Saturday, January 19, 2008

Risk

Last night, I had a lovely dinned with Lisa, talking about my future as a professor. She has good advice. And she's super funny. Before dinner, we went up into the Berkeley hills to watch the sunset.


Tonight, I'm going to a party. Yay! It's funny, here I am, living in the center of one of the hippest metropolises on the planet (here's a shot looking south from my apartment), and I almost never get out.


RISK
Anyway, something exciting is coming up this week. I'm getting together with my friend Chris from Philly to do a little presentation for the SexPol group on "risk" and queer public health on Thursday.
Many luminaries from the field will be there, which is more invigorating than it is intimidating.
The picture to the right is of an ad I saw in O'Hare airport on the way back from Providence, which seemed very apt.
As gay men, we are constantly told to reduce our risks. Actually, as people living in America, we are constantly told to reduce our risks, from smoking, from eating, drinking, and sex.
But in business, it is all about taking risks. "No risk, no reward" is a mantra. That's what this ad is playing on. Risk as thrilling, vital and essential to life itself.
Which makes for an interesting contrast, doesn't it? On the one hand we are supposed to avoid risks and feel bad about them, on the other, we are supposed to seek them out.
No wonder public health is in such a state of confusion. I'm hoping to help find ways out of that mess. More on that later.

8 comments:

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  2. How widespread is the new phenomenon?... the strategy of "Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs." Sexual health checkups reduce ambiguity/risk and can be like anything else POTENTIAL sex partners might do together.

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  3. Hey Zak,
    I don't know how common that strategy is. Sounds like it would work well for some folks, not so well for a hookup. I guess what I'm trying to figure out is how people react to the concept of risk, and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

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  4. .
              > strategies that involve
              > systemic changes

    Like home test kits for HIV. As technology advances we'll have more home test kits for a variety of sexually transmitted diseases.

    Are there home test kits for chlamydia?

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  5. I don't know if there are home tests for chlamydia. By systemic changes I mean addressing homophobia, sexism, racism, wealth extraction (redistribution to the rich), etc. Traditionally, public health has had its greatest success with things like water, sewage, & poverty remediation.

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  6.         > I don't know how common that
            > strategy is. Sounds like it would work
            > well for some folks, not so well for a
            > hookup.

    Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?


            > I guess what I'm trying to figure out is
            > how people react to the concept of
            > risk, and whether 'public health' might
            > not better be focused on some of its
            > more traditional success strategies that
            > involve systemic changes, rather than
            > individual coaching.

    With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...


            > I don't know if there are home tests for
            > chlamydia. By systemic changes I mean
            > addressing homophobia, sexism,
            > racism, wealth extraction
            > (redistribution to the rich), etc.
            > Traditionally, public health has had its
            > greatest success with things like
            > water, sewage, & poverty
            > remediation.

    and testing...

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  7. >> Sounds like it would work
    >> well for some folks, not so
    >> well for a hookup.

    >Gosh, I'm just thinkin out loud
    >here, but could "hookups" have
    >anything to do with the AIDS
    >epidemic?

    I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.
    Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way. The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

    >> I guess what I'm trying to
    >> figure out is how people react
    >> to the concept of risk, and
    >> whether 'public health' might
    >> not better be focused on some
    >> of its more traditional success
    >> strategies that involve
    >> systemic changes, rather than
    >> individual coaching.

    > With something like tuberculosis
    > the FIRST step is to get tested.
    > Workin out pretty good so far...

    >> ...Traditionally, public health
    >> has had its greatest success{es}
    >> with things like water, sewage,
    >> & poverty remediation.

    > and testing...

    Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.
    Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)
    Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

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  8. .
                >> Sounds like it would work well for some folks, not so well for a hookup.

        Gosh, I'm just thinkin out loud here, but could "hookups" have anything to do with the AIDS epidemic?

        > I was pointing out that there are common situations in the real world where the strategy you're touting wouldn't be especially helpful.

    Not washing hands before operating was also once a very common strategy--even a standard practice.


        > Do hookups have something to do with the AIDS endemic? I suppose you could look at it that way.

    I'm going out on a limb here, but will guess yes.


        > The broader question I'm asking is whether it is helpful to look at AIDS as the sum of behaviors and biologic test results (as current epidemiology & public health practice tend to do), or whether it might make sense to back off a bit and ask whether we might make more of a difference by laying off the moralism inherent in behavioral approaches

    I'm going out on a limb here, but will guess that things like clean water, sterilized instruments, and washed hands have little to do with moralism.


        > and focusing on some of the structural forces, such as homophobia, gender hierarchies, racist ideologies, and poverty production that also obviously have huge impacts on the AIDS endemics across the world.

    I'm guessing that some of the stanard practices mentioned above would work for homophobes, non-homophobes, racists, non-rascits, poor or rich people, etc, all over the world.


                >> I guess what I'm trying to figure out is how people react to the concept of risk,

    Irrationally is the word I think you're looking for.


                >> and whether 'public health' might not better be focused on some of its more traditional success strategies that involve systemic changes, rather than individual coaching.

    I'm thinking that people become infected one at a time.


        With something like tuberculosis the FIRST step is to get tested. Workin out pretty good so far...

                >> ...Traditionally, public health has had its greatest success{es} with things like water, sewage, & poverty remediation.

        and testing...

    Individuals have to take care of the testing part.


        > Tuberculosis is a great example of how structural changes far outstripped the ability of medicine and individualized behavioral messages to curtail the spread.

    Today everybody deals with it, first, by testing.


        > Arguably, the first successful steps in curtailing the spread of tuberculosis included addressing slum dwellings where people lived in extremely close quarters, pasteurization of milk, and various other public health approaches. (e.g. AJPH 1998 88(7):1105-1117)

    Its still time for individuals to get tested...


    A L Fairchild and G M Oppenheimer
    Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis
    http://www.ajph.org/
    cgi/content/abstract/88/7/1105

    http://www.ajph.org/cgi/reprint/88/7/1105

        > Testing in NYC began in the late 1880's, well after tuberculosis incidence had started declining rapidly. It probably helped somewhat after that point, but we have tended to overlook the relatively larger impacts of structural interventions that preceeded testing and continued to affect the incidence of tuberculosis afterwards as well.

    Once all the reading is finished you still need to go get tested.

    ReplyDelete