AIDS Exam 1

Creating and Sustaining Differences in the world of AIDS: "AIDS attaches itself to systems of difference" -- What differences?

Self...other Straight...gay Innocent...guilty Life...death Containment...contagion Expert...Patient Virtue....Vice 1st world...3rd world Pure....diseased

Who is the Berlin Patient?

"Cured" of HIV in 2008 Had a bone marrow transplant with CCR5 mutant cells Providing new stem cells to produce CD4 cells

What are some HIV origin theories (about where it came from)?

"Natural" mutation and leap from primates to humans - Human-Primate contact (through disrupting ecological systems and habitat, including bushmeat) - Globalization, urbanization, and mobility exacerbated this Human-made virus - Purposeful agent to destroy certain populations - Biological warfare - Genocide - Many versions of this theory (ex. When Robert R. first thought to be HIV+, people questioned why in STL, thought it was a chemical plant that STL was manufacturing on purpose) Iatrogenic effect and cover-up - Medical testing (USA, chemicals) - Vaccine development (Africa, oral polio vaccine -- theory that the origins are from when European and American scientists were going into central Africa to test oral polio virus and they used tissue samples from infected primates to harvest the vaccine and then gave it to humans. Thought the U.S. was covering this up -- but this ended up being debunked

What is the frequency of HIV transmission in male-to-male anal penetration?

*.*82%

By the end of 2014, how many people were living with HIV? How many new infections? How many deaths due to AIDS?

*People living with HIV: 37 million* New HIV infections: 2 million Deaths due to AIDS: 1.2 million

According to cultural theory, how do representations affect how a disease is understood?

Representations are powerful in how disease is understood Subtle messages and assumptions about the disease, those infected, and culpability

What are some of the themes seen in the study of HIV emergence?

- Inequalities, structural violence - Cultures of coping - Networks and geographies of risk - The politics of intervention (unintended consequences) - Public health (how it works) - Politics of mortality (how particular diseases become stigmatized) - Capitalism (drug companies don't want to develop drugs for something that won't make money)

What are counter-narratives?

Articulated awareness of a marginalized position Knowledge of the past gets folded into reading/reality of AIDS Act of resistance against dominant groups that have exploited or oppressed them - Gov., Corporations, policies, dominant groups, foreign soldiers

Why do explanatory models matter?

How we conceptualize the problem (defining the problem) shapes the policies and programs designed to intervene (designing the solution) Important to understand the context of disease and risk to create effective interventions

What is "risk"? What is a "risk category"?

Risk: The probability that a person may acquire disease Risk category: People who have certain behaviors that have been identified to create, enhance, and perpetuate risk -- these are used to make our interventions targeted

HIV as a by-product of the global economy and global inequalities

How wealth and demand... - Lower wages elsewhere - Labor-related migration with spousal separation ... Creates externalities - It is the cost of a good that is not actually factored into the cost of the good (the social cost of products -- disease, out-migration of men)

When/Who was the first confirmed AIDS death in U.S.?

Robert R. of St. Louis in 1969 Highly debated Showed initial signs in 1966, chlamydia and Kaposi's Sarcoma But he if he died at age of 16, he must have contracted it as a child (so might have been contracted through sexual abuse)

What was happening in East Africa?

Re-use of needles in medical clinics to give vaccines - Unable to determine how many cases of HIV were caused by this - Iatrogenic War in Uganda - Country ravaged by war and poverty - Women becoming sex workers - Soldiers raped women - Wasn't necessarily cultural sex practices that spread HIV -- it was the insecurity/poverty/structural violence that spread it

What is the reason some politicians started to acknowledge GRID in San Francisco?

San Fran gay community had the power to swing a vote. So some started acknowledging the gay community's disease in order to get them to support them politically

What are the two prevention philosophies?

Abstinence: - Belief that abstinence the only 100% effective method - Stop risky behavior, no tolerance - Funding = condoning abstinence (gov. money shouldn't be spent on promoting deviance and immoral behavior - Ex. "Just say no" Nancy Reagan campaign Harm (or risk) reduction: -Belief that abstinence is the only 100% effective method - But knowing that risky behaviors exist - Meet people "where they are" - Reduce negative consequences of a behavior - Incrementally reduce risky behavior (can be slow) - Initially developed for substance abuse in 1960s-1970s - Mid-1980s: Needle Exchange Programs Kind of opposing views

What are transmission routes?

Amplification opportunities that facilitate (or hinder) the rate of disease spread Ex. Bathhouses in San Francisco

Tuskegee Experiment

1932 - 1972 "Last change for special free treatment" letter to ensure participants would return for the study - Sent these letters to sharecroppers who'd tested positive for syphilis - Didn't tell them they had the disease, said they had "Bad blood" - Offered them a "last chance" to get second exam and to be given special, free treatment Aimed to understand natural history of syphilis - But during study, penicillin was invented as medication to cure syphilis, which scientists withheld from study participants A historian was going through some documents, and came across many different papers about the same team who was doing Tuskegee who did a study in Guatemala - In Guatemala, the team DID DELIBERATELY INFECT study participants with syphilis (In Tuskegee, they were simply studying it) - This information about Guatemala came out in 2010 -- they had infected nearly 700 Guatemalans

Hooper's Hypothesis: Polio Vaccine

1950s: Administering Oral Polio vaccine in central Africa - Administered to 1 million people Belief that the vaccine was grown in infected chimp kidney cells Critiques: - Oral administration insufficient to cause infection - SIV/HIV needs to get directly into bloodstream - The theory accounts for only HIV-1 transmission - HIV formed from multiple transmission events, so this wouldn't work - In 2000, the original manufacturer found the stores vaccine, and it tested negative for SIV/HIV

When did the name AIDS come to be?

1982 -- No longer the unofficially official Gay Disease

When was the AIDS virus isolated? Why was this such a big deal? Who isolated it?

1983-1984 Before virus was isolated, couldn't develop a test for it A competition between France and USA -- a nationalistic tension Finally settled by Nobel Peace Prize Award, which gave the French the credit and the award in 2008

When and what are the "Years of Great Scientific Discovery"?

1983-1991 A rush to understand everything about the virus HIV was identified as the cause of AIDS, antibody test developed, full virus was sequenced, MACS Cohort established (multi center AIDS cohort study that identified natural history, key role of CD4 count decline in predicting disease, etc.) Also the time of social advancements - Rapid penetration into 4H risk groups, increasing mortality, widespread fear, public deaths (Rock Hudson, Ryan White), announcement of Magic Johnson's positive status

When was the first antibody test for HIV/AIDS developed? What is it/how does it work?

1985 ELISA/Western blot test, enzyme linked immunosorbent assay These do not test for the virus itself, but tests for the antibodies to the virus (if HIV antibodies present, HIV is present)

When was the first combination pill for treatment created?

2000 Reduced the number of medications/pills one had to take everyday The issue of combining all of these drugs was because of patents (different pharma companies had patents on different drugs) and due to unwanted chemical reactions, but this was worked through

What is the normal CD4 cell count in a young, healthy individual?

900 - 1,200

Kaposi's Sarcoma

A cancer usually occurring in Italian men in the 1960s, and not usually serious/fatal What they saw in 1980s seemed to transcend the usual Kaposi's sarcoma

Randy Shilts

A gay journalist While writing "And the Band Played On", he began exhibiting signs of being HIV positive. But didn't want to know his status until he was done writing (didn't want his status to influence the book) Ended up being HIV positive, died quickly

Bill Krause

A gay politician in San Francisco Worked with Democrat party (liaison between gay community and government) -- But Reagan won

AIDS was the first disease called what?

A global disease

AZT

A monotherapy Lots of controversy

Michel Foucault

A recent figure in Cultural Theory Knowledge production = Power Discourse: - Process of "Normalization" - Form of regulation Thought HIV was a conspiracy against gay men - Calling it GRID - Thought it was a way to stigmatize/demonize gay men Died of HIV, but denied that it was HIV

What is a retrovirus?

A virus that stores its genetic information as RNA rather than DNA

Paula Treichler's AIDS as an "Epidemic of Signification"

AIDS as: - A biological condition - An epidemic of signification Epidemic of signification: - Language organizes our understanding of AIDS in ways that make certain representations seem "natural" through "facts" portrayed as unproblematic - A socially-constructed and ideologically-loaded condition Ex. "The Invasion of AIDS into the U.S." and "AIDS Transmitted Through Promiscuous Sex" newspaper headlines - These headlines construct the understanding of AIDS - "Invasion" sounds like an attack, like an unwanted foreigner entering - "Promiscuous" impies these people weren't being careful, sleeping around

In 2011, ART was seen to be very effective. What were the benefits and negatives of this?

ART not only suppressed viral load (by preventing virus from replicating) and supported immune system, but also helped prevent spread of HIV to others ART no longer about saving people who had HIV, but about the good of the public (preventing "innocent" people from getting HIV) Downside is that now some of the money going to prevention strategies is going to the drugs instead of actually eliminating the barriers and situations that put people at risk

Drug Prevention: Abstinence approach vs. Harm reduction approach

Abstinence: - Any level of illegal drug use is unacceptable - There is no such thing as "safe drug use" - Education and information about these harms will prevent use Risk/harm reduction: - Preventing drug use is important, but in all societies, some level of illegal drug use will exist - Educating and helping people who use drugs avoid harming themselves and others is critical (safe use) - Educating people about the harm is important, but won't necessarily reduce use

Why study local understandings of HIV if they are medically and scientifically wrong?

An intervention without local understanding will not work (the intervention will be seen as a disruption, an intrusion) Impossible to expect every culture to practice biomedicine (they will not be willing to listen to you, this creates barriers for help and healing) Start from where the people are - Risk reduction philosophy

Commercial Sex Workers in India

Asia oldest formal brothel systems vs. Africa's informal "transactional sex" Class- and ethnic-based system Historical legacy - India-Karnataka's "devadasi belt" (Historically young women who serviced the gods -- sacrificing to the gods. Evolved into sex trafficking and sex work) One study found 70% HIV+ in Mumbai brothel Condom campaign with CSWs - Brothels in Calcutta -- condom use increase 27% in 1992 to 82% in 1995 - Much easier to have these campaigns in areas that identify as sex workers

What is the median household income by race in U.S.?

Asian -- $68,000 White -- $57,000 Hispanic -- $39,000 Black -- $33,000 All races -- $51,000 This distribution hasn't really changed much over time

Richard Parker's article: The Global HIV/AIDS Pandemic, Structural Inequalities, and the Politics of International Health

Attempting to move past individual level and embed individuals among other levels (like Socio-Ecological Model) Global policy and inequalities between donor and recipient as producing risk - Structural Adjustment Programs (SAPs) SAPs in 1990s by World Bank and International Monetary Fund - "Austerity measures" (neoliberalism) -- asking state to pull back, and for private sector to emerge - Reduce gov. spending (fiscal responsibility and trickle-down) - Privatization - Deregulation of currency and markets (free market) - Restructure loans to poorer countries - Cost-sharing of public services, elimination of subsidies - Idea that free market will solve the problems, trickle-down economics Unintended consequences of SAPs - Reduced government spending on healthcare and basic needs - Migration in search for jobs (leaving villages for cities) - Food insecurity (reduced gov. subsidies, abandoned farming) - Poverty - Inflation and higher-cost goods - Infrastructural decay - Parker said this drove HIV epidemic

What is the Macro level of health communication?

Audience: General public Approach: Social Marketing - Coined in 1970 by Kotler and Zaltman - Large-scale, broad-based behavior change focused campaigns - Uses the 4 Ps of marketing (price, product, promotion, place) - Billboards, radio, magazines - Public campaigns (PSAs) - The health behavior as a "product" to be "consumed: - Ex. Smokey the Bear Purpose and Goals: - Large Awareness - De-stigmatize (makes it okay to talk about a topic) - Re-frame issue - Reach lots of people Obstacles and cons: - Funding (particularly hard to get funding for these because you can't prove they work) - Measure and prove results - Lack of priority and commitment - Debates about morality - Lack of community participation - One-way messaging (the audience can't engage with it, we don't know how the audience will respond or interpret it) - Audience as passive - Unintended consequences of demonizing the issue/disease Ex. From philanthropy to philanthro-consumption - "Product Red" campaign - Trying to reinvigorate HIV/AIDS campaign - Trying to get people to give money, to publicly declare to your peers that you're part of this globally-aware group - Had Starbucks, Nike, Coke, Converse, AmEx get involved - Critiques: (1) Masks how capitalism itself may create structural issues that contribute to these issues (2) Some of the actual manufacturing processes are the processes that may be fueling these inequalities

How does adaptive immunity (B-cells and T-cells) develop?

B-cells and T-cells both develop in the bone marrow T-cells start in bone marrow but most development is in thymus

Health Belief Model (Janz and Becker). What is it? What does it ignore? What are some similar theories? What could be a better alternative model?

Based on rational choice, people act in their best health interests Knowledge = Behavior (if people know about risk and risk reduction, they will take action) - People will do what's good for them, will behave rationally if educated - If you know something is bad for you, you'll take measures to reduce risk Ignores: - Structural and historical factors surrounding sexual behaviors (poverty, war, forced migration, rape, etc.) - Cultural, social, economic understandings and meanings of sexuality (reproductive desires, sexual desire, etc.) - Policy impact, donor agendas, and priorities (global inequalities, SAPs, World Bank loans, etc.) - Health Behavior Models lead to a narrow focus on changing individual behavior, and cannot fully account for wider factors that facilitate, shape, and compel risk Similar theories: - Theory of Reasoned Action - AIDS Risk Reduction Model Better alternative? Socio-Ecological Model

B-cells vs. T-cells

Both are part of adaptive immunity B-cells: - Develop in bone marrow - Require antibody gene rearrangement - Produce antibodies to fight bacteria and viruses T-cells (CD4 and CD8): - Start in bone marrow, but most development is in thymus - CD4: Activate B-cells and CD8 cells by releasing cytokines (the general of the army, directs immune response). Linked to helper-T cells - CD8: Kill virally infected cells (linked to cytotoxic T-cells)

When does someone officially have AIDS?

CD4 cells > 200 Antibodies against HIV don't neutralize the virus Virus infects and kills CD4 cells CD8 and B cells don't get activated for other viral infections, so no adaptive immune response

What is the third step in an outbreak narrative?

Chronicle of the epidemiological and medical work that results in disease containment (The Heroes) Critique: It always has to be the West (represented by white male) who saves the helpless others - Ex. Time Magazine put out 5 covers of Ebola Fighters, which were Western doctors "saving" Africans A Western tendency to think that if something is happening in Africa/Asia/Middle East, it's up to us to help -- don't pay attention to the resource and the infrastructure they may already have in place

Peter Duesberg

Claimed HIV wasn't the cause of AIDS He was the one to influence Mbeki to say this

What were the two competing responses to HIV epidemic in South Africa?

Conservative - Tired of "footing the bill" - Proof that blacks are immoral and in need of governing - Punishment from God - Blacks will die off and we will get our country back Left and many Black S. Africans: - Folded into lingering racial, class, and political tensions and divisions - ANC leadership disincentives to address HIV - Mistrust of government - Genocide ("Project Coast")

The Production of Space (Henri Lefebvre)

Ideas of space are political and social - Ex. Areas near water were important trading posts, port towns become important Conceptual shift away from space as - an ahistorical given - merely functional And towards an analysis of space as - Produced through policies, laws, human practices, mobility, movement, economic relations, etc. - Socially created and meaningful - Permitting and inhibiting certain behaviors - Reproducing social relations of capitalist production - Can be human made Ex. Strip clubs in St. Louis region - All in East St. Louis , and all around the lower-class black communities - There are also many residences and churches in the area - But these strip clubs do bring jobs and money

What are the steps to HIV infection/replication?

Contains an envelope protein on surface formed from 2 different genes (this is the main antigen our immune system will recognize) Proteins that the virus makes are essential for its replication (protease and integrase) When virus first encounters CD4 cell, it interacts with CD4 receptors on surface - HIV requires 2 receptors to enter the cell (CD4 and CCR5, for example) - Membrane for CD4 cell and HIV virus are very similar, so can actually merge and then the virus can dump its contents onto CD4 cell HIV reverse transcriptase converts its RNA genome to DNA - As it does this, it makes various errors Then, the integrase protein inserts HIV DNA into host cell genome - Once there, it can stay there and do nothing (latent) To turn it on, it uses cellular machinery from host. Converts DNA --> RNA --> protein for the virus. Viral envelope protein assembles on the surface, then the viral contents (proteins and RNA) assemble at the surface The virus buds off The virus matures by HIV protease cleaving its inactive multi protein complex into its parts (single functional proteins)

Parikh's From Auntie to Disco chapter

Context: - Aggressive HIV campaigns (considered great success) - Anxiety about youth sexuality (already a break-down of generations) - Local decline of kin-based sex education - Rise of commercial sector (commercialization of Ssenga in media, for example) - Rise of Evangelicalism Historical sex ed: - Age/gender-segregated - Songa - designated aunt as sex educator of girls - Balanced risk and pleasure Public health sex ed (modern): - Didn't build on historical sex id - Public messages, not clearly segregated into age, very bold - Ignore local sexual learning and teacher (once intertwined messages of risk and pleasure now bifurcated) - Silence on pleasure (to be less controversial, focus only on risk)

What do risk categories NOT tell us?

Contexts and structural factors - Don't tell us *why* - Networks, conditions - Poverty, homelessness, domestic violence, migration, mental illness, drug use Access to healthcare Secondary infection risk - Exposure by partner risk, iatrogenic risk Ability to avoid risk Nuances of people's sexuality or drug use (power dynamics, vulnerabilities) (Sexual acts vs. meanings vs. identity)

Parikh's "I was punished for loving a schoolgirl" chapter

Criminal law saying older men couldn't have relations with younger girls - Intended to catch the sugar-daddies Feminists saw that young girls were being married off/having relations with men who were much older - Criminalizing sugar-daddies - But the law wasn't used as intended - Being used instead to control young girls and their boyfriends - The average male charged was 20-21 (was catching poor boyfriends instead of sugar-daddies) Used locally to resolve another set of issues - Pregnant and sexually active teen daughters - Criminalized youth romance

Critical theory vs. Cultural theory

Critical theory: Inequalities - How do inequalities shape the distribution and spread of disease and access to care? - How does a person's socioeconomic position and access to resources shape their HIV risk and access to care? - Karl Marx - Can study rate (per 100,000) -- how many people have HIV/AIDS? Cultural theory: Representation - How is HIV and those infected represented, depicted, or constructed through language and images? - How do these representations of HIV shape public responses? - Michel Foucault

What is the central dogma in biology?

DNA --> RNA --> Protein

Karen Kroeger's AIDS Club Rumors in Indonesia -- Indonesian HIV rumors served what purpose?

Demonstrated anxiety over... - Modernity and commercialized leisure - Women's increased agency/freedoms - Foreigners and sex workers - Emergence of middle-class Essentially, anxiety over change Rumors are resistance to change and people's lack of power over it Powerlessness to change ("vulnerable bodies") -- external forces intruding national borders and cultures

Critical Medical Anthropology

Developed by/based on ideas of Karl Marx Base (means of economic production) and (social) superstructure - Base of society was the economic system when talking about capitalism - Said capitalism is the base of society, which will determine superstructure Access to economic resources (wealth) = power Control over means of production - Owners (bosses) as empowered - Workers (subordinates) as alienated Historical materialism - "History is a series of class struggles" - Marx interested in historical processes of capitalism (How it shapes society over time) Capitalism thrives best and exacerbates: - Class divisions (have and have-nots) - Inequalities - Alienation - Commodity fetishism (idealization of a set of material goods) - False consciousness (the belief you can obtain socioeconomic mobility) - Essentially, capitalism is successful when it creates divisions between wealthy and poor Critiques: Where is the human agency?

Anastasia Hudgin's article: NGO Policy, Sex Workers, and Structural Violence: Looking beyond the brothel

Discourse and policies, projects to "rescue" sex workers from brothels Vietnam's Doi Moi policies 4 critiques: - Cambodia suffered greatly due to war. Many people died, poor infrastructure -- this is still felt today. Reflects itself in persistent lawlessness (brothel owners bribing police) - Doi Moi liberalized trade, and allowed for land ownership to become more concentrated, which meant some families had to resort to low-wage labor to survive - No loans available for poor families to even try to start their own farming/business - Soldiers coming to the area and simultaneous fires causing the need to rebuild the village put the area on the world sex tourism map Women were going into sex work for economic reasons -- they didn't see themselves as vulnerable sex objects, but vulnerable economic objects. Felt a responsibility to support their families - Women would flee back to the brothels to make more money When this was written, we were all about saving sex workers - Hudgin says discourses and policies about rescuing women have unintended consequences, and these actions ignored certain structural issues shaping these women's actions

What is the second step in an outbreak narrative?

Discussion of global networks through which diseases travel (The Problem) The problem usually starts with the person - Ex. Typhoid Mary - a cook who first spread typhoid through her food - Ex. Patient Zero Blames the disease on one person or a group of people

What is the first step in an outbreak narrative?

Identification of an emerging infection (The Panic) Panic broadcast through media - Ex. Medical thrillers -- emergent of post-Cold War era (ties in our fascination with disease and fear of outbreak) - Virus seen as the enemy - Ex. "Fantastic Voyage" - Ex. "Outbreak" -- Ebola-like virus travels from Zaire to pure town in CA. Became #1 movie as real-life Ebola was occurring in Zaire - Ex. "Contagion" -- Inspired by 2003 SARS and 2009 flu pandemic. Post-apocalyptic themes mirrored to reactions to 9/11 and Hurricane Katrina

Researching geographies of sex, secrecy, and STL: Laud Humphreys study and its implications

Dissertation research - Studying private acts in public places Participant observation of same-sex interactions in public restrooms in Forest Park (or tea-rooming) - Men would go to FP and get blow jobs - There'd be a Watch Queen, who would tell them when the police were coming Humphreys interested in seeing how the space was constructed, and who these men were - Wrote down their license plates, tracked them down at their houses, collected demographic information through his PH internship - Got follow-up interviews by going to their homes Found that most men were married, many were Catholic and upper-class Humphreys' role was as Watch Queen, to watch fellatio transactions

Who are some characters of "And the Band Played On"

Dr. Don Francis - One of the first people to suggest that HIV was caused by infectious agent Dr. Mary Guinan - Among first scientists in America to identify AIDS as part of emerging disease Dr. James Curran - Led the task force on AIDS at CDC. Then led the HIV/AIDS division of CDC Dr. William Darrow - Member of CDC AIDS taskforce Dr. Michael Gottlieb - Identified AIDS as new disease by reporting initial 5 patient series Gaetan Dugas - Patient Zero Bobby Campbell - KS poster boy, early AIDS activist Bill Kraus - Gay rights politician Dr. Robert Gallo - Discovered HTLV and credited with co-discovery of HIV virus - Pioneered development of HIV blood test Dr. Luc Montaigner - French virologist at Pasteur Institute, isolated HIV virus Dr. Francoise Barré - French virologist, also worked at Pasteur Institute

Who was one of the first to officially declare that GRID was an STD?

Dr. Don Francis, from the CDC

Evolution of HIV/AIDS Knowledge: A Timeline

Early 1900s: Around when SIV spread to humans in West Africa and became HIV 1959: First suspected AIDS death (Manchester Sailor in Congo) 1969: First confirmed (but debated) AIDS death in U.S. Pre-1981: Local reportings around the world of a new ailment that leads to death of normally healthy young people (hitting them in most reproductive age) June 5, 1981: CDC's MMWR report Pneumocystic Pneumonia in 5 young MSM (official beginning of AIDS) 1982: Named AIDS (no longer the Gay Disease) 1983-1984: HIV virus isolated 1985: FDA approves first antibody test 1983-1991: "Years of Great Scientific Discovery" 1987: FDA approves first HIV treatment -- AZT 1991: Red Ribbon Campaign 1993: Revised case definition of AIDS (CD4>200, which caused slight shift in who fell into group of HIV vs. AIDS) 1994: AZT reduced mother-to-child transmission 1996: HAART becomes standard of care in wealthy countries, eventually later in poorer 1996-1998: Dramatic reduction of AIDS deaths in U.S. (not true of other countries) 2000: First combination pill 2003: UNAIDS/WHO's 3x5 Campaign and Bush's PEPFAR 2011: ART reduces transmission by 96% 2012: Promising PrEP studies 2015: UNAIDS Goals 2016: Test-and-Treat (controversial)

How does HIV enter the body/What happens when it first enters the body?

Enters body through dendritic cells Sticks part of the virus out on the cell membrane (HIV virus can be broken up in different ways) Then, can encounter a B-cell, and depending on the way the B-cell was made (if it has an antibody that recognizes/has a good fit with antigen), the B-cell may or may not recognize it - If B-cell does recognize it, it may be partially activated, and will start making antibodies - This process varies in different individuals, can take a long time Helper-T cells also have receptors that are made randomly, also need the right receptors to recognize the antigen (HIV protein) - If T-cell recognizes the HIV antigen, it will release cytokines that will go interact with partially active B-cells and turn it all the way on Cytokines will also activate killer cells (CD8) Helper-T cells are essential (B-cells can't be activated, cytotoxic T-cells can't be organized without them) CD8 cell has receptor that can interact with infected cells, and can help infected cells destroy themselves (without activating/disrupting other cells around them)

Paul Farmer's "Sending Sickness"

Ethnographic setting: - Do Kay village in Haiti - History of tragedy and suffering - Poverty (exacerbated by the dam) - Political upheavals - Local tensions and jealousy (sorcery) - Urban-rural connections Investigating how HIV affects a place that already has a lot of suffering and structural violence Studied how cultural meanings of a new "disorder" changed over time: - Went from a disease of urban wealth to a disease of rural poverty and misfortune - From a "new disease" to a "local disease" The etiology of SIDA folded into existing local ways of understanding misfortune - SIDA as a "sent sickness" (people thought it was spread through sorcery, jealousy) --> SIDA as an infectious disease (a newer understanding) - This shift from sent sickness to ID was caused by 3 people in the village who got HIV (Anita, a great, wonderful girl fell ill, but people couldn't believe someone would send an illness to her) - Shift also caused by the radio, and influx of information

Socio-Ecological Model (What is it? Why is it superior to other theories, etc.?)

Examines risk and behavior at multiple levels: - Individual (knowledge, attitudes, skill) - Interpersonal (family, friends, social network) - Organizational (organizations, social institutions) - Community (relationships among organizations) - Public policy (national, state, local laws) Superior to Health Belief Model

The Emergence of HIV -- in general, what were the emotions of responses and counter responses?

Fear, denial, prejudice, shock, unveiling of words

How do antibodies clear a virus?

Fight infection by directly neutralizing the virus -- binds to coat protein so virus can't infect a cell Binds to its target and signals other immune system cells to attack and kill the target But because of high error rate in HIV reverse transcriptase, vaccines haven't been successful

Primary vs. Secondary Immune Response

First exposure has a lag time that it takes for our bodies to find correct antibodies to respond to antigens But then our B-cells become memory B-cells, so they can respond much faster next time Optimal vaccines are antibody-based

HTLV

First human retrovirus But, at first, didn't know what the human illness was Bob Gallo discovered it -- he joined the AIDS effort because, if he identified the virus, it would win him a Nobel Prize

What were some names for AIDS in early 1980s? Who called it this?

GRID -- Gay Related Immune Deficiency Gay pneumonia Gay cancer This is what the gay press called it. The popular press didn't mention it at all.

Patient Zero

Gaetan Dugas He was a starting point of the spread, had sex with many people, who then had sex with other people Not the official starting point, but can example of how this disease can be spread sexually Offered legitimate proof that GRID could be sexually transmitted

What was happening in the U.S. that led to/contributed to spread of HIV?

Gay liberation movement, especially in CA and NY - Bath houses, sexual freedom - People were afraid that closing the bath houses would reduce gay sexual freedom (even though PH said it was necessary) - Closing bath houses was controversial and showed that there was no easy answer (unintended consequence = putting the blame on gay men, restigmatizing them, reducing their sexual freedom New presidential administration - Reagan advocated cutting spending, including PH spending (the only increase in budget was Dept. of Defense) - Refused to say AIDS Rise in injecting drug use Haitian communities now being infected - Haitians fleeing Haiti for political reasons, coming to U.S. - Saw it happening to Haitians, but there were a lot of undocumented Haitians that were infected because they were afraid to come out and get deported Patient Zero - Shows role that sex and transportation/globalization plays in spread of disease - Pt. Zero not the first to get/spread HIV The Hepatitis Study that they did with gay men became important - They went back to their tissue samples several years later, saw that many of them HIV positive - Realized some of the HIV cases in U.S. were earlier than they thought

Niehaus' Article: Dr. Wouter Basson, Americans, and Wild beasts: Men's Conspiracy Theories of HIV/AIDS in the South African Lowveld"

Gendered understanding of HIV Women express domestic anxieties, and understand HIV as a biomedical condition - Women's bodies and healthcare more medicalized - More contact and trusting of biomedical system - More likely to believe HIV was the result of gendered life (can't say no to men) Men express translocal anxieties, HIV as a reflection of wider inequalities Black S. Africans' understandings aren't necessarily a lack of knowledge bur rather an awareness and reaction to past and existing inequalities and injustices - Poverty and Apartheid - Transgressions of taboos (dilla)

What are some themes of "And the Band Played On"?

Globalization - Helped facilitate spread of HIV Epidemiology - Disease tracking (viewed AIDS as being in the gay community, but could be bridged to another community) - "What do we think, what do we know, what can we prove?" Politics and Funding - The initial discovery of virus was bureaucratic, focused on being a gay man's disease (which prevented a lot of people from caring about it) - Even though health seems to be an isolated discipline, much of the funding comes from taxpayer money, which is distributed by Congress (so health is unavoidably political) - Public funds aren't always tied to what health officials think the money need to go toward Medicine and Capitalism - Blood banks didn't want to test for HIV because it would cost a lot - The idea of ethics (Ex. Bob Gallo's behavior. Ex. When first started HIV testing people in Africa, felt it was unethical because if someone tested positive, they had no resources to give them) Stigma, Moral Anxiety, Blame - Gay community worried that closing bathhouses was reducing gay freedom - Labeled as gay man's disease - People worried about who spread it, who to blame (less interested in how to fix it) - When women and babies started getting it, there was a shift in blame Collaboration and competition - French and Americans were working almost at odds - Had they worked together, they could have helped people earlier on - Competition for funding and prestige

China's Henan "AIDS Villages" article

HIV epidemic located mainly in South Epidemic fueled by the sale of blood plasma Yunan province situated on the exchange and networking because on the border of China (particularly drug networking and commercial sex work) The epidemic in one area is very different in its texture and context than the epidemic in another province Shao Jing's "spheres of circulation" - Local context: lots of poverty, so people sold their blood to make extra money. Rural farmers being impacted by gov. policies. Commercial interests came in -- the extraction of blood/blood plasma banks. These banks knew this was a poor area, and that the farmers probably didn't have much contamination because they were rural - The way the blood was collected was illegal. They'd draw blood, pool everyone's blood together, take out the plasma they wanted, divvy up the remaining blood, and send back to donor (this would allow donors to donate more often) This also facilitated risk to partner of person who donated blood

What is the relationship between SIV and HIV?

HIV is the descendant of SIV Two strains of SIV transmitted to human: - HIV-1 and HIV-2 HIV-1 is the primary cause of AIDS HIV-2 is rarer How did the virus transmit? - Hunter theory: blood of infected ape getting into cuts or wounds on hunter/processor

The EndGame film: Big themes/Ideas

HIV not as highly discussed in black community - Phrases like "don't go sharing your business", "don't hang out your dirty laundry" Didn't believe AIDS was a black man's disease at first Drug Paraphernalia law in Oakland made it illegal to carry a needle - This led to people coming into homes and selling drugs and lending needles to shoot up there - HIV virus spread between users, to partners, and into community (unintended consequence) Gov. attempt to crack down on drug use also had unintended consequences: many arrests of black men, led to chain of young black men going to jail for drugs - When men go to jail, fewer men in community, females have more competition for a man (so harder to force man to wear condom) AIDS didn't include women, so women couldn't access healthcare. Eventually, this was changed Could've prevented this epidemic early on in black community, but no political will - Black leaders didn't know to mobilize early (thought it was early) - But, also, there's a long list of problems in black community to solve, so it wasn't their priority AIDS still a big problem in some places (ex. Selma, Alabama) - Transportation problems, suspicions/myths about epidemic, Tuskegee, distrust among black community, stigma about HIV, abstinence-based sex ed Number of AIDS cases has stayed the same in U.S. In other countries, the number has gone down If black America were a country itself, it would be eligible for PEPFAR dollars Things to do in black America to bring about change: - Personal-level, community-level, national-level Themes: - Deep-seated mistrust - People have competing needs, so HIV may not always be a priority (we're embedded in communities where we have other priorities, like feeding our children - Stigma (still very prevalent) - Care systems (not just going to a clinic, but being in the position to be able to take your meds, taking care of yourself) - Limits of PH and medicine (can't just give medicine, must fit in with the realities of peoples' lives. People are motivated by love/intimacy, so you can't just say "wear a condom") - Historical structure (in order to understand risk, need to look at black history of oppression, slavery, etc.)

Karen Kroeger's AIDS Club Rumors in Indonesia -- How was HIV understood in Indonesia?

HIV us understood in the context of bodies and anxiety about: - Public spaces - Modern spaces - Western ideals beginning to permeate Indonesian borders - Sex workers - Political instability Blamed on women: women supposed to control their sexual urges, and help her husband (who had stronger, less controllable urges). If he went to brothels, it was because she wasn't doing enough to satisfy him

Why is the HIV virus so tricky?

High mutation rate - HIV reverse transcriptase is very error prone - No proofreading capabilities, so they cannot be corrected - These mutations can sometimes have no effect - Because the virus makes so many mistakes as it copies itself, there are different forms of the virus present in a single individual (Different forms = different shapes, which react to drugs differently or not at all and present different antigens on cell surface) - New virus types can go undetected by antibodies for initial virus type Variable incubation rate (can be latent for short or very long period of time)

Who is it the highest risk for contracting HIV? Who is next highest? Who is after that? Etc.

Highest rate of transmission: Transfusion 2. Mother-to-child 3. Male-to-male 4. Needle-stick 5. Needle sharing 6. Male to female 7. Female to male

HAART

Highly Active Antiretroviral Therapy A "cocktail" combination of 3 ARTs

HIV Belt in U..S

Highway 64 and Highway 270 Rural communities in need of money -- the perfect environment for drug manufacturing - Poverty also drives people into self-medication (intimacy through sex work)

The Emergence of HIV -- in general, what were some of the representations and realities?

Homophobia, blame, "Othering", death, suffering

4H risk group

Homosexual men Haitians (marginalized immigrants) Heroin users Hemophiliacs

Interpretive Anthropology

How local understandings of HIV are filtered through pre-existing: - Ways of knowing, cultural logics - Understandings of body, illness, gender - Anxieties, stereotypes, and stigmas - Social hierarchies/inequalities among people

What is the Meso level of health communication?

Identified "risk group/target group" -- building messages and interventions based on a risk group - This allows you to really start with the people, something macro campaigns can't really do Culturally or group-tailored messages Outreach vs. In-class Peer vs. Outside facilitator - Trying to educate and implement interventions as an outsider is very different, need to consider whether there's a way you can better utilize local expertise "Evidence-based" packaged programs - From research-based to evidence-based - Research-based meant it was based on a philosophy of behavior, and what's already existing. Thought to build on the existing. Now, things need to be proven to have worked (need to measure success) - Ultimately, the measure is HIV prevalence and incidence, but also need a smaller scale measurement too Ex. CDC's 1999 Debi (Diffusion of Effective Behavioral Intervention) programs -- packaged programs that were plopped down in places. They later realized that things need to be much more tailored to the culture Purpose and goals: - Tailor interventions to the group - Create support, builds on networks - Change community- or group- level attitudes, practices - Empower with skills Obstacles and cons: - Funding - Measure and prove results - Increasingly bureaucratic - Not addressing underlying causes of risk (more about getting the message out there) - Leaves out other populations - Denying the risk of other groups (if you're not identified as being in a risk category, you're neglected)

Assuming no condom use, Risk of HIV transmission via anal intercourse if receptive partner is HIV+ Risk of HIV transmission via anal intercourse if insertive partner is HIV+

If receptive partner is HIV+ - Insertive partner's risk (circumcised): 0.11% - Insertive partner's risk (uncircumcised): 0.62% If insertive partner is HIV+ - Receptive partner's risk (without ejaculation): 0.65% - Receptive partner's risk (with ejaculation): 1.43%

Income vs. Wealth

Income -- how much money you make over a defined time period Wealth -- assets that might be able to grow over time, assets that you can cash in Wealth is important because it gets passed down (you can accumulate wealth so that you can invest in children, contributes to your economic standing over time) - White wealth has been extremely higher than black wealth over the years Whites literally dominate in terms of wealth and money - Average white family has about $111,000 in terms of wealth. Af-Am have about $7,000 and Latinos have about $8,000 Education doesn't necessarily correlate with higher salary

How does the HIV virus cause disease?

Increase in viral load is associated with a decrease in CD4 cell count Acute phase where viral load increases and CD4 cells decrease Over time, they level out and equalize - This can cause flu-like symptoms - The immune system has been turned on, is actually doing what it's supposed to be doing -- making antibodies, but they can't destroy/clear the virus Then, the viral load spikes again, and CD4 cells dip AIDS = <200 CD4 cells - Not enough CD4 cells to launch immune response and make antibodies for new pathogens they encounter CD4 cells in blood infected with HIV die cleanly through apoptosis CD3 cells in lymph nodes resist HIV replication and die by pyroptosis (Pyroptosis recruits more CD4 cells to the area, infected CD4 cells then attach to healthy CD4 cells and engulf them)

Case Study in India: Truck Drivers

India has some of the largest and most-used road networks (2-5 million drivers) Dhabas - "comfort" truck stops offer cheap food, shelter, sex Study in 1999 showed 87% truckers had casual sex partner, but only 11% used condoms Intervention campaigns: - Billboards - Peer Education Campaigns - Economic programs for sex workers - Workplace awareness (drivers, gas stations, hotels)

What is the Micro level of health communication?

Individual-level You can actually code for prevention (i.e. a computer program for doctor asking whether they discussed HIV reduction/prevention, drug prevention, etc. with patient) One-on-one counseling (risk assessment, risk reduction strategies, disclosure) Peer networks (sex workers, gay men, injecting drug users) Self-education (internet, research, incorporating cell phones and technology in PH) Purpose and goals: - Personalized attention and intervention - Address co-factors - Estimate risk assessment and plan to change Obstacles and cons: Funding Measure and prove results Increasingly bureaucratic Denial Perception of risk (we like to see ourselves as being good, hesitant to admit our risky behaviors) Social expectations Reaches fewer people

Hemophiliac Infection: The Controversy about Blood Donation

Infection of hemophiliacs called into question whether gays should be allowed to donate Hemophiliacs were afraid that gays would give them GRID But gays worried that excluding them from blood donation was a way of stigmatization It was also suggested that the blood industry need to start screening blood for AIDS - Blood industry not a fan because would cost lots of money

What are the two major sections/cells of the immune system?

Innate immune system and adaptive Innate: - Cells can recognize pathogens as foreign and engulf them to remove - First line of defense, but not the best. So they aren't usual enough - White blood cells Adaptive: - Strongest line of defense - T-cells (2 kinds: Helper T and Cytotoxic T-cells)

Interpretations of HIV: Interpretive Anthropology vs. Cultural Theory

Interpretive Anthro: - Local meanings - Local understandings and meanings as built on or folded into local histories and existing life ways - Ex. Rumors, seen in Karen Kroger and Paul Farmer's essays - Processual analysis, seen in Farmer and Parikh's essays Cultural Theory: - Public representations - How is a phenomenon publicly represented? - Representations are not neutral - Seen in Paula Treichler, Michel Foucault, Susan Sontag, and Sandra Gillman papers

Prevention vs. Intervention

Intervention: Any sort of program, policy, etc. into a situation to alter the outcome of situation Prevention: A type of intervention trying to stop an outcome from happening at all

What makes HIV a unique STI?

It affects the entire body -- works on multiple sites of body, whereas other STIs are localized in genital area HIV weakens the entire system through blood stream

Why did a hypervirulent form of SIV evolve in the early 1900s?

It's believed that SIV infection to humans probably occurred constantly, but for some reason, a hyper virulent strain emerged in early 1900s Why? - Increased urbanization/migration - Colonial vaccination campaigns (vaccination would give more chance to mutate and spread around more quickly) - GUD - Genital Ulcer Diseases and HIV spread

Dieta Pepsi guest lecture

Job is to get people to go get themselves tested Living in houses together ("House of Pepsi") Had to start parents, chain themselves to gov. buildings, throw water on mayors to get people to listen Guardian Project - Drag queens go into bars, give out condoms, show videos for prevention - On white-night, HIV tests would be greatly used - On black night, no one used them (fear of stigma and lack of accessibility to healthcare) AIDS Walk - As AIDS became less fashionable, the media supporters and partners left - Trying to restart it Very against PrEP when it first came out - Need greater adherence, very expensive - A Dr. at WashU changed opinion - PrEP's current costumer base is mostly gay white men

The Marketing of Genocide (Who proposed this, what does it mean?)

John Lauritsen, who proposed Iatro-genocide Laurtisen claims advertisements are aggressively advertising AZT - Unethical, immoral Partnership of gay press and drug companies - Partnerships between celebrities and drug companies also - FDA later ruled and told pharma they couldn't advertise as aggressively as they had been in gay magazines Use of attractive men to appeal to MSM

When was the official beginning of AIDS?

June 5, 1981

What are some possibilities for an HIV response?

Killed virus Live attenuated virus Recombinant virus Recombinant protein But all of these have failed Humoral immunity - Traditional antibody-based Cell-mediated immunity - Activating cytokine cells Combination approaches Activate adaptive and innate immune responses - Going back to innate immune system that doesn't recognize things specifically, and just engulfs - Activating both together might be an approach

South Africa HIV in Western Media

Known for Thabo Mbeki, president of S. Africa, who denied that HIV caused AIDS - Dr. Peter Duesberg, an American scientist, said AIDS not caused by HIV, and Mbeki got his data from him Within S. Africa, there's a lot of activism - Not only was activism about denialism, but also had grassroots organizations to gain access to ART More recently, Zuma (current president) had controversy - Charged with raping someone. Said afterwards he took a shower to clean himself of HIV (putting the blame on the rape victim) - This put S. Africa in international spotlight, other countries were like "wtf" Cruel irony - Right after Apartheid was ended, and a shift to black rule began, HIV hit the country. - HIV became caught up in this narrative of what happens when black people take over power from the majority white rule

Case study: The mines as a source of risk

Labor migration with spousal separation Mine work and conditions, dangerous (men are powerless) Mine-related health problems Invisible AIDS (sick men return to rural areas) Limited leisure activities Pleasure as outlet Limited social support Masculinity (provider, brave/fearless) Flipping the paradigm of HIV risk: - Before asking how to encourage safe sex, ask instead "What does unsafe sex symbolize? Why do miners have unsafe sex? What is the role of sexual identities?" - Sexual contact as outlet for stress and loneliness - Sex as symbolic

Lauritsen's "HIV Voodoo From Burroughs-Wellcome (genocide of gay men)" article

Lauritsen was a gay activist and investigative journalist Questioned why HIV was more prevalent in gay community (he had the idea that something else was going on) AIDS = Iatro-genocide via AZT Proposed theory of Iatro-genocide Also had belief that genocide was being marketed (Pharma companies advertising AZT very aggressively)

Because of its long incubation period, HIV is a ___________

Lentivirus -- a type of retrovirus that has a long incubation period, which is why it's an ideal virus Lenti = Slow

Why is circumcision beneficial in preventing HIV transmission?

Less membrane If you're uncircumcised, there's a greater likelihood that you'll get tiny tears in skin where virus can transmit *if you're inserting*

HIV-2

Less virulent, confined largely to West African countries Transmitted from Sooty Mangabeys (kept as pets, hunted for food)

What are some types of risk categories?

MSM, injecting drug users, MSM and drug injectors, heterosexual Every country has its own set of risk categories

What are the three levels of responses/representations of a disease?

Macro - Political positions, national responses, policies, laws, funding (the public/the official/the funding) Meso - Public and the media representations - The thing that circulates information, bridge between the macro and micro Micro - Local meanings, understandings, and responses (within a community)

What has the higher HIV transmission frequency -- Male to female or female to male?

Male to female is higher M to F -- .08% F to M -- .04%

When/Who was the first suspected death of AIDS?

Manchester Sailor in Congo in 1959

Harriet Phinney's "Rice is Essential but Tiresome"

Men's infidelity is not a moral failing "Opportunity structure" for men's extramarital liaison is shaped by 3 interrelated state policies policies on economic reform (Doi Moi) - These policies aren't meant to affect health, but became an unintended consequence - Facilitate men's extramarital sexuality - Encourages wives' acquiescence (infidelity in this culture = not meeting financial obligations) - As long as man is still contributing to household, the marriage is still okay

What were national responses in South Africa, and local counter-narratives?

National responses: Blame and denial in post-Apartheid Local counter-narratives: Gendered conspiracy theories

Karen Kroeger's AIDS Club Rumors in Indonesia -- How do we understand and not understand rumors?

Need to investigate the underlying anxieties behind the rumors - Focus on what these rumors can tell us about a particular society Rumors are not simply wrong or incomplete understandings, but rather collective experiences of disorder in contemporary society Rumors are a way for groups to work out/voice concerns and anxieties about modernity Rumors are a way of regulating and policing sexuality and body's influence of local and outside threats

Is AIDS solely an issue of health?

No Also a social, political, business issue. Also about development work -- households in Africa having to put money into their loved one's health

What are the 2015 UNAIDS Goals?

Reducing transmission, preventing HIV among drug users, etc. A way to consolidate strategies for global community 90% reduction in new HIV infections, 90% reduction in stigma, 90% reduction in HIV-related deaths

What is the untreated HIV natural history?

Normal CD4 cell count in healthy individual: 900 - 1,200 Acute HIV (2-8 weeks): CD4 count drops, but then goes up again - Stimulating the immune system, body is slowly building up antibodies - Body has ability to have some antibodies, so isn't as bad as it could be - This phase has variability depending on the person - Sero-conversion happening - During this window period, your antibodies aren't high enough to be able to come back positive for an HIV test Latent phase (average of 10 years) - CD4 cells go down AIDS - CD4 cells continue to drop

Delmar Divide

North of the divide: Very black (75-100% black) South of the divide: White North of divide has lower health rating - More FQHCs up north of Delmar divide Mechanisms of the divide: - Housing policy, Zoning, Covenant Deeds (who could buy property/live in certain neighborhoods), employment Gated communities in wealthier neighborhoods

Arnold and Bailey's article: How the Ballroom Community Supports African-American GLBTQ Youth

On East and West coasts These houses were placed for young MSM and WSW who didn't feel comfortable in their own home because parents didn't approve/didn't know how parents would react These organically emerged as safe places, and people became fictive kin to each other A duplication of heteronormative gender roles - House Moms were the sensitive, caring ones - House Dads worried about reputation and the outside world - This had an effect on HIV prevention/education (Mom would give condoms, talk about poor sex behavior, give advice. Dad would talk about the outside structural inequalities and try to fix them - like making children pursue an education - in order to teach them better behaviors This was organic -- an intravention (happening within, organically) rather than intervention

Erise Williams of Williams and Associates guest lecture

Organization links people to care, like housing and social services - Also do work around HIV testing - Targets minority people - Drop-in center, psychosocial support - Advocacy work, trying to reduce stigma - Have 2 sites: the storefront site more popular - Also trying out geosocial networking Gov. has had to get the many departments of HHS to communicate and create an "integrated plan" New need to integrate more care into prevention - This changes how you go after/receive funding (organizations already doing care have a leg up) 1:2 black men in their lifetime will contract HIV on current trajectory, 1:4 Latino men PrEP has helped with HIV regulation - But most people accessing it are white men - When you go on it, you need to see a doctor regularly, and many minority men don't have insurance. It's also very expensive - Some stigma with PrEP (sexual dysinhibition) Pretty low funds allocated to STL area - A lot of what happens in health policy affects Williams and Associates' efforts

What are some of the tests for HIV?

PCR tests (1-2 weeks) - Tests for presence of HIV DNA in a blood sample Antibody tests (3-4 weeks) - ELISA (Detects the presence of antibodies for a particular protein. Wells are coated with HIV protein, you add blood sample. If HIV antibodies are present in blood, they bind and the color changes. Color change = positive HIV status) - Western Blot

"Science is not immune from sexism or -ism in general" -- Who said this, what does it mean?

Paula Treichler Centered around the fact that scientific writing can be very gendered Discover magazine, 1985 - Theory of Contagion - "Vulnerable anus" - "Rugged vagina" - Vagina was thick enough to keep HIV out, but anus could not - "The rugged vagina is designed to withstand the trauma of intercourse as well as childbirth" Sex workers' vaginas "merely reservoirs" for passing HIV (She had sex with infected man, then had sex with another man who got HIV from that reservoir)

Karen Kroeger's AIDS Club Rumors in Indonesia -- What were the rumors?

People in public spaces being poked with a needle by someone who quickly vanishes, and later finding a card in their pocket that says "Welcome to the AIDS club" Rumors about disease -- not just in Indonesia, but all over Indonesia's rumors, however, were unique to the country - For example, many countries' AIDS rumors focused on one-night stands and receiving AIDS through sexual contact

Sexual Cluster

People who have had sexual relations A sexual cluster was used as an excuse not to definitively say that GRID was a STD until they could prove it scientifically (an example of how officials wanted to be politically correct/wanted to wait to share with the public until they had scientific proof

The origins of HIV comes down to ....

Phylogenetics (organization of diseases based on similarity of nucleotide sequence)

What did the CDC suspect originally as the culprit of GRID?

Poppers

PrEP -- when did it develop, what is it, what are its controversies?

Pre-Exposure Prophylactic Before this time, there was PEP (post-exposure prophylactic) for someone who accidentally stuck themselves with a needle Like a birth control pill -- can prevent sero-conversion of HIV in your body (even if you're exposed to the virus) Controversy: - Fear it may cause sexual disinhibition (people will go out and have as much sex as they can without regard to consequences) - Fear of drug resistance (if something does transmit, will resistance occur?) - Inequalities (who has access to it?)

PEPFAR

President's Emergency Plan for AIDS Relief Helped to consolidate all of the U.S.' public funding into one fund so that the money could be more directly allocated Controversial because at the same time, the global community was also creating funds for relief. Instead of joining the global community, we just decided to do it on our own

Pulls and Pushes of urbanization and migration in HIV infection (What are they? What are the migrant conditions?)

Pull: - Factories, cities, agriculture, mines, war, drug economy, taxes Push: - Rural poverty, declining infrastructure, mobility, monetization Migrant conditions: - Low wages, lack of access to healthcare, urban-to-rural transmission In U.S. most married couples live together -- if a parent gets a job in one area, the whole family usually follows BUT in global south, like Mexico, wages are so low that people can't do this - People will migrate to job and back - This allows for increased opportunities for sex (desiring intimacy while they are away from family) The amount of mobility in poor countries is huge

Robert Lorway's article: On Becoming a Male Sex worker in Mysore: Sexual Subjectivity, Empowerment, and community-based HIV prevention research

Questions how we can incorporate notions of sexual subjectivity into ideas of empowerment without losing ideas of sexuality - Building on community Many of these men did not feel like they were abused into becoming sex workers, they feel like it was a wake-up call to a life they were supposed to have

Sandra Lane's article: Structural Violence and Racial Disparity in HIV Transmission

Sexual debut or activity doesn't explain why HIV rate is higher among African-American women in NY 3 Ecological Pathways of Risk Pathway 1: - Residential segregation, gangs, and disproportionate incarceration lead to constrained social-sexual networks, which leads to a potentially higher proportion of infected partners - Limited STD clinic hours leads to infected persons to wait longer for treatment while infecting others, which also leads to potentially higher proportion of infected partners Pathway 2: - Disproportionate incarceration and disproportionate death lead to low male sex ration, which leads to concurrent partnerships (man having sex with 2+ women) - Homophobic social norms also leads to concurrent partnerships (Man having sex with man and woman to cover-up) Pathway 3: - Limited access to health insurance --> limited STD clinic hours and infected persons waiting longer for treatment --> increased STDs --> increased transmission of HIV - Sales and advertisements of douche preparations --> use of vaginal douche products --> changes in vaginal ecology --> also leads to increased transmission of HIV Community context: - HIV in correctional facilities with higher rate Af-Am incarceration - Constrained sexual networks - Residential segregation (gangs) - Limited STD services - Outmigration of men (more women) - Homophobia - Vaginal douching

Debate in public health: Society vs. Individual rights

Should policies protect the rights of the individual or of society? Ex. Diabetes - Free choice in eating vs. Food policies to keep unhealthy foods expensive and healthy foods lower - Soda tax debate Ex. Vaccinations - Forcing someone to vaccinate infringing on rights of individual vs. protecting public health - Commonwealth of MA vs. Jacobsen decided this: Supreme Court ruled that individual rights can be infringed upon if it protects PH and you don't have a legitimate reason to refuse to vaccine (ex. Religion) Debates continue about whether you can manditorily require people to do something

SIV

Simian Immunodeficiency Virus Recent ancestry with primates, especially with old world monkeys and apes, that facilitates disease transmission Naturally found in 40 African primates Non-pathogenic in most cases (host doesn't really have a known reaction to it) Minimally: 30,000 years old, but very likely to be millions of years old

In South Africa, is the epidemic a Pattern I or Pattern II? What does this mean? What does this imply to S. Africans?

Since 1987, a shift from Pattern I to Pattern II Pattern I: Concentrated - Particular identifiable risk behaviors or risk groups - In U.S., was 4H club Pattern II: Generalized - The prevalence of HIV within heterosexual community is over 1% Because of this shift (of how HIV emerged in a radicalized community), the messages of HIV were interpreted differently - HIV messages were associated with black S. Africans - Black S. Africans saw this as racially targeting them - White S. Africans happy because they thought it would off black people and they could take back their country. Thought this is what happens when black people have control - HIV education messages also interpreted differently by whites and blacks

Around the world, what gender has more HIV/AIDS infections?

Slightly more women than men are infected

Structural Violence

Social arrangements that put individuals and populations in harm's way Embedded in the political and economic organization of our social world; they are violent because they cause injury to people

The Emergence of HIV -- in general, what were the contexts?

Social, economic, and political context

Where is the HIV epidemic concentrated in Africa now?

Southern Africa Points less to sexual practice and more to conditions that promote spread - Spread of HIV between 1986-2001 followed a transnational path from Ghana down to South Africa

HIV Drug Therapies

Studying HIV replication led to new drug design possibilities - Transcription, protease, integration, maturation are all stages that drugs target AZT resembles a nucleoside but stops DNA synthesis - Our polymerases would also recognize AZT, which could stop our DNA polymerase, but it binds less well to our natural polymerase - Virus becomes resistant to AZT by about 22 weeks - AZT able to inhibit one type of HIV, but cannot stop mutated strain HIV Protease Inhibitor keeps virus from maturing - Prohibiting protease from cleaving and allowing for maturation HAART - More effective at treating multiple strains of the virus at once - With two drugs, it was more effective, but found that 3 drugs were most effective Failure to take drugs leads to resistant virus and a need for new drug types Another target for drug therapy, CCR5, was identified by studying the genetics of a resistant individual - Individuals with mutant form of CCR5 receptors resist HIV infection (HIV cannot get into the cell to begin with) Currently, there are 25 drugs on the market for HIV

What area of the world holds the largest HIV/AIDS burden?

Sub-Saharan Africa

What is HIV surveillance (and monitoring)? How is this done? Is the data 100% accurate?

Surveillance and monitoring: Ongoing, systematic collection, analysis, interpretation, and dissemination of health-related data used for planning, implementation, and evaluation of public health practice Methods of collecting: - Depends on the development of the country - U.S., Europe, Australia: *Actual* numbers as reported in HIV Testing Centers and other clinical testing centers - Asia, Africa, Carribean: *Estimated* numbers based on monitoring sites (like prenatal clinics, STD clinics, high risk populations). Based on population-based surveys The numbers are not 100% accurate. Why? - 1. Errors in collect method and reporting (recording systems are not consistent globally or within countries. There is also the possibility for human error. The developed countries aren't immune to these errors, but they have more resources and training to properly record data) - 2. Reporting bias (over and under testing certain groups, locations, regions, etc. We tend to target more at-risk groups, like MSM, while neglecting groups that seem to be at less risk))) - 3. Hidden and hard-to-reach populations (mobile and underground populations, like the homeless population for example) - 4. Incomplete story (numbers don't tell you the whole story behind the context that fuels transmission risk and uneven spread)

Jennifer Hirsch's article: The Inevitability of infidelity: Sexual reputation, Social geographies, and marital HIV risk in rural Mexico"

The "Hidden risk" of married women - Greater risk for women = sex with husband or permanent partner - Unilateral monogamy doesn't ensure protection - Marital reputation (your social reputation is most important, and should maintain semblance of being in a modern, happy marriage) Men's reputation: - Compulsory heterosexuality - Expectation for compassionate intimacy Women's reputation: - Collusion in silence about male infidelity - Importance of reproduction and child-rearing for women - Wives' submission to husband and in-laws Intersection of reputation and sociosexual geographies - Men's mobility (work and leisure) Sexual geography - spaces permitting actions that aren't typically socially permissible (man can cheat in areas away from home -- keeping the home sphere and the sex/fun sphere very separate)

Laurie Garrett's Hatari, East Africa article

The Emergence of Spread -- HIV/AIDS spread in stages due to the context of the country Mid 1960s -- Independence in Africa from European colonizers - Invented political boundaries (1884 Berlin Conference) - Fragile political and economic systems - Disrupted social systems Early 1970s -- Post-Colonial "Opening Up" - Urbanization and increased mobility - Trade and opportunities flourished Mid 1970s -- The Chaos - Civil and border wars - Poverty - Increased economic stratification - Public health infrastructure decay (reuse of needles for vaccine/meds -- iatrogenic) - Insecurity at household and individual levels

James Pfeiffer's article: Condom Social marketing, pentecostalism, and structural adjustment in Mozambique: A clash of AIDS prevention messages

The context: - Shift to market-based prevention (social marketing) - 4 Ps of advertising - SAPs (increasing poverty and inequalities) - High HIV - Transactional sex and sex work - Moral panic - Rise of Pentecostalism Analysis of condom intervention: - Problems with measuring "success" of SM programs - Condoms became intertwined with the politics of religion and morality (fear that condoms would encourage promiscuity), reproduction, gender inequalities Unintended consequences of SM: - Campaign done by "experts" (rather than collaboration with local community members) - Became target of religious and community commentary - (Mis)interpretation of messages - Conflicting messages - Unexpected shifts in local power - Competes with other contraception

What was Project Coast?

The goal was to develop a range of chemical and biologic agents designed to control, poison, and kill people within and outside of S. Africa Headed by Dr. Wouter Basson, who was later put on trial as "Dr. Death" This project folded into beliefs about public health campaigns - Lingering effect of "How do we know this PH effort is true? How do we know you're actually trying to help us?"

What is health communication?

The study of and practice of communicating promotional health information, such as in PH campaigns, health education, and between doctor and patient. The purpose of disseminating health information is to influence personal health choices by improving health literacy Health communication doesn't necessarily remedy everything, but it's important 3 levels of health communication: - Macro - Meso - Micro

War, STDs, and The Female Body - How was this representation interpreted?

The way STDs were represented during WWI and WWII period (wartime propaganda) Drawing on anxieties about: - Women's sexuality and perceived sexual freedom - Invaders, foreigners, outsiders, spies Posters that say "She may look clean, but she has syphilis" and "She may be a bag of trouble" - They're blaming the women, not telling the men to use condoms On the flip side, to avoid STDs, you should get married - If you are a good, clean person, you should get married so that there's no concern for getting STDs - Not being promiscuous

Iatro-genocide (Who proposed it, what is it, etc.)

Theory by John Lauritsen Belief that AZT was helping to spread HIV and kill gay men - AZT not a cure for AIDS, AZT's alleged benefits are not backed by hard data, and aren't sufficient to compensate for the drug's known toxicities. Recovery from AIDS will come from strengthening your body, not poisoning it. Homophobia + Drug profits = Genocide - HIV invented as a way for drug companies to make money "Death is the expected biomedical response of taking AZT, for the fundamental action of the drug is to terminate DNA synthesis, the very life process itself" - Used biomedical jargon, and kind of bending the biomedical info to how he wants it to be perceived

Hunter theory of HIV transmission

Theory of how SIV was transmitted to humans and became HIV Blood from infected ape getting into cuts or wounds on hunter/processor

What are elite controllers?

Those who can innately keep the HIV virus cell population low A person's genetics affect how the person responds to HIV and some people can keep the viral load very low, even after the first peak

Narco-economy

Trade network --> growers, transporters, sellers, buyers, users Trafficking of drugs and women - Trafficking of women sometimes goes hand-in-hand with other commodities Injecting drug networks, sex partners, generalized epidemic

What are some theories about black genocide in relation to HIV infection?

Types of theories: - HIV as a biological weapon - Drugs as toxic - Keeping effective drugs from people

In the 1970s, where was the epicenter of HIV in Africa?

Uganda Great conditions for spread of HIV (truck drivers, visiting businesspeople, etc.

What is the context of HIV transmission in Uganda?

Uganda is a case study of something that went right - First place in the world to report declining HIV rates - Some said it was because people were behaving in different ways, but some said it was because the context changed - Uganda began to open up, therefore, to global discussion Evangelical movement starting to take hold at this time - Missionaries very important because trying to help Africa become "civilized" In Uganda, there was a backlash to how public sex had become - So, Evangelical population said "we need to take control of our own sexuality" - "We need to go back to traditional African Christianity" - So, HIV became very wrapped up in morality and Christianity

What does UAI stand for?

Unprotected anal intercourse

Why is an HIV vaccine so difficult to make?

Vaccines try to stimulate your immune system to make a bunch of antibodies to a pathogen before you're exposed it But those with HIV already have antibodies that don't work

South Africa Timeline: Racialized Violence

Very segregated -- even after Apartheid ended, signs for "White Only" areas stayed up (form of white resistance) Pre-1500s: Bantu Expansion (migration, trade, and conquest in the region) 1488-1660: Cape Town hosts 1st European explorer (Portuguese); Dutch and English competition; Dutch port established (slaves and trade) -- were looking for India and spices for meat 1880-1950: Gold discovery; Anglo-Boer Wars; Native Land Act of 1973 (Only 7% of arable land went to blacks) 1945-1948: White South African Independence from British 1948-1992/4: Apartheid; racial segregation through laws and legislation; black resistance; police brutality 1992: Referendum to end Apartheid

Drug-trafficking: Opium and Heroine in Asia

Vietnam, Thailand, Laos, Afghanistan, Pakistan, Burma, Colombia, Mexico -- big areas of drug trafficking Opium is grown in places where farmers are poor -- important cash crop Thailand's Highway 107 -- known very well as HIV highway - Opium was trafficked through this highway as well

Medically, your risk of HIV transmission is dependent on...

Viral load of source case Nature of exposure (how you received it -- through needle, sex, etc.) Susceptibility of recipient (what is going on with the immune system of person receiving it)

Outbreak Narrative

Whenever a new disease becomes a big thing, there's an outbreak narrative which encapsulates how people respond to this unknown 3 parts: - Identification of an emerging infection (The Panic) - Discussion of global networks through which diseases travel (The Problem) - Chronicle of the epidemiological and medical work that results in disease containment (The Heroes)

Bathhouses

Where gay men congregated to have sex Some worried bathhouses poorly represented gay men ("I don't want everyone to think that's where all gay men go") Some bathhouses were hesitate to let officials investigate because they were worried about confidentiality of clients/stigma Hundreds to thousands of men went to bathhouses Poppers also commonly used for a cheap high

Are all ages and sexes affected equally by HIV infection?

Women infected much earlier than men - On average, 10 years earlier Why? - Gender inequality (woman's inability to negotiate sex and risk reduction) - Age differences in sex partners - Multiple sex partners - Biological reasons (increased virus in semen vs. vaginal secretions -- more fluid from male than female. Also an increased surface area of cervix and vagina than male urethra. Younger women also have thinner epithelium cell lining, which makes them more vulnerable -- older women have thicker lining, which is more protective)