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Molldrem S, Smith AKJ. Health policy counterpublics: Enacting collective resistances to US molecular HIV surveillance and cluster detection and response programs. SOCIAL STUDIES OF SCIENCE 2024; 54:451-477. [PMID: 38054426 PMCID: PMC11118791 DOI: 10.1177/03063127231211933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Health policies and the problems they constitute are deeply shaped by multiple publics. In this article we conceptualize health policy counterpublics: temporally bounded socio-political forms that aim to cultivate particular modes of conduct, generally to resist trajectories set by arms of the state. These counterpublics often emerge from existing social movements and involve varied forms of activism and advocacy. We examine a health policy counterpublic that has arisen in response to new forms of HIV public health surveillance by drawing on public documents and interview data from 2021 with 26 stakeholders who were critical of key policy developments. Since 2018, the national rollout of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs in the United States has produced sustained controversies among HIV stakeholders, including among organized networks of people living with HIV. This article focuses on how a health policy counterpublic formed around MHS/CDR and how constituents problematized the policy agenda set in motion by federal health agencies, including in relation to data ethics, the meaningful involvement of affected communities, informed consent, the digitization of health systems, and HIV criminalization. Although familiar problems in HIV policymaking, concerns about these issues have been reconfigured in response to the new sociotechnical milieu proffered by MHS/CDR, generating new critical positions aiming to remake public health. Critical attention to the scenes within which health policy controversies play out ought to consider how (counter)publics are made, how problems are constituted, and the broader social movement dynamics and activist resources drawn upon to contest and reimagine policymaking in public life.
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Schuster ALR, Bollinger J, Geller G, Little SJ, Mehta SR, Sanchez T, Sugarman J, Bridges JFP. Prioritization of ethical concerns regarding HIV molecular epidemiology by public health practitioners and researchers. BMC Public Health 2024; 24:1436. [PMID: 38811963 PMCID: PMC11137925 DOI: 10.1186/s12889-024-18881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND HIV molecular epidemiology (HIV ME) can support the early detection of emerging clusters of new HIV infections by combining HIV sequence data routinely obtained during the clinical treatment of people living with HIV with behavioral, geographic, and sociodemographic information. While information about emerging clusters promises to facilitate HIV prevention and treatment efforts, the use of this data also raises several ethical concerns. We sought to assess how those working on the frontlines of HIV ME, specifically public health practitioners (PHPs) and researchers, prioritized these issues. METHODS Ethical issues were identified through literature review, qualitative in-depth interviews, and stakeholder engagement. PHPs and researchers using HIV ME prioritized the issues using best-worst scaling (BWS). A balanced incomplete block design was used to generate 11 choice tasks each consisting of a sub-set of 5 ethical concerns. In each task, respondents were asked to assess the most and least concerning issue. Data were analyzed using conditional logit, with a Swait-Louviere test of poolability. Latent class analysis was then used to explore preference heterogeneity. RESULTS In total, 57 respondents completed the BWS experiment May-June 2023 with the Swait-Louviere test indicating that researchers and PHPs could be pooled (p = 0.512). Latent class analysis identified two classes, those highlighting "Harms" (n = 29) (prioritizing concerns about potential risk of legal prosecution, individual harm, and group stigma) and those highlighting "Utility" (n = 28) (prioritizing concerns about limited evidence, resource allocation, non-disclosure of data use for HIV ME, and the potential to infer the directionality of HIV transmission). There were no differences in the characteristics of members across classes. CONCLUSIONS The ethical issues of HIV ME vary in importance among stakeholders, reflecting different perspectives on the potential impact and usefulness of the data. Knowing these differences exist can directly inform the focus of future deliberations about the policies and practices of HIV ME in the United States.
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Affiliation(s)
- Anne L R Schuster
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43016, USA.
| | - Juli Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Susan J Little
- Division of Infectious Disease, University of California San Diego, San Diego, CA, USA
| | - Sanjay R Mehta
- Division of Infectious Disease, University of California San Diego, San Diego, CA, USA
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, 1800 Cannon Drive, Columbus, OH, 43016, USA
- Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Sun C, Fang R, Salemi M, Prosperi M, Rife Magalis B. DeepDynaForecast: Phylogenetic-informed graph deep learning for epidemic transmission dynamic prediction. PLoS Comput Biol 2024; 20:e1011351. [PMID: 38598563 PMCID: PMC11034642 DOI: 10.1371/journal.pcbi.1011351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 04/22/2024] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
In the midst of an outbreak or sustained epidemic, reliable prediction of transmission risks and patterns of spread is critical to inform public health programs. Projections of transmission growth or decline among specific risk groups can aid in optimizing interventions, particularly when resources are limited. Phylogenetic trees have been widely used in the detection of transmission chains and high-risk populations. Moreover, tree topology and the incorporation of population parameters (phylodynamics) can be useful in reconstructing the evolutionary dynamics of an epidemic across space and time among individuals. We now demonstrate the utility of phylodynamic trees for transmission modeling and forecasting, developing a phylogeny-based deep learning system, referred to as DeepDynaForecast. Our approach leverages a primal-dual graph learning structure with shortcut multi-layer aggregation, which is suited for the early identification and prediction of transmission dynamics in emerging high-risk groups. We demonstrate the accuracy of DeepDynaForecast using simulated outbreak data and the utility of the learned model using empirical, large-scale data from the human immunodeficiency virus epidemic in Florida between 2012 and 2020. Our framework is available as open-source software (MIT license) at github.com/lab-smile/DeepDynaForcast.
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Affiliation(s)
- Chaoyue Sun
- Department of Electrical and Computer Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Ruogu Fang
- Department of Electrical and Computer Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida, United States of America
- J. Crayton Pruitt Family Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, Florida, United States of America
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, Florida, United States of America
| | - Marco Salemi
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Mattia Prosperi
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Brittany Rife Magalis
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
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Shaw J, Sekalala S, Fiske A. The Urgent Need for Health Data Justice in Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:101-103. [PMID: 38394009 DOI: 10.1080/15265161.2024.2303141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Affiliation(s)
- James Shaw
- University of Toronto Joint Centre for Bioethics
| | | | - Amelia Fiske
- Technical University of Munich School of Medicine and Health
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Molldrem S, Smith AKJ, Subrahmanyam V. Toward Consent in Molecular HIV Surveillance?: Perspectives of Critical Stakeholders. AJOB Empir Bioeth 2024; 15:66-79. [PMID: 37768111 DOI: 10.1080/23294515.2023.2262967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The emergence of molecular HIV surveillance (MHS) and cluster detection and response (CDR) programs as key features of the United States (US) HIV strategy since 2018 has caused major controversies. HIV surveillance programs that re-use individuals' routinely collected clinical HIV data do not require consent on the basis that the public benefit of these programs outweighs individuals' rights to opt out. However, criticisms of MHS/CDR have questioned whether expanded uses of HIV genetic sequence data for prevention reach beyond traditional public health ethics frameworks. This study aimed to explore views on consent within MHS/CDR among critical stakeholders. METHODS In 2021 we interviewed 26 US HIV stakeholders who identified as being critical or concerned about the rollout of MHS/CDR. Stakeholders included participants belonging to networks of people living with HIV, other advocates, academics, and public health professionals. This analysis focused on identifying the range of positions among critical and concerned stakeholders on consent affordances, opt-outs, how to best inform people living with HIV about how data about them are used in public health programs, and related ethical issues. RESULTS Participants were broadly supportive of introducing some forms of consent into MHS/CDR. However, they differed on the specifics of implementing consent. While some participants did not support introducing consent affordances, all supported the idea that people living with HIV should be informed about how HIV surveillance and prevention is conducted and how individuals' data are used. CONCLUSIONS MHS/CDR has caused sustained controversy. Among critical stakeholders, consent is generally desirable but contested, although the right for people living with HIV to be informed was centrally supported. In an era of big data-driven public health interventions and routine uses of HIV genetic sequence data in surveillance and prevention, CDC and other agencies should revisit public health ethics frameworks and consider the possibility of consent processes.
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Affiliation(s)
- Stephen Molldrem
- Institute for Bioethics and Health Humanities, The University of Texas Medical Branch, Galveston, TX, USA
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Vishnu Subrahmanyam
- Institute for Bioethics and Health Humanities, The University of Texas Medical Branch, Galveston, TX, USA
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MOLLDREM STEPHEN, SMITH ANTHONYKJ, McCLELLAND ALEXANDER. Advancing Dialogue About Consent and Molecular HIV Surveillance in the United States: Four Proposals Following a Federal Advisory Panel's Call for Major Reforms. Milbank Q 2023; 101:1033-1046. [PMID: 37380617 PMCID: PMC10726778 DOI: 10.1111/1468-0009.12663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Policy Points Molecular HIV surveillance and cluster detection and response (MHS/CDR) programs have been a core public health activity in the United States since 2018 and are the "fourth pillar" of the Ending the HIV Epidemic initiative launched in 2019. MHS/CDR has caused controversy, including calls for a moratorium from networks of people living with HIV. In October 2022, the Presidential Advisory Council on HIV/AIDS (PACHA) adopted a resolution calling for major reforms. We analyze the policy landscape and present four proposals to federal stakeholders pertaining to PACHA's recommendations about incorporating opt-outs and plain-language notifications into MHS/CDR programs.
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Affiliation(s)
- STEPHEN MOLLDREM
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch
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Molldrem S, Bagani S, Subrahmanyam V, Permar R, Matsiri O, Caiphus C, Kizito B, Modongo C, Shin SS. Botswana tuberculosis (TB) stakeholders broadly support scaling up next-generation whole genome sequencing: Ethical and practical considerations for Botswana and global health. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002479. [PMID: 37967081 PMCID: PMC10651001 DOI: 10.1371/journal.pgph.0002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/16/2023] [Indexed: 11/17/2023]
Abstract
Global health agencies are increasingly promoting the scale-up of next-generation whole genome sequencing (NG-WGS) of pathogens into infectious disease control programs, including for tuberculosis (TB). However, little is known about how stakeholders in low-to-middle income countries (LMICs) understand the ethics, benefits, and risks of these proposals. We conducted a qualitative study in Greater Gaborone, Botswana to learn how TB stakeholders there viewed a potential scale-up of NG-WGS into Botswana's TB program. We conducted 30 interviews and four deliberative dialogues with TB stakeholders based in Greater Gaborone, the country's largest city and capital. We created and showed participants an animated video series about a fictional family that experienced TB diagnosis, treatment, contact tracing, and data uses that were informed by NG-WGS. We analyzed transcripts using reflexive thematic analysis. We found broad support for the scale-up of TB NG-WGS in Botswana, owing to perceived benefits. Support was qualified with statements about ensuring adequate planning, resource-allocation, community and stakeholder engagement, capacity-building, and assessing ethical norms around publishing data. Our results suggest that scaling up NG-WGS for TB in Botswana would be supported by stakeholders there, contingent upon the government and other entities adequately investing in the initiative. These findings are relevant to other LMICs considering scale-ups of NG-WGS and related technologies for infectious diseases and suggest the need for sustained research into the acceptability of pathogen sequencing in other contexts.
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Affiliation(s)
- Stephen Molldrem
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas, United States of America
| | | | - Vishnu Subrahmanyam
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Rebecca Permar
- Program for Leadership and Character, Office of Academic Advising, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | | | | | | | | | - Sanghyuk S. Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, United States of America
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Smith AKJ, Schermuly A, Newman CE, Fitzgerald L, Davis MDM. Empowering Queer Data Justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:56-58. [PMID: 37879030 DOI: 10.1080/15265161.2023.2256264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health, The University of New South Wales
| | | | - Christy E Newman
- Centre for Social Research in Health, The University of New South Wales
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Grierson L, Cavanagh A, Youssef A, Lee-Krueger R, McNeill K, Button B, Kulasegaram K. Inter-institutional data-driven education research: consensus values, principles, and recommendations to guide the ethical sharing of administrative education data in the Canadian medical education research context. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:113-120. [PMID: 38045068 PMCID: PMC10690000 DOI: 10.36834/cmej.75874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Administrative data are generated when educating, licensing, and regulating future physicians but these data are rarely used beyond their pre-specified purposes. The capacity necessary for sensitive and responsive oversight that supports the sharing of administrative medical education data across institutions for research purposes needs to be developed. Method A pan-Canadian consensus-building project was undertaken to develop agreement on the goals, benefits, risks, values, and principles that should underpin inter-institutional data-driven medical education research in Canada. A survey of key literature, consultations with various stakeholders and five successive knowledge synthesis workshops informed this project. Propositions were developed, driving subsequent discussions until collective agreement was distilled. Results Consensus coalesced around six key principles: establishing clear purposes, rationale, and methodology for inter-institutional data-driven research a priori; informed consent from data generators in education systems is non-negotiable; multi-institutional data sharing requires special governance; data governance should be guided by data sovereignty; data use should be guided by an identified set of shared values; and best practices in research data-management should be applied. Conclusion We recommend establishing a representative governance body, engaging trusted data facility, and adherence to extant data management policies when sharing administrative medical education data for research purposes in Canada.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, and Scientist, McMaster Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Alice Cavanagh
- Michael G. DeGroote School of Medicine, McMaster University and Health Policy PhD Program, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Alaa Youssef
- Stanford School of Medicine, Department of Radiology, Stanford Center for Artificial Intelligence in Medicine and Imaging, California, USA
| | - Rachelle Lee-Krueger
- Faculty of Education, University of Ottawa, Ontario, Canada
- Education Consultant, Office of Continuing Medical Education & Professional Development, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kestrel McNeill
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Ontario, Canada
| | - Brenton Button
- Northern Ontario School of Medicine University, Ontario, Canada
- Faculty of Education, University of Winnipeg, Manitoba, Canad
| | - Kulamakan Kulasegaram
- Department of Community and Family Medicine, University of Toronto and Scientist at Wilson Centre, University of Toronto, Ontario, Canada
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Jamrozik E, Munung NS, Abeler-Dorner L, Parker M. Public health use of HIV phylogenetic data in sub-Saharan Africa: ethical issues. BMJ Glob Health 2023; 8:e011884. [PMID: 37407228 DOI: 10.1136/bmjgh-2023-011884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Phylogenetic analyses of HIV are an increasingly accurate method of clarifying population-level patterns of transmission and linking individuals or groups with transmission events. Viral genetic data may be used by public health agencies to guide policy interventions focused on clusters of transmission or segments of the population in which transmission is concentrated. Analyses of HIV phylogenetics in high-income countries have often found that clusters of transmission play a significant role in HIV epidemics. In sub-Saharan Africa, HIV phylogenetic analyses to date suggest that clusters of transmission play a relatively minor role in local epidemics. Such analyses could nevertheless be used to guide priority setting and HIV public health programme design in Africa for sub-populations in which transmission events are more concentrated. Phylogenetic analysis raises ethical issues, in part due to the range of potential benefits and potential harms (ie, risks). Potential benefits include (1) improving knowledge of transmission patterns, (2) informing the design of focused public health interventions for subpopulations in which transmission is concentrated, (3) identifying and responding to clusters of transmission, (4) reducing stigma (in some cases) and (5) informing estimates of the (cost-)effectiveness of HIV treatment programmes. Potential harms include (1) privacy infringements, (2) increasing stigma (in some cases), (3) reducing trust in public health programmes, and (4) increased prosecution of legal cases where HIV transmission, homosexuality or sex work is criminalised. This paper provides analysis of relevant issues with a focus on sub-Saharan Africa in order to inform consultations regarding ethical best practice for HIV phylogenetics.
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Affiliation(s)
- Euzebiusz Jamrozik
- Ethox and the Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
| | | | | | - Michael Parker
- Ethox and the Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Tordoff DM, Minalga B, Trejo A, Shook A, Kerani RP, Herbeck JT. Lessons learned from community engagement regarding phylodynamic research with molecular HIV surveillance data. J Int AIDS Soc 2023; 26 Suppl 1:e26111. [PMID: 37408448 PMCID: PMC10323319 DOI: 10.1002/jia2.26111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION The widespread implementation of molecular HIV surveillance (MHS) has resulted in an increased discussion about the ethical, human rights and public health implications of MHS. We narrate our process of pausing our research that uses data collected through MHS in response to these growing concerns and summarize the key lessons we learned through conversations with community members. METHODS The original study aimed to describe HIV transmission patterns by age and race/ethnicity among men who have sex with men in King County, Washington, by applying probabilistic phylodynamic modelling methods to HIV-1 pol gene sequences collected through MHS. In September 2020, we paused the publication of this research to conduct community engagement: we held two public-facing online presentations, met with a national community coalition that included representatives of networks of people living with HIV, and invited two members of this coalition to provide feedback on our manuscript. During each of these meetings, we shared a brief presentation of our methods and findings and explicitly solicited feedback on the perceived public health benefit and potential harm of our analyses and results. RESULTS Some community concerns about MHS in public health practice also apply to research using MHS data, namely those related to informed consent, inference of transmission directionality and criminalization. Other critiques were specific to our research study and included feedback about the use of phylogenetic analyses to study assortativity by race/ethnicity and the importance of considering the broader context of stigma and structural racism. We ultimately decided the potential harms of publishing our study-perpetuating racialized stigma about men who have sex with men and eroding the trust between phylogenetics researchers and communities of people living with HIV-outweighed the potential benefits. CONCLUSIONS HIV phylogenetics research using data collected through MHS data is a powerful scientific technology with the potential to benefit and harm communities of people living with HIV. Addressing criminalization and including people living with HIV in decision-making processes have the potential to meaningfully address community concerns and strengthen the ethical justification for using MHS data in both research and public health practice. We close with specific opportunities for action and advocacy by researchers.
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Affiliation(s)
- Diana M. Tordoff
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Brian Minalga
- Fred Hutch, Office of HIV/AIDS Network CoordinationSeattleWashingtonUSA
| | - Alfredo Trejo
- Department of Political ScienceUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Alic Shook
- Seattle University, College of NursingSeattleWashingtonUSA
- Seattle Children's Center for Pediatric Nursing ResearchSeattleWashingtonUSA
| | - Roxanne P. Kerani
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Public Health – Seattle & King County, HIV/STD ProgramSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Joshua T. Herbeck
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
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Bollinger JM, Geller G, May E, Brewer J, Henry LM, Sugarman J. Brief Report: Challenges in Obtaining the Informed Perspectives of Stakeholders Regarding HIV Molecular Epidemiology. J Acquir Immune Defic Syndr 2023; 93:87-91. [PMID: 36805407 PMCID: PMC10293093 DOI: 10.1097/qai.0000000000003179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND HIV molecular epidemiology (HIV-ME) is now being used in a variety of ways, including molecular HIV surveillance to help identify and respond to emerging HIV transmission clusters as specified in the Ending the HIV Epidemic in the U.S. initiative. However, HIV-ME in general, and its use for cluster detection and response, in particular, raises significant ethical and social concerns, which have spurred vigorous debates. Nevertheless, there is a paucity of information regarding how these potential benefits and concerns are perceived among people living with HIV and people without HIV at an increased risk. SETTING Virtual engagement with US participants. METHODS We rigorously developed a brief informational video about HIV-ME and conducted a series of in-depth interviews with people living with HIV and people without HIV at an increased risk. RESULTS Through extensive stakeholder engagement during the video development process and subsequent in-depth interviews (N = 24), several preliminary findings surfaced. In contrast to the high level of concern raised by some critics of HIV-ME, our data appear to show broad support for it. In addition, we observed conflation of perspectives about HIV-ME with concerns about HIV public health surveillance more generally. CONCLUSION Our experiences reveal substantial communication challenges related to the nature of HIV-ME that need to be overcome to ensure that it is properly understood, which is necessary for meaningfully engaging stakeholders in discussions about its use. Moreover, ongoing, responsive, engagement efforts are critical. Additional systematic data are needed to help inform policy making and practice regarding HIV-ME.
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Affiliation(s)
- Juli M. Bollinger
- Berman Institute of Bioethics, Johns Hopkins University, Maryland, USA
| | - Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Maryland, USA
- School of Medicine, Johns Hopkins University, Maryland, USA
| | | | - Janesse Brewer
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Maryland, USA
| | - Leslie Meltzer Henry
- Berman Institute of Bioethics, Johns Hopkins University, Maryland, USA
- University of Maryland Carey School of Law, Maryland, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Maryland, USA
- School of Medicine, Johns Hopkins University, Maryland, USA
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Molldrem S. Research on the Development of Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in People With Advanced Human Immunodeficiency Virus Disease Should Highlight Structural Conditions and Avoid Harmful Stereotypes. Clin Infect Dis 2023; 76:1701-1702. [PMID: 36718523 DOI: 10.1093/cid/ciad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Affiliation(s)
- Stephen Molldrem
- Department of Bioethics and Health Humanities, School of Public and Population Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Hallmark CJ, Luswata C, Del Vecchio N, Hayford C, Mora R, Carr M, McNeese M, Benbow N, Schneider JA, Wertheim JO, Fujimoto K. Predictors of HIV Molecular Cluster Membership and Implications for Partner Services. AIDS Res Hum Retroviruses 2023; 39:241-252. [PMID: 36785940 PMCID: PMC10171944 DOI: 10.1089/aid.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Public health surveillance data used in HIV molecular cluster analyses lack contextual information that is available from partner services (PS) data. Integrating these data sources in retrospective analyses can enrich understanding of the risk profile of people in clusters. In this study, HIV molecular clusters were identified and matched to information on partners and other information gleaned at the time of diagnosis, including coinfection with syphilis. We aimed to produce a more complete understanding of molecular cluster membership in Houston, Texas, a city ranking ninth nationally in rate of new HIV diagnoses that may benefit from retrospective matched analyses between molecular and PS data to inform future intervention. Data from PS were matched to molecular HIV records of people newly diagnosed from 2012 to 2018. By conducting analyses in HIV-TRACE (TRAnsmission Cluster Engine) using viral genetic sequences, molecular clusters were detected. Multivariable logistic regression models were used to estimate the association between molecular cluster membership and completion of a PS interview, number of named partners, and syphilis coinfection. Using data from 4,035 people who had a viral genetic sequence and matched PS records, molecular cluster membership was not significantly associated with completion of a PS interview. Among those with sequences who completed a PS interview (n = 3,869), 45.3% (n = 1,753) clustered. Molecular cluster membership was significantly associated with naming 1 or 3+ partners compared with not naming any partners [adjusted odds ratio, aOR: 1.27 (95% confidence interval, CI: 1.08-1.50), p = .003 and aOR: 1.38 (95% CI: 1.06-1.81), p = .02]. Alone, coinfection with syphilis was not significantly associated with molecular cluster membership. Syphilis coinfection was associated with molecular cluster membership when coupled with incarceration [aOR: 1.91 (95% CI: 1.08-3.38), p = .03], a risk for treatment interruption. Enhanced intervention among those with similar profiles, such as people coinfected with other risks, may be warranted.
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Affiliation(s)
- Camden J. Hallmark
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Houston Health Department, Houston, Texas, USA
| | - Charles Luswata
- Houston Health Department, Houston, Texas, USA
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Natascha Del Vecchio
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Christina Hayford
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | | | - Nanette Benbow
- Third Coast Center for AIDS Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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15
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Milne R, Patch C. Ethical Challenges Associated with Pathogen and Host Genetics in Infectious Disease. New Bioeth 2023; 29:24-36. [PMID: 35972296 DOI: 10.1080/20502877.2022.2109697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The Covid-19 pandemic has demonstrated the potential of genomic technologies for the detection and surveillance of infectious diseases. Pathogen genomics is likely to play a major role in the future of research and clinical implementation of genomic technologies. However, unlike human genetics, the specific ethical and social challenges associated with the implementation of infectious disease genomics has received comparatively little attention. In this paper, we contribute to this literature, focusing on the potential consequences for individuals and communities of the use of these technologies. We concentrate on areas of challenges related to privacy, stigma, discrimination and the return of results in the cases of the surveillance of known pathogens, metagenomics and host genomics.
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Affiliation(s)
- Richard Milne
- Engagement and Society, Wellcome Connecting Science, Hinxton, UK.,Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, UK
| | - Christine Patch
- Engagement and Society, Wellcome Connecting Science, Hinxton, UK
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16
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Michaud L, van der Meulen E, Guta A. Between Care and Control: Examining Surveillance Practices in Harm Reduction. CONTEMPORARY DRUG PROBLEMS 2023; 50:3-24. [PMID: 36733491 PMCID: PMC9885017 DOI: 10.1177/00914509221128598] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023]
Abstract
As harm reduction programs and services proliferate, people who use drugs (PWUD) are increasingly subjected to surveillance through the collection of their personal information, systematic observation, and other means. The data generated from these practices are frequently repurposed across various institutional sites for clinical, evaluative, epidemiological, and administrative uses. Rationales provided for increased surveillance include the more effective provision of care, service optimization, risk stratification, and efficiency in resource allocation. With this in mind, our reflective essay draws on empirical analysis of work within harm reduction services and movements to reflect critically on the impacts and implications of surveillance expansion. While we argue that many surveillance practices are not inherently problematic or harmful, the unchecked expansion of surveillance under a banner of health and harm reduction may contribute to decreased uptake of services, rationing and conditionalities tied to service access, the potential deepening of health disparities amongst some PWUD, and an overlay of health and criminal-legal systems. In this context, surveillance relies on the enlistment of a range of therapeutic actors and reflects the permeable boundary between care and control. We thus call for a broader critical dialogue within harm reduction on the problems and potential impacts posed by surveillance in service settings, the end to data sharing of health information with law enforcement and other criminal legal actors, and deference to the stated need among PWUD for meaningful anonymity when accessing harm reduction and health services.
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Affiliation(s)
- Liam Michaud
- Socio-Legal Studies Graduate Program, York University, Toronto,
Ontario, Canada,Liam Michaud, Socio-Legal Studies Graduate
Program, York University, 4700 Keele St, Toronto, Ontario M3J 1P3, Canada.
| | - Emily van der Meulen
- Department of Criminology, Toronto Metropolitan University, Toronto,
Ontario, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Ontario,
Canada,Australian Research Centre in Sex, Health and Society, La Trobe
University, Melbourne, Victoria, Australia
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17
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Shaw J, Sekalala S. Health data justice: building new norms for health data governance. NPJ Digit Med 2023; 6:30. [PMID: 36854964 PMCID: PMC9972302 DOI: 10.1038/s41746-023-00780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/17/2023] [Indexed: 03/02/2023] Open
Abstract
The retention and use of health-related data by government, corporate, and health professional actors risk exacerbating the harms of colonial systems of inequality in which health care and public health are situated, regardless of the intentions about how those data are used. In this context, a data justice perspective presents opportunities to develop new norms of health-related data governance that hold health justice as the primary objective. In this perspective, we define the concept of health data justice, outline urgent issues informed by this approach, and propose five calls to action from a health data justice perspective.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Sharifah Sekalala
- grid.7372.10000 0000 8809 1613School of Law, University of Warwick, Coventry, CV4 7AL United Kingdom
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18
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Garcia M, Devlin S, Kerman J, Fujimoto K, Hirschhorn LR, Phillips II G, Schneider J, McNulty MC. Ending the HIV Epidemic: Identifying Barriers and Facilitators to Implement Molecular HIV Surveillance to Develop Real-Time Cluster Detection and Response Interventions for Local Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3269. [PMID: 36833963 PMCID: PMC9964218 DOI: 10.3390/ijerph20043269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The rapid implementation of molecular HIV surveillance (MHS) has resulted in significant challenges for local health departments to develop real-time cluster detection and response (CDR) interventions for priority populations impacted by HIV. This study is among the first to explore professionals' strategies to implement MHS and develop CDR interventions in real-world public health settings. Methods: Semi-structured qualitative interviews were completed by 21 public health stakeholders in the United States' southern and midwestern regions throughout 2020-2022 to identify themes related to the implementation and development of MHS and CDR. Results for the thematic analysis revealed (1) strengths and limitations in utilizing HIV surveillance data for real-time CDR; (2) limitations of MHS data due to medical provider and staff concerns related to CDR; (3) divergent perspectives on the effectiveness of partner services; (4) optimism, but reluctance about the social network strategy; and (5) enhanced partnerships with community stakeholders to address MHS-related concerns. Conclusions: Enhancing MHS and CDR efforts requires a centralized system for staff to access public health data from multiple databases to develop CDR interventions; designating staff dedicated to CDR interventions; and establishing equitable meaningful partnerships with local community stakeholders to address MHS concerns and develop culturally informed CDR interventions.
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Affiliation(s)
- Moctezuma Garcia
- Department of Social Work, College of Health & Sciences, San José State University, San Jose, CA 95112, USA
| | - Samantha Devlin
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Jared Kerman
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX 77030, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gregory Phillips II
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John Schneider
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Moira C. McNulty
- The Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
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19
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Smith AKJ, Davis MDM, MacGibbon J, Broady TR, Ellard J, Rule J, Cook T, Duck-Chong E, Holt M, Newman CE. Engaging Stigmatised Communities in Australia with Digital Health Systems: Towards Data Justice in Public Health. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023; 20:1-12. [PMID: 36776992 PMCID: PMC9900552 DOI: 10.1007/s13178-023-00791-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 05/07/2023]
Abstract
Introduction In 2018, following government policy changes to Australia's national electronic health record system, 'My Health Record', consumer advocates-including organisations representing people living with HIV, people who use drugs and sex workers-raised concerns about privacy and data security. Responding to these controversies, this study explores the practical, ethical and political complexities of engaging stigmatised communities with digital health systems. Methods We conducted 16 qualitative semi-structured interviews in 2020 with key informants representing communities who experience stigma, discrimination and marginalisation in Australia. These communities included people living with HIV, sex workers, people who inject drugs, gay and bisexual men and transgender and gender diverse people. We conducted a reflexive thematic analysis. Results Key informants were sceptical of proposed benefits of electronic health records for their communities, and concerned about privacy risks and the potential for discrimination. Meaningful consultation, consent mechanisms and tackling structural stigma were raised as solutions for engaging communities. Conclusions Although communities could benefit from being included in digital health systems, significant cultural, legal and social reforms from government were believed to be necessary to build trust in digital health systems. We argue that these forms of data justice are necessary for effective future systems. Policy Implications Engaging stigmatised communities-including in relation to gender, sexuality, sex work, drug use, HIV-requires a commitment to data justice. The design and implementation of digital health systems requires investment in ongoing and meaningful consultation with communities and representative organisations.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Mark D. M. Davis
- School of Social Sciences, Monash University, Melbourne, Australia
| | - James MacGibbon
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Timothy R. Broady
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - John Rule
- National Association of People With HIV Australia, Newtown, Australia
| | - Teddy Cook
- ACON, Surry Hills, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Martin Holt
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Christy E. Newman
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
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20
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Cholette F, Lazarus L, Macharia P, Thompson LH, Githaiga S, Mathenge J, Walimbwa J, Kuria I, Okoth S, Wambua S, Albert H, Mwangi P, Adhiambo J, Kasiba R, Juma E, Battacharjee P, Kimani J, Sandstrom P, Meyers AFA, Joy JB, Thomann M, McLaren PJ, Shaw S, Mishra S, Becker ML, McKinnon L, Lorway R. Community Insights in Phylogenetic HIV Research: The CIPHR Project Protocol. Glob Public Health 2023; 18:2269435. [PMID: 37851872 DOI: 10.1080/17441692.2023.2269435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
Inferring HIV transmission networks from HIV sequences is gaining popularity in the field of HIV molecular epidemiology. However, HIV sequences are often analyzed at distance from those affected by HIV epidemics, namely without the involvement of communities most affected by HIV. These remote analyses often mean that knowledge is generated in absence of lived experiences and socio-economic realities that could inform the ethical application of network-derived information in 'real world' programmes. Procedures to engage communities are noticeably absent from the HIV molecular epidemiology literature. Here we present our team's protocol for engaging community activists living in Nairobi, Kenya in a knowledge exchange process - The CIPHR Project (Community Insights in Phylogenetic HIV Research). Drawing upon a community-based participatory approach, our team will (1) explore the possibilities and limitations of HIV molecular epidemiology for key population programmes, (2) pilot a community-based HIV molecular study, and (3) co-develop policy guidelines on conducting ethically safe HIV molecular epidemiology. Critical dialogue with activist communities will offer insight into the potential uses and abuses of using such information to sharpen HIV prevention programmes. The outcome of this process holds importance to the development of policy frameworks that will guide the next generation of the global response.
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Affiliation(s)
- François Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Lisa Lazarus
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - Laura H Thompson
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Canada
| | - Samuel Githaiga
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - John Mathenge
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | | | - Irene Kuria
- Key Population Consortium of Kenya, Nairobi, Kenya
| | - Silvia Okoth
- Bar Hostess Empowerment and Support Programme, Nairobi, Kenya
| | | | - Harrison Albert
- Health Options for Young Men on HIV/AIDS and STIs (HOYMAS), Nairobi, Kenya
| | - Peninah Mwangi
- Bar Hostess Empowerment and Support Programme, Nairobi, Kenya
| | - Joyce Adhiambo
- Partners for Health Development in Africa (PHDA), Nairobi, Kenya
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
| | | | - Esther Juma
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
| | | | - Joshua Kimani
- Sex Worker Outreach Programme (SWOP), Nairobi, Kenya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Paul Sandstrom
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Adrienne F A Meyers
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS (BCCfE), St. Paul's Hospital, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
- Bioinformatics Programme, University of British Columbia, Vancouver, Canada
| | - Matthew Thomann
- Department of Anthropology, University of Maryland, College Park, MD, USA
| | - Paul J McLaren
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Sexually Transmitted and Blood-Borne Infections, National Microbiology Laboratory at JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Souradet Shaw
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Marissa L Becker
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lyle McKinnon
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Robert Lorway
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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21
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Molldrem S, Smith AKJ, McClelland A. Predictive analytics in HIV surveillance require new approaches to data ethics, rights, and regulation in public health. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2113035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Stephen Molldrem
- Bioethics and Health Humanities, The University of Texas Medical Branch at Galveston, Texas, United States
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia
| | - Alexander McClelland
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, Ontario, Canada
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22
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Meagher KM, Watson S, Suh GA, Virk A. The New Precision Stewards? J Pers Med 2022; 12:jpm12081308. [PMID: 36013256 PMCID: PMC9409858 DOI: 10.3390/jpm12081308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.
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Affiliation(s)
- Karen M. Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9528
| | - Sara Watson
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Gina A. Suh
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abinash Virk
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
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23
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Buchbinder M, Juengst E, Rennie S, Blue C, Rosen DL. Advancing a Data Justice Framework for Public Health Surveillance. AJOB Empir Bioeth 2022; 13:205-213. [PMID: 35442141 PMCID: PMC10777676 DOI: 10.1080/23294515.2022.2063997] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bioethical debates about privacy, big data, and public health surveillance have not sufficiently engaged the perspectives of those being surveilled. The data justice framework suggests that big data applications have the potential to create disproportionate harm for socially marginalized groups. Using examples from our research on HIV surveillance for individuals incarcerated in jails, we analyze ethical issues in deploying big data in public health surveillance. METHODS We conducted qualitative, semi-structured interviews with 24 people living with HIV who had been previously incarcerated in county jails about their perspectives on and experiences with HIV surveillance, as part of a larger study to characterize ethical considerations in leveraging big data techniques to enhance continuity of care for incarcerated people living with HIV. RESULTS Most participants expressed support for the state health department tracking HIV testing results and viral load data. Several viewed HIV surveillance as a violation of privacy, and several had actively avoided contact from state public health outreach workers. Participants were most likely to express reservations about surveillance when they viewed the state's motives as self-interested. Perspectives highlight the mistrust that structurally vulnerable people may have in the state's capacity to act as an agent of welfare. Findings suggest that adopting a nuanced, context-sensitive view on surveillance is essential. CONCLUSIONS Establishing trustworthiness through interpersonal interactions with public health personnel is important to reversing historical legacies of harm to racial minorities and structurally vulnerable groups. Empowering stakeholders to participate in the design and implementation of data infrastructure and governance is critical for advancing a data justice agenda, and can offset privacy concerns. The next steps in advancing the data justice framework in public health surveillance will be to innovate ways to represent the voices of structurally vulnerable groups in the design and governance of big data initiatives.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, UNC—Chapel Hill
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, UNC—Chapel Hill
| | - David L. Rosen
- Division of Infectious Diseases, Department of Medicine, UNC—Chapel Hill
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24
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Shook AG, Buskin SE, Golden M, Dombrowski JC, Herbeck J, Lechtenberg RJ, Kerani R. Community and Provider Perspectives on Molecular HIV Surveillance and Cluster Detection and Response for HIV Prevention: Qualitative Findings From King County, Washington. J Assoc Nurses AIDS Care 2022; 33:270-282. [PMID: 35500058 PMCID: PMC9062191 DOI: 10.1097/jnc.0000000000000308] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Responding quickly to HIV outbreaks is one of four pillars of the U.S. Ending the HIV Epidemic (EHE) initiative. Inclusion of cluster detection and response in the fourth pillar of EHE has led to public discussion concerning bioethical implications of cluster detection and response and molecular HIV surveillance (MHS) among public health authorities, researchers, and community members. This study reports on findings from a qualitative analysis of interviews with community members and providers regarding their knowledge and perspectives of MHS. We identified five key themes: (a) context matters, (b) making sense of MHS, (c) messaging, equity, and resource prioritization, (d) operationalizing confidentiality, and (e) stigma, vulnerability, and power. Inclusion of community perspectives in generating innovative approaches that address bioethical concerns related to the use of MHS data is integral to ensure that widely accessible information about the use of these data is available to a diversity of community members and providers.
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Affiliation(s)
- Alic G. Shook
- College of Nursing, Seattle University Seattle, Washington, USA
| | - Susan E. Buskin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Epidemiologist, Public Health – Seattle & King County, Seattle, Washington, USA
| | - Matthew Golden
- Public Health – Seattle King County HIV/STD Program
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Julia C. Dombrowski
- Public Health-Seattle & King County HIV/STD Program
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Roxanne Kerani
- Department of Medicine, University of Washington, Seattle, Washington, USA
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25
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Hoppe T, McClelland A, Pass K. Beyond criminalization: reconsidering HIV criminalization in an era of reform. Curr Opin HIV AIDS 2022; 17:100-105. [PMID: 35225250 DOI: 10.1097/coh.0000000000000715] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This paper reviews recent studies examining the application of human immunodeficiency virus (HIV)-specific criminal laws in North America (particularly the United States and Canada). In the wake of the development of new biomedical prevention strategies, many states in the United States (US) have recently begun to reform or repeal their HIV-specific laws. These findings can help inform efforts to 'modernize' HIV laws (or, to revise in ways that reflect recent scientific advances in HIV treatment and prevention). RECENT FINDINGS Recent studies suggest that HIV-specific laws disproportionately impact Black men, white women, and Black women. The media sensationally covers criminal trials under these laws, especially when they involve Black defendants who they often describe in racialized terms as predators. Activists contest these laws and raise concerns about new phylogenetic HIV surveillance techniques that have the potential to be harnessed for law enforcement purposes. SUMMARY These findings collectively raise urgent concerns for the continued use of HIV-specific criminal laws. These policies disproportionately impact marginalized groups - particularly Black men. Media coverage of these cases often helps to spread misinformation and stigmatizing rhetoric about people living with HIV and promulgate racist stereotypes. Although well-intentioned, new phylogenetic HIV surveillance technologies have the potential to exacerbate these issues if law enforcement is able to gain access to these public health tools.
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Affiliation(s)
- Trevor Hoppe
- UNCG: University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Philbin MM, Perez-Brumer A. Promise, perils and cautious optimism: the next frontier in long-acting modalities for the treatment and prevention of HIV. Curr Opin HIV AIDS 2022; 17:72-88. [PMID: 35225248 PMCID: PMC8915989 DOI: 10.1097/coh.0000000000000723] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This paper provides a critical review of recent therapeutic advances in long-acting (LA) modalities for human immunodeficiency virus (HIV) treatment and prevention. RECENT FINDINGS LA injectable antiretroviral therapy (ART) has been approved in the United States, Canada and Europe; the United States also has approved LA injectable preexposure prophylaxis (PrEP) and the World Health Organization has recommended the vaginal PrEP ring. Current LA PrEP modalities in clinical trials include injections, films, rings, and implants; LA ART modalities in trials include subcutaneous injections and long-term oral pills. Although LA modalities hold incredible promise, global availability is inhibited by long-standing multilevel perils including declining multilateral funding, patent protections and lack of political will. Once available, access and uptake are limited by factors such as insurance coverage, clinic access, labor markets, stigma, and structural racism and sexism. These must be addressed to facilitate equitable access for all. SUMMARY There have been tremendous recent advances in the efficacy of LA ART and PrEP modalities, providing renewed hope that 'ending the HIV epidemic' is within reach. However, pervasive socio-structural inequities limit the promise of LA modalities, highlighting the need for cautious optimism in light of the embedded inequities in the trajectory of research, development, and population-level implementation.
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Affiliation(s)
- Morgan M. Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Minalga B, Chung C, Davids JD, Martin A, Perry NL, Shook A. Research on transgender people must benefit transgender people. Lancet 2022; 399:628. [PMID: 35151395 DOI: 10.1016/s0140-6736(21)02806-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Brian Minalga
- Office of HIV/AIDS Network Coordination, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
| | | | - J D Davids
- Strategies for High Impact, Brooklyn, NY, USA
| | - Aleks Martin
- Public Health-Seattle and King County, Seattle, WA, USA
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Long JE, Tordoff DM, Reisner SL, Dasgupta S, Mayer KH, Mullins JI, Lama JR, Herbeck JT, Duerr A. HIV transmission patterns among transgender women, their cisgender male partners, and cisgender MSM in Lima, Peru: A molecular epidemiologic and phylodynamic analysis. LANCET REGIONAL HEALTH. AMERICAS 2022; 6:100121. [PMID: 35178526 PMCID: PMC8849555 DOI: 10.1016/j.lana.2021.100121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Transgender women (TW) in Peru are disproportionately affected by HIV. The role that cisgender men who have sex with TW (MSTW) and their sexual networks play in TW's risk of acquiring HIV is not well understood. We used HIV sequences from TW, MSTW, and cisgender men who have sex with men (MSM) to examine transmission dynamics between these groups. METHODS We used HIV-1 pol sequences and epidemiologic data collected through three Lima-based studies from 2013 to 2018 (n = 139 TW, n = 25 MSTW, n = 303 MSM). We identified molecular clusters based on pairwise genetic distance and used structured coalescent phylodynamic modeling to estimate transmission patterns between groups. FINDINGS Among 200 participants (43%) found in 62 clusters, the probability of clustering did not differ by group. Both MSM and TW were more likely to cluster with members of their own group than would be expected based on random mixing. Phylodynamic modeling estimated that there was frequent transmission from MSTW to TW (67·9% of transmission from MSTW; 95%CI = 52·8-83·2%) and from TW to MSTW (76·5% of transmissions from TW; 95%CI = 65·5-90·3%). HIV transmission between MSM and TW was estimated to comprise a small proportion of overall transmissions (4·9% of transmissions from MSM, and 11·8% of transmissions from TW), as were transmissions between MSM and MSTW (7·2% of transmissions from MSM, and 32·0% of transmissions from MSTW). INTERPRETATION These results provide quantitative evidence that MSTW play an important role in TW's HIV vulnerability and that MSTW have an HIV transmission network that is largely distinct from MSM.
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Affiliation(s)
- Jessica E. Long
- Department of Epidemiology, University of Washington, UW Box #, 351619, Seattle, WA 98195, United States
- Corresponding authors at: Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA 98195, United States.
| | - Diana M. Tordoff
- Department of Epidemiology, University of Washington, UW Box #, 351619, Seattle, WA 98195, United States
- Department of Global Health, International Clinical Research Center, University of Washington, Seattle, WA, United States
- Corresponding authors at: Department of Epidemiology, University of Washington, UW Box #351619, Seattle, WA 98195, United States.
| | - Sari L. Reisner
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Sayan Dasgupta
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kenneth H. Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States
| | - James I. Mullins
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Microbiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Joshua T. Herbeck
- Department of Global Health, International Clinical Research Center, University of Washington, Seattle, WA, United States
| | - Ann Duerr
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Fujimoto K, Paraskevis D, Kuo JC, Hallmark CJ, Zhao J, Hochi A, Kuhns LM, Hwang LY, Hatzakis A, Schneider JA. Integrated molecular and affiliation network analysis: Core-periphery social clustering is associated with HIV transmission patterns. SOCIAL NETWORKS 2022; 68:107-117. [PMID: 34262236 PMCID: PMC8274587 DOI: 10.1016/j.socnet.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study investigates the two-mode core-periphery structures of venue affiliation networks of younger Black men who have sex with men (YBMSM). We examined the association between these structures and HIV phylogenetic clusters, defined as members who share highly similar HIV strains that are regarded as a proxy for sexual affiliation networks. Using data from 114 YBMSM who are living with HIV in two large U.S. cities, we found that HIV phylogenetic clustering patterns were associated with social clustering patterns whose members share affiliation with core venues that overlap with those of YBMSM. Distinct HIV transmission patterns were found in each city, a finding that can help to inform tailored venue-based and network intervention strategies.
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Affiliation(s)
- Kayo Fujimoto
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jacky C. Kuo
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | | | - Jing Zhao
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Andre Hochi
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital, and Northwestern University, Feinberg School of Medicine, Department of Pediatrics, 225 E. Chicago Avenue, #161, Chicago, IL 60611
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue MC 5065, Chicago, IL 60637
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Guta A, Newman PA. Virality, desire and health assemblages: mapping (dis)continuities in the response to and management of HIV and COVID-19. CULTURE, HEALTH & SEXUALITY 2021; 23:1516-1531. [PMID: 34657555 DOI: 10.1080/13691058.2021.1981453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
In this paper, we explore the relationship between "viral load" as a virological, immunological, epidemiological and social category and how it links the four decades-long global HIV pandemic to the ongoing response to COVID-19. We argue, metaphorically, that the response to SARS-CoV-2 contains 'genetic' material from HIV, which has (as a result of the digital age which reproduces error-filled data at incredible speed) mutated and is being transmitted into the social and political body. Using sexual health and substance use as focal points, we turn to Deleuzoguattarian theoretical insights about the assemblage of desire, affect and material factors that produce epidemics. Contrasting historical and contemporary scenes and issues, we explore the complex assemblage created by viral loads, medical and public health protocols, conceptions of risk, responsibility and fear that connect both pandemics. Finally, we consider the goal of viral eradication and related militaristic metaphors, alongside the increasing convergence of medicine, public health, the law and corporate interests, and contrast this with community responses that engage with what it means to be living and dying in viral times.
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Affiliation(s)
- Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Molldrem S, Hussain MI, Smith AKJ. Open science, COVID-19, and the news: Exploring controversies in the circulation of early SARS-CoV-2 genomic epidemiology research. Glob Public Health 2021; 16:1468-1481. [PMID: 33661076 PMCID: PMC8338786 DOI: 10.1080/17441692.2021.1896766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/22/2021] [Indexed: 01/15/2023]
Abstract
Some early English language news coverage of COVID-19 epidemiology focused on studies that examined how SARS-CoV-2 (the coronavirus that causes COVID-19) was evolving at the genetic level. The use of phylogenetic methods to analyse pathogen genetic sequence data to understand disease dynamics is called 'molecular' or 'genomic' epidemiology. Many research groups in this subfield utilise open science practices, which can involve the circulation of early unreviewed findings on publicly-accessible venues online. From March to May 2020, media outlets covered early SARS-CoV-2 genomic studies that claimed to have discovered types of SARS-CoV-2 that had mutated to be more transmissible. We use methods from Science and Technology Studies (STS) to examine three cumulative cases in which unripe facts about SARS-CoV-2 genomics moved out of scientific publics and into mainstream news. The three cases are: (1) 'A More "Aggressive" Strain of SARS-CoV-2?', (2) 'Eight SARS-CoV-2 Strains?', and (3) 'A "More Contagious," "Mutant" Strain?' In each case, findings were called into question and reporters' framing was overly sensational. We interpret the COVID-19 pandemic as a 'stress-test' for open science practices, and argue that it is important for stakeholders to understand changes in scientific publication and dissemination processes in the wake of the pandemic.
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Affiliation(s)
- Stephen Molldrem
- Department of Anthropology, University of California, Irvine, CA, USA
| | | | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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Hastings C, McClelland A, Guta A, Owino M, Manning E, Orsini M, Elliott R, Gagnon M, Molldrem S. Intersections of Treatment, Surveillance, and Criminal Law Responses to HIV and COVID-19. Am J Public Health 2021; 111:1252-1254. [PMID: 34110919 DOI: 10.2105/ajph.2021.306236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Colin Hastings
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Alexander McClelland
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Adrian Guta
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Maureen Owino
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Eli Manning
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Michael Orsini
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Richard Elliott
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Marilou Gagnon
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
| | - Stephen Molldrem
- Colin Hastings is with the Department of Sociology and Anthropology, Concordia University, Montreal, QC. Alexander McClelland is with the Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON. Adrian Guta is with the School of Social Work, University of Windsor, Windsor, ON. Maureen Owino is with the Faculty of Environmental Studies, York University, Toronto, ON. Eli Manning is with the School of Social Work, Dalhousie University, Halifax, NS. Michael Orsini is with the Institute of Feminist and Gender Studies, University of Ottawa, Ottawa, ON. Richard Elliott is with the HIV Legal Network, Toronto, ON. Marilou Gagnon is with the School of Nursing, University of Victoria, Victoria, BC. Stephen Molldrem is with the Department of Anthropology, University of California, Irvine
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Juengst ET, Van Rie A. Transparency, trust, and community welfare: towards a precision public health ethics framework for the genomics era. Genome Med 2020; 12:98. [PMID: 33218363 PMCID: PMC7677909 DOI: 10.1186/s13073-020-00800-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
Infectious disease control is experiencing a paradigm shift, as pathogen sequencing technologies and digital applications are increasingly implemented for control of diseases such as tuberculosis, Ebola, and COVID-19. A new ethical framework should be a critical part of this emerging paradigm to ensure that the benefit of precision public health interventions based on advances in genomics research is not outweighed by the risks they pose to individuals, families, and vulnerable segments of the population. We suggest that the ethical framework guiding practice in this domain combines standard precepts from public health ethics with emerging ethics principles from precision medicine.
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Affiliation(s)
- Eric T Juengst
- Center for Bioethics, School of Medicine, University of North Carolina at Chapel Hill, 333 MacNider Hall, Chapel Hill, NC, 27599-7240, USA.
| | - Annelies Van Rie
- Family Medicine and Population Health, Faculty of Medicine, University of Antwerp, Campus Drie Eiken R232, Universiteitsplein 1, 2610, Wilrijk, Belgium
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French M, Guta A, Gagnon M, Mykhalovskiy E, Roberts SL, Goh S, McClelland A, McKelvey F. Corporate contact tracing as a pandemic response. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1829549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Martin French
- Department of Sociology and Anthropology, Concordia University, Montreal, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, Canada
| | | | - Stephen L Roberts
- Institute for Global Health, University College London (UCL), London, UK
| | - Su Goh
- Department of Economics, McGill University, Montreal, Canada
| | - Alexander McClelland
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, Canada
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Guta A, Gagnon M, Philbin MM. Ethical Convergence and Ethical Possibilities: The Implications of New Materialism for Understanding the Molecular Turn in HIV, the Response to COVID-19, and the Future of Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:26-29. [PMID: 33016822 DOI: 10.1080/15265161.2020.1806400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Klugman CM. What is a Bioethics of the Oppressed in the Age of COVID-19? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:29-31. [PMID: 33016831 DOI: 10.1080/15265161.2020.1806397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Bernard EJ, McClelland A, Cardell B, Chung C, Castro-Bojorquez M, French M, Hursey D, Khanna N, Minalga MB, Spieldenner A, Strub S. We Are People, Not Clusters! THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:1-4. [PMID: 32945744 DOI: 10.1080/15265161.2020.1809550] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
| | | | - Barb Cardell
- Colorado Organizations and Individuals Responding to HIV/AIDS
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Della Croce Y. Conceptualizing a Bioethics of the Oppressed: Oppression, Structure, and Inclusion. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:42-44. [PMID: 33016821 DOI: 10.1080/15265161.2020.1806386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Mutenherwa F, Wassenaar D, de Oliveira T. Adding a Voice to the Unique Ethical Considerations in Molecular HIV Surveillance. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:34-36. [PMID: 33016832 DOI: 10.1080/15265161.2020.1806399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Farirai Mutenherwa
- University of KwaZulu-Natal
- KwaZulu-Natal Research Innovation and Sequencing Platform
| | - Douglas Wassenaar
- University of KwaZulu-Natal
- South African Research Ethics Training Initiative, University of KwaZulu-Natal
| | - Tulio de Oliveira
- University of KwaZulu-Natal
- KwaZulu-Natal Research Innovation and Sequencing Platform
- University of Washington
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Molldrem S, Smith AKJ. Technology Changes the Ethical Stakes in HIV Surveillance and Prevention: Response to Open Peer Commentaries on "Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:W1-W3. [PMID: 32945742 DOI: 10.1080/15265161.2020.1815472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Dawson L, Latham SR. Molecular HIV Surveillance and Public Health Ethics: Old Wine in New Bottles. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:39-41. [PMID: 33016834 DOI: 10.1080/15265161.2020.1806393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Dencik L. Advancing Data Justice in Public Health and Beyond. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:32-33. [PMID: 33016829 DOI: 10.1080/15265161.2020.1806945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Smith JC. Fourth Pillar or "Third Rail?:" Towards a Community-Centered Understanding of the Role of Molecular HIV Surveillance in Ending the HIV Epidemic in the United States. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:5-6. [PMID: 33016820 DOI: 10.1080/15265161.2020.1812266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Justin C Smith
- Positive Impact Health Centers
- Emory University Rollins School of Public Health
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Haire B. Benefit of HIV Molecular Surveillance is Unclear, but Risks to Prevention Norms Are Clear. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:47-49. [PMID: 33016824 DOI: 10.1080/15265161.2020.1806388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Rennie S, Sullivan K, Dennis A. HIV Molecular Epidemiology: Tool of Oppression or Empowerment? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:44-47. [PMID: 32945759 PMCID: PMC7808252 DOI: 10.1080/15265161.2020.1806392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
| | | | - Ann Dennis
- University of North Carolina at Chapel Hill
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Watson M, Sweeney P. Furthering Discussion of Ethical Implementation of HIV Cluster Detection and Response. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:24-26. [PMID: 33016830 PMCID: PMC7543986 DOI: 10.1080/15265161.2020.1806398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Meg Watson
- Centers for Disease Control and Prevention
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Seiler N, Horton K, Vanecek A, Heyison C. Wise Use of Surveillance Data: Evolving HIV Policy and Emerging Considerations Regarding COVID-19. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:36-39. [PMID: 33016828 DOI: 10.1080/15265161.2020.1806384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Naomi Seiler
- George Washington University School of Public Health
| | - Katie Horton
- George Washington University School of Public Health
| | - Anya Vanecek
- George Washington University School of Public Health
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