LICENTIA COGITATIONIS

On Spectacle, Institutional Mythmaking, and the Politics of an Epidemic That Refuses to Disappear After more than a decade of working in the HIV milieu, I have come to accept something I once resisted: there will be no end to the HIV epidemic. More than that, I have begun to question whether “ending the epidemic” was ever a realistic goal at all. Perhaps the promise of an ending has always been a myth—one that, paradoxically, helps sustain the very systems through which the epidemic continues. Conspiratorial thinking notwithstanding, the United States—and, from there, much of the world—will almost certainly fail to achieve the major HIV goals established for 2030: dramatic reductions in new infections and HIV-related deaths, alongside viral suppression for nearly everyone living with HIV. But why? I do not believe the answer is simply that powerful people want “us” dead. Nor is it because we lack the infrastructure to treat and prevent HIV. It cannot be explained entirely by inadequate...

A patient consents to HIV genotyping because their physician needs the information to select treatment. The patient is never meaningfully informed that the viral sequence will also enter a government surveillance system. Their sequence is subsequently identified as part of a rapidly growing molecular cluster. Public-health officials then use that classification to decide where and how to intervene. The individual never consented to having their clinical specimen repurposed to map their relationship to a population-level transmission network. This creates a provocative comparison with conventional research ethics. If I recruited 5,000 people living with HIV into a university study, collected their viral sequences, linked those sequences to demographic and epidemiological information, constructed molecular clusters, and evaluated interventions based on those clusters, an IRB would scrutinize questions of consent, risk, privacy, data governance, and protection of participants. Yet when so...

Public Health: Epidemiology and Anthropology  My intellectual position sits at a crossroads these scholars collectively helped create: HIV is no longer understood merely as a viral pathogen moving through populations, but as a socially produced condition embedded in desire, inequality, pharmacology, surveillance, migration, stigma, intimacy, and late-capitalist forms of embodiment. What distinguishes your focus is that you are not only examining risk, but also pleasure, agency, erotic culture, and the moral politics surrounding “raw sex” and chemsex among gay and queer communities. That shift matters. Paul Farmer and Philippe Bourgois would push you to ask what structural conditions produce chemsex environments in the first place. Rather than reducing condomless sex or stimulant use to “bad decisions,” their frameworks redirect analysis toward housing precarity, loneliness, labor alienation, minority stress, criminalization, biomedical inequality, and the psychic afterlife of th...

Prevention for Whom? Telemedicine is innovative....but this essay asks asks not just what works , but what works for whom, where, and why . Implementation science, economics, systems, and synergies refers to an integrated way.... -What is it? - who is being left out, how, why  - describe the relationship between pharmacy-based programs and nonprofit funding      340b               - is this relationship a negative correlation where as one increases (the profit margin for the nonprofits and telemedicine), the other decreased (the brick-and-mortar clinical settings, and respective resources (salaries, etc)  - how is this phenomenon affecting the EHE goals - is there an impact on overall STI rates relative to the ease of access of preventive medicines like doxyPEP; especially considering the lack of health education and supportive services that once accompanied biomedical interventions  -how are online biomedical i...

Multivariable Correlates of Early Sexual Debut, Condom Use, and Substance Use as Predictors of STI Risk Among U.S. Adolescents: Evidence from the 2023 Youth Risk Behavior Survey Introduction Adolescents in the United States experience a disproportionately high burden of sexually transmitted infections, driven by overlapping behavioral and social factors (Centers for Disease Control and Prevention, 2024). Early sexual debut is associated with increased risk due to longer exposure to sexual activity and lower likelihood of protective behaviors. Substance use before sex further increases risk by impairing judgment and reducing condom use (Leigh & Stall, 1993). Experiences of sexual violence also contribute to vulnerability by limiting the ability to negotiate safe sex (DiClemente et al., 2005). This study examines how these factors interact to influence STI risk and whether condom use acts as a mediating pathway. Background Sexually transmitted infections (STIs) remain a major public ...

HIV/HCV/Syphilis & Polysubstance Use Disorder for Homelessness  Presentation Script Good evening. My name is Clay Porter, and today I am presenting STREETRx at Valley Health Care , which stands for Syndemic Treatment, Rapid Engagement, and Equitable Transitions . This proposed program addresses the intersection of homelessness, polysubstance use disorder, overdose risk, HIV, hepatitis C, and syphilis among unhoused individuals in Columbus, Georgia. The central argument of this project is that these conditions should not be treated as separate public health problems. Instead, they operate as a syndemic , meaning they interact with and intensify one another within a context of housing instability, poverty, fragmented care, and structural inequity. The purpose of STREETRx is to create a low-barrier, co-located MAT and syndemic screening model within Valley Health Care’s existing clinical and outreach infrastructure. Rather than relying on traditional referral systems that requir...