Author: Matt Johnson

A Queer Health Reading List

The following is a list of books and articles related to queer health that might be useful for some individuals interested in the topic. The list is by no means exhaustive.

HIV:

  1. Race, K. (2016). Reluctant Objects Sexual Pleasure as a Problem for HIV Biomedical Prevention. GLQ: A Journal of Lesbian and Gay Studies22(1), 1-31.
  2. Gonzalez, O. R. (2010). Tracking the bugchaser: Giving the gift of HIV/AIDS. Cultural Critique75(1), 82-113.

Research & Infrastructures:

  1. Nguyen, V. K. (2009). Government-by-exception: Enrolment and experimentality in mass HIV treatment programmes in Africa. Social Theory & Health7(3), 196-217.
  2. Murphy, M. (2017). The economization of life. Duke University Press.

Regarding MSM:

  1. Boellstorff, T. (2011). But do not identify as gay: A proleptic genealogy of the MSM category. Cultural Anthropology26(2), 287-312.
  2. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American journal of public health95(7), 1144-1149.

Medical interventions:

  1. Epstein, Steven. 2010. “The great undiscussable: Anal cancer, HPV, and gay men’s health.” In Three shots at prevention: The HPV vaccine and the politics of medicine’s simple solutions, edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz. Baltimore: Johns Hopkins University Press, pp. 61 -90.
  2. Blackwell, Courtney, Jeremy Birnholtz, and Charles Abbott. 2014. Seeing and being seen: Co-situation and impression formation using Grindr, a location-aware gay dating app. New Media & Society: 1461444814521595.

Precarity:

  1. Butler, J. (2006). Precarious life: The powers of mourning and violence. Verso.

PrEP:

  1. Fiereck, K. J. (2015). Cultural Conundrums: The Ethics of Epidemiology and the Problems of Population in Implementing Pre-Exposure Prophylaxis. Developing World Bioethics15(1), 27–39. http://doi.org/10.1111/dewb.12034
  2. Singh, J. A., & Mills, E. J. (2005). The Abandoned Trials of Pre-Exposure Prophylaxis for HIV: What Went Wrong? PLoS Medicine2(9), e234. http://doi.org/10.1371/journal.pmed.0020234
  3. Calabrese, S. K., Earnshaw, V. A., Underhill, K., Hansen, N. B., & Dovidio, J. F. (2014). The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS Behav, 18(2), 226-240. doi:10.1007/s10461-013-0675-x
  4. Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002
  5. Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816
  6. Dumit, J. (2012). Drugs for life: how pharmaceutical companies define our health. Duke University Press.

Trans health:

  1. Plemons, E. D. (2014). It is as it does: Genital form and function in sex reassignment surgery. Journal of Medical Humanities35(1), 37-55.
  2. Preciado, Paul Beatriz. 2013. Testo junkie: Sex, drugs, and biopolitics in the pharmacopornographic era. New York: The Feminist Press at CUNY. (End of “The Micropolitics of Gender,” pp. 365 – 398).
  3. Spade, Dean. 2006. “Mutilating Gender.” In The Transgender Studies Reader, edited by Susan Stryker and Stephen Wittle. New York: Routledge, 315-32.
  4. Currah, Paisley. 2008. Expecting bodies: the pregnant man and transgender exclusion from the Employment Non-Discrimination Act. Women’s Studies Quarterly, 36(3&4).
  5. Crawford, Lucas Cassidy. 2008. Transgender without organs? Mobilizing a geo-affective theory of gender modification. WSQ: Women’s Studies Quarterly, 36(3&4): 127-43.
  6. Butler, J. (2001). Doing justice to someone: Sex reassignment and allegories of transsexuality. GLQ: A Journal of Lesbian and Gay Studies7(4), 621-636.
  7. Karaian, Lara. 2013. Pregnant men: Repronormativity, critical trans theory and the re (conceive)ing of sex and pregnancy in law. Social & Legal Studies: 0964663912474862.

Critical Disability Studies:

  1. McRuer, R., & Wilkerson, A. L. (Eds.). (2003). Desiring disability: Queer theory meets disability studies. Duke University Press.
  2. Cheslack-Postava, Keely, and Rebecca M. Jordan-Young. 2012. Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine 74(11): 1667-1674.
  3. Jack, Jordynn. 2011. The Extreme Male Brain? Incrementum and the Rhetorical Gendering of Autism. Disability Studies Quarterly 31(3). http://dsq-sds.org/article/view/1672/1599
  4. Garland-Thomson, R. (2005). Feminist disability studies. Signs: Journal of Women in Culture and Society30(2), 1557-1587.
  5. Shakespeare, T. (2006). The social model of disability. The disability studies reader2, 197-204.
  6. Breckenridge, C. A., & Vogler, C. A. (2001). The critical limits of embodiment: Disability’s criticism. Public Culture13(3), 349-357.

Masculinity & health:

  1. MacLeish, Kenneth T. 2012. Armor and anesthesia: exposure, feeling, and the soldier’s body. Medical anthropology quarterly 26(1): 49-68.
  2. Oudshoorn, Nelly. 2000. “Imagined men: Representations of masculinities in discourses on male contraceptive technology.” In Bodies of technology: Women’s involvement with reproductive medicine, edited by Ann Rudinow Saetnan, Nelly Oudshoorn, and Marta Kirejczyk. Columbus: Ohio State University Press, 123-45.
  3. Serlin, David. 2006. “Disability, masculinity, and the prosthetics of war, 1945 to 2005.” In The prosthetic impulse: From a posthuman present to a biocultural future, edited by Marquard Smith and Joanne Mora. Cambridge: The MIT Press, 155-86.
  4. Shakespeare, T. (1999). The sexual politics of disabled masculinity. Sexuality and disability17(1), 53-64.

Gender theory, race, and reproductive health:

  1. Waggoner, Miranda R. 2015. Cultivating the maternal future: Public health and the prepregnant self.” Signs 40(4): 939-962.
  2. Franklin, Sarah. 2013. Biological Relatives: IVF, Stem Cells, and the Future of Kinship. Durham: Duke University Press. (“Miracle Babies” and “Reproductive Technologies,” pp. 31 – 67 and 150 – 84).
  3. Murphy, M. (2012). Seizing the means of reproduction: Entanglements of feminism, health, and technoscience. Duke University Press.
  4. Roberts, Dorothy E. Killing the black body: Race, reproduction, and the meaning of liberty. Vintage Books, 1999.
  5. Bridges, Khiara. 2011. Reproducing race: An ethnography of pregnancy as a site of racialization. Berkeley: The University of California Press. (“The Production of Unruly Bodies” and “The ‘primitive pelvis,’ racial folklore, and atavism in contemporary forms of medical disenfranchisement,” pp. 74 – 100 and 103-43).

39th Minority Health Conference – 23 Feb

The 39th Minority Health Conference will be held at the Friday Center in Chapel Hill next week (Friday, February 23, 2018). According to the conference website, “This year’s theme, Reclaiming the Narrative, is based in the recognition that the world is organized by the stories we tell. Stories have the power to influence the way we view ourselves and others and have the power to shape our actions. Given this sometimes unacknowledged influence, we must ask who are the storytellers, and who benefits from these narratives. The answers to these questions can offer an understanding of how we as public health professionals can progress and push public health agendas forward in a meaningful way. This year’s theme challenges us to end perpetuation of damaging rhetoric against marginalized communities. It highlights how resilient communities have fought to speak truth to power and refused to have their voices silenced and how public health practitioners can join such efforts. By reclaiming the narrative, communities and public health practitioners can reconcile the past and present and take agency in the future to promote health for all people.”

The event will feature keynote lectures from Monica Raye Simpson, Executive Director of SisterSong Women of Color Reproductive Justice Collective, and Vann R. Newkirk II, MSPH, a staff writer at The Atlantic.

Information about registering for the event in person is available here, but there is also an option to watch a live webcast of the event.

Fore more information about the event, visit their website.

Warming Up Before Your Workout With the RAMP Method

Many people, perhaps especially men, go into the gym for a heavy workout and head straight to the weights. At best, they might take a few minutes on a treadmill before getting into their workout. However, research shows that this isn’t the best way to exercise. A proper warm up can improve the strength and power of your muscles among other benefits (Jeffreys, 2006).

The RAMP method is a three stage (though four letters) method for optimizing your warm up: (1) Raise your heart rate, blood flow, body temperature, etc. (2) Activate the muscles groups you’ll be exercising or that you want to focus on and Mobilize the joints and ranges of motion that will be employed for your workout, (3) Potentiate, referring to using activities more directly related to the sport or workout you’ll be doing (e.g. if I’m doing back squats, here I could start doing air squats or back squat with the bar and slowly add weight up to my working set.)

Using the RAMP method to warm up for leg day, we could start with 5-10 minutes on a treadmill, stairclimber, or using other cardio. Next, we can either mobilize or activate first. In this case, we might use a foam roller or dynamic stretches to mobilize the hip and knee joints. To mobilize the hips, you might try forward and side leg swings, half pigeon pose, or frog pose. Look for dynamic stretches that keep you actively moving through the range of motion rather than static stretches. To activate the leg muscles, especially the glutes, try clams, lateral walks or air squats all using a resistance band. If you have trouble feeling your calves, try one-legged calf raises using your bodyweight or light weights to activate the calf muscles before your workout. For the potentiate phase, move towards the specific exercises for your workout. Perform lunges or squats with just your bodyweight and slowly add weight to your working sets.

 

Jeffreys, I. (2006). Warm up revisited–the ‘ramp’method of optimising performance preparation. Uksca J6, 15-19.

Image: Sutherland, Ben. “Warm up.” 10 Oct 2009. Online image licensed under a Creative Commons Attribution 2.0 Generic (CC-BY2.0). Accessed 30 Jan 2018. https://www.flickr.com/photos/bensutherland/4004584424

Digital Health Symposium at Carolina – Feb 22, 2018

The UNC Health Sciences Library will be hosting the Digital Health Symposium on February 22, 2018 from 8:30am to 2pm. According to the Carolina Digital Health Research Initiative’s (CaDHRI) newsletter (available here), “The theme of the event is “Digital Health Everywhere”, and the symposium will span a wide range of digital health topics. Speakers will include UNC researchers, students, and library staff, as well as representatives from industry, government, and non-profits. Topics will range from app development for different user groups, novel devices for research, ethics in digital health work, and more.” For more information from CaDHRI, visit their website (http://digitalhealth.web.unc.edu/) or follow them on Twitter ().

For anyone (students and faculty) interested in submitting their work as a poster for the conference, the call for posters is open until February 5, 2018 and can be submitted using this google form. To submit, you only need to include an abstract of the poster being submitted, though you can also submit the final poster if you already have on created.

For more information and to register, keep an eye out at http://hsl.lib.unc.edu/dhsymposium

Whether or not you submit your work, you should still save the date for this exciting event!

A Multi-Level Analysis of Barriers to Care: Macro Level (Structural)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men). This post focuses on structural barriers, but the micro and meso level analyses are also available.

At the structural level, queer men, especially those who are men of color, poor, disabled, or uneducated,  face stigma, low health literacy, discrimination, incarceration, poverty, and a general lack of access to healthcare all of which impact their ability to gain access to PrEP and other prevention measures and to continue their treatment and care (Levy et al., 2014; Philbin et al., 2016; Rucker et al., 2017; Thomann et al., 2017). Stigma continues to stand out as a huge structural barrier, especially with respect to access to PrEP or anything related to HIV or sexual health. HIV can often still be considered a “gay men’s disease” or something that only slut and whores have to worry about; these notions continue even from the medical institution, which also continues to emphasize the idea of “Truvada Whores”—the idea that queer men take PrEP in order to participate in riskier sexual behaviors rather than to decrease their risk of contracting HIV (Calabrese et al., 2017; Calabrese & Underhill, 2015). Some providers and researchers have gone so far as to recommend PrEP for everyone; however, we must remember to target PrEP to individuals who are at risk of contracting the disease rather than encouraging everyone to take it even if they are incredibly unlikely to contact HIV (Calabrese, Underhill, et al., 2016). Of course, there are heterosexual individuals who are at risk of contracting HIV, who should likely be taking PrEP, though it has primarily been targeted towards gay men (in sometimes insensitive advertisements that increase stigma for the queer community), but there are also people who don’t have enough risk factors to warrant the medication.

Calabrese, S. K., Magnus, M., Mayer, K. H., Krakower, D. S., Eldahan, A. I., Hawkins, L. A. G., . . . Dovidio, J. F. (2017). “Support Your Client at the Space That They’re in”: HIV Pre-Exposure Prophylaxis (PrEP) Prescribers’ Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS, 31(4), 196-204. doi:10.1089/apc.2017.0002

Calabrese, S. K., & Underhill, K. (2015). How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. Am J Public Health, 105(10), 1960-1964. doi:10.2105/ajph.2015.302816

Calabrese, S. K., Underhill, K., Earnshaw, V. A., Hansen, N. B., Kershaw, T. S., Magnus, M., . . . Dovidio, J. F. (2016). Framing HIV Pre-Exposure Prophylaxis (PrEP) for the General Public: How Inclusive Messaging May Prevent Prejudice from Diminishing Public Support. AIDS Behav, 20(7), 1499-1513. doi:10.1007/s10461-016-1318-9

Levy, M. E., Wilton, L., Phillips, G., Glick, S. N., Kuo, I., Brewer, R. A., . . . Magnus, M. (2014). Understanding Structural Barriers to Accessing HIV Testing and Prevention Services Among Black Men Who Have Sex with Men (BMSM) in the United States. AIDS Behav, 18(5), 972-996. doi:10.1007/s10461-014-0719-x

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

Rucker, A. J., Murray, A., Gaul, Z., Sutton, M. Y., & Wilson, P. A. (2017). The role of patient-provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men. Cult Health Sex, 1-11. doi:10.1080/13691058.2017.1375156

Thomann, M., Grosso, A., Zapata, R., & Chiasson, M. A. (2017). ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Health Sex, 1-15. doi:10.1080/13691058.2017.1380230

A Multi-Level Analysis of Barriers to Care: Meso Level (Interactional & Community)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men). This post focuses on the meso or mid-range level of analysis, and an analysis of the micro level is available from last week.

Black queer men especially lack trust in the pharmaceutical industry as well as in providers and the medical institution themselves (Philbin et al., 2016; Rucker et al., 2017; Thomann et al., 2017). This moves into a community level and interactional level issue where the community has many reasons not to trust providers or drug companies. We can think back to previous studies like the Tuskegee experiments, but we can also think about the lack of adequate care for black patients currently, including limited pain management and less patient-centeredness to name a few examples (Hoffman, Trawalter, Axt, & Oliver, 2016). This is a considerable barrier for providers to overcome in order to provide better treatment to black queer men. Similarly, queer men generally face implicit and explicit bias from providers and receive worse care, and this lack of care is exacerbated by other marginalized social positions (Phelan et al, 2014).

These could also be seen as macro level issues at the institutional level because the medical institution and pharmaceutical industry have constructed a practice that is ineffective for many marginalized individuals. Further, this stems from structural issues in our country such as racism, incarceration, and stigma that limit access to health care and impact our institutions.

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A, 113(16), 4296-4301. doi:10.1073/pnas.1516047113

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

Rucker, A. J., Murray, A., Gaul, Z., Sutton, M. Y., & Wilson, P. A. (2017). The role of patient-provider sexual health communication in understanding the uptake of HIV prevention services among Black men who have sex with men. Cult Health Sex, 1-11. doi:10.1080/13691058.2017.1375156

Thomann, M., Grosso, A., Zapata, R., & Chiasson, M. A. (2017). ‘WTF is PrEP?’: attitudes towards pre-exposure prophylaxis among men who have sex with men and transgender women in New York City. Cult Health Sex, 1-15. doi:10.1080/13691058.2017.1380230

 

A Multi-Level Analysis of Barriers to Care: Micro Level (Individual)

I argued in a previous post that public health should look at factors impacting health using a multi-level approach. In this post, I attempt to outline the various multi-level barriers to medical care (specifically access to PrEP, HIV prevention, and AIDS care) for black queer men (or black men who have sex with men).

At the individual level (the micro level), queer men are skeptical of medication for healthy individuals and wary of the potential side effects caused by these medications (Philbin et al., 2016). These ideas seem to go hand-in-hand. If you don’t want to take medication as a healthy person, you’d be worried about the potential side effects that would ultimately make a health person sick in order to prevent something that you might or might not contract. In this sense, it might be important to make people recognize the real possibility of contract the disease. We’re treating risk here, but preventing the disease is important. Further, the side effects of PrEP are fairly uncommon.

Queer men might think that this medication would be useful for others but not for them. Here, we have to think about assessing the individual patient to decide whether or not PrEP is right for them (Philbin et al., 2016). We’re not treating someone because they’re black and queer, and black queer men have the highest rates of HIV. It’s obviously possible for black queer men to have low associated risk of HIV. Treating high risk means treating patients with high risk factors not treating everyone from a population that has high rates of the disease. However, this presents an added barrier for providers to convince patients with high risks that this is the right drug for them.

Philbin, M. M., Parker, C. M., Parker, R. G., Wilson, P. A., Garcia, J., & Hirsch, J. S. (2016). The Promise of Pre-Exposure Prophylaxis for Black Men Who Have Sex with Men: An Ecological Approach to Attitudes, Beliefs, and Barriers. AIDS Patient Care and STDs, 30(6), 282-290. doi:10.1089/apc.2016.0037

 

 

What is Information Poverty?

The theory of information poverty was originally introduced by Elfreda Chatman (E.A. Chatman, 1991, 1996, 1999). The definition and use of information poverty has developed since Chatman’s original conception, and several scholars have attempted to trace this lineage (Haider & Bawden, 2007; Yu, 2006, 2011). However, Britz (2004) combines the connectivity, content, and human approaches to information poverty to outline seven important elements of information poverty. Using these elements, he provides the following definition: “Information poverty is that situation in which individuals and communities, within a given context, do not have the requisite skills, abilities or material means to obtain efficient access to information, interpret it and apply it appropriately. It is further characterized by a lack of essential information and a poorly developed information infrastructure” (Britz, 2004, p. 204). Lor and Britz (2010) also remind us to question what it means to have access to knowledge, specifically introducing access as an epistemological dimension that looks at information and knowledge socially and to understanding knowledge as a process, an idea derived from constructivist approaches to education.

For example, Lingel and boyd (2013) approached the extreme body modification community to understand information poverty experienced by its members and to examine the information world. Ultimately, they found that the community itself was highly knowledgeable, but stigma contributed to a security culture and hiding of information from outsiders. Further, Savolainen (2016) proposes six socio-cultural barriers to information seeking, which are “barriers due to language problems, barriers related to social stigma and cultural taboo, small-world related barriers, institutional barriers, organizational barriers, and barriers due to the lack of social and economic capital.”

Britz, J. J. (2004). To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science, 30(3), 192-204. doi:10.1177/0165551504044666

Chatman, E. A. (1991). Life in a Small World: Applicability of Gratification Theory to Information-Seeking Behavior. Journal of the American Society for Information Science (1986-1998), 42(6), 438.

Chatman, E. A. (1996). The Impoverished Life-World of Outsiders. Journal of the American Society for Information Science, 47(3), 193.

Chatman, E. A. (1999). A Theory of Life in the Round. Journal of the American Society for Information Science, 50(3), 207.

Haider, J., & Bawden, D. (2007). Conceptions of “information poverty” in LIS: A discourse analysis. Journal of Documentation, 63(4), 534-557. doi:10.1108/00220410710759002

Lor, P. J., & Britz, J. (2010). To access is not to know: A critical reflection on A2K and the role of libraries with special reference to sub-Saharan Africa. Journal of Information Science, 36(5), 655-667. doi:10.1177/0165551510382071

Savolainen, R. (2016). Approaches to socio-cultural barriers to information seeking. Library & Information Science Research, 38(1), 52-59. doi:10.1016/j.lisr.2016.01.007

Yu, L. (2006). Understanding information inequality: Making sense of the literature of the information and digital divides. Journal of Librarianship and Information Science, 38(4), 229-252. doi:10.1177/0961000606070600

Yu, L. (2011). The divided views of the information and digital divides: A call for integrative theories of information inequality. Journal of Information Science, 37(6), 660-679. doi:10.1177/0165551511426246

Multi-level Models of Health Behavior for HIV

In a post about public health and epistemologies of ignorance, I argued that public health interventions have focused solely on the individual rather than looking at other factors impacting health. Moving forward, we need to develop multi-level models of health behavior, so here are a few examples of a multi-level analysis and multi-level models related to HIV prevention and AIDS care. Kaufman et al (2014) present a multi-level analysis of factors impacting HIV-related behavior and behavior change and review a few recent models for looking at HIV-related health behavior from multiple levels. The transtheoretical and health belief models and the theories of reasoned action and planed behavior have been used repeatedly in public health literature about HIV-related health behaviors, but all of these models and theories focus on the individual rather than looking at the individual as part of a larger system.

Kaufman et al (2014) looked at four multi-level models that expand on the individual models of health behavior to look at a more holistic picture:

  1. The Multiple Domain Model: Zimmerman, R. S., Noar, S. M., Feist-Price, S., Dekthar, O., Cupp, P. K., Anderman, E., & Lock, S. (2007). Longitudinal test of a multiple domain model of adolescent condom use. Journal of Sex Research44(4), 380-394.
  2. The Network-Individual-Resource Model: Johnson, B. T., Redding, C. A., DiClemente, R. J., Mustanski, B. S., Dodge, B., Sheeran, P., … & Carey, M. P. (2010). A network-individual-resource model for HIV prevention. AIDS and Behavior14(2), 204-221.
  3. The Dynamic Social Systems Model: Latkin, C., Weeks, M. R., Glasman, L., Galletly, C., & Albarracin, D. (2010). A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS and Behavior14(2), 222-238.
  4. The Transmission Reduction Intervention Project: Friedman, S. R., Downing, M. J., Smyrnov, P., Nikolopoulos, G., Schneider, J. A., Livak, B., … & Psichogiou, M. (2014). Socially-integrated transdisciplinary HIV prevention. AIDS and Behavior18(10), 1821-1834.

These are just a few examples of models that look at factors on multiple levels, specifically for HIV. More work should be done to expand and perfect these models, though the move towards multi-level models is certainly a move in the right direction. We should attempt to use a social-ecological framework with thinking about other public health interventions as well.

Kaufman, M. R., Cornish, F., Zimmerman, R. S., & Johnson, B. T. (2014). Health Behavior Change Models for HIV Prevention and AIDS Care: Practical Recommendations for a Multi-Level Approach. Journal of Acquired Immune Deficiency Syndromes (1999)66(Suppl 3), S250–S258. http://doi.org/10.1097/QAI.0000000000000236

Public Health & Epistemologies of Ignorance

The field of public health has primarily thought about improving health by making changes for individuals. We try to get individual people to quit smoking, make dietary changes to combat obesity, and start using condoms or other safer sex practices to limit exposure to sexually transmitted infections (STIs). However, all of these interventions focus only on changes that individual people are supposed to make. They don’t think about barriers that impact an individuals ability to make these changes or other factors that could be affecting, positively or negatively, the health of individuals.

In thinking about public health interventions, we should think about a multi level analysis, including the micro level (individual), the meso level (interactional, community), and the macro level (institutional, structural). Factors at each of these levels can positively and negatively impact health; however, by only looking at the individual (the micro level), we miss a significant portion of the picture in terms of health, especially when we start thinking about health disparities.

Lisa Bowleg (2017) argues that this represents an epistemology of ignorance, specifically that the focus on the individual and on health as a characteristic solely of the individual (a very neoliberal position), “obscure[s] the role of social–structural factors (e.g., political, economic, institutional discrimination) that constrain the health of historically marginalized individuals, communities, and societies” (678). She continues to argue that “[e]pistemologies of ignorance illustrate that willful ignorance is functional (Alcoff, 2007; Mills, 1997, 2007). Neglecting the historical legacy of how race (as well as the other marginalized social positions that intersect with race) has structured social inequality for people of color in the United States serves to center the health experiences of White people as normative, “color blinds” White privilege to highlight positive health outcomes among White people as the product of their individual actions, and reifies negative stereotypes about the “irresponsible” health behaviors of people of color (Bowleg et al., 2017).” From a political perspective, she argues that this focus on the individual in public health, and in other spheres, limits the political imperative and pressure to conduct research and enact laws that would address the social-structural factors in order to alleviate health disparities.

Bowleg, L. (2017). Towards a Critical Health Equity Research Stance: Why Epistemology and Methodology Matter More Than Qualitative Methods. Health Educ Behav, 44(5), 677-684. doi:10.1177/1090198117728760