Synergistic Disparities and Public Health Mitigation of COVID-19 in the Rural United States.

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population.

Information Disorder Syndrome and Its Management.

Many of us may be unknowingly suffering from information disorder syndrome. It is more prevalent due to the digitized world where the information flows to every individual's phone, tablet and computer in no time. Information disorder syndrome is the sharing or developing of false information with or without the intent of harming and they are categorized as misinformation, disinformation and malinformation. The severity of the syndrome is categorized into three grades. Grade 1 is a milder form in which the individual shares false information without the intent of harming others. Grade 2 is a moderate form in which the individual develops and shares false information with the intent of making money and political gain, but not with the intent of harming people. Grade 3 is a severe form in which the individual develops and shares false information with the intent of harming others. The management of this disorder requires the management of false information, which is rumor surveillance, targeted messaging and community engagement. Repeated sufferers at the Grade 1 level, all sufferers from grade 2 and 3 levels need psycho-social counseling and sometimes require strong regulations and enforcement to control such information disorder. The most critical intervention is to be mindful of the fact that not all posts in social media and news are real, and need to be interpreted carefully.

"As I Was Walking Down the Street, Four Strange Guys Came and Took Me Under the Bridge, Where They All Raped Me": An Interpretative Phenomenological Analysis of the Types of Rape Experienced by Men in South Africa.

Globally, rape is regarded as the most demoralizing type of trauma, and it has negative implications for victims and their families. Although rape affects the community in general, there is a paucity of literature on rape victimization of men. As a result, the types of rape experienced by them are not understood, and thus it is often difficult to develop contextually relevant interventions to prevent male rape and to support male rape victims. The objective of this study was to first determine and then describe, the types of rape experienced by men. An interpretative phenomenological analysis (IPA) qualitative approach was used to collect and analyze data from a purposive sample of 11 participants, using semistructured individual interviews. The findings of the study reveal six themes and related subthemes as six types and related subtypes of rape experienced by men as follows: acquaintance rape, including familial rape; stranger rape; gang rape, including corrective-gang rape, drug-facilitated gang rape, pack-hunting rape, women retributive rape (or women vengeance) for violence experienced from men; homophobic rape; prison rape, including transactional rape and gang initiation rape; and armed rape. The findings reveal the different contexts or settings where men are vulnerable to rape. This highlights the possibilities for the development of context-specific sexual violence prevention interventions for men, which include self-defense training and awareness campaigns specific to rape victimization of men. Furthermore, future studies are recommended to expose this pandemic. Activism is advocated to stop the silence around this public and social health issue.

Research 101: A process for developing local guidelines for ethical research in heavily researched communities.

BACKGROUND: Marginalized communities often attract more than their share of research. Too often, this research benefits researchers disproportionately and leaves such communities feeling exploited, misrepresented, and exhausted. The Downtown Eastside (DTES) neighborhood of Vancouver, Canada, has been the site of multiple public health epidemics related to injection drug use as well as the site of much community-led resistance and struggle that has led to the development of cutting-edge harm reduction interventions (e.g., North America's first supervised injection facility, Insite) and a strong sense of community organization. This background has made the DTES one of the most heavily researched communities in the world. Amidst ongoing experiences of unethical or disrespectful research engagement in the neighborhood, a collaboration between local academic researchers and community representatives developed to explore how we could work together to encourage more respectful, community-responsive research and discourage exploitative or disrespectful research. METHODS: We developed a series of six weekly workshops called "Research 101." These workshops brought together approximately 13 representatives from peer-based organizations in the DTES with a variety of experiences with research. Research 101 created space for community members themselves to discuss the pitfalls and potential of research in their neighborhood and to express community expectations for more ethical and respectful research. RESULTS: We summarized workshop discussions in a co-authored "Manifesto for Ethical Research in the Downtown Eastside." This document serves as a resource to empower community organizations to develop more equitable partnerships with researchers and help researchers ground their work in the principles of locally developed "community ethics." Manifesto guidelines include increased researcher transparency, community-based ethical review of projects, empowering peer researchers in meaningful roles within a research project, and taking seriously the need for reciprocity in the research exchange. CONCLUSIONS: Research 101 was a process for eliciting and presenting a local vision of "community ethics" in a heavily researched neighborhood to guide researchers and empower community organizations. Our ongoing work involves building consensus for these guidelines within the community and communicating these expectations to researchers and ethics offices at local universities. We also describe how our Research 101 process could be replicated in other heavily researched communities.

Ethics of radiological risk governance: justice of justification as a central concern.

Due to the specific character of the radiological risk, judgements on whether the use of nuclear technology would be justified in society have to consider knowledge-related uncertainties and value pluralism. The justice of justification not only informs the right of the potentially affected to participate in decision making, but also implies the responsibility of concerned actors to give account of the way they rationalise their own position, interests, hopes, hypotheses, beliefs, and concerns in knowledge generation and decision making. This paper characterises the evaluation of whether the use of nuclear technology would be justified in society as a 'complex social problem', and reflects on what it would imply to deal with its complexity fairly. Based on this assessment, the paper proposes 'reflexivity' and 'intellectual solidarity' as ethical attitudes or virtues for all concerned actors, to be understood from a specific 'ethics of care' perspective 'bound in complexity'. Consequently, it argues that there is a need for an 'interactive' understanding of ethics in order to give ethical attitudes or virtues a practical meaning in a sociopolitical context, and draws conclusions for the case of radiological risk governance.

Disease prioritarianism: a flawed principle.

Disease prioritarianism is a principle that is often implicitly or explicitly employed in the realm of healthcare prioritization. This principle states that the healthcare system ought to prioritize the treatment of disease before any other problem. This article argues that disease prioritarianism ought to be rejected. Instead, we should adopt 'the problem-oriented heuristic' when making prioritizations in the healthcare system. According to this idea, we ought to focus on specific problems and whether or not it is possible and efficient to address them with medical means. This has radical implications for the extension of the healthcare system. First, getting rid of the binary disease/no-disease dichotomy implicit in disease prioritarianism would improve the ability of the healthcare system to address chronic conditions and disabilities that often defy easy classification. Second, the problem-oriented heuristic could empower medical practitioners to address social problems without the need to pathologize these conditions. Third, the problem-oriented heuristic clearly states that what we choose to treat is a normative consideration. Under this assumption, we can engage in a discussion on de-medicalization without distorting preconceptions. Fourth, this pragmatic and de-compartmentalizing approach should allow us to reconsider the term 'efficiency'.

Conceptual and practical problems of moral enhancement.

Recently, the debate on human enhancement has shifted from familiar topics like cognitive enhancement and mood enhancement to a new and - to no one's surprise - controversial subject, namely moral enhancement. Some proponents from the transhumanist camp allude to the 'urgent need' of improving the moral conduct of humankind in the face of ever growing technological progress and the substantial dangers entailed in this enterprise. Other thinkers express more sceptical views about this proposal. As the debate has revealed so far, there is no shared opinion among philosophers (or scientists) about the meaning, prospects, and ethical evaluation of moral enhancement. In this article I will address several conceptual and practical problems of this issue, in order to encourage discussion about the prospects of (thinking about) moral enhancement in the future. My assumption is that (i) for the short term, there is little chance of arriving at an agreement on the proper understanding of morality and the appropriateness of one single (meta-)ethical theory; (ii) apart from this, there are further philosophical puzzles loosely referred to in the debate which add to theoretical confusion; and (iii) even if these conceptual problems could be solved, there are still practical problems to be smoothed out if moral enhancement is ever to gain relevance apart from merely theoretical interest. My tentative conclusion, therefore, will be that moral enhancement is not very likely to be made sense of - let alone realized - in the medium-term future.

Arguments in favour of compulsory treatment of opioid dependence.

Twelve agencies of the United Nations, including the World Health Organization, have issued a joint statement that calls on Member States to replace the compulsory detention of people who use opioids in treatment centres with voluntary, evidence-informed and rights-based health and social services. The arguments in favour of this position fall into three broad categories: Compulsory treatment centres infringe on an individual's liberty, they put human beings at risk of harm, and evidence of their effectiveness against opioid dependence has not been generated. The United Nations statement underscores that although countries apply different criteria for sending individuals to compulsory treatment centres, detention often takes place without due process, legal safeguards or judicial review. This clearly violates internationally recognized human rights standards. Furthermore, people who are committed to these centres are often exposed to physical and sexual violence, forced labour and sub-standard living conditions. They are often denied health care, despite their heightened vulnerability to HIV infection and tuberculosis. Finally, there is no evidence, according to the statement, that these centres offer an environment that is conducive to recovery from opioid dependence or to the rehabilitation of commercial sex workers or of children who have suffered sexual exploitation, abuse or lack of care and protection. The author of this paper sets forth several arguments that counter the position taken by the United Nations and argues in favour of compulsory treatment within a broader harm reduction strategy aimed at protecting society as well as the individual concerned.

Douze agences des Nations Unies, parmi elles l'Organisation mondiale de la Santé, ont émis une déclaration commune qui appelle les États membres à remplacer la détention obligatoire des consommateurs d'opioïdes dans des centres de traitement par des services sanitaires et sociaux volontaires qui s'appuient sur des données probantes et soient fondés sur le droit. Les arguments en faveur de cette position se répartissent en trois grandes catégories: les centres de traitement obligatoire empiètent sur la liberté de l'individu, ils exposent les êtres humains à des risques et la preuve de leur efficacité contre la dépendance aux opioïdes n'a pas été démontrée. La déclaration des Nations Unies souligne que même si les pays appliquent des critères différents pour l'envoi des individus dans des centres de traitement obligatoire, leur détention survient souvent sans procédure régulière, protection légale ou contrôle juridictionnel. Cet état de fait contrevient clairement aux normes des droits de l'homme reconnues au niveau international. En outre, les personnes remises à ces centres sont souvent exposées à des sévices physiques et sexuels, à du travail forcé et à des conditions de vie inférieures aux normes. Ils se voient souvent refuser des soins de santé en dépit de leur vulnérabilité accrue à l'infection par le VIH et à la tuberculose. Enfin, il n'y a aucune preuve, selon cette déclaration, que ces centres offrent un climat propice à la récupération de la dépendance aux opioïdes ou à la réinsertion des professionnels du sexe ou des enfants victimes d'exploitation sexuelle, de maltraitance ou de manque de soins et de protection.L'auteur de ce document de travail avance plusieurs arguments contraires à la position adoptée par les Nations Unies et milite en faveur d'un traitement obligatoire participant d'une stratégie élargie de réduction des risques visant à protéger la société, mais aussi l'individu concerné.

Doce agencias de las Naciones Unidas, entre ellas la Organización Mundial de la Salud, han emitido una declaración conjunta que insta a los Estados miembros a reemplazar la retención obligatoria en centros de tratamiento de personas que hacen uso de opiáceos por servicios sociales y sanitarios voluntarios, basados en pruebas científicas y en sus derechos. Los argumentos a favor de esta postura se clasifican en tres amplias categorías: Los centros de tratamiento obligatorio atentan contra la libertad individual, ponen a las personas en riesgo y no existen pruebas de su eficacia contra la dependencia de opiáceos. La declaración de las Naciones Unidas enfatiza que, aunque cada país aplica criterios distintos a la hora de enviar a los individuos a los centros de tratamiento obligatorio, es frecuente que la retención se lleve a cabo sin el debido proceso, la seguridad jurídica ni el examen judicial correspondiente, lo que viola claramente las normas de los derechos humanos reconocidas a nivel internacional. Además, las personas internadas en dichos centros se ven expuestas, con frecuencia, a violencia física o sexual, trabajos forzados y condiciones precarias de vida, y es frecuente que se les niegue la atención sanitaria a pesar de ser más vulnerables a la infección por VIH y a la tuberculosis. Por último, no hay ninguna evidencia, de acuerdo con la declaración, de que dichos centros ofrezcan un ambiente propicio para la recuperación de la dependencia a los opiáceos o para la rehabilitación de trabajadores sexuales o de niños que han sufrido explotación sexual, abusos o falta de cuidado y atención.El autor del presente artículo describe numerosos argumentos que rebaten la posición adoptada por las Naciones Unidas a favor de un tratamiento obligatorio en el ámbito de una estrategia más amplia enfocada a la reducción del daño y cuyo objetivo es proteger tanto a la sociedad como al individuo afectado.

"Living cadavers" in Bangladesh: bioviolence in the human organ bazaar.

The technology-driven demand for the extraction of human organs--mainly kidneys, but also liver lobes and single corneas--has created an illegal market in body parts. Based on ethnographic fieldwork, in this article I examine the body bazaar in Bangladesh: in particular, the process of selling organs and the experiences of 33 kidney sellers who are victims of this trade. The sellers' narratives reveal how wealthy buyers (both recipients and brokers) tricked Bangladeshi poor into selling their kidneys; in the end, these sellers were brutally deceived and their suffering was extreme. I therefore argue that the current practice of organ commodification is both exploitative and unethical, as organs are removed from the bodies of the poor by inflicting a novel form of bioviolence against them. This bioviolence is deliberately silenced by vested interest groups for their personal gain.

Persistence of racial differences in attitudes toward homosexuality in the United States.

BACKGROUND: Stigma may mediate some of the observed disparity in HIV infection rates between black and white men who have sex with men (MSM). METHODS: We used data from the General Social Survey to describe race-specific trends in the US population's attitude toward homosexuality, reporting of male same-sex sexual behavior, and behaviors that might mediate the relationship between stigma and HIV transmission among MSM. RESULTS: The proportion of blacks who indicated that homosexuality was "always wrong" was 72.3% in 2008, largely unchanged since the 1970s. In contrast, among white respondents, this figure declined from 70.8% in 1973 to 51.6% in 2008 with most change occurring since the early 1990s. Participants who knew a gay person were less likely to have negative attitudes toward homosexuality (relative risk, 0.60; 95% confidence interval, 0.52 to 0.69). Among MSM, twice as many black MSM reported that homosexuality is "always wrong" compared with white MSM (57.1% versus 26.8%, P = 0.003). MSM with unfavorable attitudes toward homosexuality were less likely to report ever testing for HIV compared with MSM with more favorable attitudes (relative risk, 0.50; 95% confidence interval, 0.31 to 0.78). CONCLUSIONS: US attitudes toward homosexuality are characterized by persistent racial differences, which may help explain disparities in HIV infection rates between black and white MSM.

The asymmetrical relationship between the health care professional and the patient in public hospitals.

The relationship between the health care professional and the patient is universally seen, in medicine, as the core of medical practice. Through it, the doctor acquires professional abilities and pursues the objectives of medicine, among them, that of curing. This relation is contextualized here by using articles 47 and 48, from the chapter on Human Rights, found in the Code of Ethical Medicine of the Federal Council of Medicine of the Federative Republic of Brazil--both in the sense of the transformational link between two people, and as a relationship of interpersonal tolerance. The objectives of this article are: 1) to evaluate the asymmetry present in the clinical doctor-patient encounter, with respect to the doctor's social and political commitment regarding the patient. Recorded testimonies were used, of individuals who utilize medical assistance in Public Hospitals, carried out in the hallways of the 'das Clínicas Hospital' in Recife, Pernambuco; and 2) to weave an analogy with the book "Masters and Slaves" ('Casa Grande & Senzala'): 'Formation of the Brazilian Family under the Regime of a Patriarchal Economy', written by the Pernambucan sociologist Gilberto Freyre. Among the recorded talks, the resentment regarding discrimination and the authority of the doctor's position can be clearly observed. As a result, this power relation was considered the focus of our discussion--the same power relation as that which reigned over the Brazilian colonization period, in the times of "Masters and Slaves" (Casa Grande & Senzala).

Politics and Israeli psychologists: is it time to take a stand?

In Israel, it is quite rare for psychologists to relate to political and social issues. This remarkable tendency of psychologists to avoid dealing with such matters seems to supersede the common indifference or obtuseness of other groups in the Israeli public and similar groups in particular (e.g., physicians or social workers). Within this context, this paper focuses on the qualities and forms of reaction of the psychotherapeutic community in Israel to the national conflict that has been present intermittently since the late 1980s - namely, the two Intifadas. More specifically, as opposed to the current situation (the second Al-Aksa Intifada), in the course of the first Intifada (1987-1996), the voice of Israeli psychologists was clearly heard. Until now, this is the only exception to the rule of neutrality and passivity, in which psychologists in Israel became politically active. Specific elements of involvement of the therapeutic community is presented and discussed. Also, an attempt is made to suggest possible reasons to the very puzzling questions: Why then? Or what factors allowed for this change in position to occur? And more importantly, why did the protest of the psychologists in Israel vanish and their clear voices turn into silence?