Pushing up against the limits of progress

PUBHLTH 405
Social History of Infectious Disease
University of Michigan School of Public Health

Jon Zelner
[email protected]
epibayes.io

Agenda

  • Reflecting on Fiasco as a whole

  • What is harm reduction and why is it so controversial?

  • “How to Hide a Plague”

  • Time to incorporate feedback from presentations

How do we go from a pandemic to an endemic disease? (~9m)

Fiasco has taken us from the emergence of HIV to its managment as a chronic, endemic infection

In the google doc:

  • What surprised or struck you the most in the final episode, “No Harm”?

  • What is your biggest takeaway from listening to the series as a whole?

  • What do you still want to know?

10:00

Tracking the evolution of COVID from a collective to an individual problem (~5m)

Needle exchange programs are clearly effective

  • Prevent transmission of HIV, HCV and other pathogens among people who inject drugs (PWID)

  • Increased rates of spontaneous hepatatis C clearence among PWID participating in needle exchange. (Kåberg et al. 2018)

  • Needle exchange is one approach to harm reduction.

  • Harm reduction implicitly assumes that these are collective rather than individual moral problems to solve.

What explains moral opposition to needle exchange and harm reduction more generally?

Survey-based research suggested that placing a strong value on moral ‘purity’ was predictive of reduced support for needle exchange (Christie et al. 2019)

These attitudes impact people who participate in these programs

From (Szott 2020)

Earlier testing and case-finding could have slowed a large HIV outbreak in Indiana

Modeling results from (Gonsalves and Crawford 2018)

Some questions for the class:

  • What similarities and differences do you see in the social trajectory of the COVID pandemic vs. the HIV pandemic?

  • Was HIV ever treated as a collective problem? If so, for whom?

Some questions to think about during the next clip 🎬

  • Do you buy Feldman’s arguments about the normalization of COVID?

  • Are there parallels in the ways scientific authority was used and abused during the early days of HIV and throughout the COVID-19 pandemic?

  • If we don’t hide pandemics to get back to some form of normal everyday life, what is the alternative?

Being an effective participant in the conversation, you have to be clear about the interests that shape it (~15m)

In small groups

  • Do you buy Feldman’s arguments about the normalization of COVID?

  • Are there parallels in the ways scientific authority was used and abused during the early days of HIV and throughout the COVID-19 pandemic?

  • If we don’t hide pandemics to get back to some form of normal everyday life, what is the alternative?

10:00

Next time

  • Last class!

  • Brief wrap-up of the term & opportunity for feedback

  • Pathogen project group work time

References

Christie, Nina C., Eustace Hsu, Carol Iskiwitch, Ravi Iyer, Jesse Graham, Barry Schwartz, and John R. Monterosso. 2019. “The Moral Foundations of Needle Exchange Attitudes.” Social Cognition 37 (3): 229–46. https://doi.org/10.1521/soco.2019.37.3.229.
Gonsalves, Gregg S, and Forrest W Crawford. 2018. “Dynamics of the HIV Outbreak and Response in Scott County, IN, USA, 2011–15: A Modelling Study.” The Lancet HIV 5 (10): e569–77. https://doi.org/10.1016/S2352-3018(18)30176-0.
Kåberg, Martin, Georg Navér, Anders Hammarberg, and Ola Weiland. 2018. “Incidence and Spontaneous Clearance of Hepatitis C Virus (HCV) in People Who Inject Drugs at the Stockholm Needle Exchange—Importance for HCV Elimination.” Journal of Viral Hepatitis 25 (12): 1452–61. https://doi.org/10.1111/jvh.12969.
Szott, Kelly. 2020. “‘Heroin Is the Devil’: Addiction, Religion, and Needle Exchange in the Rural United States.” Critical Public Health 30 (1): 68–78. https://doi.org/10.1080/09581596.2018.1516031.