Decision making in conditions of risk and uncertainty: The response to HIV/AIDS

Abstract

This paper addresses influences on decision making under conditions of risk and uncertainty and draws on empirical data from longitudinal qualitative studies of British health authority responses to HIV/AIDS. It considers a little discussed aspect of the response made to an identified hazard, the possible influence of the hazard in fundamentally changing the situation in which it occurs. This may give rise to perceptions of qualitatively different risks from those attributable to the nature of the hazard itself, which may influence decision making in unexpected ways. The paper looks first at the nature of decision making in situations of risk and uncertainty, and of people's behaviour when forced to make risky choices. In the following sections, empirical evidence about the development of services for HIV/AIDS is used to illustrate some qualitatively different perceptions of risk that have mediated decision making, and some possible consequences of these decision processes. Finally, moving from HIV/AIDS as a specific issue, the paper considers the contribution these findings may make to general understanding of the nature of decision making in situations of risk and uncertainty. It is suggested that in seeking to understand decision making under these conditions it may be fruitful to consider the nature and extent of any changes in the environment as a consequence of the focal hazard, and decision makers' perceptions of and reactions to other, qualitatively different, risks these may pose.