All right, so in the course of the lectures that we've done, and in particular a number of things that David's talked about with some of his research, we've seen how infection can change the behavior of the host to help facilitate transmission. In this week in some of the lectures, we talked about how behavior can be used as a control. How changing behavior through communication and various different mechanisms can help slow down transmission, or stop transmission. And one of the classic examples is this has been messaging for sexually transmitted diseases. And so one of the questions that was put forth in the forum is, what evidence is there in human sexually transmitted disease that we've actually collectively changed our behavior in response to sexually transmitted diseases? And if we have, does it actually seem to be working? Are there good examples of how behavioral change has slowed down transmission or stopped transmission? >> I think when considering parasites and behavior, it's important to make the early distinction that there's two ways in which we might see the change. The first is parasites adaptively controlling, and there are many systems in non-human animals, and that's not what we're talking about. The other is that behavior avoidance, which we can see evolving truer processes of natural selection, over many, many long periods, and the lobster example is a good one. So lobsters, which are infected with a virus are excluded from the group, because the other members don't want to get infected. In the case of these human changes in behavior which emerging diseases like HIV, AIDS, it occurs over very short time periods, 90 or 100 years. So I'll just hand over to Rachel now, that the evidence for human changes in behavior, because she's better at being able to speak to that. >> So, that's a complicated question. I mean, to do the normal, human behavior's not complicated when you don't want to say biology's complicated. The question of whether messaging can work, messaging can certainly work to change behavior. But there are lots of times where we go ahead and put out messages that are not very thoughtful, and are not done with the guidance of what we understand will change the behavior in the recommended direction, and we get all kinds of backfire and contempt. So, we can put out messages in the hopes of getting attention and we create this stigma around it, and then people react to the stigma, which ends up interfering with the actual behavior, so what have we helped? So you can get communities that then come together because they've all experienced the ostracism which is a terribly painful thing to experience. It's actually the wrong way to do induce stress, our question from before. And you can get co-infections as people are now intentionally hanging out with each other. You can have all kinds of things again, exacerbated and created. You can also have a lack of access to treatment. So if you created enough of a stigma, then you end up having healthcare providers who won't see those patients, and that you can even get it into the legal codes, and things change for certain groups. And again, all of those things don't necessarily help with the transmission dynamics that we were talking, right? So even one of the confusions that happened with, even human pavlovian virus, is we talked about it exclusively as being sexually transmitted, people only looked at sexual transmission, and they stopped looking at any skin to skin contact. And the evidence about you could have other forms of skin to skin contact that were problematic, that men could get it as well. All the rest of that, we had a much harder time changing all of the attitudes and beliefs that would end up encouraging the right behaviors. because we've been so quick at getting out a message, we've done it part of the way, we'd gotten out half the information, and we didn't think carefully about we were doing. So we can change behavior, if we're not thoughtful about it, we'll change it in the wrong direction. >> Mm-hm. >> But there's lots of evidence that what people say to each other affects their behavior, for sure. >> One of the things I don't understand, and since this is a day after election. >> Yeah. >> It seems that in politics we're very good at messaging, and if. >> If you're the winner. [LAUGH] >> Well, yeah. They've spent enormous amount of money on these people, I'll put it that way, and in marketing we seem to be quite good at it. What is it about health messaging that makes it so less understood, or is that an unfair summary? >> So, what's interesting is, if you look at the strategies that marketers will use for health, products, or behaviors they're selling. They use different strategies than most public health programs use in getting out messages about things that are of concern or epidemic. So you can actually see, for example, with open sitting trying to change what people are doing. Love, positive, happy messages about going in and getting a surgery. And really condemning, shaming messages about what you're giving your child to eat, and you get very different reactions. In terms of, well, I will just go get that surgery because it's given to me in a very happy, positive way that I'm going to be paying attention to. Instead of well, who are you to tell me how I should be parenting my kids? >> [CROSSTALK] >> Shame on you if it doesn't work at all, and you get all this back fire. >> Does that mean the public messaging isn't good, it's not actually [CROSSTALK]? >> The public health messaging, I think it's changing. I think we're getting more theories involved, to understand what we can do so we can predict the behavior better. But I think we've had a different push, I think some of the messaging that's come out has been trying to quickly gain attention. And you can gain attention by scaring people, and you can gain attention by making people angry. But that doesn't always lead to the behavior that we're looking for. >> So how do you quantify whether or not these messages actually have impacted transmission, or disease? I think that the idea that it's probably very easy to measure whether or not someone changes they're behavior, right, because they'd do something differently. >> Or is [CROSSTALK]? >> But how well is this affecting broad scale transmission of disease? >> So I think it depends on what we're trying to track. So, even on behavior if it's something that is done privately, it's very hard for us to track it. We're getting, for better or for worse, much more clever in unobtrusive ways. So, everybody's cellphones right now are a part of tracking that's being done by some groups in terms of contact patterns. So that we could then track off your cell phones how much behavior has changed because of messages that have gone out. We don't always need to tell with them any verbal messages, we can close roads, those are non-verbal messages. >> [LAUGH] >> We can take handles off of doors. [LAUGH] We can do other things, and then see how it's changing behavior. The pill caps we now have, those are all monitored, so we know how many times you're opening the cap. We don't quite have it down to, but maybe close, the nanobot that will know if you actually ingested the drug therapy so that it would go back. But we have, especially at the individual level, much more clever ways of doing it. I think we're getting close to things like traffic patterns and other kinds of things to get bigger. >> The next point is going one step further, can we actually look back to the diseased dynamics, to the infection dynamics? >> It would take meetings like this. I think what's happened in a large part is some of the behavioral groups are all talking to each other, and the infectious disease modellers are talking to each other. But we haven't had as much crossover in conservation that we need to actually integrate these models together. >> So there's an interesting example that might be worth mentioning. >> Yeah. In this context about, it's not a pleasant outcome of changing social behaviors. But with Herpes viruses, which we're introducing this week in the video from our lab, we've seen in the last five years a surge in the number of HSV-1 infections which used to be present mostly orally, in the general area. So that there's a larger number right now of new genital infections caused by HSV-1, not by HSV-2, and we talked about that in the video to explain the difference between those two. But that's more, it may be due to differences in our immunoreactivity. But one of the other competing theories for why that happens is changes in social behavior. That the encouragement perhaps for abstinence, or have later times of sexual intercourse are driving people to have more oral sex or other kind of interactions that are giving the virus opportunities to be introduced to a different niche. >> Mm-hm. >> And these are very personal topics that people don't want to talk about, so that makes it difficult to assess, I'm sure. >> Yep, absolutely. >> From the perspective of looking at the efficacy of the advice that we give people and what they actually do. >> Yes. >> And so what you can just observe at the disease level and the epidemiology is this disturbing change in pattern. >> Yes. >> Where we have to be reactive rather than proactive because we can't tell what's going on. But you see it when you look at who's presenting it at the doctor's office. >> Yeah, and I think the other thing that we've developed are more, it's not the public health messaging is blatantly bad or marketing is blatantly good. We're also integrating more evaluation plans from the beginning so we can monitor things like, oh, we could have perturbed the system in a way we didn't anticipate. Oh, how can we correct the messaging or something else? So, to give a completely different example, when we were working with HIV in Namibia it was under the edicts of abstinence, be faithful, and condom use, it was the ABC's. And largely with the President at the time, the be faithful and abstinence over condom use. And when the messages were presented through the churches that were largely influential in the Namibia, being faithful got understood as devotion to the devout, not as monogamy. And we had to, only because we were in there, and we were talking to people that we understood that that had happened. And we can change the messages to monogamy is, we need to also be monogamous to this partner as well ensure we're being faithful to the divine. [LAUGH] But that kind of thing, we haven't necessarily had the funding, and it's not the foresight, but it's largely been the funding. To be able to go back in and double check that when we go return system, that it's happened the way we expected it to, and have enough resources to make sure that what we're trying to get out there is doing what we think its doing. We're having the same problems with the antibiotic resistance. We have to make sure that the funding is not just there from the beginning to create the message, but to track it, and to continue to see how the system responds. >> Right. >> Right.