipped to address the incarcerated community's physical and mental health needs. Current laws and policies remain outdated and do not adequately address the complex health issues faced by incarcerated individuals, particularly the aging and terminally ill patients in correctional settings. We present a case of a male with schizophrenia whose ongoing psychiatric symptoms impaired his decisional capacity, leading to him to refuse medical treatment for an initially treatable medical condition, ultimately resulting in his death due to the lack of a surrogate decision-maker. This case underscores the urgent need for policy revisions to assign medical decision-making authority for individuals in custody and highlights potential interventions to bridge existing gaps in care for this population.

13.
Behav Res Methods ; 56(2): 667-679, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36781699

RESUMO

In the study of human behaviour, non-social targets are often used as a control for human-to-human interactions. However, the concept of anthropomorphisation suggests that human-like qualities can be attributed to non-human objects. This can prove problematic in psychological experiments, as computers are often used as non-social targets. Here, we assessed the degree of computer anthropomorphisation in a sequential and iterated prisoner's dilemma. Participants (N = 41) faced three opponents in the prisoner's dilemma paradigm-a human, a computer, and a roulette-all represented by images presented at the commencement of each round. Cooperation choice frequencies and transition probabilities were estimated within subjects, in rounds against each opponent. We found that participants anthropomorphised the computer opponent to a high degree, while the same was not found for the roulette (i.e. no cooperation choice difference vs human opponents; p = .99). The difference in participants' behaviour towards the computer vs the roulette was further potentiated by the precedent roulette round, in terms of both cooperation choice (61%, p = .007) and cooperation probability after reciprocated defection (79%, p = .007). This suggests that there could be a considerable anthropomorphisation bias towards computer opponents in social games, even for those without a human-like appearance. Conversely, a roulette may be a preferable non-social control when the opponent's abilities are not explicit or familiar.


Assuntos
Comportamento Cooperativo , Dilema do Prisioneiro , Humanos , Cabeça , Fatores Socioeconômicos
14.
J Relig Health ; 2024 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-39312104

RESUMO

Rest and sleep are health fundamentals and essential phases of human life rhythms. Sleep disturbances can negatively affect an individual's physical and mental balance. Due to the psychological pressure resulting from problems, prisoners experience more sleep disturbances than other people. Therefore, this study aimed to compare the effects of spiritual care with and without aromatherapy on the sleep quality of prisoners in the emergency department of the central prison clinic in Sanandaj County. A single-blind clinical trial was conducted on 90 male prisoners of the emergency department of the central prison clinic in Sanandaj, Kurdistan-Iran, and they were randomly assigned to three groups: spiritual care (intervention 1), spiritual care with aromatherapy (intervention 2), and control group. Spiritual care and aromatherapy, along with spiritual care interventions, were performed using lavender essence for one month. Data collection was performed using a demographic checklist and the pittsburgh sleep quality index before and after the interventions. The collected data were analyzed using descriptive and analytical statistical methods in SPSS.26. The mean age of the prisoners was 34.99 ± 7.011 years, 75.6% had a diploma or lower education level, and 46.7% had been imprisoned for more than one year. At baseline, the mean sleep quality score was 9.33 ± 3.55 in intervention group 1, 9.53 ± 4.06 in intervention group 2, and 10.50 ± 3.59 in the control group, with no significant difference between the groups (p = 0.413). After the interventions, the mean sleep quality score was 8.40 ± 2.94 in intervention group 1, 7.86 ± 4.90 in intervention group 2, and 11.23 ± 3.81 in the control group, showing a significant difference between the groups (p = 0.002). According to findings, aromatherapy, along with spiritual care, significantly improved the sleep quality of prisoners (p = 0.003), but spiritual care alone was not effective (p = 0.137). Aromatherapy-based spiritual care improved the sleep quality of prisoners; hence, considering the congruency of spirituality with pleasant scents symbolizing cleanliness and aligning with human nature and religious recommendations, the combination of these two interventions can be used to enhance the sleep quality of prisoners.

15.
Hum Brain Mapp ; 44(12): 4535-4544, 2023 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-37357970

RESUMO

Previous findings have shown a strong relationship between sports and interpersonal cooperative behavior. Physical activity is the basic form of sport. In this study, we investigated the effect of physical activity on interpersonal cooperative behavior and its inter-brain correlates. Eighty college students were recruited and randomly divided into the experimental or control group (20 dyads per each). The experimental group performed a 30-min of moderate intensity single-person cycling exercise, while the control group performed a 30-min single-person sitting. Interpersonal cooperative behavior was measured by a Prisoner's Dilemma task before and after the intervention, while neural activities in the frontal cortex in each dyad were measured by the near-infrared spectroscopy-based hyperscanning approach. The results showed that the average cooperation rate and cooperation efficiency of the experimental dyads were significantly higher after the exercise intervention compared to that before intervention, but not in control group. Meanwhile, the interpersonal neural synchronization (INS) in the left frontal cortex was significantly increased after intervention only in experimental dyads. Moreover, the INS increased in left frontal cortex was positively correlated with the cooperation improvement. Taken together, these results indicate that one single-person bicycling can improve interpersonal cooperation behavior, which may be associated with enhanced interpersonal neural synchronization in the left frontal cortex.


Assuntos
Ciclismo , Encéfalo , Humanos , Mapeamento Encefálico/métodos , Comportamento Cooperativo , Lobo Frontal/diagnóstico por imagem , Relações Interpessoais
16.
Br J Psychiatry ; 222(1): 4-6, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36263739

RESUMO

In a double-blind randomised controlled trial by Asherson et al., involving prisoners with attention-deficit hyperactivity disorder (ADHD), the rates of response to osmotic-release oral system methylphenidate (OROS-methylphenidate) and placebo were very similar (~50%). I critically discuss this trial against other international literature, highlighting the key issues in the field in terms of clinical practice and research.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Metilfenidato , Prisioneiros , Humanos , Metilfenidato/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Prisões , Administração Oral , Método Duplo-Cego , Resultado do Tratamento , Preparações de Ação Retardada/uso terapêutico
17.
J Math Biol ; 87(1): 12, 2023 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-37335377

RESUMO

Network structure is a mechanism for promoting cooperation in social dilemma games. In the present study, we explore graph surgery, i.e., to slightly perturb the given network, towards a network that better fosters cooperation. To this end, we develop a perturbation theory to assess the change in the propensity of cooperation when we add or remove a single edge to/from the given network. Our perturbation theory is for a previously proposed random-walk-based theory that provides the threshold benefit-to-cost ratio, [Formula: see text], which is the value of the benefit-to-cost ratio in the donation game above which the cooperator is more likely to fixate than in a control case, for any finite networks. We find that [Formula: see text] decreases when we remove a single edge in a majority of cases and that our perturbation theory captures at a reasonable accuracy which edge removal makes [Formula: see text] small to facilitate cooperation. In contrast, [Formula: see text] tends to increase when we add an edge, and the perturbation theory is not good at predicting the edge addition that changes [Formula: see text] by a large amount. Our perturbation theory significantly reduces the computational complexity for calculating the outcome of graph surgery.


Assuntos
Comportamento Cooperativo , Teoria dos Jogos , Análise Custo-Benefício , Evolução Biológica
18.
J Pers ; 91(3): 556-565, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35837856

RESUMO

OBJECTIVE: To test a novel proposition that dispositional forgiveness has the unrecognized benefit of buffering feelings of paranoia following negative interpersonal experiences and interpersonal transgressions. METHODS: In Study 1 (N = 128), we used an experimental paradigm, the Prisoner's Dilemma Game (PDG), to test the premise that an interpersonal transgression increases state paranoia. Study 2 (N = 180) used a longitudinal design to test the central proposition that dispositional forgiveness buffers state paranoia following naturally occurring difficult (vs pleasant) interpersonal events. Study 3 (N = 102) used a novel experimental paradigm to determine the causal effect of manipulating forgiveness on paranoia. RESULTS: In Study 1, interpersonal transgressions in the PDG increased paranoia. In Study 2, paranoia was higher following difficult (rather than pleasant) events, and higher levels of dispositional forgiveness moderated the negative effect of difficult events on paranoia. In Study 3, there was a causal effect of forgiveness on (reduced) paranoia. CONCLUSIONS: This is the first evidence that (1) interpersonal transgressions increase paranoia, (2) high dispositional forgiveness moderates the deleterious effect of interpersonal transgression on paranoia, and (3) dispositional forgiveness is causally related to less paranoia.


Assuntos
Perdão , Humanos , Relações Interpessoais , Transtornos Paranoides , Emoções , Personalidade
19.
Bioethics ; 37(6): 575-580, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37148564

RESUMO

In 2011, bioethicists turned their attention to the question of whether prisoners on death row ought to be allowed to be organ donors. The discussion began with a provocative anti-procurement article by Arthur Caplan and prompted responses from an impressive lineup of commentators. In the 10 years since, the situation for death-row inmates seeking to donate has hardly changed: U.S. prison authorities consistently refuse to allow death-row procurement. We believe that it is time to revisit the issue. While Caplan's commentators rebutted his narrow contention that organ procurement would undermine the goals of deterrence and retribution, none of them attempted to make a positive, nonconsequentialist case for organ donation as a right of death-row inmates. That is the task we take up in this paper. After sketching and briefly defending a theory of punishment, we show how denial of organ donation is inconsistent with punishment's basic logic.


Assuntos
Transplante de Órgãos , Prisioneiros , Obtenção de Tecidos e Órgãos , Humanos , Doadores de Tecidos
20.
BMC Health Serv Res ; 23(1): 71, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36690986

RESUMO

BACKGROUND: Assisted partner notification (APN) is recommended as a public health strategy to increase HIV testing in people exposed to HIV. Yet its adoption in many countries remains at an early stage. This qualitative study sought the opinions of HIV health service providers regarding the appropriateness and feasibility of implementing APN in Indonesia where such services are on the cusp of adoption. METHODS: Four focus group discussions totaling 40 health service providers were held in Jakarta, Indonesia to consider APN as an innovative concept and to share their reactions regarding its potential implementation in Indonesia. Voice-recorded discussions were conducted in Bahasa, transcribed verbatim, and analyzed. RESULTS: Participants recognized APN's potential in contacting and informing the partners of HIV-positive clients of possible viral exposure. They also perceived APN's value as a client-driven service permitting clients to select which of three partner notification methods would work best for them across differing partner relationships and settings. Nonetheless, participants also identified personal and health system challenges that could impede successful APN adoption including medical and human resource limitations, the need for specialized APN training, ethical and equity considerations, and lack of sufficient clarity concerning laws and government policies regulating 3rd party disclosures. They also pointed to the job-overload, stress, personal discomfort, and the ethical uncertainty that providers might experience in delivering APN. CONCLUSION: Overall, providers of HIV services embraced the concept of APN but forecast practical difficulties in key service areas where investments in resources and system change appeared necessary to ensure effective and equitable implementation.


Assuntos
Infecções por HIV , Parceiros Sexuais , Humanos , Busca de Comunicante/métodos , Indonésia , Infecções por HIV/epidemiologia , Atitude do Pessoal de Saúde , Pessoal de Saúde
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