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Nicholas Papageorge Talks about Behavior and Policy During a Pandemic Using HIV as an Analogy

Nicholas PapageorgeOn Wednesday, September 9, the Schroeder Center for Health Policy kicked off a multidisciplinary speaker series on the COVID-19 pandemic with a virtual talk from Nicholas Papageorge, Ph.D. Dr. Papageorge is the Broadus Mitchell Associate Professor of Economics at Johns Hopkins University and his research focuses on human capital, broadly construed to include education, physical and mental health, socio-emotional skills, and genetic endowments. Dr. Papageorge’s presentation “Behavior and Policy During a Pandemic: HIV as an Historical Analogy” was presented over Zoom.  Hosting the event were Jennifer Mellor, Director of the Schroeder Center and Professor of Economics, and Peter Savelyev, Professor of Economics. 

Before the COVID-19 pandemic hit, Dr. Papageorge spent a few years studying HIV/AIDs in the United States from a human capital perspective. Specifically, Dr. Papageorge and his co-authors applied Michael Grossman’s economic theories of health capital to HIV/AIDs. Dr. Grossman wrote a seminal paper in 1972 that analyzed health as an individual investment: engaging in risky behaviors could be considered a disinvestment in one’s health that affects many other areas of one’s life, whereas engaging in healthy behaviors or choosing not to engage in risky behaviors could be thought of as an investment in one’s health. 

Dr. Papageorge said that research into what makes people choose to invest or disinvest in one’s health is helpful for developing good public health policy that is built around what people will do, not what we want them to do. In the case of HIV/AIDs, policies that assume everyone will have safe sex or take their medications were bad policies, because they did not have a backup plan for when people inevitably do not fall in line. In the case of COVID-19, this suggests that policies which assume everyone will engage in social distancing or wear a mask may not be good policies. 

Dr. Papageorge also said that HIV/AIDs is a somewhat flawed but ultimately useful historical analogy for understanding COVID-19. HIV/AIDs is a pandemic that contemporary scholars understand reasonably well, and both HIV/AIDs and COVID-19 disproportionately affect marginalized populations. However, HIV/AIDs affected a very small percentage of people in most developed countries, posing a stark contrast to the vast nature of the COVID-19 pandemic. 

One of the trends in his HIV/AIDs research which Dr. Papageorge found especially applicable to COVID-19 was related to Highly Active Antiretroviral Therapy (HAART), an anti-HIV drug. Dr. Papageorge’s research showed that the negative side effects of HAART were causing a decline in job productivity among gay men with HIV in the United States. Because of this, some patients chose to stop taking HAART in order to keep their jobs. This meant that gay men from lower socioeconomic groups, who were the most at risk for HIV/AIDs, were more likely to stop taking HAART since they needed to protect their occupational income more than those from higher socioeconomic groups. 

Applying Dr. Grossman’s ideas to these findings, Dr. Papageorge and his colleagues concluded that the best public policies for battling HIV/AIDs might include giving HIV patients from lower socioeconomic classes a financial incentive to stay on HAART. Even though such an incentive might cause the beneficiaries to leave the workforce, their ability to take HAART could decrease rates of viral transmission and positively impact society as a whole. 

What does this have to do with COVID-19? Dr. Papageorge presented some preliminary findings which suggested that people in lower socioeconomic classes are less likely to adhere to social distancing guidelines for the same reason gay men in lower socioeconomic classes stopped taking HAART: they need to work. Dr. Papageorge said that many of the people who are struggling with COVID-19 restrictions aren’t doing so because they are bad people, but because they need to keep food on the table. 

“One thing I found really interesting was the parallel between the HIV/AIDs epidemic and the COVID-19 pandemic in the public’s response to the emergence of the disease,” said Matt Siroty, a sophomore double majoring in Psychology and Health Sciences who attended the talk. “In both, public health professionals handled the response to the disease knowing full well that not everyone would adhere to the guidelines in place.” 

Overall, Dr. Papageorge’s presentation was a great reminder about the benefits of looking to history when writing public health policy. By developing a better understanding of what has and has not worked in the past and recognizing the incentives and constraints people face, policymakers are better equipped to create successful policies in the present and the future.