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

1. Modeling the Exchange of AIDS Prevention and Treatment Strategies in Hong Kong Richard Callahan Linder & 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.

2. 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

3. 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?

4. 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

5. 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

6. 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

7. A Multidimensional Scaling Algorithm for Network Analysis • Distance is defined according to a metric with Minkowski parameter

8. A Multidimensional Scaling Algorithm for Network Analysis • Distance is then converted to a table of observed frequencies • The power paffects the degree to which frequencies attenuate as distance from a vertex increases

9. 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

10. HIV/AIDS Prevalence in Hong Kong

11. The NGOs

12. 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

15. Hong Kong NGOs Relative to their Target Groups

16. 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

17. Policy Implications • Information about prevention strategies currently travels slowly between 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

18. 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

19. Acknowledgements • This research was supported by a grant from the Goodman Foundation at Dartmouth 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