In this paper, I consider how trust affects the decisions of men who have sex with men (MSM) around using pre-exposure prophylaxis (PrEP) as HIV prevention in their sexual and romantic relationships, and how the use of PrEP affects their relationships with healthcare providers. MSM have to trust their sexual and romantic partners as well as their healthcare providers for PrEP to be successful as a relatively new HIV prevention strategy. This trust includes both interpersonal trust and institutional trust and (...) it is complicated by different kinds of relationship dynamics and the history of prejudice against MSM in healthcare institutions. (shrink)

The book examines how medical knowledge is produced around bodies that do not fit in the heteronormative framework of the state’s rationale and processes. The marginal bodies studied in this research are termed MSM, men who have sex with men, categorized as a high-risk group in the backdrop of HIV/AIDS. These Queer bodies entered the registers of epidemiology and governmentality. This classification is the point of departure for the book. The book interrogates and asks how does a sexual subject become (...) a political question? To answer this political trajectory, the book analyses the category of risk in biomedicine. It investigates how the category of risk becomes critical to the Indian state’s rationale and policies wherein, through the ambit of health and population, sexuality is managed. Unearthing the sexual politics in South Asia, the book, based on rich empirical evidence derived from the lived experiences of MSM, narrates the construction of sexual subjectivity and masculinity. Theprocess of construction occurs in negotiation with the Indian state, bringing forth the dimension of the Indian state as a medico-legal governmentality regime and how MSM takes on the identity of a medicalized subject. (shrink)

Few other social technologies and institutions are more consequential to human societies than money. Yet money remains a deeply perplexing phenomenon. On the one hand, it is a pan-human system of valuation, but on the other, it is conventional and variable in its uses. While it is controversial if money instantiates a fully-fledged sign system, it is rife with semiotic capacities. To present an illuminating analysis of money is thus a test case for the Motivation & Sedimentation Model (MSM) of (...) meaning making, with roots in the phenomenology of Husserl and Merleau-Ponty. Using MSM, we analyze two origin accounts of money: the commodity money account evidenced in archaic and classical Greek coinage, and the credit money account exemplified by early findings in Mesopotamia. Both accounts focus on the interactions between the three levels of MSM: the pre-signitive Embodied, the cultural Sedimented, and the interactional Situated levels of meaning and propose different series of “loops” to account for the genesis of money. Despite key differences in the two origins, both imply semiotic processes operating according to motivated, and hence non-arbitrary, conventions developing within institutional formations that ultimately influenc present-day concepts of money. (shrink)

Shambu is a member of staff at the MSM branch of a non-profit organisation in urban Bangalore, India, who works on HIV/sti awareness and prevention. His daily life is a careful balance between family responsibilities, his job, multiple sexual partners and sex work. This piece shares Shambu’s reflections on his early experiences with sexuality, his engagement in cruising sites, gender performance, engagement with male sex workers, non-consensual sex and the financial realities that shape his life, including his involvement in activism. (...) Defying rigid identity boundaries and societal expectations, he openly discusses his relationships with both men and his wife while expressing a desire to be transgender. He recalls a significant relationship with a man he called his ‘panthi’, marked by an intricate dynamic of emotions, sex, dominance, economic exchange and silence. His narrative offers a nuanced exploration of identity, gender, sexuality, activism, consent, morality and economic survival in Bangalore. It defies the hegemonic structure of society by challenging the binary construction of gender and sexuality. (shrink)

Background Ethical safeguards are critical in HIV research involving minors, especially vulnerable groups such as men who have sex with men (MSM) under 18 years. This systematic review explores how informed assent and consent practices are reported, guided by the 2016 Council for International Organizations of Medical Sciences (CIOMS) guidelines. Methods A systematic review was conducted of peer-reviewed studies from 2010 to 2023 involving MSM under 18 years, using PubMed, Embase, and Scopus databases. Key ethical components were extracted and synthesized (...) thematically. Results Of 410 articles screened, 65 met inclusion criteria. All included studies reported informed consent, but only 20% (n = 13) included informed assent. Most were conducted in high-income countries (64%), with no representation from low-income settings. Only 7% involved minors living with HIV. Quantitative methods were predominant (82%), and 20% used online platforms. Waivers of parental permission were reported in 27% of studies, while only 3% obtained parental permission. Four studies described tailored consent/assent approaches, such as simplified language, comprehension checks, and involvement of minor advocates. Conclusion This review highlights inconsistencies in how informed assent is addressed in HIV research involving MSM minors. Only one in five studies described ethically appropriate, youth-tailored processes. Limited use of waivers and adapted assent procedures points to ongoing gaps in aligning research with ethical standards. Future studies should adopt clearer, age-appropriate consent practices, ensure transparent reporting, and strengthen researcher training in ethics involving vulnerable minors. (shrink)

In this article, I challenge the risk assessment approach to the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention among men who have sex with men (MSM). Traditional risk assessment focuses on the medical risks and benefits of using medical technologies, but this emphasizes certain risks and benefits over others. The medical risks of using PrEP are presently being overblown and its social and political risks are being overlooked. By recontextualizing risk within the history of HIV and considering the lived (...) experiences of MSM with sex, HIV, and HIV prevention, we can broaden the present risk assessment framework to include all of the relevant risks involved in using PrEP. We can also better situate risk as one of several moral concepts, including trust and solidarity, which move us towards a more nuanced analysis of the social and political effects of PrEP on the relationships and communities of MSM. (shrink)

In order to demedicalize the ethics of pre-exposure prophylaxis as HIV prevention, I consider the social effects on men who have sex with men. The Centers for Disease Control and Prevention considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side effects, drug resistance (...) and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention. (shrink)

© 2015, Springer Science+Business Media New York. Previous analyses of partner notification have addressed individual, interpersonal, social, and structural issues influencing PN outcomes but have paid less attention to the conceptual framework of PN itself. We conducted 18 individual interviews and 8 group discussions, in a two-stage qualitative research process, to explore the meanings and contexts of PN for sexually transmitted infections among men who have sex with men and men who have sex with men and women in Lima, Peru. (...) Participants described PN as the open disclosure of private, potentially stigmatizing information that could strengthen or disrupt a partnership, structured by the tension between concealment and revelation. In addition to informing partners of an STI diagnosis, the act of PN was believed to reveal other potentially stigmatizing information related to sexual identity and practices such as homosexuality, promiscuity, and HIV co-infection. In this context, the potential development of visible, biological STI symptoms represented a risk for disruption of the boundary between secrecy and disclosure that could result in involuntary disclosure of STI status. To address the conflict between concealment and disclosure, participants cited efforts to “manejar la situacion” by controlling the biological risks of STI exposure without openly disclosing STI status. We use this concept of “managing the situation” as a practical and theoretical framework for comprehensive Partner Management for HIV/STI control systems among MSM in Latin America. (shrink)

Stellen Kondome einen potenten Schutz sowohl vor HIV als auch von anderen sexuell übertragbaren Infektionen (STIs) dar, und besteht außerdem ein barrierefreier Zugang zur HIV-Postexpositionsprophylaxe (PEP) (z. B. nach Kondom-Fatigue), muss präzise sondiert werden, wann die sich zunehmend etablierende HIV-Präexpositionsprophylaxe (PrEP) die bessere Wahl darstellt. Vor dem Hintergrund einer generalisierten everyone at risk-Annahme über MSM wird die PrEP zunehmend zu einem standard of care. Zwar kann kein Zweifel daran bestehen, dass dies für bestimmte MSM mit einem bestimmten Risikoprofil wünschenswert ist. (...) Es ist aber von Variabilitäten (z. B. casual condomless sex versus random condomless sex) auszugehen, die zur Vermeidung einer unverhältnismäßigen Medikalisierung berücksichtigt werden müssen. Im Spannungsfeld von hochpotenter HIV-Prävention und Medikalisierung insbesondere von Männern, die Sex mit Männern praktizieren, soll im Sinn einer Güterabwägung gefragt werden, wann genau eine PrEP (dauerhaft oder on demand) mehr Vorteile und weniger Nachteile bietet als der Gebrauch von Kondom oder PEP. Dazu gehört ein Fokus auf den aktuellen Stand der klinischen Forschung und ein Fokus auf die medizinethische Debatte. Die Medizingeschichte der Prävention und der HIV-Erkrankung erweist sich dabei als relevanter Erörterungszusammenhang für die weitgehend noch ausstehende ethische Untersuchung der PrEP. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur über die HIV-Präexpositionsprophylaxe im Besonderen und über HIV-Prävention im Allgemeinen. Basierend auf den PRISMA (Prefered Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines wurden aus der Datenbank PubMed/MEDLINE solche Studien ausgewählt, die die aktuelle klinische Praxis der PrEP oder eine medizinethische Diskussion der PrEP zum Gegenstand haben. Auf der Basis dieser Literatur erfolgt eine diskursive Erörterung und Abwägung der verfügbaren Pros und Cons zur PrEP. Präventionsmaßnahmen treten regelmäßig als ambivalente Instrumente der Gesundheitsförderung zwischen Liberalisierung und Restringierung des Individuums hervor. Insgesamt bietet daher die PrEP on demand gegenüber der kontinuierlichen PrEP im Sinne der Personalisierung die Option einer individuellen Anpassung an konkretes Risikoverhalten. Auch im Sinne einer Güterabwägung hat die PrEP gewichtige Vorteile gegenüber der kontinuierlichen PrEP und gegenüber einer PEP, wenn kein dauerhaft gleichhohes Risiko vorliegt. In dieser medizinethischen Untersuchung wird darauf hingewiesen, dass es sich bei MSM um eine heterogene Gruppe handelt, deren individuelles Sexualverhalten eine ebenfalls individualisierte HIV-Präventions-Strategie benötigt. Diese Studie argumentiert daher für ein stark personalisiertes decision making bei möglicher Indikation für eine PrEP bei MSM. Damit soll ein wesentlicher Faktor zur Vermeidung einer Medikalisierung von MSM dargestellt werden. (shrink)

In 2015, the FDA revised its indefinite deferral policy towards MSM blood donors. I develop an empirical case for the revised policy and show why rights-based objections fail. I introduce and defend a distinction between “ordinary” and “exact” justification that accounts for the worries in the empirical case. I conclude that the FDA is committed to further revising the policy to let MSM donors with exact justification donate.

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the limits (...) of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

U.S. Food and Drug Administration policy prohibits blood donation from men who have had sex with men even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the MSM policy (...) and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy. (shrink)

Would metaphors used in the context of psychotherapy by people who experience various forms of anxiety disorders differ from those used by people who experience stress? We investigated this question with the help of the Motivation & Sedimentation Model (MSM), a theory of meaning-making developed within the synthetic new discipline of cognitive semiotics. The analysis of a sample of ten transcripts of psychotherapy sessions concerning the topic of anxiety, and a comparable sample concerning stress, showed a significantly stronger proportion of (...) conventionalized metaphors in the stress sample, and a marginally significant difference in the number of innovative metaphors in the anxiety sample. These results suggest that lived experience of an anxiety disorder or another form of maladaptive anxiety affects metaphorical meaning-making, and manifests itself in spontaneous metaphor use. Furthermore, as a result of the conceptual and the empirical investigations of the topic, we propose novel theoretical and operational definitions of the notion of metaphoricity. (shrink)

The ethics of safe sex in the gay community has, for many years, been focused on debates surrounding the responsibility (or lack thereof) regarding the use of condoms to prevent HIV transmission, once the only tool available. With the development of Truvada as a pre-exposure prophylaxis (PrEP) for HIV, for the first time in the history of the HIV/AIDS epidemic there is the potential to significantly reduce the risk of HIV transmission during sex without the use of condoms (without taking (...) into consideration ‘treatment as prevention’ with HIV-positive people). The introduction of PrEP necessitates a renewed discussion about the politics and ethics of safe sex for men who have sex with men (MSM). We present the arguments of authors who hold radically opposite positions with regard to the ethics of condom use by gay men, but who currently both criticize the use of PrEP. We offer a critique of their arguments and advance the position that the use of PrEP, even without condoms, can be acceptable and part of a safe sex ethics framework for MSM. (shrink)

Policymakers increasingly draw on scientific methods, including simulation modeling, to justify their decisions. For these purposes, scientists and policymakers face an extensive choice of modeling strategies. Discussing the example of smallpox epidemiology, this paper distinguishes three types of strategies: Massive Simulation Models (MSMs), Abstract Simulation Models (ASMs) and Macro Equation Models (MEMs). By analyzing some of the main smallpox epidemic models proposed in the last 20 years, it discusses how to justify strategy choice with reference to the core characteristics of (...) these respective strategies. First, I argue that MEMs often suffice for policy purposes, and need to be replaced only if they are insufficiently robust. Such robustness results, however, only requires the use of ASMs, not MSMs. Second, I argue that although MSMs have larger potentials than ASMs in various dimensions, they are also more likely to fail—and that in many cases, this probability of failing outweighs their higher potential. In particular, these dimensions include the representation of the relevant target, the accurate measurement of the relevant parameters, the number of parameters included, the number of mechanisms modeled simultaneously, and the ways of dealing with structural uncertainty. While this in no way excludes the prospect that some MSMs provide good justifications for policy decisions, my arguments caution against a general preference for MSMs over ASMs for policy decision purposes in general and vaccination problems in particular. (shrink)

This article seeks to model the agenda-setting strategies of stakeholders equipped with online and other media in three cases involving protests against multinational corporations (MNCs). Our theoretical objective is to widen agenda-setting theory to a dynamic and nonlinear networked stakeholder context, in which stakeholder-controlled media assume part of the role previously ascribed to mainstream media (MSM). We suggest system dynamics (SD) methodology as a tool to analyse complex stakeholder interactions and the effects of their agendas on other stakeholders. We find (...) that largely similar dynamics of interactions occur among stakeholders in these cases, and that the costs for managements of maintaining their agendas steadily rises. We conclude that the “web of watchdogs” comprises a powerful reason for managers to engage in responsibility negotiations with their stakeholders. (shrink)

In 2006, a human papillomavirus (HPV) vaccine targeting the four most lethal strands was licensed. In the United Kingdom, females ages 12–13 were the first to be offered the vaccine in 2012. By 2018, the HPV vaccine was extended to males ages 12–13, and then “high-risk” individuals, that is, gay males and “men who have sex with men” (MSM) and, later, transmen and transwomen. Vaccination programs in the United Kingdom are limited; although everyone is at risk of HPV, not everyone (...) is offered the vaccine as part of National Health Service (NHS) services, with age being the primary exclusionary factor. Those most affected are females—the very group most at risk for death from cancers related to HPV—who are ineligible for NHS vaccines after the age of 25. Closing the vaccination gap is essential to aligning individual and public health and remedy unethical policies. (shrink)

Marginal structural models can be used to estimate the causal effect of a potentially time-varying treatment in the presence of time-dependent confounding via weighted regression. The standard approach of using inverse probability of treatment weighting can be sensitive to model misspecification and lead to high-variance estimates due to extreme weights. Various methods have been proposed to partially address this, including covariate balancing propensity score to mitigate treatment model misspecification, and truncation and stabilized-IPTW to temper extreme weights. In this article, we (...) present kernel optimal weighting, a convex-optimization-based approach that finds weights for fitting the MSMs that flexibly balance time-dependent confounders while simultaneously penalizing extreme weights, directly addressing the above limitations. We further extend KOW to control for informative censoring. We evaluate the performance of KOW in a simulation study, comparing it with IPTW, sIPTW, and CBPS. We demonstrate the use of KOW in studying the effect of treatment initiation on time-to-death among people living with human immunodeficiency virus and the effect of negative advertising on elections in the United States. (shrink)

In cognitive semiotics, metaphor and metonymy are crucially treated as special forms of sign use. In contrast, researchers in cognitive linguistics have extended the scope of metaphor and metonymy far beyond the traditional understanding of these semiotic figures based on, respectively, iconicity and contiguity into purely mental processes. I argue that this has led to unbounded over-extension, and general confusion about what metaphor and metonymy actually are, and thus on how to be able to reliably identify them in language and (...) other semiotic systems like gesture and depiction. There is therefore an urgent need to constrain the concepts of metaphor and metonymy to more reasonable proportions, and in this article I propose such a more constrained approach, using the Motivation & Sedimentation Model (MSM) of meaning-making. For the purpose, I spell out an integrated definition of metaphor and metonymy along traditional lines, but not limiting them to language. I illustrate the applicability of this definition by offering analyses of political cartoons, showing how the two semiotic figures interact in complex ways, sometimes allowing for different interpretations. (shrink)

Blood service organizations employ various ways to ensure transfusion blood safety, including the testing of all donations for transfusion-transmissible infections (TTI) and the exclusion of donors who are at increased risk of a recent infection. As some TTIs are more common among men who have sex with men (MSM), many jurisdictions (temporarily) defer the donation of blood by sexually active MSM. This boils down to a categorical exclusion of a large group solely on the basis of their sexual orientation, which (...) is seen as unduly discriminatory and stigmatizing. Blood service organizations in the U.K. and the Netherlands have recently changed their deferral policies for MSM. The problem of the MSM deferral involves a conflict between fundamental rights: the right of MSM to equal treatment and the right to health of the recipients of blood and blood products. We distinguish and discuss three broad alternative options to the current categorical deferral of MSM donations: (1) completely abandoning donor selection on the basis of sexual behavior, (2) individual risk assessment of the sexual activities of each potential donor, and (3) individual risk assessment of the sexual activities of MSM only. The new U.K. policy falls within the second category, and the new Dutch policy is in the third category. We argue that each approach comes with moral costs but that the most reasonable option is different from the policies of both the U.K. and the Netherlands. (shrink)

Otto Sterns wissenschaftliches Interesse galt wie schon in Band I ausgeführt zwei Themenschwerpunkten: 1. Der Thermodynamik und im Besonderen der Bedeutung und Verbindung der thermodynamischen Eigenschaft ENTROPIE mit der modernen QUANTENPHYSIK und 2. der Molekularstrahlmethode MSM und was man in derWelt der Quanten damit untersuchen konnte. In den meisten Briefen, die Stern mit den anderen „Giganten der Physik“ (wie Einstein, Planck, Bohr, Laue, Nernst, Pauli etc.) ausgetauscht hat, wurden Fragen der Entropie sowie der Reversibilität von Reaktionen zwischen Quantenteilchen diskutiert, Briefe (...) zur Anwendung der Molekularstrahlmethode MSM hat Stern vor allem mit Rabi ausgetauscht. Einstein hatte außerdem ein besonderes Interesse am Ergebnis (Nachweis der Richtungsquantelung) des Stern-Gerlach-Experiments. Die Briefe der beiden Themengebiete werden in zwei Abschnitten getrennt in chronologischer Folge dargestellt, wobei einzelne Unterthemen mit einer bestimmten Person jedoch im Zusammenhang und nicht unbedingt in chronologischer Folge aufgeführt werden. Die oft vorkommenden Personen werden im Personenregister vorgestellt, die oft vorkommenden Sachbegriffe im Sachregister aufgeführt. (shrink)

As the world has entered the fourth decade of the AIDS epidemic, Men who have sex with men (MSM) continue to be disproportionately affected by HIV and victims of stigma, prejudice, and discrimination in the Caribbean and Haiti. Using a mixed-methods realist design, we have engaged with MSM communities, healthcare providers, policymakers, and members of civil society to analyze the impact of stigma on the linkages across the continuum of HIV services through engagement, linkage, and retention. Findings showed that from (...) the social construction of heteronormativity to Christian religious and political influences, several factors lie behind sexual and HIV-related stigma, resulting in loss to follow-up and failure to realize the health benefits of proper treatment fully. However, societal engagement and partnerships, multi-level and contextual-based interventions can produce stigma mitigation through personal, health systems’ and contextual mechanisms for better engagement, adherence, and retention in healthcare. (shrink)

Blood service organizations employ various ways to ensure transfusion blood safety, including the testing of all donations for transfusion-transmissible infections (TTI) and the exclusion of donors who are at increased risk of a recent infection. As some TTIs are more common among men who have sex with men (MSM), many jurisdictions (temporarily) defer the donation of blood by sexually active MSM. This boils down to a categorical exclusion of a large group solely on the basis of their sexual orientation, which (...) is seen as unduly discriminatory and stigmatizing. Blood service organizations in the U.K. and the Netherlands have recently changed their deferral policies for MSM. The problem of the MSM deferral involves a conflict between fundamental rights: the right of MSM to equal treatment and the right to health of the recipients of blood and blood products. We distinguish and discuss three broad alternative options to the current categorical deferral of MSM donations: (1) completely abandoning donor selection on the basis of sexual behavior, (2) individual risk assessment of the sexual activities of each potential donor, and (3) individual risk assessment of the sexual activities of MSM only. The new U.K. policy falls within the second category, and the new Dutch policy is in the third category. We argue that each approach comes with moral costs but that the most reasonable option is different from the policies of both the U.K. and the Netherlands. (shrink)

In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men (young MSM) in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is (...) important to deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis (PrEP), are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically (eg, the dapivirine vaginal ring) or systemically (eg, injectable cabotegravir). The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

Of these two books by Jon Elster, Making Sense of Marx is the more substantial. In it the most substantial parts of Explaining Technical Change reappear; and in it - in its impoverished conception of contradiction - the most striking omission of ETC takes the heaviest toll. ETC is to a very considerable extent taken up with reviews of other people's work on the economics of technical change. Its Part One survey of the philosophy of social science is very rapid, (...) with little novelty in- tended or offered. The survey is not systematically, or even incessantly, drawn upon in the Part Two discussion of technical change. MSM, by contrast, is a library of penetrating and provocative discussion, which ranks in quality with books by G.A. Cohen and John Roemer or Richard Miller among the number of recent exactingly analytical studies of Marx's theories, and is more comprehensive than any of these. (shrink)

Alternatives to convenience sampling (CS) are needed for HIV/STI surveillance of most-at-risk populations in Latin America. We compared CS, time space sampling (TSS), and respondent driven sampling (RDS) for recruitment of men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. During concurrent 60-day periods from June-August, 2011, we recruited MSM/TW for epidemiologic surveillance using CS, TSS, and RDS. A total of 748 participants were recruited through CS, 233 through TSS, and 127 through RDS. The TSS (...) sample included the largest proportion of TW (30.7 %) and the lowest percentage of subjects who had previously participated in HIV/STI research (14.9 %). The prevalence of newly diagnosed HIV infection, according to participants' self-reported previous HIV diagnosis, was highest among TSS recruits (17.9 %) compared with RDS (12.6 %) and CS (10.2 %). TSS identified diverse populations of MSM/TW with higher prevalences of HIV/STIs not accessed by other methods. (shrink)

Modelling contagious diseases needs to include a mechanistic knowledge about contacts between hosts and pathogens as specific as possible, e.g., by incorporating in the model information about social networks through which the disease spreads. The unknown part concerning the contact mechanism can be modelled using a stochastic approach. For that purpose, we revisit SIR models by introducing first a microscopic stochastic version of the contacts between individuals of different populations (namely Susceptible, Infective and Recovering), then by adding a random perturbation (...) in the vicinity of the endemic fixed point of the SIR model and eventually by introducing the definition of various types of random social networks. We propose as example of application to contagious diseases the HIV, and we show that a micro-simulation of individual based modelling (IBM) type can reproduce the current stable incidence of the HIV epidemic in a population of HIV-positive men having sex with men (MSM). (shrink)

There is a prevailing conviction that if traditional medicine (TRM) or complementary and alternative medicine (CAM) are integrated into healthcare systems, modern scientific medicine (MSM) should retain its principal status. This paper contends that this position is misguided in medical contexts where TRM is established and remains vibrant. By reflecting on the Chinese policy on three entrenched forms of TRM (Tibetan, Mongolian and Uighur medicines) in western regions of China, the paper challenges the ideology of science that lies behind the (...) demand that all traditional forms of medicine be evaluated and reformed according to MSM standards. Tibetan medicine is used as a case study to indicate the falsity of a major premise of the scientific ideology. The conclusion is that the proper integrative system for TRM and MSM is a dual standard based system in which both TRM and MSM are free to operate according to their own medical standards. (shrink)

U.S. Food and Drug Administration policy prohibits blood donation from men who have had sex with men even one time since 1977. Growing moral criticism claims that this policy is discriminatory, a claim rejected by the FDA. An overview of U.S. blood donation, recent donor deferral policy, and the conventional ethical debate introduce the need for a different approach to analyzing discrimination claims. I draw on an institutional understanding of injustice to discern and describe five features of the MSM policy (...) and its FDA context that contribute to its discriminatory effect. I note significant similarities in the 1980s policy of deferring Haitians, suggesting an historical pattern of discrimination in FDA deferral policy. Finally, I point to changes needed to move toward a nondiscriminatory deferral policy. (shrink)

Many men who have sex with men (MSM) express feeling marginalized by discourses within public health and sexual health nursing that determine bareback sex is deviant and unsafe. Their resistance to risk‐based discourses can be seen within radical sex practices such as deliberately becoming‐infected with HIV (bug‐chasing) and breeding‐infection (gift‐giving). The metaphors of bug‐chasing and gift‐giving, particularly those spread across global online spaces, can influence the sexual experiences and practices of MSM. A metaphor analysis was conducted of Internet forums discussing (...) HIV chasing and gifting metaphors, and showed a variety of discursive meanings, tactics and effects to the radical sex practice. A radical research approach was used to explore the processes of becoming‐infected and breeding‐infection as determinant steps in the symbolic resistance of risk‐based discourses, as well as the creation of new forms of life and community among MSM. Our analyses demonstrate how the gifting/chasing metaphors express MSM's marginalization as well as their lines of flight from having their practices captured within public health discourses. We hope to offer alternative nursing approaches for thinking through and engaging with transgressive and queer sexual practices. (shrink)

Despite billions of dollars spent in risk-reduction measures, the HIV rate in men who have sex with men continues to soar. Although MSM represent approximately 4 percent of the male population in the United States, in 2010 male-to-male sex accounted for 78 percent of new HIV infections among males. More emphasis needs to be given to risk-avoidance measures. The Catholic Church is both courageous and medically correct in stating that homosexual acts are harmful. The health risks of homosexual sex are (...) scarcely mentioned in the public debate, as misguided political correctness seems increasingly to hold science and medical data hostage. Our brothers should be informed about the dangers of an active homosexual lifestyle and encouraged to live chastely. National Catholic Bioethics Quarterly 14.4 : 637–645. (shrink)

Evidence‐based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, (...) PsychInfo, MEDLINE and the CDC compendium of evidence‐based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. (shrink)

Sometimes, people who are otherwise eligible to donate blood are unduly deferred from donating. “Unduly” indicates a gap where a deferral policy misstates what exposes potential donors to risk and so defers more donors than is justified. Since the error is at the policy-level, it’s natural and understandable to focus criticism on reformulating or eliminating the offending policies. Policy change is undoubtedly the right goal because the policy is what prevents otherwise safe eligible donors from donating needed blood. But focusing (...) exclusively at the policy-level passes over a largely undiscussed question: if policy change takes time and there is an urgent need for blood now, then what should unduly deferred donors do in the meanwhile? Blood banks and federal agencies recommend that deferred donors donate their time or money until they become eligible, but blood is a non-fungible good: donated cash or volunteered time cannot replace a transfusion. Further, this request ignores that otherwise eligible donors could safely donate their blood in addition to their time and money. Here is the central question I will focus on in this paper: is a donor morally justified in lying on a questionnaire to donate blood if they justifiably believe that their blood poses no risk to a recipient and knows that honestly answering a donor questionnaire would unduly defer them from donating? (shrink)

Little research has focused on the ethical issues around using social media for HIV prevention in low- and middle-income countries, such as Peru. This study surveyed participants from the HOPE social media HIV intervention in Peru to assess their experiences and perceptions of ethical issues in the study and the impact of age on their experiences and perceptions. This study found that, compared to younger participants, older participants were more likely to express higher levels of understanding of the consent form (...) and trust that other participants were real. Older participants also reported being less likely to benefit from learning about their HIV status. Findings suggest that age plays a role in participants’ experiences in a social-media-based HIV intervention. (shrink)

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. (...) Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs. (shrink)

The impending implementation of pre-exposure prophylaxis has prompted complicated bioethical and public health ethics concerns regarding the moral distribution of antiretroviral medications to ostensibly healthy populations as a form of HIV prevention when millions of HIV-positive people still lack access to ARVs globally. This manuscript argues that these questions are, in part, concerns over the ethics of the knowledge production practices of epidemiology. Questions of distribution, and their attendant cost-benefit calculations, will rely on a number of presupposed, and therefore, normatively (...) cultural assumptions within the science of epidemiology specifically regarding the ability of epidemiologic surveillance to produce accurate maps of HIV throughout national populations. Specifically, ethical questions around PrEP will focus on who should receive ARVs given the fact that global demand will far exceed supply. Given that sexual transmission is one of the main modes of HIV transmission, these questions of ‘who’ are inextricably linked to knowledge about sexual personhood. As a result, the ethics of epidemiology, and how the epidemiology of HIV in particular conceives, classifies and constructs sexual populations will become a critical point of reflection and contestation for bioethicists, health activists, physicians, nurses, and researchers in the multi-disciplinary field of global health. This paper examines how cultural conundrums within the fields of bioethics and public health ethics are directly implicated within the ethics of PrEP, by analyzing the problems of population inaugurated by the construction of the men who have sex with men epidemiologic category in the specific national context of South Africa. (shrink)

The colonial historiographyColonial historiography in scholarly writings has focused on the macro-sites of politics and arrangements of powerMacro-sites of power. The focus has been on trade, commerce, law, the army, revolts, colonial patriarchy, colonial reformist approach and policies, and the colonial state. All these aspects presented history as a linear expression of events and the sole authority on what constituted history. The subalternSubaltern studies, characterised as history from below, disrupted the linear understanding of history. The subalternSubaltern studies focused on the (...) history that lay on the margins and did not figure in the macro-sites of analysis. The history of the subalterns was primarily the history of the masses, who were mainly the agents of political and social change. Their history was unknown in the configurations of macro-politics of powerMacro-sites of power. In the context of the historicity of homosexualityHomosexualityand male-to-maleMale-to-male sexuality in colonial India and other colonies of the British EmpireBritish Empire, the scholarship on the history of sexuality and homosexualityHomosexuality has little or no documentation of the experiences of people from the non-western worldNon-western world. (shrink)