XIX International AIDS Conference Washington, DC - July 19, 2012 T. Bella Dinh-Zarr, PhD, MPH

XIX International AIDS ConferenceWashington, DC - July 19, 2012

T. Bella Dinh-Zarr, PhD, MPHNorth American Director, Road Safety Fund

Road Safety Director, FIA Foundation

What’s Road Safety Got to Do With It?The Intersection of Road Safety with Public Health

and Development in the Context of HIV/AIDS

The FIA Foundation is an independent philanthropy which funds activities and works with governments and organizations to prevent road traffic injuries and deaths. The Foundation initiated the Make Roads Safe Campaign, an international advocacy campaign which led to the UN declaring a Decade of Action for Road Safety 2011-2020. The Foundation, pro bono, manages The Road Safety Fund, with the World Health Organization (WHO).

FIA Foundation

Traffic deaths and injuries: a worldwide epidemic

2004 2030

Dangerous overtaking – predictions of global mortality

Source: WHO Global Burden of Disease 2008

G20 countries - road traffic death rates – a concern for everyone

WHO Global Status Report, 2009

Road traffic deaths: 1.3 M per year

Road traffic WHO 2004

MalariaWHO 2008

TuberculosisWHO 2007

AIDS-related deathsUNAIDS 2008

1.3 million deaths 20-50 million injured

The Potential of a Decade of Action for Road Safety

Guria, J. for CGRS, 2009

1.3 million deaths a year

Launching the Decade of Action

Saul Billingsley, Deputy Director, FIA Foundation

Policy Forum, Como, 17th May 2010

UNITED NATIONS GENERAL ASSEMBLY, 2nd March 2010:

“Proclaims the period 2011-2020 as the Decade of Action for Road Safety, with a goal to stabilize and then reduce

the forecast level of road traffic fatalities around the world”

“It is totally unacceptable that more than one million people die on the roads and more than fifty million are injured. The human costs are profound. Through the United Nations Decade of Action for Road Safety, I sincerely hope that we can save human lives.”

- Ban Ki-moon, UN Secretary General

DECADE ACTION PLAN

Five pillars for a Safe Systems approach

Build Capacity

Safer User behavior

SaferRoads & Mobility

Safer Vehicles

Post-crash response

www.who.int/roadsafety/decade_of_action/

“Best buys” in road safety

Speed reduction Seat-belts Child-restraints Helmets Drinking and driving

Low cost engineering measures Safer vehicles Pre-hospital and Trauma care

LawsEnforcement

StandardsBehavior

Good Practice Manuals

Road Traffic Injuries1.3 Million Deaths Per Year – and rising.

Loss of 2-3% of a country’s GDP.

Like HIV/AIDS:A Public Health IssueA Medical IssueA Development IssueA Human Rights Issue

Also, A Transportation Issue

Other Intersections of RTI and AIDS/HIV• Safe road infrastructure also helps people travel

to receive preventive and lifesaving medical treatment more safely and efficiently.

• Safe roads increase the ability for women and girls to go to work and school, lessening their risk of becoming infected with HIV/AIDS.

• It is important to minimize the risk of injuries because people with HIV/AIDS are more vulnerable.

• AIDS and RTI interventions (alcohol, speed, safe driving practices, etc.) could be delivered together in commercial driver training.

Theoretical BasisPaucity of behavioral theories and models pertaining to injury, but Fishbein’s Framework applies to both HIV/AIDS and injury prevention.

Fishbein’s Unified Framework Based on 5 Theories• Health Belief Model• Social Cognitive Theory• Theory of Reasoned Action• Theory of Self-Regulation and Self-Control• Theory of Subjective Culture and Interpersonal

Relationships

8 Factors that Account for Variation in Health Behaviors

• Intentions• Environmental Barriers• Skills• Outcome expectations or attitude• Social Norms• Self-Standards• Emotional Reactions• Self-Efficacy

Necessary & Sufficient

Fishbein’s Unified Framework (Action)

Fishbein et al. Factors influencing behavior and behavior change. In: Baum A, Tevenson TA, Singer JE (eds.). Handbook of Health Psychology, 2001.

1. The person forms a strong positive intention or makes a commitment to perform a behavior.

2. There are no environmental barriers that make it impossible to perform the behavior.

3. The person possesses the skills necessary to perform the behavior.

4. The person believes that the advantages of performing the behavior outweigh the disadvantages.

5. The person perceives more formative pressure to perform the behavior than to not perform it.

6. The person perceives that performance of the behavior is consistent with his or her self image or values.

7. The person’s emotional reaction to performing the behavior is more positive than negative.

8. The person perceives that he or she has the capabilities to perform the behavior under different circumstances.

Helmets = Vaccines against head injury

Global Helmet Vaccine Initiative (helmetvaccine.org)In Vietnam, the motorbike is the “family car.”

Motorcycle Helmets in Vietnam

Intentions (commitment to wearing)+

Environmental Barriers (low cost or free tropical-weight safe helmets)

+Skills

(training to wear helmet correctly)+

Modifying/Strengthening Variables (laws)=

High Probability of Helmet Wearing =

Fewer Deaths and Injuries

Motorcycle safety campaigns in Vietnam HELMETVACCINE.ORG- Low-cost tropical weight helmets manufactured and disseminated

in Vietnam; school-based traffic safety education- Helmet laws increased use from 10% to 90%; 12% reduction in

deaths and 24% reduction in injuries ($200M saved in first year by Vietnamese government in health care cost, lost income, etc.)

School Area Road Assessment and Implementation (SARSAI) – AMEND.ORGRoad safety education & light Infrastructure improvements (crossings, speed bumps)

School Area Road Safety Assessment and Implementation (SARSAI) in TanzaniaIntentions (commitment to getting children to school safely)

+Environmental Barriers (infrastructure improvements such as

speed bumps, safe crossings)+

Skills (road safety education for students, parents, teachers)+

Modifying/Strengthening Variables=

High Probability of using safe paths to travel to school = Fewer deaths and injuries

"Tunataka Tuta”= “We want bumps" in Swahili.