Communication is a two-way street: investigating communication from counselors to low-risk individuals on the conditional risk of HIV

Abstract

In 2006, the Center for Disease Control and Prevention recommended the revision of state HIV testing laws. With these recommendations, more low-risk individuals are tested regardless of their risk group. However, there is a greater chance of a false positive test result for low-risk individuals than for high-risk individuals. Additionally, previous research found that doctors and HIV counselors in Germany did not accurately communicate the relationship between risk factors and false positive tests (Gigerenzer, Hoffrage, & Ebert, 1998). This study aimed to (1) compare the findings of the 1998 German sample to HIV hotline counselors in the United States in 2011; and (2) to investigate the ability of students to calculate the conditional probability of HIV for a low-risk individual after receiving a positive test, based on idealized transcripts of conversations with HIV hotline counselors. The first study found that HIV hotline counselors use both verbal expressions of risk and percentages to communicate HIV testing statistics. Additionally, 2011 American counselors were more aware of the chance of false positives and false negatives than compared to the 1998 German sample. However, no 2011 American counselors were able to provide an accurate positive predictive value for a low-risk woman. The second study found low performance among students in the calculation of the positive predictive value. Performance was facilitated by a natural frequency format for high numerate individuals. There were different patterns of results for the General Numeracy Scale and the Subjective Numeracy Scale. This would suggest that these two scales might be measuring different constructs. These findings are consistent with the two theories supporting the Frequency Effect, namely the Frequentist Hypothesis and the Nested Sets Hypothesis. Additionally, this research suggests computation of the conditional risk of HIV is facilitated by a natural frequency format. Teaching techniques have been developed and demonstrate long lasting improvement in health related computations. If a few hours of training is all that it takes to communicate these life and death statistics in a manner that is consistent with reasoning, health practitioners and students should be required to have more education in communicating and computing probabilities.