The beginning of the twentieth century saw the emergence of the discipline of genetics. It is striking how many female scientists were contributing to this new field at the time. At least three female pioneers succeeded in becoming professors: Kristine Bonnevie (Norway), Elisabeth Schiemann (Germany) and the Tine Tammes (The Netherlands). The question is which factors contributed to the success of these women's careers? At the time women were gaining access to university education it had become quite the norm for (...) universities to be sites for teaching and research. They were still expanding: new laboratories were being built and new disciplines were being established. All three women benefited from the fact that genetics was considered a new field promising in terms of its utility to society; in the case of Tammes and Schiemann in agriculture and in the case of Bonnevie in eugenics. On the other hand, the field of genetics also benefited from the fact that these first female researchers were eager for the chance to work in science and wanted to make active contributions. They all worked and studied in environments which, although different from one another, were positive towards them, at least at the start. Having a patron was generally a prerequisite. Tammes profited from her teacher's contacts and status. Bonnevie made herself indispensable through her success as a teacher and eventually made her position so strong that she was no longer dependent on a single patron. The case of Schiemann adds something new; it shows the vulnerability of such dependency. Initially, Schiemann's teacher had to rely on the first generation of university women simply because he was unable to attract ambitious young men to his institute. In those early, uncertain years of the new discipline, male scientists tended to choose other, better established, and more prestigious disciplines. However, when genetics itself had become an established field, it also became more attractive to men. Our case studies also demonstrate that a new field at first relatively open to women closes its doors to them once it becomes established. (shrink)

Filosofisk værk om kærlighed med udgangpunkt i personalismen.

We argue that lateralities are not merely a result of phylogenetic processes but reflect probability functions that are influenced by task characteristics and extended practice. We support our argument by empirical findings on lateral biases in early infancy in general, and footedness in particular, and on hand preferences in nonhuman primates.

Everett’s Relative State Interpretation has gained increasing interest due to the progress of understanding the role of decoherence. In order to fulfill its promise as a realistic description of the physical world, two postulates are formulated. In short they are for a system with continuous coordinates \, discrete variable j, and state \\), the density \=|\psi _j|^2\) gives the distribution of the location of the system with the respect to the variables \ and j; an equation of motion for the (...) state \. The first postulate connects the mathematical description to the physical reality, which has been missing in previous versions. The contents of the standard postulates are derived, including the appearance of Hilbert space and the Born rule. The approach to probabilities earlier proposed by Greaves replaces the classical probability concept in the Born rule. The new quantum probability concept, earlier advocated by Deutsch and Wallace, is void of the requirement of uncertainty. (shrink)

What makes some human rights campaigns for the physical integrity rights of prisoners more effective than others? Despite various normative arguments condemning these practices, only limited systematic analysis documents the relative effectiveness of different arguments on individuals. This is surprising, because the success of human rights campaigns depends on getting individuals to care about and support policy positions that protect human rights. We constructed an experiment to compare the effects of six different arguments against prisoner abuse and torture. We found (...) that an argument which emphasized the suffering of the prisoner had a consistently positive and significant effect on opposition to torture and prisoner abuse. However, this effect was largely contingent on subjects’ political ideology. Political conservatives actually became less opposed to torture, on average, after reading the same argument emphasizing the prisoners’ suffering or the sacredness of human beings. (shrink)

The recorded musical text -- Recording, repetition, and meaning in absolute music -- Schnabel's rationalism, Gould's pragmatism -- Digital mythologies -- Beethoven and the iPod Nation -- Photo/phono/pornography -- Mahler as imagist.

Background: We previously showed, by means of an online-based survey, that the belief of being infected by coronavirus disease 2019 acted as a nocebo and predicted higher perception of symptoms similar to COVID-19 symptoms. However, there is little known about the psychological mechanisms that give rise to beliefs such as certainty of being infected by COVID-19, and this was investigated in the present study.Objective: Using the same data from the previous online survey with the same research team, we further investigated (...) whether certainty of being infected by COVID-19 is associated with age, sex, health anxiety, and/or personality traits.Methods: Respondents filled out an online survey with 57 questions about symptoms similar to COVID-19, certainty of being infected by COVID-19, anxiety, stress, health anxiety, and personality dimensions.Results: Higher levels of conscientiousness and health anxiety were independently associated with certainty of being infected by COVID-19. The model predicted 29% of the variance in certainty of being infected by COVID-19.Conclusion: Being conscientious and worried about health issues were associated with the belief of being infected by COVID-19. Such finding may have implications for health care personnel who provide COVID-19 testing or consulting services to general population, as individuals high in these traits may over-report COVID-like symptoms. Theoretically, these findings point to psychological factors that may increase nocebo and possibly placebo effects. Clinically, the findings suggest that individuals high in conscientiousness and health anxiety may be more likely to over-report their bodily experiences. (shrink)

Genetic information and technologies are increasingly important in health care, not only in technologically advanced countries, but world-wide. Several global factors promise to increase future demand for morally conscious genetic health services and research. Although they are the largest professional group delivering health care world-wide, nurses have not taken the lead in meeting this challenge. Insights from feminist analysis help to illuminate some of the social institutions and cultural obstacles that have impeded the integration of genetics technology into the discipline (...) of nursing. An alternative model is suggested - the transdisciplinary model - which was developed initially by a nurse and introduced in the 1970s into the delivery of health care and social services for children with developmental disabilities. This holistic model enables all health care professionals to have an equal voice in determining how genetic health care will be globalized. (shrink)

The current case study focused on a crucial match in the qualification for the Norwegian Premier League. In the match, the participants of the study experienced a radical change in performance toward the end of the second half, from being behind by several goals to scoring 3 goals in 6 min and winning the qualifying game. The purpose of this study was therefore to examine the perceptions and reflections of players and coaches on what occurred within their own team and (...) within the opposing team. The momentum shift in the opposition team can be described as a collective collapse. In the study, the theoretical collective collapse process model was used as a guide for the design of the interview questions where five semi-structured interviews were conducted with participants involved in the match. The participants watched excerpt clips from the match to recall the main events, which they subsequently reflected on. The results highlighted the importance of the “before-game” aspects, the “during-the-game” behavior and the cognitive and emotional reactions to the match unfolding. In addition, social contagion processes were evident in both teams relating to emotion and behavior. Overall, the data from this study investigated the general structure of the process model of collective sport team collapse and found support for the notion of a temporal cascade of causes for a team collapse. Future research is encouraged to examine this model, to provide guidance to teams, coaches, and sport psychologists in order to make recommendations for dealing with collective collapse in sport teams. (shrink)

Individual soccer performance is notoriously difficult to measure due to the many contributing sub-variables and the variety of contexts within which skills must be utilised. Furthermore, performance differs across rather specialised playing positions. In research, soccer performance is often measured using combinations of, or even single, sub-variables. All too often these variables have not been validated against actual performance. Another approach is the use of proxies. In sports research, the age of athletes when winning championship medals has been used as (...) a proxy for determining their age of peak performance. In soccer, studies have used the average age of players in top European leagues or in the Champions League to determine the age of individual peak performance. Such approaches have methodological shortcomings and may underestimate the peak. We explore the use of a new proxy, the age at nomination for major individual awards, to determine the average age at peak individual soccer performance. A total of 1,981 players nominated for major awards from 1956 to 2019 were included, and a subset of 653 retired players was extracted, thus including players’ complete careers. Players’ average ages at nomination, at their first nomination, and at their last ever nomination were calculated, and differences across playing positions were calculated together with changes over time in the average age at peak. Based on our proxy, the age of individual peak soccer performance occurs around 27–28 years, varying across playing positions from 26 to 31 years. A player’s first peak, on average, seems to coincide with known peaks of physiological variables; their last-ever peak occurs long after physiological performance has started to decline, indicating that the decline can be compensated for by other variables. The peak age is higher than previously reported for soccer; however, it is similar to those in other team ball sports. The average age at peak performance has increased over time, especially in the last decade. Our approach of using proxies for unearthing information about hidden features of otherwise immeasurable complex performance appears to be viable, and such proxies may be used to validate sub-variables that measure complex behaviour. (shrink)

Published data show that new HIV prevention strategies including treatment‐as‐prevention and pre‐exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV‐based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment‐as‐prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment‐as‐prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment‐as‐prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV‐based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

Published data show that new HIV prevention strategies including treatment-as-prevention and pre-exposure prophylaxis (PrEP) using oral antiretroviral drugs (ARVs) are highly, but not completely, effective if regimens are taken as directed. Consequently, their implementation may challenge norms around HIV prevention. Specific concerns include the potential for ARV-based prevention to reframe responsibility, erode beneficial sexual norms and waste resources. This paper explores what rights claims uninfected people can make for access to ARVs for prevention, and whether moral claims justify the provision (...) of ARV therapy to those who do not yet clinically require treatment as a way of reducing HIV transmission risk. An ethical analysis was conducted of the two strategies, PrEP and treatment-as-prevention, using a public health stewardship model developed by the Nuffield Bioethics Council to consider and compare the application of PrEP and treatment-as-prevention strategies. We found that treating the person with HIV rather than the uninfected person offers advantages in settings where there are limited opportunities to access care. A treatment-as-prevention strategy that places all the emphasis upon the positive person's adherence however carries a disproportionate burden of responsibility. PrEP remains an important option for receptive partners who face increased biological vulnerability. We conclude that the use of ARV for prevention is ethically justified, despite imperfect global to drugs for those in clinical need. The determination of which ARV-based HIV prevention strategy is ethically preferable is complex and must take into account both public health and interpersonal considerations. (shrink)

This paper examines how first Rousseau and later Marx both try to tackle heritage as tradition. Following Althusser’s analysis, it is argued that Rousseau’s attempt at solving the problem fails, and that Marx, although his initial approach to the pro- blem resembles that of Rousseau, in his mature writings finds a more constructive way to deal with tradition as ideology. Finally, it is suggested that the failure of Rousseau’s approach may be due to his way of framing the question.

Recension av Caterina Stenius, ”Sanningen är alltid större. En essä på sju famnars djup” (Vasa: Förlaget Scriptum, 2022).

When E. M. Forster published the novel Howards End in 1910, it was at the height of ‘the inheritance society’, and the gulf between rich and poor was great and problematic; a fact that Forster was very well aware of. Yet in spite of this, the main character in Howards End, Margaret Schlegel, is a financially independent rentier living off of the wealth of her ancestors, and her wealth increases when she is named the ‘spiritual heir’ of Ruth Wilcox and (...) thus inherits the house of Howards End. In this study, I argue that Forster shifts the focus from inherited money to inherited values in order to pardon a society of great inequality. Drawing on an aristocratic principle, Forster thus deals with inheritance as an inalienable and spiritual subject rather than as a legal and economic one. (shrink)

While it is well-known that the intense albeit short-lived Hegel renaissance of the 1930s’ and 1940s’ France had a huge influence on later intellectual currents of the 20th century, its importance to Simone de Beauvoir is often left unnoticed or reduced to her appropriation of the master/slave dialectic. This paper argues that Beauvoir – who came to know Hegel through the work of Alexandre Kojève as well as her own studies during the war – in fact, makes recourse to Hegelian (...) dialectics in her conceptual composition of the ‘woman problem’ in The Second Sex. The paper identifies four figures of femininity, from the abstract mystique of the ‘Sphinx’ to the internal conflict of ‘The Little Mermaid’, and shows how the negative determinations culminate in a figure of contradiction, which implies that we may interpret The Second Sex as a work of critical thought. This means that the Hegelian legacy of feminist critique has as its objective an emancipatory project rather than equality. (shrink)

The article discusses different but related figures of trans-generational heritage in the writings of Hannah Arendt, Walter Benjamin, Heinrich Heine, and Sigmund Freud. The common ground of these German-Jewish authors is an interpretative pattern within the theory of history/memory based in the idea of a strong bond of subsequent generations and their interrelation, which refers back to the biblical origins of the idea of ‘heritage’. Both Heine and Benjamin hypothesize a secret agreement between the generations, which might be read as (...) the origin of the idea of solidarity. In Freud’s psychoanalysis we find a complementary concept in the figure of ‘archaic heritage’ elaborated in Monotheism, namely a trans-generational trans- feral of repressed memories of the ancestors to their offspring. While Freud, not coincidentally after the First World War and during the rise of Nazism, discovers the unconscious transfer of guilt, Arendt seeks – after the Second World War – to regain, in the space between human beings, action as the space of the political. By emphasizing ‘natality’ as a basic human condition she invests policy in the acting of men in history with the condition of the possibility of a new beginning. The future, according to the insight of these authors, will not be created in abstract images or produced by means of a program, but will come into being by the treatment of the past and the heritage of those who lived before us and by the way in which we act in the present. (shrink)

Inheritance is about cold cash and warm emotions. On a macroeconomic level inherited wealth is a source of inequality, but on a personal level it is a gift between relatives that can involve gratitude, but also a sense of obligation and duty continuity, but also conflicts. These perspectives often clash in public discussions about inheritance law and taxation. This article discusses the implicit notions about inheritance and their relationship to positions in the public debate in three Danish filmic works: Per (...) Fly’s Inheritance (2003), first season of the TV-series The Heirs (2014) and Christian Sønderby Jepsen’s The Will (2011). (shrink)

1. ʻArve naḥal, ḥashivuto shel kol Yehudi --2. Isur hitḥabrut ʻim reshaʻim--3. Ketsad la-ʻazor le-vaʻale teshuvah.

There is no cure or vaccine for HIV/AIDS. The only life-prolonging treatment available is antiretroviral (ARV) therapy. WHO estimates, however, that less than 5 percent of those who require treatment in developing countries currently enjoy access to these medicines. In Africa fewer than 50,000 people–less than 2 percent of the people in need–currently receive ARV therapy. These facts have elicited strongly divergent reactions, and views about the appropriate response to this crisis have varied widely.The intensity of the debate concerning access (...) to life-prolonging medicines for the treatment of HIV/AIDS, and the heated rhetoric with which they are often conducted, suggest that these disagreements may be rooted in deeper disagreements of value. It is not obvious, however, what disagreements of value are at stake in this debate. By analyzing the statements of scholars, public officials, activist organizations, and private sector representatives, each of whom may endorse very different policy recommendations on access to HIV/AIDS drugs, we have identified and created a typology of the different sources of disagreement in the debate. We conclude that the central disagreements concerning access to medicines arise from competing understandings of how responsibilities for bringing remedy to hardships should be allocated to different agents and institutions. A central lesson that emerges from our analysis is that thinking about “health equity” must extend beyond the explanation and justification of goals, values, and ideals, and engage more honestly with the difficult question of how responsibilities for bringing remedy to health crises should be allocated in complex social contexts. (shrink)

Gutenbergs tryckteknik ledde till en medierevolution som förändrades Europa. I 1500-talets början spreds litteratur, grafik och vetenskap, men också nyhetsblad om katastrofer, pamfletter om invaderande turkar och religiösa stridsskrifter. Medan mycket ännu vägde blommade renässanshumanismen genom Erasmus av Rotterdam. Han stod bakom en femtedel av Europas böcker, och skulle ge framtiden ett viktigt arv. Nina Burton skriver om Erasmus och hans tid så att man känner sig vara med när han träffar konstnärerna och de intellektuella? Albrecht Dürer, Holbein d.y., Paracelsus, (...) Thomas More och Luther? lika väl som påvar, kejsare, pedagoger och rebeller. Genom honom möter man en hel epok. Vilken var Erasmus hemlighet? I sina brev klottrade han självporträtt med dubbla ansikten, och hans förmåga att se två sidor födde ett samtal bortom all fanatism? en dröm om ett gränslöst Europa, där kultur och vetenskap knöt nya samband. Men då religiösa strider började skaka världen fick han mäktiga fiender. Erasmus visade vilken roll litteraturen kan spela i en dramatisk tid som har många likheter med vår egen. (shrink)

Las dificultades para garantizar el suministro de medicamentos específicos para el tratamiento del virus de inmunodeficiencia humana / síndrome de inmunodeficiencia adquirida (VIH/sida) son recurrentes ante el avance de políticas de ajuste. En Argentina, el engranaje que sostiene el cumplimiento de obligaciones en salud pública es permeable a las crisis. El problema se focaliza en el momento más agudo de la crisis de diciembre de 2001, y se trabajó desde la perspectiva de Oszlak y O´Donnell. Objetivo: reconstruir los procesos de (...) discusión, generación e implementación de políticas públicas desde el Ministerio de Salud de la Nación —específicamente en su vínculo con las agencias internacionales—, con el fin de garantizar el suministro de antirretrovirales (ARV) a todas las personas viviendo con VIH/sida del país. Con un abordaje cualitativo, se utilizaron cuatro expedientes de la gestión de medicamentos del Ministerio de Salud de la Nación, actas de comisiones y se realizaron entrevistas individuales semiestructuradas a actores clave según su rol durante la emergencia sanitaria. Se presenta una categoría de la primera dimensión: estrategias implementadas por el Estado para garantizar la adquisición de ARV, categoría agencias internacionales. Se construyó una matriz de datos para analizar la información. La reconstrucción muestra que la problemática tenía agenda internacional y que los compromisos debían cumplirse a pesar de la crisis. En el marco de los derechos económicos, sociales y culturales, se encuentran tensiones y contradicciones, teniendo en cuenta la progresividad y no regresividad de los derechos. Los estados tienen doble presión internacional: organismos que monitorean indicadores de derechos y organismos de préstamo que definen en qué pueden gastar los países receptores. Los estados débiles institucionalmente, con baja autonomía y en crisis generan vulnerabilidad programática. El acceso a medicamentos es fundamental para alcanzar el derecho a la salud y es una problemática constante en países emergentes. (shrink)

In this study a combination of computer tools for coupling and virtual screening is detailed, in 108 active molecules and 3620 decoys to find stabilizers for G quadruplex. To have more precise results, combinations of coupling programs with fifteen energy scoring functions were applied. The validation and evaluation of the metrics was done with the CompScore genetic algorithm. The results showed an increase in BEDROC and EF of 50% compared to other strategies, as well as reflecting early recognition of active (...) molecules. From these results it is possible to work with the molecules that showed a good early recognition and evaluate their effect as G4 stabilizers. This ensures more efficient and accurate results in the preclinical stage for the development of anticancer drugs. Keywords: Enrichment metrics; telomere; G quadruplex ; CompScore. References [1]M. Porru, P. Zizza, M. Franceschin, C. Leonetti and A. Biroccio. «EMICORON: A multi-targeting G4 ligand with a promising preclinical profile» 2017. Biochimica et Biophysica Acta - General Subjects, 1861, 1362–1370. [Online]. Available: https://doi.org/10.1007/s00294-018-0836-6. [2]K. Tomita. «How long does telomerase extend telomeres? Regulation of telomerase release and telomere length homeostasis». Current Genetics, 64, 1177–1181. 2018. [Online]. Available: https://doi.org/10.1016/j.bbagen. 2016.11.010. [3]M. Jafri, S. Ansari, M. Alqahtani and J. Shay. «Roles of telomeres and telomerase in cancer, and advances in telomerase-targeted therapies. Genome Medicine., 2016. [Online]. Available: https://doi.org/10.3390/ijms19020482. [4]J. Huppert and S. Balasubramanian. «G-quadruplexes in promoters throughout the human genome». 35, 406–413. 2007. [Online]. Available: https://doi.org/10.1016/j.bbapap.2017.06.012. [5]S. Joy, Vijayakumar, S. Choi and H. Sunhye. «Role of computer-aided drug design in modern drug discovery». Archives of Pharmacal Research. 2015. [Online]. Available: https://doi.org/10.1007/s12272-015-0640-5. [6]S. Asamitsu, S. Obata, Z. Yu, T. Bando and H. Sugiyama. «Recent Progress of Targeted G-Quadruplex-Preferred Ligands Toward Cancer Therapy». Molecules, 24, 429. 2019. [En línea]. Available: https://doi.org/10.3390/molecules24030429. [7]R. Monsen and J. Trent. «Biochimie G-quadruplex virtual drug screening : A review». Biochimie, 152, 134–148. 2018. [Online]. Available: https://doi.org/10.1039/c9cc06748e. [8]J. Beauvarlet, P. Bensadoun, E. Darbo, G. Labrunie, E. Richard, I. Draskovic and M. Djavaheri-mergny. «Modulation of the ATM / autophagy pathway by a G-quadruplex ligand tips the balance between senescence and apoptosis in cancer cells». 1–18. 2019. [Online]. Available: https://doi.org/10.1093/nar/gkz095. [9].Z. Crees, J. Girard, Z. Rios, G. Botting, K. Harrington and C. Shearrow. « Oligonucleotides and G-quadruplex stabilizers: targeting telomeres and telomerase in cancer therapy».2014. [Online]. Available: https://doi.org/10.2174/1381612820666140630100702. [10].M. Meier, A. Moya-torres, N. Krahn, M. Mcdougall, L. Orriss, E. Mcrae and T. Patel. «Structure and hydrodynamics of a DNA Gquadruplex with a cytosine bulge»., 1–13. 2018. [Online]. Available: https://doi.org/10.1093/nar/gky307. (shrink)

Hans Skjervheim har hatt stor betydning for norsk åndsliv og offentlig ordskifte. Han hadde en unik evne til å vise hvordan tidløse filosofiske problemstillinger ikke bare angår fagfilosofer, men også er til stede i den politiske debatt og i hverdagens små og store utfordringer. Mange forbinder nok Skjervheim særlig med ±positivismestriden? på 1960- og 1970-tallet. Denne antologien viser bredden i virksomheten hans, og at mange av Skjervheims tekster har noe betydelig å si om også vår egen tids utfordringer - blant (...) annet om tiltroen til vitenskapen, filosofiens rolle, forvitringen av den liberale orden, økologisk krise, algoritmestyrte sosiale medier, ±fake news? og identitetspolitikk. Forfatterne er en blanding av en eldre garde, som skrev og virket samtidig med Skjervheim, og en yngre garde bestående av toneangivende fagpersoner fra ulike fagområder i dag. De tar alle for seg en eller flere sentrale tekster av Skjervheim og leser dem inn i samtidige problemstillinger. Disse nylesningene aktualiserer og bruker av Skjervheims filosofiske og litterære arv, men peker også på blindflekker og svakheter i hans tenkning - helt i tråd med slik Skjervheim ønsket å bli lest. (shrink)

In May 2011, the Brazilian Ministry of Health announced the distribution of the first batch of locally produced generic tenofovir disoproxil fumarate (TDF) to support its program of universal and free access for the treatment of HIV/AIDS. The inclusion of TDF in the public health program illustrates what has been considered the ‘Brazilian model’ of HIV/AIDS response, as it illustrates the current phase of the Brazilian pharmaceutical economy. Brazil is known for having managed to control the expansion of HIV/AIDS through (...) a unique initiative combining the public health and the industrial production of generics. But, if at first local manufacturers could freely copy ARVs and produce cheaper generic versions that were delivered to the Ministry of Health, since the country started to grant patents on drugs in 1996, the sustainability of this policy has been challenged by the high cost of patented second-line HIV/AIDS treatments. In order to assure continuity of the local production of ARVs, and keep the program of public health alive, Brazilians are now forced to deal with conflicts of drugs' intellectual property rights in order to open the path to generic production. This article aims to describe the experiences surrounding TDF in Brazil and the unprecedented conflicts and challenges it has brought for our different interviewees. Blurring the frontier between the public and the private, the TDF case was driven at the same time by an ethic of drug access and regulation of drug quality, which has inspired Brazilians to intervene and transform the world they live in. (shrink)

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

Drawing on the theoretical frameworks of antiblackness and intersectionality and the concept of viral visibility, this essay attends to the considerable archive of research about endemic Kaposi’s sarcoma in sub-Saharan Africa accrued during the mid-20th century. This body of data was inexplicably overlooked in Western research into KS during the first decade of the AIDS epidemic, during which period European and Mediterranean KS cases were most often cited as precedents despite the volume of African data available. This paper returns to (...) the research on KS conducted in Africa during the colonial and postcolonial period to consider visibility, racial erasure, and discourses of global epidemiology, suggesting that the dynamics of medical research on HIV/AIDS have proceeded according to a tacit paradigm of antiblackness manifest in multiple exclusions of Africa from global health agendas—most recently the exclusion of the region from antiretroviral drug therapy during the first decades of the treatment’s availability. During that decade KS all but disappeared among people with access to ARV therapy while KS became even more prevalent in sub-Saharan Africa, escalating along with HIV. (shrink)

Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV‐infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm‐shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the (...) goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic?Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV‐infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm‐shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug‐allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs. (shrink)

In my quest for Aurai in Greek art, I have been surprised by the haste of commentators to label each and every running woman as a Nereid. Surely it should depend on the evidence. I begin with two Attic pyxides in the Fitzwilliam Museum, Cambridge. The first GR 1. 1933 was given and published by Miss Lamb in CVA Cambridge ii pl. 26. In Beazley, ARV 297, this vase was said to be in the Manner of Douris. In ARV 451 (...) this vase has lost its own reference and acquired that of GR 10. 1934.‘Nereids’ is an inadequate description of either vase; for both include different sexes.The pyxis 1. 1933 is not in good condition. The central figure is surely not the male, as Miss Lamb says, but a running woman taking up twice as much room as anyone else. She holds one dolphin and has lost another, so she must be the heroine Thetis. On one side of her stands a man with a dark beard, but he holds an old man's crooked stick, so he must be Nereus in spite of his dark beard: and a frightened Nereid rushes by him to the left: on a third side a stationary woman has just frightened a woman with a sceptre off her chair; the sceptre holder must be Doris. Here then we have a Peleus and Thetis scene, but there is no room for Peleus. (shrink)

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

The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to reduce (...) risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment. (shrink)

Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the (...) goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic? Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV-based pre-exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at-risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother-to-child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive (...) measures. In this sense, it represents a new bio-technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource-poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

Amidst growing global endorsements of new biomedical HIV prevention strategies, ARV‐based pre‐exposure prophylaxis (ARV PrEP) has garnered considerable attention as a potentially promising prevention strategy. Though it may offer more effective protection for certain at‐risk groups than conventional prevention strategies (such as sexual partner reduction, condom use, and prevention of mother‐to‐child transmission), PrEP is more costly. PrEP requires more ongoing contact between individuals and providers, and a level of surveillance from the health system that is not necessary with other preventive (...) measures. In this sense, it represents a new bio‐technology for HIV prevention that poses particular challenges for worldwide implementation, given developing countries’ struggling health systems and incomplete HIV treatment programs. Since the emergence of PrEP has stimulated ethical discussions premised on incomplete knowledge of efficacy and implementation, this paper explores the ethical parameters of a likely scenario for PrEP usage in a single, resource‐poor country. We first develop a plausible model for PrEP deployment and utilization based on current PrEP research, while carefully considering the reigning institutional values of feasibility and effectiveness in global health approaches. Drawing on ethnographic research of HIV treatment and prevention approaches in Lesotho, we address ethical questions arising from this scenario of PrEP delivery. Lesotho presents a compelling and emblematic case study of PrEP's potential successes and pitfalls in a developing country, given the country's high HIV prevalence, struggles to achieve universal access to HIV treatment regimes, continued existence of stigma around the epidemic, and difficulties in addressing persistent social inequalities that fuel infections. (shrink)

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to the (...) first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about also require critical examination. (shrink)