Dan Allman

The sociology of social inclusion

This article looks at social inclusion from a sociological perspective. It argues that sociology complements biological and other natural order explanations of social stratification. The article interrogates a variety of forms of social integration, including ostracism within 5th century b.c. Greece, 19th-century solidarism, and Goffman’s mid-20th-century work on stigma. It does so to demonstrate how in each of these contexts, social inclusion and exclusion can function as apparati that problematize people on the margins, and by extension, contribute to their governance and control. The article proposes that sociology provides a valuable orientation from which to consider social inclusion because it illuminates how social integration maintains and manages the ways in which people move about and through their socially stratified worlds.

The prevalence and correlates of hepatitis C virus (HCV) infection and HCV-HIV co-infection in a community sample of gay and bisexual men.

OBJECTIVE To describe hepatitis C virus (HCV) and HIV prevalence and co-infection, and to examine variables associated with infection in a community sample of men who have sex with men (MSM). METHODS Data were from an anonymous, cross-sectional study (N=5080) in Canada. Men self-completed a questionnaire and provided an optional saliva specimen for HCV and HIV testing. Polytomous logistic regressions identified variables associated with HCV, HIV, and HCV-HIV co-infection. RESULTS The prevalences of HCV, HIV, and HCV-HIV co-infection were 1.9%, 9.0%, and 0.7%, respectively. The greatest contribution to HCV (odds ratio (OR) 23.66, 95% confidence interval (CI) 9.69-57.73) and HCV-HIV co-infection (OR 26.76, 95% CI 7.97-89.80) was injection drug use. Sexual behaviors and proxies were associated with HIV but not HCV infection. CONCLUSIONS Results suggest there are subgroups of MSM at risk for HCV. While sexual transmission of HCV was not ruled out, the predominant risk was needle sharing. The greater prevalence of HCV among HIV-positive men suggests the need for greater vigilance in the detection of HCV in this group.

‘Who is Helsinki?’ Sex workers advise improving communication for good participatory practice in clinical trials

After premature closures in 2004 of biomedical human immunodeficiency virus (HIV) prevention trials involving sex workers in Africa and Asia, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Global Advocacy for HIV Prevention (AVAC) undertook consultations to establish better participatory guidelines for such trials in order to address ethical concerns. This study investigated sex workers’ knowledge and beliefs about research ethics and good participatory practices (GPP) and the perspectives of sex workers on research participation. A 33-question survey based on criteria identified by UNAIDS and AVAC was translated into three other languages. Participants were recruited through mailing lists and contacts with existing sex work networks. In total, 74 responses from Europe, the Americas and Asia were received. Thirty percent of respondents reported first-hand involvement in biomedical HIV prevention trials. Seventy percent indicated a lack of familiarity with codes of ethics for research. This paper focuses exclusively on communication issues described in survey responses. Communication was an important theme: the absence of clear communication between trial participants and investigators contributed to premature trial closures in at least two sites. Sex workers had recommendations for how researchers might implement GPP through improved communication, including consultation at the outset of planning, explaining procedures in non-technical terms and establishing clear channels for feedback from participants.

An analysis of the implementation of PEPFAR’s anti-prostitution pledge and its implications for successful HIV prevention among organizations working with sex workers

Since 2003, US government funding to address the HIV and AIDS pandemic has been subject to an anti‐prostitution clause. Simultaneously, the efficacy of some HIV prevention efforts for sex work in areas receiving US government funding has diminished. This article seeks to explain why.

Delayed application of condoms with safer and unsafe sex: factors associated with HIV risk in a community sample of gay and bisexual men

Abstract While condom use remains one of the most effective measures to prevent the sexual transmission of HIV, decreasing attention appears to be given to its importance and techniques of effective use relative to potential biomedical technologies. This paper focuses on delayed condom application (DCA), one practice which has been implicated in HIV transmission among gay and bisexual men. It examines the prevalence of the practice within a gay community and explores factors associated with condom use among those who practice only safer sex and those who report at least some unprotected anal sex. Data were taken from an anonymous, cross-sectional study of a self-identified sample of gay and bisexual men (N=5080). Among 2614 men who responded to relevant questions, multivariate polytomous logistic regressions were used to identify variables associated with DCA. Nearly, half of the men reported delayed condom application for insertive anal intercourse in the previous 12 months. While the majority of this group also reported episodes of unprotected anal sex, more than 25% of those who reported delayed application only reported safer sexual practices. Most socio-demographic variables found to be associated with unsafe sex in other studies were not associated with DCA. Negative condom use experiences such as tearing, splitting and slippage were associated with delayed application among the two groups. DCA, which may be considered by men as an effective harm reduction strategy requires attention. Interventions to address this behavior need to consider the physical issues of condom use along with the complex array of social, structural, psychological, and interpersonal issues.

Clinical Trials As An Industry And An Employer Of Labour

This is an Accepted Manuscript of an article published by Journal of Cultural Economy, available online: https://doi.org/10.1080/17530350.2011.535376

How ethical is your clinical trial

Is Institutional Review Board (IRB) approval and a rigorous informed consent process enough? It is our view that this is no longer the case. Conventional research ethics emphasise the importance of weighing the risks and benefits for prospective participants as one of the key determinants of deeming a clinical trial ethical. We support the notion that ethical obligations of research should include considerations not only at the individual level, but also at the community level (1,2).

Planning for Community-based Evaluation

We present a planning guide that can be used to improve community-based evaluation. The planning guide consists of a set of questions that need to be discussed with all stakeholders. It covers issues relating to the nature and purpose of a community-based evaluation project, research methods and approaches, participation and decision-making, conflict and conflict resolution, and dissemination and use of results. The planning guide was developed through our experiences in an HIV/AIDS research and evaluation unit and a review of the literature. If community-based evaluators keep in mind the questions in this planning guide and discuss them early on with stakeholders, the evaluation process should benefit.

A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings

BackgroundWhile HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs.MethodsTen electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework.ResultsIncluded studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples.ConclusionsFuture research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.

Introduction to the Culture, Health & Sexuality Virtual Special Issue on sex, sexuality and sex work

Abstract This article provides an editorial introduction to a virtual special issue on sex work and prostitution. It offers a brief history of sex work studies as published in the journal Culture, Health & Sexuality; reflects on the breadth and scope of papers the journal has published; considers the contribution of the journal’s papers to the wellbeing and sexuality of people who sell sex; and envisions future areas of inquiry for sex work studies. As authors, we identify major themes within the journal’s archive, including activism, agency, context, discourse, hazard, health, legalisation, love, place, power, race, relationships, stigma and vulnerabilities. In particular, we reflect on how HIV has created an environment in which issues of culture, health and sexuality have come to be disentangled from the moral agendas of earlier years. As a venue for the dissemination of a reinvigorated scholarship, Culture, Health & Sexuality provides a platform for a community of often like-minded, rigorous thinkers, to provide new and established perspectives, methods and voices and to present important developments in studies of sex, sexuality and sex work.