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Effect of ‘lifestyle stigma’ on public support for NHS-provisioned pre-exposure prophylaxis (PrEP) and preventative interventions for HPV and type 2 diabetes: a nationwide UK survey
  1. Timothy Hildebrandt1,
  2. Leticia Bode2,
  3. Jessica S C Ng1
  1. 1 Department of Social Policy, London School of Economics and Political Science, London, UK
  2. 2 Communication, Culture & Technology, Georgetown University, Washington, DC, USA
  1. Correspondence to Dr Timothy Hildebrandt; T.R.Hildebrandt{at}


Objectives This study examines how the perceived role of poor lifestyle and irresponsible behaviour in contracting HIV, human papilloma virus (HPV) and diabetes affects public support for government-provisioned prevention efforts in Britain. It assesses whether public attitudes on healthcare spending are broadly sensitive to ‘lifestyle stigmas’.

Methods We conducted an online survey of 738 respondents in Britain and embedded three separate survey experiments to measure support for government-provisioned interventions for HIV, HPV and type 2 diabetes. In each experiment, we manipulated language used to describe the extent to which the diseases are caused by lifestyle choices. Most respondents participated in all three experiments, but assignment was randomised within each condition. Analysis compared support among respondents exposed to ‘lifestyle’ treatment (information emphasising the disease’s lifestyle causes) versus control treatment. We estimated three separate t-tests in which support for government provision of interventions is the dependent variable.

Results Support for government-provisioned prevention was high for all three diseases. There was no statistical difference between treatment and control conditions for HIV (treatment mean=3.73, control mean=3.86, p=0.38). But in both HPV (treatment mean=3.96, control mean=4.43, p<0.01) and type 2 diabetes (treatment mean=3.53, control mean=4.03, p<0.01) experiments, support for government-provisioned interventions was significantly lower under lifestyle treatment conditions.

Conclusions Public opinion on healthcare expenditures in Britain is unexpected and uneven. Consistent participant support for pre-exposure prophylaxis (PrEP) shows public attitudes are not always sensitive to lifestyle stigmas—but for other diseases, perceived relationships between individual behaviour and poor health can still shape public opinion about health expenditures. Policymakers and practitioners should remain attentive to how health problems are framed and discussed to ensure broad public support, and take advantage of policy windows like with PrEP as they may close.

  • pre-exposure prophylaxis (PrEP)
  • HIV
  • HPV
  • diabetes
  • public opinion

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  • Contributors TH: conceptualisation, methodology, investigation, writing—original draft, writing—review and editing, supervision, project administration, funding acquisition. LB: methodology, validation, formal analysis, investigation, data curation, visualisation, writing—original draft, writing—review and editing. JSCN: investigation, writing—original draft, writing—review and editing.

  • Funding This work was supported by a Titmuss Meinhardt Research Grant from the Department of Social Policy at the London School of Economics and Political Science.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for the survey was granted in September 2016 by the Ethical Review Board at London School of Economics and Political Science.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open-access repository.

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