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

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. XIX International AIDS Conference Washington, DC - July 19, 2012 T. Bella Dinh-Zarr, PhD, MPH North American Director, Road Safety Fund

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

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  1. What’s Road Safety Got to Do With It? The Intersection of Road Safety with Public Health and Developmentin the Context of HIV/AIDS XIX International AIDS Conference Washington, DC - July 19, 2012 T. Bella Dinh-Zarr, PhD, MPH North American Director, Road Safety Fund Road Safety Director, FIA Foundation

  2. FIA Foundation 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).

  3. Traffic deaths and injuries: a worldwide epidemic 2004 2030

  4. Dangerous overtaking – predictions of global mortality Source: WHO Global Burden of Disease 2008

  5. G20 countries - road traffic death rates – a concern for everyone WHO Global Status Report, 2009

  6. Road traffic deaths: 1.3 M per year 3 1.3 million deaths 20-50 million injured  2 1.8 Million people   1.3 1.3  1 <1 AIDS-related deaths UNAIDS 2008 Tuberculosis WHO 2007 Road traffic WHO 2004 Malaria WHO 2008

  7. The Potential of a Decade of Action for Road Safety 1.3 million deaths a year Guria, J. for CGRS, 2009

  8. Launching the Decade of Action Saul Billingsley, Deputy Director, FIA Foundation Policy Forum, Como, 17th May 2010

  9. 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”

  10. “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

  11. DECADE ACTION PLAN Five pillars for a Safe Systems approach Build Capacity Safer Roads & Mobility Safer Vehicles Safer User behavior Post-crash response www.who.int/roadsafety/decade_of_action/

  12. “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 Laws Enforcement Standards Behavior

  13. Good Practice Manuals

  14. Road Traffic Injuries 1.3 Million Deaths Per Year – and rising. Loss of 2-3% of a country’s GDP. Like HIV/AIDS: A Public Health Issue A Medical Issue A Development Issue A Human Rights Issue Also, A Transportation Issue

  15. 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.

  16. Theoretical Basis Paucity 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

  17. 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 ✔ ✔

  18. Fishbein’s Unified Framework (Action) The person forms a strong positive intention or makes a commitment to perform a behavior. There are no environmental barriers that make it impossible to perform the behavior. The person possesses the skills necessary to perform the behavior. The person believes that the advantages of performing the behavior outweigh the disadvantages. The person perceives more formative pressure to perform the behavior than to not perform it. The person perceives that performance of the behavior is consistent with his or her self image or values. The person’s emotional reaction to performing the behavior is more positive than negative. The person perceives that he or she has the capabilities to perform the behavior under different circumstances. Fishbein et al. Factors influencing behavior and behavior change. In: Baum A, Tevenson TA, Singer JE (eds.). Handbook of Health Psychology, 2001.

  19. Helmets = Vaccines against head injury Global Helmet Vaccine Initiative (helmetvaccine.org) In Vietnam, the motorbike is the “family car.”

  20. 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

  21. 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.)

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

  23. School Area Road Safety Assessment and Implementation (SARSAI) in Tanzania Intentions (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

  24. School Area Road Assessment and Implementation (SARSAI) – AMEND.ORG Road safety education & light Infrastructure improvements (crossings, speed bumps) "TunatakaTuta”= “We want bumps" in Swahili.

  25. Fishbein’s Unified Framework (Action) The person forms a strong positive intention or makes a commitment to perform a behavior. There are no environmental barriers that make it impossible to perform the behavior. The person possesses the skills necessary to perform the behavior. The person believes that the advantages of performing the behavior outweigh the disadvantages. The person perceives more formative pressure to perform the behavior than to not perform it. The person perceives that performance of the behavior is consistent with his or her self image or values. The person’s emotional reaction to performing the behavior is more positive than negative. The person perceives that he or she has the capabilities to perform the behavior under different circumstances. Fishbein et al. Factors influencing behavior and behavior change. In: Baum A, Tevenson TA, Singer JE (eds.). Handbook of Health Psychology, 2001.

  26. The Decade Tag: the new global symbol for road safety Sam Dalembert President Clinton & Mayor Bloomberg Bob Geldof Aung San SuuKyi

  27. May 11, 2011 Decade of Action for Road Safety 2011-2020 launched in 110 countries

  28. Sesame Street – Takalani Sesame – Sesame Square Ambassadors KAMI GROVER First HIV+ Muppet Road Safety Muppet

  29. Zenani Campaign - Mandela Foundation

  30. Managed pro bono by FIA Foundation – UK registered, self financed philanthropy – and World Health Organization (WHO) • 100% of donations go to safety projects (no management fees - FIA Foundation is also a donor). • www.roadsafetyfund.org

  31. If you want to go fast, go alone. If you want to go far, go together.

  32. THANK YOU Bella Dinh-Zarr, PhD, MPH FIA Foundation Road Safety Fund dinhzarr@decadeofaction.org (202) 701-5656 www.decadeofaction.org

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