An ‘elephant in the room’? Stigma and hepatitis C transmission among HIV‐positive ‘serosorting’ gay men

Recent research has highlighted concerns about sexually transmitted infection with hepatitis C virus (HCV) in populations of HIV‐positive men who have sex with men. This paper presents results from a qualitative pilot study exploring the experience of stigma in HIV/HCV co‐infected men. The preliminary findings suggest that HCV infection can be experienced as more stigmatising than HIV among gay and other men who have sex with men. This hierarchical stigmatisation complicates the disclosure of HCV infection, threatening the ‘safety’ of HIV serosorted unprotected sexual practice. Further research is required to explore the effect of stigma on HIV/HCV co‐infected men, but these preliminary findings suggest that heath promotion initiatives are needed to counter hepatitis C stigma by raising awareness and facilitating greater empathetic ownership of hepatitis C as a gay community issue.     

An Immunodeficient and ‘Backward’ Child

Abstract

The direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban are US Food and Drug Administration (FDA)-approved target-specific oral anticoagulants (TSOACs) that have emerged onto the market for use in some indications similar to those for warfarin; in addition, edoxaban is seeking FDA approval. Similar indications include reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation for all 3 agents, for the prevention of deep vein thrombosis that may lead to pulmonary embolism in patients undergoing hip or knee surgery for rivaroxaban and apixaban, and for the treatment and prevention of deep vein thrombosis and pulmonary embolism. As anticoagulants, they are all associated with a risk of bleeding, and, unfortunately, there are no approved antidotes for reversal of these agents. A number of small studies in human subjects and in human/animal models exposed to TSOACs have evaluated the use of activated charcoal, hemodialysis for dabigatran, or clotting factor concentrates for their ability to neutralize the anticoagulant effects or reduce drug concentrations of TSOACs. Clotting factor concentrates that have been used include prothrombin complex concentrates and recombinant factor VII. This review examines studies and case reports evaluating these strategies for expedited or emergent reversal of TSOACs.     

‘It's really a hard life’: Love,gender and HIV risk among male‐to‐female transgender persons

Scientific studies demonstrate high rates of HIV infection among male‐to‐female (MTF) transgender individuals and that stigma and discrimination place MTFs at increased risk for infection. However, there is little research examining how gender roles contribute to HIV risk. This paper reports on in‐depth interviews with 20 MTFs attending a community clinic. Data reveal that stigma and discrimination create a heightened need for MTFs to feel safe and loved by a male companion and that in turn places them at a higher risk for acquiring HIV. Male‐to‐female transgender individuals appear to turn to men to feel loved and affirmed as women; their main HIV risk stems from their willingness to engage with sexual partners who provide a sense of love and acceptance but who also may also request unsafe sexual behaviours. A model illustrating how HIV risk is generated from stigma and discrimination is presented.     

‘It's like the treasure’: beliefs associated with semen among young HIV‐positive and HIV‐negative gay men

This paper examines cultural and social meanings associated with semen, along with related issues of unprotected receptive anal intercourse, HIV seroconversion, treatment optimism and viraemia. The findings are derived from qualitative interviews conducted with 12 HIV‐positive young gay men and 12 HIV‐negative counterparts who participated in a prospective cohort study in Vancouver, Canada. Focussing on the narratives of young gay men, the analysis reveals a diverse range of knowledge, values and functions of semen, especially in relation to its exchange. Beliefs about semen appeared to differ by HIV serostatus and were linked with intimacy, identity and pleasure, particularly among the HIV‐positive men. Against dominant representations of semen in relation to issues of loss, anxiety and infertility, this unique study sheds much needed light on its role within the cultural construction of sexuality among gay men. As such, these narratives are of direct importance to primary and secondary HIV prevention, including condom promotion and the development of rectal microbicides.     

‘Big Food’ and ‘gamified’ products: promotion,packaging, and the promise of fun

The promise of ‘fun’ is an increasingly common strategy used by Big Food in the promotion of packaged products. Gamification, or ‘making it fun’, has been identified as a top consumer packaged goods trend for 2014, and is finding its way into the spectrum of packaged goods and target markets. Once solely the preserve of children’s fare, fun is now applied to ‘junk’ food, ‘healthy’ food, snack food, ‘adult’ food, and ‘kids’ food. The rise and implications of such marketing has yet to be explored, and this article draws from the critical literature in food studies, current food marketing campaigns, and primary research from the trade press to map and critique ‘fun’ in association with food promotion. I argue that the promise of fun – while positioned as a playful, edible ‘pause’ in a hectic world – works to occlude some significant health, attitudinal and policy considerations related to the industrial diet. The seemingly lightweight focus on fun as a driver in food promotion promises a more embodied level of engagement than does a focus on nutritionism. However, ‘fun’ can simultaneously work to reconfigure relationships with food, increase consumption, and distance processed foodstuffs from issues of nutrients, as well as the non-communicable diseases associated with excessive consumption of highly processed fare.     

Is ‘bareback’ a useful construct in primary HIV‐prevention? Definitions,identity and research

This paper discusses sexual health strategies among Chilean women living in Melbourne, Australia. Twenty in-depth qualitative interviews and a survey questionnaire were administered to 100 Chilean-born women. Findings illustrate the importance of 'authority' when it comes to 'socially risky' illnesses like sexually transmitted diseases (STDs). Women stressed that western trained doctors are the only answer for STDs and the only way women can protect themselves from getting STDs is by visiting the doctor. The western trained doctor is seen to have the authority and legitimacy to treat the disease and heal the social relationships threatened by STDs. Chilean women continue to value the importance of alternative medicine within the array of health and medical seeking behaviours, although their use has shifted from the traditional Latin American folk healer to the Chinese doctor, herbalist and other alternative medical practitioners, including naturopaths. We conclude by arguing that while traditional medicines are still widely used by the Chilean migrant community, when it comes to 'socially risky' conditions such as STDs, western trained doctors, because of their conferred power, authority and social legitimacy, are key figures for prevention and treatment.     

From ‘Implications’ to ‘Dimensions’: Science, Medicine and Ethics in Society

Much bioethical scholarship is concerned with the social, legal and philosophical implications of new and emerging science and medicine, as well as with the processes of research that under-gird these innovations. Science and technology studies (STS), and the related and interpenetrating disciplines of anthropology and sociology, have also explored what novel technoscience might imply for society, and how the social is constitutive of scientific knowledge and technological artefacts. More recently, social scientists have interrogated the emergence of ethical issues: they have documented how particular matters come to be regarded as in some way to do with ‘ethics’, and how this in turn enjoins particular types of social action. In this paper, I will discuss some of this and other STS (and STS-inflected) literature and reflect on how it might complement more ‘traditional’ modes of bioethical enquiry. I argue that STS might (1) cast new light on current bioethical issues, (2) direct the gaze of bioethicists towards matters that may previously have escaped their attention, and (3) indicate the import not only of the ethical implications of biomedical innovation, but also how these innovative and other processes feature ethics as a dimension of everyday laboratory and clinical work. In sum, engagements between STS and bioethics are increasingly important in order to understand and manage the complex dynamics between science, medicine and ethics in society.     

What ‘children’ experience and ‘adults’ may overlook: phenomenological approaches to media practice,education and research

Abstract

This paper argues that each utterance of media should be seen as in dialogue with each other utterance, and that children, being the phenomenological hub to their lived media experience, should be recognised as engaging with media holistically. Argument draws upon two recent qualitative studies with children between six and eleven years of age. These studies, although separate, shared certain phenomenology orientated conceptual underpinnings and arrived at relatable findings. Notably that participating children tended to address media in a platform agnostic manner and offered little sense that they saw the media platform itself as being of overriding significance to their holistic media engagement. Ultimately, if children’s lived media engagement is dialogic and holistic, then focusing on only one discreet media utterance (like television for example) can be said to become deeply problematic to those within children’s media practice, education and research.     

Between ‘0’ and ‘1’: safer sex and condom use among young gay men in Hong Kong

Young men who have sex with men are becoming the most at-risk subgroup for HIV incidence in Hong Kong. To understand how young gay men in Hong Kong interpret and implement safer sex and condom use, focus-group discussions and individual in-depth interviews were held. The 74 participants were nearly all ethnic Chinese gay men aged between 18 and 25 years. Findings indicate that the challenge for health intervention lies in young gay men’s inconsistent condom use despite their high level of HIV-related knowledge. Participants described using condoms, testing for HIV and abstaining from anal sex as measures undertaken to prevent HIV infection. However, sociocultural norms and expectations pertaining to ‘0’ (docile, bottom) and ‘1’ (assertive, top) roles and trust between partners complicate the consistent implementation of risk-reduction measures. Influenced by heteronormative and romantic beliefs, sexual behaviours such as condomless anal sex and internal ejaculation hold symbolic meanings – exclusivity, commitment, intimacy, possession – for young gay men in Hong Kong, which override health concerns. These findings support more empowerment-driven HIV programming for young gay men.     

Is plasmid based differentiation ofCoxiella burnetii in ‘acute’ and ‘chronic’ isolates still valid?

Ten humanCoxiella burnetii isolates from french patients with acute hepatitis or chronic endocarditis were characterized according to their polymorphism in DNA restriction patterns and differentiated by plasmid-specific PCR. The aim of this investigation was to clarify if the present classification of so called acute and chronicCoxiella burnetii isolates — based on plasmid profile of a so far limited number of partly ancient isolates — could be confirmed with lately isolated organisms of this agent. The data obtained in this investigation indicate that this classification based onC. burnetii plasmid content is no longer justified.     

‘Dirty looks’ and ‘trampy places’ in young people's accounts of community and neighbourhood: Implications for health inequalities

This paper draws on preliminary data collected in an ongoing school-based research project for the Health Education Authority (HEA) which is exploring Putnam's (1993) concept of 'social capital' in relation to children and young people's well-being and health. Putnam's conceptualization of social capital consists of the following features: trust, reciprocal support, civic engagement, community identity, and social networks; and the premise is that levels of social capital in a community have an important effect on people's well-being. A range of qualitative methods have been used to elicit 12-15 year olds' views of friendship networks and neighbourhoods: (1) written accounts of out-of-school activities, who is important, definitions of 'friend', future aspirations and social networks (2) visual methods including map drawing and photography by the participants and (3) group discussions exploring use of and perceptions of neighbourhoods, and community and institutional participation. The paper presents data, which suggest that young people face many paradoxes and contradictions in their environments that on the one hand support them and on the other hand exclude them. They often seem to develop their own 'communities' in the face of a strongly felt hostility from the adults around them. The paper concludes firstly that age is an important structuring principle which needs to be taken into account when considering entitlements to use of public space within neighbourhoods, and secondly that how young people use and experience communal areas is likely to have an important effect on their sense of community identity and ultimately their well-being.     

Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status

Abstract

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV ‘risk’ actually means in different cultures and contexts. A ‘socially situated’ approach to HIV risk moves beyond its scientific conceptualisation as an objective ‘fact’, revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of ‘difference’, a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of ‘risk’ arise and, thus, where couples’ sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.     

What is a ‘generic’ hospital model?—a comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows

The paper addresses the question in the title via a survey of experienced healthcare modellers and an extensive literature review. It has two objectives.

‘U’ technique and standard technique of Norplant removal

Objectives To compare the side effects and time required for Norplant removal between the U technique (using the no-scalpel vas deferens holding forceps) and the standard technique.Materials and methods A randomized controlled clinical trial was carried out of acceptors in family planning clinics in Dr Kariadi Hospital, Semarang, who wanted to have Norplant removal. The Norplant was removed by experienced doctors who had been trained for both the U technique and the standard technique. Removal time, capsule condition and complications were examined.Results From 41 clients in the U technique group and 41 clients in the standard technique group, the removal times were 2.75±1.28 and 6.57±2.93 minutes, respectively (p<0.01). One week after Norplant removal, complications were found in 5 clients, 1 from the U technique group (2.44%) and 4 from the standard technique group (9.76%). Two weeks after Norplant removal no complications were found.Conclusion The U technique was quicker and less complicated compared with the standard technique.

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ResumenObjectivos Comparar los efectos secundarios y el tiempo requerido para el retiro de Norplant con la técnica U y la técnica estándar.Materiales y métodos Un ensayo clínico controlado aleatorizado de aceptadoras en la clínica de planificación familiar Dr. Kariadi Hospital Semarang que deseaban que se retirase el Norplant. El Norplant fue retirado por médicos experimentados que habían sido adiestrados tanto en la técnica U como en la estándar. Se examinaron el tiempo de retiro, el estado de las cápsulas y las complicaciones.Resultados En 41 clientas en la técnica U y 41 clientas en la técnica estándar, el tiempo de retiro fue 2,75±1,28 y 6,57±2,93 minutos (p<0,01) respectivamente. Se detectaron complicationes después de una semana del retiro de Norplant en 5 clientas, 1 caso (2,44%) en la técnica U y 4 (9,76%) en la técnica estándar. Dos semanas después no se detectaron complicaciones.Conclusión La técnica U fue más rápida y señaló menos complicaciones que la técnica estándar.

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ResumèObjectifs Comparer les effets secondaires et le temps nécessaire pour le retrait du Norplant, entre la technique en U et la technique standard.Matériels et méthodes Un essai clinique randomisé a été effectué sous contrôle à la clinique de planning familial de l'hôpital Dr. Kariadi de Semarang sur des patientes sollicitant le retrait du Norplant. Celui-ci a été retiré par des médecins expérimentés qui avaient, été formés à la technique de retrait dite en U et à la technique standard. On a relevé les temps de retrait, l'état des implants et les complications survenues.Résultats Pour 41 patientes soumises à la technique en U et 41 patientes à la technique standard, les temps de retrait ont été respectivement de 2,75±1,28 et 6,57±2,93 minutes (p<0,01). Des complications ont été observées une semaine après le retrait de Norplant chez 5 femmes, soit 1 cas (2,44%) pour la technique en U et 4(9,76%) pour la technique standard. Deux semaines plus tard, aucune complication n'a été constatée.Conclusion La technique en U est plus rapide et entraîne moins de complications que la technique standard.

     

‘Getting off’ and ‘going out’: young people's conceptions of (hetero)sexual relationships

Research that has explored young people's (hetero)sexual behaviour has often assumed that the idea of ‘relationships' is transparent. Subsequently, the diversity which exists within this concept has been neglected. This paper endeavours to unpack the concept of ‘relationships' with reference to young people's own understandings and meanings of the term. Drawing on findings from focus group research with 17–19 year‐olds in New Zealand, it analyses how relationships are constituted and differentiated. Some of the determining characteristics are: the time partners spend together, a sense of exclusivity and intimacy, emotional attachment and the kinds and frequency of sexual activity engaged in. On the basis of various configurations of these elements, young people's relationships can be loosely categorized as ‘one‐night stands’, ‘short‐term relationships’, ‘casual dating’ and ‘going out’. The diversity, complexity and fluidity in these conceptualizations present a challenge to traditional understandings of these relationships, and have implications for how sexual health promotion might be carried out.