Human papillomavirus self-sampling: A tool in cancer prevention and sexual health promotion.

This article examines human papillomavirus (HPV) self-sampling as an approach to cervical cancer prevention and the ways self-sampling kits are promoted directly to consumers in the United States. Public health, biomedicine and health tech have increasingly imagined self-sampling, which allows individuals to collect their own vaginal specimen, mail to a laboratory for testing and receive delivered results, as a component of cervical cancer prevention and sexual health promotion. This article examines the scientific and biomedical claims used to configure the problem in need of this solution and the ways persons, publics and markets are established. We analyse scientific literature, interviews with clinicians and other key actors, and websites of directly to consumers (DTC) companies. HPV self-sampling is constructed as both a solution to inequities and gaps in cervical cancer screening and a solution to the wants and needs of those already engaged in self-projects of body monitoring and risk reduction. These multidirectional biomedical tendencies also reveal how sexuality and sexual health and cervical cancer prevention and sexual health promotion are entangled objects. While we do not want to undermine the potential of HPV self-sampling, we encourage a focus on equity and care and not commodified markets that reinforce notions of 'good' patients monitoring their health.

Orienting Toward Possibility: Girls and Bisexuality at School.

While many more high school girls identify as bisexual than as lesbian, queer, or other marginalized sexual identities, girls who identify as bisexual remain peripheral to sexuality research and to many sexual health education programs. Nevertheless, research suggests that bisexuality is a distinct claim and experience for girls, marked by highly gendered discourses of sexuality and queerness. Based on the Beyond Bullying Project, a multimedia storytelling project that invited students, teachers, and community members in three U.S. high schools to enter a private booth and share stories of LGBTQ (lesbian, gay, bisexual, transgender and queer or questioning) sexuality and gender, this article explores the work the identity "bisexual" and the category "bisexuality" accomplish for girls when claimed for themselves or another or put into circulation at school. We consider the range of meanings and identifications mobilized by bisexuality and, drawing on insights of critical narrative intervention, explore how sexual health and sexuality educators might receive girls' narratives of bisexuality as capacious and contradictory-as claims to identity, as uncertain gestures toward desire, and as assertions of possibility and resistance. We show that in the assertion of bisexuality, girls align themselves with the surprise of desire and position themselves to resist the disciplining expectations of heteronormative schooling. Critical narrative intervention, with its focus on using stories to challenge the status quo, allows educators and researchers to recognize in girls' stories of bisexuality, the potential of new approaches to sexual health education and social belonging.

The imaginary of precision public health.

In recent years, precision medicine has emerged as a charismatic name for a growing movement to revolutionise biomedicine by bringing genomic knowledge and sequencing to clinical care. Increasingly, the precision revolution has also included a new paradigm called precision public health-part genomics, part informatics, part public health and part biomedicine. Advocates of precision public health, such as Sue Desmond-Hellmann, argue that adopting cutting-edge big data approaches will allow public health actors to precisely target populations who experience the highest burden of disease and mortality, creating more equitable health futures. In this article we analyse precision public health as a sociotechnical imaginary, examining how calls for precision shape which public health efforts are seen as necessary and desirable. By comparing the rhetoric of precision public health to precision warfare, we find that precision prescribes technical solutions to complex problems and promises data-driven futures free of uncertainty, unnecessary suffering and inefficient use of resources. We look at how these imagined futures shape the present as they animate public health initiatives in the Global South funded by powerful philanthropic organisations, such as the Bill & Melinda Gates Foundation, as well as local efforts to address cancer disparities in San Francisco. Through our analysis of the imaginary of precision public health, we identify an emerging tension between health equity goals and precision's technical solutions. Using large datasets to target interventions with greater precision, we argue, fails to address the upstream social determinants of health that give rise to health disparities worldwide. Therefore, we urge caution around investing in precision without a complementary commitment to addressing the social and economic conditions that are the root cause of health inequality.

Development of a privacy and security policy framework for a multistate comparative effectiveness research network.

Comparative effectiveness research (CER) conducted in distributed research networks (DRNs) is subject to different state laws and regulations as well as institution-specific policies intended to protect privacy and security of health information. The goal of the Scalable National Network for Effectiveness Research (SCANNER) project is to develop and demonstrate a scalable, flexible technical infrastructure for DRNs that enables near real-time CER consistent with privacy and security laws and best practices. This investigation began with an analysis of privacy and security laws and state health information exchange (HIE) guidelines applicable to SCANNER participants from California, Illinois, Massachusetts, and the Federal Veteran's Administration. A 7-member expert panel of policy and technical experts reviewed the analysis and gave input into the framework during 5 meetings held in 2011-2012. The state/federal guidelines were applied to 3 CER use cases: safety of new oral hematologic medications; medication therapy management for patients with diabetes and hypertension; and informational interventions for providers in the treatment of acute respiratory infections. The policy framework provides flexibility, beginning with a use-case approach rather than a one-size-fits-all approach. The policies may vary depending on the type of patient data shared (aggregate counts, deidentified, limited, and fully identified datasets) and the flow of data. The types of agreements necessary for a DRN may include a network-level and data use agreements. The need for flexibility in the development and implementation of policies must be balanced with responsibilities of data stewardship.

Homeplace: Care and resistance among public housing residents facing mixed-income redevelopment.

Low-income communities of color experience significant political, economic, and health inequities and, not unrelatedly, are disproportionately exposed to violent crime than are residents of higher income communities. In an effort to mitigate concentrations of poverty and crime, governmental agencies have partnered with affordable housing developers to redevelop public housing "projects" into mixed-income communities and to do so within a "trauma-informed" framework. The current study analyzes how residents have historically and contemporaneously negotiated, endured, and resisted structural and interpersonal violence in 2 long-standing, predominately African American, public housing communities undergoing a public-private housing redevelopment initiative. Interviews with 44 adult public housing residents (age range = 18-75 years; 82% African American/Black) were conducted during a 2-year period while residents' homes were being demolished and rebuilt into mixed-income communities. Analysis of in-depth interviews used constructivist grounded theory principles to reveal a common theme and basic social process of the ongoing formation of homeplace, with subthemes focusing on the ways homeplace emerges through shared lineage, knowing and caring practices; how homeplace is maintained through networks of protection in unsafe contexts; how homeplace is disrupted as a result of redevelopment activities; and the reclamation of homeplace during redevelopment in the service of hope and healing. These findings offer a nuanced view of resident's lived experiences of place-based trauma and collective resistance and resilience, while also highlighting the place-specific ways in which redevelopment unsettles deeply rooted sociocultural configurations of home and community. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Queering reproduction in transnational bio-economies.

In this commentary, I consider how scholars, practitioners and those seeking to have babies via assisted reproductive technology (ART) might be accountable to 21st century family-making in ways that attend to reproductive stratifications (the uneven support for people to conceive and raise children), and yet refuse to renaturalize or valorize certain forms of reproduction or reproduction by certain categories of persons [e.g. lesbian, gay, bisexual, transgender and gender queer (LGBTQ)/non-normative people]. I offer a queer reproductive justice (QRJ) framework that joins the shift in feminist politics from advocating safe, affordable and equitable access to ART to imagining other ways of doing and making kinship, care and children. QRJ suggests that kinship can be queered via choice and ART without succumbing to either a binary choice between queerness and normativity or without being unaccountable to oneself, others within systems of power, and the very systems that make our choices legible. QRJ neither marginalizes nor valorizes LGBTQ desires and practices for inclusion in reproductive biomedicine, and refuses to renaturalize or valorize certain forms of reproduction over others. Instead, QRJ posits queer kinship as a social formation that variously challenges and reinforces the values of neoliberal, future-oriented reproductivity and the global biological market economies in which these increasingly take shape. QRJ encourages kinship forms that include multiple possibilities for intimacies, belonging and making kin.

The proliferation of sexual health: Diverse social problems and the legitimation of sexuality.

Especially since the 1990s, the term sexual health has flourished in professional, commercial, and lay domains. Yet the more the phrase has become visible, the greater the mutability in its meanings. These developments matter for an understanding of healthism-the idea that modern individuals are enjoined to recognize a moral obligation to maximize their health. Theorists of healthism have paid relatively little attention to sexuality and its frequent rendering as controversial, illegitimate, or stigmatizing. We argue that because pairing "sexual" with "health" serves to legitimize and sanitize sexuality, the framing of sexual issues as matters of sexual health is widely appealing across multiple social arenas, and this appeal helps to explain both the proliferation of the term and the diversification of its uses. Secondly, we argue that while the polysemy of sexual health might suggest that the phrase lacks a clear meaning, in another sense the term is quite meaningful: content analysis of journal articles, newspaper articles, and websites shows that the semantics of sexual health can be categorized into six social problem niches, within which sexuality and health are construed in distinctive ways. For each social problem framing, we identify the implied meanings of both sexuality and health, the "opposite" of sexual health, the institutional action plans, the individual injunctions, and the presumed ontologies of bodies and selves. By focusing on how the conjoining of "sexual" and "health" changes the meanings of both terms, our analysis adds nuance to discussions of healthism: it challenges a singular conception of healthism and points to the need for clearer consideration of its different forms. At the same time, we call attention to the significance of "sexual healthism" as a particular example of the "will to health" while also highlighting implications of characterizing sexual issues as matters of health.

The pharmaceuticalization of sexual risk: vaccine development and the new politics of cancer prevention.

Vaccine development is a core component of pharmaceutical industry activity and a key site for studying pharmaceuticalization processes. In recent decades, two so-called cancer vaccines have entered the U.S. medical marketplace: a vaccine targeting hepatitis B virus (HBV) to prevent liver cancers and a vaccine targeting human papillomavirus (HPV) to prevent cervical and other cancers. These viruses are two of six sexually transmissible infectious agents (STIs) that are causally linked to the development of cancers; collectively they reference an expanding approach to apprehending cancer that focuses attention simultaneously "inward" toward biomolecular processes and "outward" toward risk behaviors, sexual practices, and lifestyles. This paper juxtaposes the cases of HBV and HPV and their vaccine trajectories to analyze how vaccines, like pharmaceuticals more generally, are emblematic of contemporary pharmaceuticalization processes. We argue that individualized risk, in this case sexual risk, is produced and treated by scientific claims of links between STIs and cancers and through pharmaceutical company and biomedical practices. Simultaneous processes of sexualization and pharmaceuticalization mark these cases. Our comparison demonstrates that these processes are not uniform, and that the production of risks, subjects, and bodies depends not only on the specificities of vaccine development but also on the broader political and cultural frames within which sexuality is understood.

Queering the fertility clinic.

A sociologist examines contemporary engagements of queer bodies and identities with fertility biomedicine. Drawing on social science, media culture, and the author's own empirical research, three questions frame the analysis: 1. In what ways have queers on the gendered margins moved into the center and become implicated or central users of biomedicine's fertility offerings? 2. In what ways is Fertility Inc. transformed by its own incorporation of various gendered and queered bodies and identities? And 3. What are the biosocial and bioethical implications of expanded queer engagements and possibilities with Fertility Inc.? The author argues that "patient" activism through web 2.0 coupled with a largely unregulated free-market of assisted reproduction has included various queer identities as "parents-in-waiting." Such inclusions raise a set of ethical tensions regarding how to be accountable to the many people implicated in this supply and demand industry.

Patient informed governance of distributed research networks: results and discussion from six patient focus groups.

Understanding how to govern emerging distributed research networks is essential to their success. Distributed research networks aggregate patient medical data from many institutions leaving data within the local provider security system. While much is known about patients' views on secondary medical research, little is known about their views on governance of research networks. We conducted six focus groups with patients from three medical centers across the U.S. to understand their perspectives on privacy, consent, and ethical concerns of sharing their data as part of research networks. Participants positively endorsed sharing their health data with these networks believing that doing so could advance healthcare knowledge. However, patients expressed several concerns regarding security and broader ethical issues such as commercialism, public benefit, and social responsibility. We suggest that network governance guidelines move beyond strict technical requirements and address wider socio-ethical concerns by fully including patients in governance processes.

The nurse clinical trial coordinator: benefits and drawbacks of the role.

It has become common for nurses to be recruited into and/or seek careers outside of the traditional domain of hospital-based work. This article draws on interview data to consider a position nurses are occupying within biomedicine, that of the nurse clinical trial coordinator. It examines and analyzes the value attributed to such positions by nurse trial coordinators. The analysis reveals that nurses identify three aspects of the position-social relations, the acquisition of skills and knowledge, and work and control-as having both advantages and disadvantages over other work roles within nursing. It concludes with suggestions for further research on the role and involvement of nurses in clinical research.