Thinking About Thinking
This section is an introduction to the theoretical framework
used in this project. Or, perhaps, it is better to say, a rejection of the
rigidity of contemporary theory and occidental frames for analysis are what is presented
here; introducing the work of deconstruction as a generative mechanism for
discovery, an alternative to production, that is truly a
dialectical symbol in action.
Epistemology
Epistemology is how we know. In KO we make implicit
epistemic statements about knowledge of concepts, acts (such as
representation), entities, and systems. In so doing, we create knowledge, and
our epistemic stance dictates what kind of knowledge that is. Some common names
of epistemic stances are: pragmatic, positivistic, operationalist, referential,
instrumental, empiricist, rationalist, realist, etc. Each of these makes claims
as to what kind of knowledge can be created through research, and how it is gathered
and how it is presented. These epistemic stances do this work because they have
a systematic view on reality, our knowledge of it, and the meaning we can
ascribe to it.
Theory
How do we infer meaning from the world?
Theory is what humans use to infer meaning from the world,
be it in the analytical observations of research, or among the diverse datum
collected in epidemiological fieldwork; experiences are made meaningful from
theory, which is then framed by our interpretations, and represented in every
element of the communication process: the sender, the receiver, the
(informative) message and culture. This is true for all discourses which
discipline our minds and determine our view of reality; but only the
epidemiologic perspective is considered here. The pattern of meaning that
connects all communication in the epidemiology of HIV and STIs necessitates
context; because, without context there is no meaning. We must examine more
than the communication inventions that have so far been produced and used in
epidemiology (such as those described in “We Are People, Not Clusters” which
reviews the conventions of molecular HIV/STI surveillance). We must consider
the problem for which these inventions were intended as a solution. We must
consider the problems which arise when we try to solve any problem by
invention—that is, the appropriateness of the research and development
context.
This practicum project’s theoretical framework understands
the world as text which can be read; and as such, is interpretive (function),
postmodern (conceptual), and deconstructive (practical), and based on a
pragmatic view of reality- and research- that is focused on the outcomes of the
research itself- the actions, situations, and consequences of inquiry and
analysis- rather than antecedent conditions (as in postpositivism, where the
focus is on causal relations- such as causation explained by the Social
Determinants of Health- and assumes that the way scientists think and work and
the way we think in our everyday life are not distinctly different. I reject
that perspective because it is effectively untrue. The relationship between
science and society is a dialectic with material effects in the lives of
subjects in the real world. Thus, the epistemological enterprise defined by the
framework of analysis adopted for this study is meant to highlight these
effects and the implications they have for the epidemiology of HIV and STDs, as
well as for those named and subjectified by this research.
Symbols in Action
As we said above, theory is set of propositions used to
explain some phenomena; it is a narrative. Theories are, in the most general
sense, unifying narratives about phenomena. Such narratives can predict, while
others recast our perspective or view on the world. Others are created to shift
our views on social action fundamentally. The kind of narrative (predictive,
perspective, or invoking a fundamental shift) depends on the epistemic stance.
There are several terms and some theory used in this paper
which are not cotemporaneous with any epistemic priorities in public health and
have not yet come to be represented in epidemiological paradigms, or disease
prevention practices; especially, when the alterity presented is meant to
challenge prevailing perspectives.
The multiplicity of forms of health-related knowledge,
including biomedical knowledge, law knowledge, and critical constructionist
knowledge, raises challenges for health professionals entangled in the HIV and
STI milieu- or anyone invested in the myriad of research and development
contexts from which knowledge of sexual health and disease intervention is
produced.
Productive Power
The ‘systems of meaning’ in question are perceptions of
economic and political reality: the productive power of an epistemic framework
is found within the classification and interpretation processes which drive
agents’ actions. These frameworks are embedded within epistemic communities,
sites of ‘collective interpretation and choice.’[1] Epistemic communities enact the policy
coordination necessary for international economic order based upon the
expectations formed by the interpretive processes that define and modify
meanings of action. Here, epistemic validity becomes a proxy for governance,
with the power to create the patterns which guide, regulate, and control life
at individual, state, and international level. https://www.e-ir.info/2013/06/01/epistemic-frameworks-in-the-international-economic-order/
Epistemic communities define, and are in turn defined by,
constituent actors’ positions and interests. When addressing policy, epistemic
communities exercise productive power over classification by defining the
nature of the issue and the context in which ideas and information are
interpreted, further shaping actors’ interpretation of the issue at hand.
STI National Strategic Plan
Approximately 350 pages of federally stylized writing,
notwithstanding any data visualization or other analytic instrumentation, defines
development in disease prevention and describes different strategies for
dealing with multiplicity public health and epidemiologic efforts to End the
HIV Epidemic- together with converging STI rates.
A nascent and nuanced HIV National Strategic Plan was
recently issued to all jurisdictional health authorities in the U.S. as a
“roadmap to end the epidemic” for fiscal years 2021 to 2025, which, when
juxtaposed to the novel STI Plan, will set new standards for discourse and the
delineation of nascent measures for progress toward reducing this public health
syndemic. Following a not-so-new vision for the next five years, both plans
acknowledge the diversity of stakeholders and robust processes involved in
research and development. Still on page 3, another disclosure is made which
directs attention to the “language used in the (HIV/) STI Plan;” and it is with
this text that I disclose my contributions to the division of each plan and
demarcation of analytical alterity for evaluating their instrumentation. By
demonstrating how I have helped shape the goals, objectives, and strategies in
creating an HIV/STI integrated plan, I am framing optimism in the critical
dissertations to follow.
Methodology
Methodology is the combination of epistemic stance and the
methods of investigation. Methods of investigation, what I will call
techniques, form a practice that carries with it the knowledge needed to have a
result faithful to the chosen epistemology
Writing as Technique
The majority research in KO is done using writing as the
technique.
This may be because it is explicitly linked to a family of
epistemic stances and knowledge claims, drawn from the tradition of textual
criticism, and founded on the belief that the power of rhetoric and perspective
can shape action
STI National Strategic Plan
Language used in the STI Plan: The STI Plan places value on
the lived experiences and choices of all people, regardless of age, sex, gender
identity, sexual orientation, race, ethnicity, religion, disability, geographic
location, or socioeconomic circumstance. To reflect this vision, a concerted
effort was made to use inclusive and person-first language throughout the STI
Plan. Evidence-based, contemporary terminology is also used to convey respect
and empowerment and to reduce stigma faced by communities and populations
disproportionately impacted by these infections. Despite these efforts,
specific terminology or language may be unintentionally offensive or
stigmatizing to some individuals or populations. Language is subjective, and
the meaning and use of language changes over time. This approach is intended to
help the STI Plan’s users to identify these societal shifts in preferred
terminology and to communicate in a manner that reflects its vision for a
collective, inclusive, and respectful national response.
I rejected the theory/applied divide throughout the course
of Community Practicum and throughout all my scholarship and disciplinary
efforts in public health, drawing on the traditions of postmodernism and deconstruction
(Derrida), I present an alternative to contemporary disease prevention
practice, laying new ground for the critical evaluation and disruptive
innovations necessitated by the HIV/STI syndemic. We cannot continue to spin
tires in the collegial quagmire of academia, digging deeper into the
disciplinary tracks which divide us; and remain detached from any meaningful
connection to the identities and issues of intersubjectivity in our inquiries.
It is time to accept the collective wisdom of those working in the HIV and STI
milieu and surmounting four decades of militant scholarship on the
interconnectedness of disease distribution and determinants of health; and
consider the underlying principles controlling the relations of these
associations as prediscursive patterns of causation and consequences of epistemic
priority in different epidemiologic contexts.
Interdisciplinarity and multimethod instrumentation are not
simple social theories made to soften dialogic rigidity in STEM; nor do they
represent “slower” routes to “the real.” Instead, their disruptive inclusions present
a path to holism and nonseparability in the educative structure/agency of scientific-
and social- revolution.
Just like the language disclaimer apart the HIV and STI
Plans, and the sundry of scholarly innovations and interventional strategies
for addressing syndemic-specific disparities, there is always already a demand
for pluralist acceptance of the variety of health-related knowledge. And, at
the same time, the need to improve health calls for action, and thus for
choices between opposing forms of knowledge are always already given to
context.
The present analysis proposes a more pragmatic approach to
this epistemological problem, by identifying implications for research
methodology and the choice of research goals; it understands knowledge is a
tool for action and as such it should be evaluated according to whether it
serves the desired interests. Because pragmatics describes generally the forces
in play for a given utterance (or incidence,) it includes the study of power,
gender, race, identity, and their interactions with culture, health, and
sexuality as intersubjective functions of communicative actuation (…desire).
What kind of knowledge does discourse analytical research
produce? What is the status of its results, and what can they be used for?
These questions, conventionally posed in all academic work, form part of a
wider discussion about the nature of scientific (and social scientific)
knowledge. It assumes that all knowledge is discursively produced and therefore
contingent, and that there is no possibility of achieving absolute or universal
knowledge since there is no context-free, neutral base for truth-claims. By
overcoming the distinction between analytic and synthetic truth, (between
analysis and synthesis (see: Pyramid),) it evaluates postmodernity and
describes the deconstruction of formal logics and the irreconcilably
contradictory meanings of Western taxonomizing. Instead, it embraces the ontological
precarity and operational performances of discourses, meaning, and knowledge
formations, separate from but including the differences in language use and
linguistic appropriation. The focus is on how scientific knowledge and
educative expertise is produced through plural and contingent praxes across
different sites. Such an approach bridges a symbolic-material
(interpretive/empirical, epidemiologic/ethnographic) distinction and signals
the always already politicized nature of “the real.”
So, then, what is the responsibility of intellectuals?
"Rad Sex"
Some notes on what a deconstructive approach to inquiry in the HIV and STD milieu
-
Towards a new theory and practice in addressing
HIV/STI syndemic disparate inequities among non-heteronormative assemblages in
the United States.
-
Using Critical Discourse Analysis to examine the
language of culture, health, and sexuality
o
Utilize to disarm its negative social
codifications
o
Transform the subtext of risk
o
Within the capitalist system, cost and risk may
be read as interconnected concepts.
-
Critical discourse analysis of the ….is
important for the practice of public health as it helps practitioners to better
understand the activities of MSM who are a part of a sexual subculture, keeping
in mind that the MSM population is still the prime target of public health
campaigns regarding STI and HIV
-
“raw” or safe
o
The term “raw” is introduced ..charged with
political meaning,.
o
Mediated intimacies: raw sex, Truvada, and the
politics of chemoprophylaxis
o
Mediated intimacies through technologies
-
History of AIDS pandemic in the U.S., anal sex
between men has accrued an evolving nomenclature that telegraphs its shifting
significance for those who pursue it
-
Raw sex bears some of the same erotically
charged connotations as bareback, but with the stigma.
o
To make this point is to register that the names
we use for sexual acts alter how those acts are perceived and indeed
experienced.
-
The nomenclature we employ for discussing sex
matters deeply.
o
The implications for how scholars of sexuality
and sexual health constitute our objects of research via that languages we use
to describe…
-
Unprotected anal intercourse convey disciplinary
affiliations, methodological assumptions, and ideological priorities through
their distinct vocabularies of sex.
-
What are we trying to prove with such
linguistic choices?
o
No one, not ever, has messaged me on any
social media platform (from Myspace…to Grindr) and asked “do you want to have
unprotected anal intercourse” or “do you prefer condomless anal
penetration/reception”
-
[It is] Ethically imperative to write about
the subculture in an idiom that would not sound complete alien to the
subcultural participants themselves.
-
“depathologize”
-
U.S. public health systems (doctors, health
professionals, academicians, etc…) – still treats sex with a debilitating
mixture of prurience and squeamishness.
-
Identity: homosexuality wasn’t recognized
as an identity category until the 1920’s
-
Gay sexual practices and its pharmacological
mediations
-
The United States is where the new approach
of “treatment as prevention” originated, and it is this reorientation of HIV
prevention that is altering the sexual landscape in ways that prompt
reassessment
o
They flipped everything on its head- healthy
people are given treatments developed for sick people
-
[we need to reconceptualize] our way of
understanding bareback/raw sex as group behavior rather than as merely an
individual preference or mistake.
-
We need to consider all the ways in which power
(defined here in terms of epistemic structures of risk) infiltrates and shapes
life itself.
-
Focusing on cultural, pharmacological, and methodological
mediations of “raw sex”
-
Perhaps, the most decisive form of mediation for
gay men in the U.S. today involved the availability of Truvada for PrEP.
Truvada is an AIDS drug that now is officially (CDC/VDH) recommended for
HIV-negative MSM.
o
Via the expert technological of PrEP, the long
history of medicalizing homosexuality has embarked upon a significant new
phase.
-
High-tech chemoprophylaxis threatens to
supersede the low-tech prophylaxis of condoms, with pharmacology taking over
where behavior modification has failed.
-
Officially (CDC/VDH) this
new technology/biomedical intervention is not meant to displace the old-
federal guidelines specific that Truvada should be combined with condom use-
almost everyone suspects it will.
-
Officially licensed as a
prophylactic, Truvada seems also license enjoyment without limits!
-
“Why would you take a pill every day to
avoid…having to take a pill every day?” skeptics
-
WHO reports that approx.. 10m people globally
are on some form of antiretroviral drug treatment
o
Epidemiological standpoint, it is but one
logical step to go from “zero deaths” to eliminating HIV-transmission
altogether.
o
Given that epidemiologist view populations
differently from how members of those populations see themselves, it is also
necessary to consider Truvada from something other than a purely
epidemiological standpoint.
o
CDC guidelines recommending that as many as half
of million (2014**) uninfected Americans go on Truvada for PrEP. Making a sea
change in how the US officially regards HIV-prevention.
o
Urging everyone who is “at-risk” to begin using
Truvada, the CDC is basically saying we have the technology, lets use it.
§
And this has implications for individual/
PrEP “uptake”.. what may be involved in regarding oneself as “at-risk” is less
straight forward than the CDC appears ready to concede…for gay men to identify
as “at-risk” entails their acknowledging a desire for raw sex …that goes
against community norms (since birth we’ve been told ABC’s )
-
“lifestyle” in the US exacerbates the disjunction
between how individuals self-identify and how they are CATEGORIZED by
epidemiologist
*this new technology also intersects and leads to MHS**
- concern about drug adherence elides the larger problem of
condom adherence. Research have had to rely on self-reporting when it comes to
measuring condom use , and they have been reluctant to admit just how
unreliable this measure it. **methodological critique**
-reliance on self-reports of adherence may be qualified by
more object measurements of drug levels in plasma.
Sexual surveillance now can bypass subjectivity
altogether by going directly inside the body to elicit information!!!
Rad’ Sex
-
Towards a new theory and practice in addressing
HIV/STI syndemic disparate inequities among non-heteronormative assemblages in
the United States.
-
Using Critical Discourse Analysis to examine the
language of culture, health, and sexuality
o
Utilize to disarm its negative social
codifications
o
Transform the subtext of risk
o
Within the capitalist system, cost and risk may
be read as interconnected concepts.
-
Critical discourse analysis of the ….is
important for the practice of public health as it helps practitioners to better
understand the activities of MSM who are a part of a sexual subculture, keeping
in mind that the MSM population is still the prime target of public health
campaigns regarding STI and HIV
-
“raw” or safe
o
The term “raw” is introduced ..charged with
political meaning,.
o
Mediated intimacies: raw sex, Truvada, and the
politics of chemoprophylaxis
o
Mediated intimacies through technologies
-
History of AIDS pandemic in the U.S., anal sex
between men has accrued an evolving nomenclature that telegraphs its shifting
significance for those who pursue it
-
Raw sex bears some of the same erotically
charged connotations as bareback, but with the stigma.
o
To make this point is to register that the names
we use for sexual acts alter how those acts are perceived and indeed
experienced.
-
The nomenclature we employ for discussing sex
matters deeply.
o
The implications for how scholars of sexuality
and sexual health constitute our objects of research via that languages we use
to describe…
-
Unprotected anal intercourse convey disciplinary
affiliations, methodological assumptions, and ideological priorities through
their distinct vocabularies of sex.
-
What are we trying to prove with such
linguistic choices?
o
No one, not ever, has messaged me on any
social media platform (from Myspace…to Grindr) and asked “do you want to have
unprotected anal intercourse” or “do you prefer condomless anal
penetration/reception”
-
[It is] Ethically imperative to write about
the subculture in an idiom that would not sound complete alien to the
subcultural participants themselves.
-
“depathologize”
-
U.S. public health systems (doctors, health
professionals, academicians, etc…) – still treats sex with a debilitating
mixture of prurience and squeamishness.
-
Identity: homosexuality wasn’t recognized
as an identity category until the 1920’s
-
Gay sexual practices and its pharmacological
mediations
-
The United States is where the new approach
of “treatment as prevention” originated, and it is this reorientation of HIV
prevention that is altering the sexual landscape in ways that prompt
reassessment
o
They flipped everything on its head- healthy
people are given treatments developed for sick people
-
[we need to reconceptualize] our way of
understanding bareback/raw sex as group behavior rather than as merely an
individual preference or mistake.
-
We need to consider all the ways in which power
(defined here in terms of epistemic structures of risk) infiltrates and shapes
life itself.
-
Focusing on cultural, pharmacological, and methodological
mediations of “raw sex”
-
Perhaps, the most decisive form of mediation for
gay men in the U.S. today involved the availability of Truvada for PrEP.
Truvada is an AIDS drug that now is officially (CDC/VDH) recommended for
HIV-negative MSM.
o
Via the expert technological of PrEP, the long
history of medicalizing homosexuality has embarked upon a significant new
phase.
-
High-tech chemoprophylaxis threatens to
supersede the low-tech prophylaxis of condoms, with pharmacology taking over
where behavior modification has failed.
-
Officially (CDC/VDH) this
new technology/biomedical intervention is not meant to displace the old-
federal guidelines specific that Truvada should be combined with condom use-
almost everyone suspects it will.
-
Officially licensed as a
prophylactic, Truvada seems also license enjoyment without limits!
-
“Why would you take a pill every day to
avoid…having to take a pill every day?” skeptics
-
WHO reports that approx.. 10m people globally
are on some form of antiretroviral drug treatment
o
Epidemiological standpoint, it is but one
logical step to go from “zero deaths” to eliminating HIV-transmission
altogether.
o
Given that epidemiologist view populations
differently from how members of those populations see themselves, it is also
necessary to consider Truvada from something other than a purely
epidemiological standpoint.
o
CDC guidelines recommending that as many as half
of million (2014**) uninfected Americans go on Truvada for PrEP. Making a sea
change in how the US officially regards HIV-prevention.
o
Urging everyone who is “at-risk” to begin using
Truvada, the CDC is basically saying we have the technology, lets use it.
§
And this has implications for individual/
PrEP “uptake”.. what may be involved in regarding oneself as “at-risk” is less
straight forward than the CDC appears ready to concede…for gay men to identify
as “at-risk” entails their acknowledging a desire for raw sex …that goes
against community norms (since birth we’ve been told ABC’s )
-
“lifestyle” in the US exacerbates the disjunction
between how individuals self-identify and how they are CATEGORIZED by
epidemiologist
*this new technology also intersects and leads to MHS**
- concern about drug adherence elides the larger problem of
condom adherence. Research have had to rely on self-reporting when it comes to
measuring condom use , and they have been reluctant to admit just how
unreliable this measure it. **methodological critique**
-reliance on self-reports of adherence may be qualified by
more object measurements of drug levels in plasma.
Sexual surveillance now can bypass subjectivity
altogether by going directly inside the body to elicit information!!!
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