FINAL
Race (Geary)
-the discourse of bio- and sociopathology) naturalizes the structuring of relations of inequality and domination that produce conditions of disease vulnerability and their embodiment. While this tradition has evolved over time, from its earliest articulation it argued against racialist theories that reduced black ill health or disease to either black biological difference (so-called race) from nonblacks or black cultural pathology (so-called culture or ethnicity). "Race" refers to physical differences that groups and cultures consider socially significant, while "ethnicity" refers to shared culture, such as language, ancestry, practices, and beliefs -black=race
Geographies of blame (Geary)
A dominant narrative that describes the spread of HIV as a series of contacts between innocence and danger (the innocent and the dangerous). Disease diffusion actually follows a pretty set and measurable pattern → not reducible to individuals or groups of individuals. Social organization and social inequality structure the spread.
Outbreak narrative (Geary ch. 2)
Familiar narrative about how diseases spread and are cured. Includes a story of how people are connected to each other. Related by Geary to "nonknowledge" and folk notions of contact and contagion. follows a formulaic plot that begins with the identification of an emerging infection, includes discussion of the global networks throughout which it travels, and chronicles the epidemiological work that ends with its containment virus can travel quickly around the globe through things like airplanes now -cultural anxiety of contagion
Why does Geary reject these theories? (of racism)
Geary first challenges the notion of black bodies as inherently biologically more vulnerable. Second, he challenges the stereotypes of the black community and the viability of lifestyle explanations. • Epidemiological studies have been unable to demonstrate behavioral differences between black and nonblack populations in the United States that would explain rates of HIV. • vulnerable through malnutrition, environmental poisoning, parisitosis, and other indices of impoverishment and social violence • black women weren't getting hiv at higher rates as white men
Modern transportation (Geary)
Planes, truck routes, other technologies of transport.
How is Mass Incarceration a technology of social and health stratification?
Prisons and former prisoners are embedded in social worlds: members of families neighborhoods communities. • Their incarceration disrupts more than their own lives: reduces quality of life, increases economic precarity. Prison is not a scene of risk behaviors it is an apparatus that produces and amplifies poor health for the populations connected to it.
Hierarchical diffusion (Geary)
Result of stuctured relations among cities. Major cities develop dense material connections between each other (trade, migration, political and economic power, and infrastructure). Cities have a much denser network of connections with each other than they do with rural or semi-urban surroundings. Density matters for infectious diseases. Disease therefore appears to jump or hopscotch between cities.
How is a materialist analysis different than a risk analysis?
Risk based upon what people do..."Practices of Everyday Life" "Rather than upon the material structuring of life worlds through relations of inequality, exploitation, and structured violence - their conditions of everyday life."(p.10) Geary argues it is not "sexual intimacies" that are the important risk factor but what he calls "state intimacies" and "state violence" -materialist attends to environment first, behavor second -materialist tradition in health science "define[s] the social causes and origins of health and disease, relating them to the power relations
Spatially contagious diffusion (Geary)
Secondary to the hopscotch from port cities to major (and dense) urban areas HIV diffused out to surrounding areas following local patterns of human contact.
Non-knowledge (Geary)
what might not yet have been discovered (HIV status, medical and scientific ignorance) and inadequate sexual health education etc.
Punitive Urbanism (MacLeod, Gordon, and Colin McFarlane. "Introduction: grammars of urban injustice." Antipode 46, no. 4 (2014): 857-873.)
"punitive urbanism" (Cochrane 2007; Dikeç 2006; MacLeod and Johnstone 2012) as placeholders that serve both to encapsulate ways in which the orchestrators and defenders of a neoliberal urbanism punish and take revenge upon marginal urban groups, whether through incarceration or "interdictory" architectures and technologies (Flusty 2001), and to connect processes of political economic transformation with forms of state aggression, outright violence and public intolerance: all of which can reframe the normative orders of policing and the legitimacy of who comes to represent "the public". Making it harder for people with addictions and HIV, shut down shelters at the solution
What are some alternative methods of stimulating innovation? (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
- Collaborative efforts such as the nonprofit Alliance for Clinical Research Excellence and Safety as well as the industry-driven TransCelerate initiative have reimagined R&D systems and approaches that could reduce the cost and time required to bring a new drug to market, thereby benefiting patients, industry, and investors. Such multistakeholder initiatives have the collateral benefit of fostering regulatory innovation - propose prizes or prize-type mechanisms, such as advanced market commitments in which the prize is conditional on the existence of demand in a given market. A proposed government-funded global Health Impact Fund would, instead of a patent, grant registrants a share of the contribution made to the global health outcomes of all registered products. - ) propose that companies should receive a priority review voucher (PRV) when they develop an FDA-approved therapy clinically superior to existing treatments in treating a neglected disease. They would be required to forgo patent rights on and find a manufacturer for the therapy. The voucher could be used to expedite the review of another drug under development or could be sold on the open market
Boundary Work (Pienaar, Kiran. "(Re) reading the political conflict over HIV in South Africa (1999-2008): A new materialist analysis." Social Theory & Health 12, no. 2 (2014): 179-196.)
- tussling over the demarcation between science and non-science in order to assert the 'truth' about HIV/ AIDS. -disease made through politics -looking at good science vs bad science - boundary-work comprises instances in which boundaries, demarcations, or other divisions between fields of knowledge are created, advocated, attacked, or reinforced. • - Maintenance of boundary between inside and outside of biomedicine.
Agential Realism (Pienaar, Kiran. "(Re) reading the political conflict over HIV in South Africa (1999-2008): A new materialist analysis." Social Theory & Health 12, no. 2 (2014): 179-196.)
-HIV as disease in the making - agential realism pursues a kind of realism but one that integrates the agency of objects in its realism, rather than treating objects as the passive ground for agency
Lay expertise (Epstein)
-Individuals without formal credentials or training who have expertise on an issue, often through experience -example of this is AIDS patients -Significance: Lay experts often have different kinds of knowledge than traditional experts, and different assessment of risk. This can prove crucial to solving a scientific problem
Disease and epidemic as social events (Geary)
-Disease and epidemic are social events and entirely dependent on the social production of necessary conditions. They cannot be reduced to an agent (like a virus)and its 'natural, biological and harmonious laws,' let alone to kinds of people and their natural or unnatural dispositions
Reductive fetishization of the moments of transmission
-Geary views theory that focuses upon modes and moments of transmission as "reductive fetishization that slide from "transmission mechanisms to forms of identity" - A materialist account of the US AIDS epidemic, one that does not rely on the reductive fetish of the moment of transmission and the easy slide from transmission mechanisms to forms of identity (e.g., from a male-bodied person engaging in anal intercourse with another male-bodied person, who is not properly using a condom, to a "man who has sex with men (MSM)") must begin from three dominant demographic facts about it
How is racism embodied?
-Racism as it is embodied by black people compromises immune functioning in ways that leave black people more susceptible to infection with HIV if exposed to it, even if black people by-and-large exhibit similar or even fewer potentially transmitting behaviors than nonblack What is the ecological explanation for disparities in HIV rates?
What does Geary argue as the cause of black-white disparities in HIV rates?
-argues that the cause is due to racism, and stereotypes. Blacks have harder time getting job, often receive poor healthcare, live in poorer neighborhoods with poor schools, causes stress which negatively effects the immune system. Effects body ability in fighting off disease. Malnutrition. Persistent, untreated infections due to lack of healthcare.
What stereotypes about the black community does Geary argue influence public health policy?
-black people are all deviant -they all do drugs -their bodies are just different than white peoples -hypermasculinity of black men -they have more risky sex -African-Americans are represented as illiberally intolerant, producing a climate of shame and stigma in which "high-risk behaviors" are unchecked rather than brought under the rational administration of "counseling and testing." -poor, homeless, bad workers -consequences are the result of their actions -homophobia and racism -black people are suspicious of hiv testing
Racism (Geary)
-blaming the victim -prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one's own race is superior. -racism against blacks leads to health disparities
Pre-modern Bodies (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
-bodies incapable of accessing innocence
generic prescriptions (Documentary: Fire In The Blood)
-cheaper, same ingredients
Can you apply some of D. Lupton's ideas to Cindy Patton's findings? (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
-sorts groups of innocence and deviance
Racialized Poverty
-disportioncate levels of poverty due to ones race
Special Goods (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
-drugs, values not captured by the marketplace. pharmaceutical companies have an obligation to make drugs available to patients who cannot pay the profit-maximizing patent monopoly prices such companies charge
social conditions (Pellowski et al)
-economic inequalities, mental health, substance use, access to care
What are some structural interventions aimed at reducing race disparities in HIV/AIDS? (Blankenship, K.M., Smoyer, A.B., Bray, S.J. and Mattocks, K., )
-education, drug programs instead of incarceration, needle exchange program, eliminate mandatory minimum sentences, prisons could provide condoms.
Compromised health (Geary)
-explains differential rates of HIV in the black community compared to the nation as a whole or to white communities -Compromised health has been shown to increase the likelihood that exposure to HIV will result in infection and to increase an individual's infectiousness to others, if living with HIV. Over the long term, compromised health within a given population will lead to greater disease burden in it, even if this population engages in the same distribution of potential transmission behaviors as healthier populations -blacks have compromised health due to discrimination, limited access to jobs and healthcare, can't get vitamins, leave their immune systems weak and them susceptible to hiv.
How does the idea of "innocence" and valuing innocence impact sex education policy? (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
-fear that if we teach innocent kids about comprehensive sex education, then they will start doing the acts and it will ruin their innocence
How were the goals of TAG accomplished
-formed paitent rights groups -creation of gloserry or terms -performed cultural competence, more successful when person is educated -acquired language of biomedicine
Mbeke (Pienaar, Kiran. "(Re) reading the political conflict over HIV in South Africa (1999-2008): A new materialist analysis." Social Theory & Health 12, no. 2 (2014): 179-196.)
-former South Africa president - Mbeki administration and prominent South African AIDS organisation, the Treatment Action Campaign (TAC) responded to the dominant scientific model of HIV/AIDS. - Mbeki has been characterised as an AIDS denialist for questioning the viral causation of AIDS and for arguing that poverty, not HIV, is the main driver of the epidemic in South Africa. While Mbeki was not the architect of South Africa's HIV policy, his position influenced the national response to the epidemic, notably the government's reluctance to deliver programmes for the prevention of mother-to-child transmission and anti-retroviral treatment (ART). - Mbeki's refusal to acknowledge the ways in which South Africa's high rates of gender-based violence are connected to HIV prevalence is particularly concerning given the feminisation of the South African epidemic and the 'nexus between violence, risky behaviour and reproductive health - Mbeki's view that the HIV epidemic is related to the 'disease of racism' in post-apartheid South Africa AIDS dissidence it is interested in how the conflict over HIV helps to materialise the disease, not whether particular positions articulated in the conflict accurately represent the disease or, relatedly, whether the 'truth' behind denialism or dissidence can be exposed. 'Disease of Racism' -AIDS as a disease in the making -never stable and complete, always open to being remade
Cracker v. Powder Cocaine
-harsher punishment and longer prison sentences for people who use crack cocaine. Most people who use crack cocaine are black and minorities while whites use powder cocaine.
Incarceration (Blankenship, K.M., Smoyer, A.B., Bray, S.J. and Mattocks, K., )
-imprisonment, mostly people of color due to war on drugs
biological factors (Pellowski et al)
-infectioness, infectable cells, STI, male circumcision
Immiseration (and Poverty) (Geary)
-leads to increase hiv susceptibility -Reduction in Health of the Body's Barriers to Infection -) Reduction of Overall Health and Immune System -Increase in (individual) Viral Load -Population Health and (lack of) "Herd Immunity"
How did TAG get AIDS scientists to take their ideas and concerns seriously?
-learned the language of biomedicine, limited discrimination by saying all people can contribute to science regardless of race/ sex. -learned the culture of medical science to show that they understand
Innocent Bodies (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
-maintain innocence until adulthood. Children who don't identify with LGBT or who come from a ghetto
War on Drugs (Geary)
-more people in U.S. arrested for drugs and get longer, harsher punishments, affects mostly people of color
Hollowed out Urban Core (Geary)
-people living inside inner cities, ghetto
What role does drug pricing and patents play in stimulating innovation? (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
-people need to pay the cost of some drugs to survive. Patents make it harder for cheaper drugs to come out. - Reference pricing may also, however, create unintended consequences by discouraging innovation within existing classes of drugs (42) and by providing a reference point for manufacturers to collude on prices -patents decrease innovation
How does economic inequality affect HIV rates? (Pellowski et al)
-people who live in poverty are more susceptible to getting HIV. Less access to healthcare and medication. Hard to afford food so more likely to suffer from malnutrician. Cant afford to send kids to good schools. People who face health scarcity are more likely to get HIV
Clean v Fastidious Trials (Epstein)
-pragmatic approach to clinical trials. -isolation of variables -all trials will be messy, you can only be a clean subject once. -need to perform fastidious trials to get clean data
Biological vulnerability (Geary)
-profound poverty and structural violence Risk: Exposure = Infection (equal odds for all bodies, differential odds for acts). You are "lucky" if you don't get the disease. Behaviors produce risk Prevention = prevent exposure though changing behaviors
local HIV prevalence -Network viral load, detected infections, undetected infections. individual behaviors (Pellowski et al)
-sexual behaviors -injection drug use
How did the "war on drugs" change the rate of incarceration and the demographic composition of U.S. prisons? How does this impact HIV rates?
-the war of drugs caused a rapid increase in the numbers of incarceration and led to overcrowding of prisons. Black men more likely dealing with discrimination which leads to long imprisonment sentences. This leads to stress which can effect their immune system. Share needles because scared to be caught carrying needles on them. -sex in prisons and injection use in prisons, most of prison population has hiv
Sexual networks (Geary)
-transport is imagined to connect not only people but communities - large networks that connect small networks (communities of deviance).
How does segregation, improved population health lead to decreased HIV susceptibility?
-well established in medical history that the decreasing virulence of major epidemics in the global North was the result of improvements in overall population health due to social investments like clean drinking water, sanitation systems, urban pest control, and increased nutrition. Epidemic disease was not conquered by biological medicine; its decline was well under way before biological medicine had anything to offer. -increased community efforts like cleaning the environment, getting safer drinking eater, and increasing nutrition helps everyone who is not segregated and lowers their chances of getting hiv
White Flight (Geary)
-whites left ghetto neighborhoods when it became more black, created a bigger apartheid
What are the three facts that Geary argues demonstrate black suffering?
1. In 4 decades the racial composition of the prison was reversed. From 70% white at mid-century to 70% black and latinx at the end of the century. 2. Rates of incarceration have soared over the last 4 decades. 1 in 8 black men in the 20s in in jail or prison at any given time. In the formerly industrialized northern cities (eg Detroit) there is a 1 in 3 lifetime incidence rate of incarceration for black men. 3. Black- White incarceration rate disparity expanded swiftly and dramatically since the 1970s a Bears no direct relationship to the crime rate! b No fundamental racial or ethnic pattern change in the last 4 decades. c AND crime rates have declined since the mid-1990s
How do poverty and immiseration lead to increased HIV susceptibility?
1. Reduction in Health of the Body's Barriers to Infection • -Healthy bodily surfaces are a barrier that defends against infections, including HIV. • Conditions of poverty adversely effect these bodily barriers. • Malnutrition: both micro- and macronutrients help sustain these systems. Lack of these degrades mucus membranes and other systems/organs • Persistent, Untreated Infections (not just STI) compromise these surfaces as well. • STI increases bodily susceptibility, it is not just an index for "risk" behavior. 2. Reduction of Overall Health and Immune System • -IF HIV passes through the physical barrier of the skin, the next step is immune response. • If immune system is impacted by conditions of poverty/social violence then it cannot as effectively fight the virus. • Malnutrition, persistent or untreated infections, and stress will all impact immune function. Infections have a double impact: not only can they suppress the immune system, they create a more "welcoming environment" for HIV. There are more of the kind of cells that HIV can access, so a greater chance of hijacking the immune system -malnutrician increases likelihood of infection 3. Increase in (individual) Viral Load • -The same conditions that increase susceptibility (points 1 & 2) to disease increase infectiousness of those living with HIV by increasing the viral load in their bodies. As viral load increases, likelihood of infection upon exposure is also increased 4. Population Health and (lack of) "Herd Immunity" • -Just as community level poor health can increase susceptability and infectiousness, good health can reduce these same attributes. • Overall good health can have an effect akin to immunization herd effect. • Collective health becomes protective: it resists entry by the virus and retards the circulation of HIV. • If less disease is present to be exposed to for all people in the community (network viral load) - even those with poor health within that community - there will be fewer cases of HIV infection. • -emergence- Emergence is the success of a pathogen in causing disease or an epidemic. • To succeed pathogens must be embedded within an enabling environment or ecology. • Travel introduces the pathogen, but inequality/poverty is what allows it to emerge.
Risk Group (Geary)
1.Risk groups can be based upon identity 2.The group as a whole is identified as having a greater rates of illness 3.The greater rate is converted into greater risk 4.Risk groups are often reduced to kinds of behaviors 5.The behavior is seen as the cause of risk 6.And the group is then conceptualized as being made up of individuals who commit certain behaviors. 7.The boundary becomes blurred
CDC strategy and two kinds of risk groups for hiv (Geary)
2 types of risk groups: 1.Behavioral subjects (gay, bisexual, MSM) 2.Identity subjects (Black, Latina) -Geary notes a discursive slippage between these two kinds of risk groups in the discussion of AIDS in black Americans. This is a "racialist understanding of behavioral difference" → leads to an understanding of rates of AIDS in black Americans as being the result of racialized (or cultural) differences in behavior. He discusses this as the culturalization of race. Behavioral and Identity categories become collapsed. -CDC- Center for disease control, argues that we should be looking at stigmas and discrimination as a means for the increase in blacks getting hiv, not biology
Risk Behavior (Geary)
8.Risk is rarely neutral or devoid of political implications or moral questions. 9.Risk behaviors are identified not only by their likelihood of biomedical relevance totransmission but their relationship to society and deviance. 10.Behavior based risk is supposed to be separate from groups or individuals -led to discrimination of blacks as being bisexual and into drugs -behaviors that person people at risk for negative consequences. Risk behaviors as stereotypes.
Social-Structural Level (Pellowski et al)
At the social structural level, environmental resources and psychological influences affect other social-structural and individual-level factors—namely, access to care, health behaviors, and psychoimmunology ∗ - Poverty, discrimination, inequality and other social conditions facilitate HIV transmission by influencing local HIV prevalence as well as an individual's risk behaviors. ∗ Example: Substance use might reduce preventative actions (disinhibition, trading drugs for sex, prostitution) and some substances can stimulate HIV growth. ∗ Other examples: Relationship instability, economic instability, prison stay, access to care.
Expertise and credibility (Epstein)
Credibility-ability to make claims How do you get credibility? • Status - Early scientists (Natural Philosophers) had credibility by virtue of being gentlemen. • Evidence - A shift later occurred to science as a kind of witnessing, values of experimentation and replicability became dominant. • Expertise - Combines these concepts. Experts are credible by virtue of status, knowledge, and peer monitoring.
Embodiment of Racism (Geary)
Over time, all of the components that regulate blood pressure adapt to life under stress." 54 Hypertension, thus, emerges as the "new normal" blood pressure of lives lived under constant threat or perceived threat. For black people, this is deadly. Among its other consequences, the embodiment of racism as high blood pressure puts extra stress on pregnant women and their fetuses, leading to more preterm and other birth complications, more low birth weight infants, and more infant deaths. -discrimination against one thing leads to consequences for other health issues
Redlining (Geary)
racial redlining; antiblack restrictions on access to capital (mortgages, business loans, etc.); formal, political disenfranchisement; organized intrusion into and destruction of families; exclusion from mechanisms of social mobility; unchecked police violence; employment discrimination and exclusion; organized disinvestment and destruction of the built environment -neighborhoods segregated into blacks vs whites. Blacks had higher taxes and less good quality schools. White neighborhoods more desirable
Youth As Subculture Model (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
Gay teens or ghetto black kids. -threatened by adult gay men, no access to innocence, assumed to already have knowledge about sex and don't need shielding from it. Safe sex education
Generic Medications (Documentary: Fire In The Blood)
Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts.
Social Justice (MacLeod, Gordon, and Colin McFarlane. "Introduction: grammars of urban injustice." Antipode 46, no. 4 (2014): 857-873.)
Social Justice is considered a "pathbreaking exploration of urban land use, the problem of ghetto formation, and the circulation of surplus value within urban economies - justice in terms of the distribution of wealth, opportunities, and privileges within a society
Cultural Competence (Epstein)
Learning the language and culture of medical science
Relationship between Moral Authority and Clinical Trials
Moral authority- Yoking together methodological (or epistemelogical) arguments and moral (or political) arguments so as the monopolize different forms of credibility in different domains. Clinical trials-Clinical trials should be representative of the different social groups affected by the epidemic. Shift from the right to be PROTECTED from harm to the right to assume risks and make choices in risking unknown benefits.
PEPFAR
President's Emergency Plan for AIDS Relief • - the ABC approach (Abstain, Be faithful, and correct and consistent use of Condoms); prevention of mother to child transmission (PMTCT) interventions; and programs focusing on blood safety, injection safety, secondary prevention ("prevention with positives"), counseling and education. • 20% of overall funding was to be spent on prevention, 1/3 of that (6.7%) was to be spent on abstinence only until marriage programs. 2008 renewal eliminated these requirements • - Provides funding for (ART), although initially required that ART not use generics. • Supports prevention and treatment of opportunistic infections. • Services to prevent and treat malaria, tuberculosis, waterborne illness, and other acute infections. • Also funds: training/$$ for personnel,$$ for health care facilities (renovation, laboratory equipment) distribution systems, logistics and management for drugs.
How does mass incarceration facilitate the AIDS epidemic?
Rather, what the authors demonstrate is that the social experience of mass incarceration suffered by black Americans is connected to higher rates of other suffering, including AIDS - Experience of prison bears negatively on an individual's health. - Those who are incarcerated have generally worse health upon entry (class and racial disparities) Negative health effects of contact with the penal system tends to be greater after the period of direct incarceration than during. - Better healthcare access in prison - Whirlpool of risks :increased injury, increased exposure to infectious diseases, and increased stress. - The prison amplifies economic marginalization and social destitution of the ghetto à lends to disease vulnerability. - Not only elevated rates of HIV transmission rates but increased rates of sexually transmitted diseases, increased rates of TB and other infectious disease. Many go untreated/persist after incarceration. - Life after prison is WORSE for health: - Felon class - cannot access educational programs, welfare programs. Prone to joblessness, homelessness, recidivism. - No condoms in prison
Ecological Model (Geary)
Risk: Exposure + Susceptibility = potential infection (uneven odds for different bodies). Risk originates from bodily and community susceptibility and infectiousness of the disease. Prevention: Change Susceptibility = change the environment.
State intimacies (Geary)
Structured violence of antiblack racial formation in the US have produced conditions - social institutional, and physiological - that have allowed the HIV virus to establish itself and spread. Structuring of conditions of human social and physiological vulnerability to disease is more central to HIV disparities than the structuring risk of behaviors. the structured forms of violence and inequality mediated by the state that have produced conditions of embodied vulnerability to disease and ill health for black people in particular, but also other queers -state intimacy, or the violent intimacy of the racist state. From structured impoverishment to racial segregation, and from mass incarceration to the "political death" meted out to former prisoners, the state has structured the ways in which black Americans have been made vulnerable to HIV exposure and infection far beyond the capacity of any individual or community mitigation or control
Gatekeeping (Epstein)
The act of controlling and limiting general access to something -Establishment of ACT UP as representatives of AIDS patients -"activists thus constructed themselves as an 'obligatory passage point' standing between the researchers and the trials they sought to conduct. Of course, by the same token, the activists wanted to see the trials conducted: so the point, really, is that the relationship became a powerfully symbiotic one."
What is the relationship that Geary proposes between the prison system, anti-black racism, and the ghetto? How does this relationship shape the ecological (environment) conditions for an epidemic?
The prison system, anti-black racism, and the ghetto all disadvantage black people and lead them to have higher rates of HIV -puts stress on people, weakens their immune system, makes them more susceptible to HIV and eventually leads to an epidemic.
Embodiment (Geary)
The process of our bodies physically imbibing these ecologies/gene-environment systems
T.A.G. (Epstein)
Treatment Action Group wanted to interact with scientists studying AIDS but had some challenges of expertise, credibility, and access.
Mass Incarceration (Geary)
U.S. incarcerates more of our population than any other country -increase numbers of people going to prison, most people in prison for drugs, other crimes have dropped
Compare and contrast the strategies of activism seen in "How to Survive a Plague" and "Fire In The Blood".
both brought to government attention how many people were dying from this disease. in fire movie, people were dying because they couldn't afford Aid medication, it had a patent so nobody could make generic medications. People who couldn't afford it died. This discriminated against poor people and showed how the U.S. only cares about making profit. People in both films protested for medication and used media to tell their stories of the innocent who were dying. The U.S. wouldn't fund for medication for HIV and people had to protest for it. Both showed people marching in front of legislature to fight for better medicine options. Brought list of names of the dead, the other brought a quilt.
Zackie Achmat (Documentary: Fire In The Blood)
Zackie" Achmat is a South African activist and film director. He is a co-founder the Treatment Action Campaign and known worldwide for his activism on behalf of people living with HIV and AIDS in South Africa. -had HIV, siblings died from it, refused to take medication until it was available to everyone
Patents (Documentary: Fire In The Blood)
a government authority or license conferring a right or title for a set period, especially the sole right to exclude others from making, using, or selling an invention.
What were some of the specific goals and accomplishments of TAG had?
a) access to, or provision of, health-care services (b) disease, illness experience, disability and contested illness (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality -challenged medical policy and belief systems Act up- Aids coalition to unleash power
Compulsory Licensing (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
allows "governments to issue production licenses for [Intellectual Property] protected innovations that are needed to respond to public emergencies," such as the AIDS pandemic in Africa
Compassionate Urbanism (MacLeod, Gordon, and Colin McFarlane. "Introduction: grammars of urban injustice." Antipode 46, no. 4 (2014): 857-873.)
homeless drop-in centers, soup runs and street-based outreach organizations skillfully balance duties of care, compassion and sustenance to their clients while negotiating a local-state instructed decree to maintain abeyance: Having compassion for homeless and people with HIV
Viral Load
how much HIV virus cells are active In a persons system. Determines how likely they are to spread disease to others through things like unprotected sex. - The spread of HIV requires a minimal prevalence in a population to maintain sufficient exposure for transmission
Urban Core (Geary)
inner cities, where blacks mostly live -urban ghetto
Factors (Pellowski et al)
local HIV prevalence, individual behaviors, biological factors, and social conditions
War on Drugs (Blankenship, K.M., Smoyer, A.B., Bray, S.J. and Mattocks, K., )
more people in U.S. arrested for drugs and get longer, harsher punishments, affects mostly people of color
Urban Solidarity (MacLeod, Gordon, and Colin McFarlane. "Introduction: grammars of urban injustice." Antipode 46, no. 4 (2014): 857-873.)
social movements to locate clues not just for understanding processes of urban injustice, but for generating discourses and processes of urban justice - e, the grammar of urban justice is not just in the work of forging connections across issues and spaces in a city—although, to be sure, Occupy had its own territorial geographies that mattered a great deal to its existence—but in forging imaginary and practical connections across more distanciated spaces. This is a grammar of urban justice with a global sense of place -society forms a tie to end social injustice and hiv rates from increasing
Differential Pricing (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
some drug companies employ differential pricing, i.e., selling in different countries at different prices to reflect the income level of each country
Drug Policy (Blankenship, K.M., Smoyer, A.B., Bray, S.J. and Mattocks, K., )
stricter punishment for drug use and more arrests. Longer probation sentences.
Market Price (Parker-Lue, Sara, Michael Santoro, and Greg Koski. "The ethics and economics of pharmaceutical pricing.")
the price of a commodity when sold in a given market.
Good health and Herd Immunity
the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination. -Overall good health can have an effect akin to immunization herd effect
Susceptibility and Infectiousness
the state or fact of being likely or liable to be influenced or harmed by a particular thing -how likely you are to transmit disease to others
"Normally Abnormal" (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
white, middle class kids
Storm and Stress Model (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
white, middle class. Catergorized as innocent and we should keep them innocent. Not yet acquired with adult knowledge and should not be able to obtain it easily. Aids knowledge about casual transmission and avoidance.
How does Geary prove that behavior is not enough to explain the disparity in HIV rates?
• -Epidemiological studies have been unable to demonstrate behavioral differences between black and nonblack populations in the United States that would explain rates of HIV. -I argue that the racial blackness of the US AIDS epidemic has been produced not by the behaviors of AfricanAmericans but by conditions of structured, racist domination. Racism, not race, ethnicity, or culture • -Studies have failed to document significant differences in HIV "risk behavior" between blacks and whites. • Further, the math doesn't support the hypothesis. For behavioral difference alone to explain the global distribution of HIV, "people in some African countries [would have to] have a least 250 and even 2500 times more unprotected/unsafe sex than people in Eurpose, the USA or Australia" (Katz, as quoted by Geary) For black Americans the primary intimacy that has shaped risk of infection with HIV has not been the queer intimacies of sex between men or injection drug use but the enforced intimacy of the state apparatuses of repression: the police, the prison, and the corrections system more broadly.
Ecologies of Racism (Geary)
• -Most analysis views the environment as something passive and stable: a context for disease or health. • Ecosocial sees human beings as organisms interacting dynamically with other living organisms, inanimate matter, and energy over time and space. • Takes into account the structuring role of human organization upon human biology. Racism as it is embodied by black people compromises immune functioning in ways that leave black people more susceptible to infection with HIV if exposed to it, even if black people by-and-large exhibit similar or even fewer potentially transmitting behaviors than nonblacks. To extend Roberts's argument, the concept of embodying race not only "redirects attention from genetic explanations," it also offers theoretical resources for shifting attention from behavioral accounts of infectious disease dispersion to an understanding of the racist structuring of collective embodied vulnerability to infection within ecologies of racism.
Treatment Action Campaign (Documentary: Fire In The Blood)
• Founded on International Human Rights Day, December 10, 1998 • Founded by Zackie Achmat and 10 other activists. • Achmat had a history in Anti-apartheid activism. • Had a primary and a secondary grievance related to HAART. - Primary with South African President Thabo Mbeki to make antiretrovirals available - Secondary with the global community and PEPFAR regarding - Allied with the government in a suit against the pharmaceutical industry around patent protections (April, 2001) - When they "won" the case (Pharmaceutical companies withdrew) the government failed to follow up on their advantage. - TAC sues the South African government for not ensuring that Mother-to-child-transmission prevention medication was available to all mothers. (2002) - Not until 2003 that the South African Government approved a plan to make HAART available to the public, despite availability of cheaper drugs.
Ghettos/ghettoizing (Geary)
• Ghettos are the result of intentional policies and racist conditions • They are a form of internal colonization • And they have a symbiotic relationship with the other institution Geary will address: the prison system.
Deviant Bodies (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
• Heuristic used to understand risk. • Risk itself ends up becoming a category of deviance. • Patton associates "deviant bodies" with pre-modern bodies and bodies incapable of accessing the category of innocence.
Hopscotch pattern (Geary)
• In Urbanized societies we see a "Hopscotch" pattern between urban areas called "hierarchical diffusion" and the spreading pattern Is called "spatially contagious diffusion" • Determined by urban structuring Geographers have discovered that within highly urbanized societies, diseases tend to "hopscotch" from city to city, generally from larger cities to small ones, before diffusing from cities to surrounding communities in a manner
Abstinence Only Education (Patton, Cindy. Between innocence and safety: Epidemiologic and popular constructions of young people's need for safe sex. 1995. pp. 338 - 356)
• No sex positioned as safe sex • → Only sex that is "safe" is not have sex (lack of sex positioned as a sex option) • Ergo → No kind of sex is safe. Beyond abstinence: SAFEST option: Heterosexual, Married (Monogamous), Procreative Sex
Infectable cells (Pellowski et al)
∗ For HIV transmission to occur, the virus must have direct contact with cells that are susceptible to infection—namely, those cells that carry the specific surface membrane molecules to which the virus attaches and thereby infects the host cell.
Infectiousness (Pellowski et al)
∗ HIV infected persons vary in their infectiousness depending on stage of disease, health status, and strain of the disease.
Psychoneuroimmunology (Pellowski et al)
∗ Psychological, social, and physical stressors can alter immune functioning and undermine health ∗ As previously discussed, depression is a key example. ∗ Allostatic load ∗ Stress-management interventions ∗ OR maybe change the structure?
