“HIV is a virus that doesn’t care what people think. It only cares what people do.” This is a statement by Elizabeth Pisani in her book, The Wisdom of Whores : Bureaucrats, Brothels and the Business of AIDS. I used the main title of  her book for today’s Perspectives. What people think may be their attitudes and what they do may be their behaviours. Even so, people’s thinking (attitude) may provide clues as to what they do (behaviours). Also, what people think (attitude) and what people do (behaviour) may be at odds with each other.

These attitude/behaviour configurations may happen consistently, or rarely. And sometimes people believe that the attitude you have could become your behaviour. Nevertheless, a person’s attitude does not necessarily become a behaviour. Even so, attitude and behaviour could be the same. There, therefore, are several ways of looking at attiude and behaviour.

Dr. Marie Jahoda, at a public lecture at the University College, London (UCL), talked about the difficulties of studying ‘attitude’ and ‘behaviour’. Attitude and behaviour are different things. At this lecture, Jahoda provided an example of where a person was asked whether he liked eating bread and that person answered in a ‘yes’ or a ‘no’ (attitude); and suppose that person had said that he liked eating bread (attitude), but when at home, he hated eating bread (behaviour). In this instance, there is a clear difference between attitude and behaviour.
In this example, there is a difference between what a person thinks and what he does with that thinking. Notwithstanding this difference, that thinking (attitude) with the help of motivation may give a sense as to the coming behaviour. So Pisani’s statement “HIV is a virus that doesn’t care what people think. It only cares what people do.” Is correct in so far as the virus is concerned. At any rate, people’s thinking may produce risk behaviours.
For this reason, we have to care what people think, even though the virus will not care.  Failure to do this, say in behavioural surveillance, would mean heaping questions on differentiated groups of people without first understanding their needs, interests, and qualities.  This is precisely the point that Pisani makes in The Wisdom of Whores, in that we do not understand people, as whores and those on drugs, from their points of view, but from our own. That is why in some studies, wrong questions produce wrong information on both attitude and behaviour.
In the book The Wisdom of Whores, Pisani, an epidemiologist, is at pains to point out that in another context to do with time, researchers draw wrong conclusions because they have wrong data. For example, when researchers ask people how many sex partners they had over a long period of time, say six months ago, they may not remember and so may give wrong answers. Perhaps, it may be better to ask how many sex partners they had two weeks ago. For these reasons, it is better to ask specific questions over a shorter time period, in order to receive precise and accurate answers.
The Ministry of Health, Guyana and Family Health International (2004) in their Behavioural Surveillance Survey asked questions, among others, relating to these data: “Percentage of sexually active respondents who had one or more non-regular partner in past 12 months”; “Consistent (100 percent) condom use in anal sex with regular male partner in past six months”. Would we receive accurate answers from questions that ask a person to retell their sexual exploits over a six or 12-month period. I doubt it. Nevertheless, public health policymakers generally use this information, even if incorrect, to formulate and adjust HIV/AIDS policies.
Pisani would argue that there is need to seek the truth on how people, as whores and those on drugs, contract HIV, and not to conceal that truth through vested interests or prejudice on sex and drugs. Behavioural surveillance surveys in many countries, intentionally or not, tend to present less than the truth on HIV/AIDS.
(*Re-published by public acclamation)