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The story of colonial expansion has often been entwined with the social and health impact of syphilis. The purpose of this study was to examine the effect of syphilis (in its primary, secondary and tertiary forms) on hospital admissions and individual patients in Queensland in the pre-antibiotic era. This article centres on available hospital patient records for the years 1880–1920, stored at the Queensland State Archives. From these records, 220 cases of syphilis were retrieved, the majority diagnosed as primary-stage infections. Overall, it was found that the number of deaths from syphilis in its tertiary form was not significant compared with other causes of death in that period. The perception of colonial syphilis as highly prevalent and a serious threat to the population is not supported by our review of hospital records, which suggests that its reputation in relation to its social implications exceeded the evidence of its prevalence.

The HIV care continuum represents a linear clinical pathway from testing to viral suppression; however, it does not capture the psychosocial complexities of contemporary HIV care. We developed an innovative and appealing visual learning resource to extend the scope of HIV health literacy beyond biomedical constructs. Based on the lived experiences of recently diagnosed people living with HIV in Queensland, the "Journeys through the HIV Care Continuum" Map presents the continuum as a complex journey incorporating challenges such as poor health literacy, health service access and stigma alongside facilitators to care, including emotional and peer support. Designed for audiences who may not access academic literature, the Map can be used to facilitate conversations between recently diagnosed people living with HIV and peer navigators, and as a learning tool for health professionals, carers and students. The Map highlights opportunities to support PLHIV in meaningful ways that will reduce stigma and promote care access.

The trajectories of people attempting to reduce harmful methamphetamine use are frequently understood within a binary framework of transitioning between states of health and disease. This framework can often be reinforced by service interactions informed by these dominant narratives of recovery and addiction. In this paper, we draw on a critical interactionist analysis of ethnographic fieldwork conducted with people who use methamphetamine, to examine how their experiences could undermine this binary, observing the ways participants experienced growth, change, and progress, without necessarily maintaining abstinence. These findings support a more diverse understanding of drug use trajectories, and we explore the concept of ‘living with drug use’, similar to how people live with other chronic conditions by finding ‘health in illness’. Participant experiences are also interpreted within the context of counter public health, arguing for the recognition and integration of values and goals which are divergent from the implicit aims of public health practice.

The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.

The orthodox construction of agency within addiction recovery discourse is built upon a fault line between two conflicting principles: that people who use drugs in harmful ways cannot control their behavior, but that they can also regain that control through intentional effort. The conceptual confusion inherent in this framework can harm people using drugs by producing inadequate accounts of commonly invoked aspects of recovery such as “triggers,” “self-control,” and “addictive behavior.” This ethnographic study involved qualitative interviews and observations with nine people over 6 months as they engaged in recovery from harmful methamphetamine use, to explore their experiences of agency, and how these experiences could be shaped by the discourse of volition/compulsion. Thematic analysis was conducted using a posthumanist theoretical framework. We found “relapse triggers” to be diffuse aspects of particular environments rather than specific stimuli, able to provoke what would normally be considered conscious, intentional behavior rather than only autonomic or “mindless” processes. Participants also described their identities as internally divided and multiple, with drug related behaviors separated from their true selves. Finally, agency was experienced as emergent and distributed rather than as a particular resource located within individuals. Attending to these complex experiences of agency can help resolve the tension between loss of control and personal responsibility for people who use drugs, by renegotiating the historically imposed categorical distinction between volitional and compelled actions, and the cultural constructions of “addictive” versus “normal” behavior.

BACKGROUND: B-cell maturation antigen (BCMA)–directed chimeric antigen receptor (CAR) T-cell therapies have generated responses in patients with advanced myeloma, but relapses are common. G protein–coupled receptor, class C, group 5, member D (GPRC5D) has been identified as an immunotherapeutic target in multiple myeloma. Preclinical studies have shown the efficacy of GPRC5D-targeted CAR T cells, including activity in a BCMA antigen escape model. METHODS: In this phase 1 dose-escalation study, we administered a GPRC5D-targeted CAR T-cell therapy (MCARH109) at four dose levels to patients with heavily pretreated multiple myeloma, including patients with relapse after BCMA CAR T-cell therapy. RESULTS: A total of 17 patients were enrolled and received MCARH109 therapy. The maximum tolerated dose was identified at 150×10(6) CAR T cells. At the 450×10(6) CAR T-cell dose, 1 patient had grade 4 cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome (ICANS), and 2 patients had a grade 3 cerebellar disorder of unclear cause. No cerebellar disorder, ICANS of any grade, or cytokine release syndrome of grade 3 or higher occurred in the 12 patients who received doses of 25×10(6) to 150×10(6) cells. A response was reported in 71% of the patients in the entire cohort and in 58% of those who received doses of 25×10(6) to 150×10(6) cells. The patients who had a response included those who had received previous BCMA therapies; responses were observed in 7 of 10 such patients in the entire cohort and in 3 of 6 such patients who received 25×10(6) to 150×10(6) cells. CONCLUSIONS: The results of this study of a GPRC5D-targeted CAR T-cell therapy (MCARH109) confirm that GPRC5D is an active immunotherapeutic target in multiple myeloma. (Funded by Juno Therapeutics/Bristol Myers Squibb; ClinicalTrials.gov number, NCT04555551.)

Support networks promote care engagement and prevent social isolation for people living with HIV (PLWH). This study examined the personal support networks of recently diagnosed PLWH and explored how these networks change over time. We developed qualitative social network maps with 10 recently diagnosed PLWH in Queensland and identified unique and dynamic support networks. Network changes over time were influenced by changing support needs and experiences of stigma. Some support networks grew, whereas others remained small and close-knit or became sparse. The pivotal role of peers for information and emotional support was revealed. Socially isolated PLWH also described substantial reliance on long-term professional support. Others described reasons why health professionals were excluded from support networks, revealing the importance of nonjudgmental attitudes and HIV literacy among health professionals. Facilitating ongoing links with peers and professionals are crucial strategies to help PLWH foster effective and sustainable networks for comprehensive long-term support.

This round-table discussion, edited by Eva Urban and Lisa FitzGerald, took place on 5 July 2019 as part of the conference ‘New Romantics: Performing Ireland and Cosmopolitanism on the Anniversary of Human Rights’ organized by the editors at the Brian Friel Theatre, Queen’s University Belfast. Lisa FitzGerald is a theatre historian and ecocritic who completed postdoctoral fellowships at the Centre de Recherche Bretonne et Celtique (CRBC), Université Rennes 2 and the Rachel Carson Centre for Environment and Society, Ludwig Maximilian University of Munich. She is the author of Re-Place: Irish Theatre Environments (Peter Lang, 2017) and Digital Vision and the Ecological Aesthetic (forthcoming, Bloomsbury, 2020). Eva Urban is a Senior Research Fellow at the Senator George J. Mitchell Institute for Global Peace, Security, and Justice, Queen’s University Belfast, and an Associate Fellow of the Institute of Irish Studies, QUB. She is the author of Community Politics and the Peace Process in Contemporary Northern Irish Drama (Peter Lang, 2011) and La Philosophie des Lumières dans le Théâtre Breton: Tradition et Influences (Université de Rennes, 2019). Rosemary Jenkinson is a Belfast playwright and writer of five short story collections. Her plays include The Bonefire (Rough Magic), Planet Belfast (Tinderbox), White Star of the North, Here Comes the Night (Lyric), Lives in Translation (Kabosh Theatre Company), and Michelle and Arlene (Accidental Theatre). Her writing for radio includes Castlereagh to Kandahar (BBC Radio 3) and The Blackthorn Tree (BBC Radio 4). She has received a Major Individual Artist Award from the Arts Council of Northern Ireland to write a memoir. Tom Maguire is Head of the School of Arts and Humanities at Ulster University and has published widely on Irish and Scottish theatre and in the areas of Theatre for Young Audiences and Storytelling Performance. His heritage research projects include the collection Heritage after Conflict: Northern Ireland (Routledge, 2018, co-edited with Elizabeth Crooke). David Grant is a former Programme Director of the Dublin Theatre Festival and was Artistic Director of the Lyric Theatre in Belfast. He has worked extensively as a theatre director throughout Ireland and is co-investigator of an AHRC-funded research project into Arts for Reconciliation. He lectures in drama at Queen’s University Belfast.

Gender diverse young people face well-documented physical, mental and sexual health disparities compared to the general population. Differential access to healthcare is a key driver of these inequities and literature highlights high unmet healthcare need among members of this group. Healthcare access has been described through a model that defines five dimensions of health services: approachability; acceptability; availability and accommodation; affordability; and appropriateness; and five abilities of health service consumers that interact with these dimensions: the abilities to perceive, seek, reach, pay and engage. This comprehensive literature review examined barriers to and facilitators of healthcare access among gender diverse young people using the lens provided by this model as it relates to dimensions of access at the health service level and/or the abilities of health service users. We advocate expansion of this model to incorporate demand- and supply-side barriers and facilitators of access, and important structural factors including the gender binary health system framework, intersectionality and stigma. Findings highlight the need for improvements to healthcare provider education and the participatory redesign of health services with a focus on intersectionality, individually-tailored service provision and healthcare that is responsive to the unique needs of gender diverse young people.

Understanding of HIV self-management increasingly focuses on treatment adherence and associated health-related behaviors, yet people living with HIV (PLWH) seldom perform these actions in a social vacuum. Thus, delivering comprehensive self-management support programs for PLWH requires an understanding of the social and emotional dimensions of HIV self-management. Through thematic analysis of in-depth interviews with 35 newly diagnosed PLWH, this descriptive qualitative study highlights these dimensions and their effect on experiences of HIV diagnosis and care. HIV self-management involves interpersonal interactions that affect efforts to seek support and reimagine one's personal identity in a changed reality. Managing disclosures and navigating stigma constitute everyday work for many PLWH. Because stigma continues to impede care engagement and well-being for PLWH, health practitioners must extend focus beyond viral suppression and prioritize support for emotional and social self-management. Nurses can create safe, nonstigmatizing spaces for conversations about HIV, uphold the rights of PLWH around disclosure, and ensure that PLWH are connected to peer support services.

Understanding the clinical impact of COVID-19 has been central to emerging research in the HIV field, but in focusing on the biomedical, researchers must not overlook the socially embedded nature of HIV and the potential social impacts of this new pandemic on PLHIV. We conducted a scoping review to explore emerging research examining the social impacts of COVID-19 on PLHIV in OECD countries over the first 12 months of the pandemic. Twenty articles were identified and included for review. Key themes included: impacts on HIV care access/telehealth; stress and mental health; social isolation and loneliness; food insecurity; changes to sexual behaviour; changes to substance use; impacts on income, education and employment; and racial and social inequality. Results from this review can help guide research into areas where it is needed to help minimise the negative social impacts of the COVID-19 pandemic.

The sexual rights and well-being of women living with HIV (WLHIV) in developing countries are often restricted by socio-cultural concerns. Therefore, this convergent parallel mixed methods research combined quantitative and qualitative approaches to explore the factors influencing WLHIV sexual quality of life in Banten Province, Indonesia. Data from a 2017 cross-sectional survey of 207 reproductive-aged WLHIV were analyzed using univariate and multivariate logistic regression statistics. Furthermore, in-depth interviews with a sub-sample of survey participants (n = 30) were thematically analyzed. Most of the women (60%) involved reported loss of sexual pleasure and depressed sexual life. Meanwhile, 48% affirmed low sexual quality of life which was associated with unemployment (aOR: 2.90, and 95% CI: 1.51 – 5.58), limited sexual activities (aOR: 2.89, and 95% CI: 1.20 – 6.93), living with extended family (aOR: 2.68, and 95% CI: 1.27 –5.65), and experiencing intimate partner violence (aOR: 2.28, and 95% CI: 1.03 – 5.03). The respondents described unsatisfactory sexual life in relation to a belief that having sex is a wife's duty and choosing not to talk about sexual issues or refuse sexual invitation in fear of triggering intimate partner violence. Inter-related personal, social, cultural, and religious factors affected the sufferers’ sexual life. Developing health policy and strategies oriented towards building women’s capability to voice their sexual rights and needs, and also develop pro-women public health policies is essential.

What is an archipelagic imagination and from which cultural and geographical context does it emerge? How do coastal environments permeate our thoughts and filter through our aesthetic systems to pr...

Whales figure in human accounts of the natural world as a behemoth. At a metaphorical level, they are creatures that have value both as a barometer of the decline of material resources and a gatewa...

Globally, young people experience physical, sexual and emotion abuse within their intimate relationships. There is a need to explore creative, participatory sexual and relationship education that p...

The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.

This study explores conceptualisations and understandings of intimate relationships with young people in Samoa - an at-risk group experiencing high rates of intimate partner violence and alienation from sexual and relationship health promotion. Insights contribute to the immediate need to advance knowledge and practice around prevention with this group. An arts-based approach, which included a two-day interactive drama workshop coupled with follow-up, peer-led focus groups, was used to explore perceptions and understandings related to intimate relationships with 15 tertiary educated young people (nine female and six male) from across Samoa. Intersectionality informed the data collection and thematic analysis, examining participants' lived experiences and the ways multiple and intersecting identities interact within social and cultural systems to influence and inform these experiences. Outcomes highlight important tensions for young people, including the way in which age, gender, religion and sexuality interact with social hierarchies and power structures, socially prescribed gender norms, family structures and globalisation. This research provides insights that can inform the development of prevention strategies to address the root causes of intimate partner violence, building the knowledge and skills required for establishing intimate relationships free from violence with young people.

The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.

Background Despite its well documented risks and harms, methamphetamine use can also be experienced as a pleasurable, purposeful, and productive activity. Drug use discourse has historically deemphasised the pleasures of drug use, as they can contradict the expectations of neoliberalism that individuals be moderate, rational consumers. The purpose of this study was to explore the experiences of people trying to reduce or control their methamphetamine use, utilising a critical interactionist approach to excavate the subjugated knowledge of methamphetamine-related pleasure, and construct an understanding of methamphetamine use that incorporated these positive experiences. Methods Qualitative interviews and ethnographic observation were conducted over an eight-month period with a group of twelve people using methamphetamine and accessing recovery services. Transcripts and fieldnotes were analysed thematically with a critical interactionist lens. Results The pleasures of methamphetamine use were differentiated into pursuing the rush, exploring sociality, self-medication, and desiring productivity. The interwoven nature of these themes presents a multidimensional understanding of methamphetamine use resulting from a cascade of interacting causes and effects, rather than a linear product of individual choice or structural forces. These findings also highlight the complex symbiotic relationship between pleasure, productivity, and risk for people using methamphetamine which can be traced to the broader cultural and economic context in which use occurs. Conclusion Interventions and policies responding to harmful methamphetamine use must address the content and nature of the methamphetamine use cascade, acknowledging the diverse needs methamphetamine can meet for contemporary neoliberal citizens, and the sometimes complex and sophisticated purposes for which people may utilise its effects.

Background: There has been limited qualitative inquiry aimed at understanding the gendered and unique experiences of women living with HIV in high-income countries. In Australia, the relatively small number of women living with HIV means they have been largely overlooked in social, clinical, and policy representations of HIV over time. Objectives: To explore the experiences of women living long-term and aging with HIV, to understand the complex intersections between their health and social trajectories. Methods: Data were collected as part of Living Positive in Queensland, a longitudinal qualitative study of the experiences of living long-term and aging of people living with HIV in Queensland, Australia. This study analysed data from three annual, semi-structured interviews with the 11 female participants. Results: Women negotiated gendered roles and identities as they grappled with ongoing and intertwined health and psychosocial challenges over their life course. Development of co-morbidities, experiences of stigma, gendered social roles, financial precarity, and limited social support amplified the challenges of living with HIV and cumulatively impacted women’s health and wellbeing as they aged with HIV. Conclusion: The health and wellbeing of women living with HIV are adversely impacted by intersecting complex health issues, HIV-related stigma, gendered identities, social disadvantage, and aging. Greater attention to the unique needs of women living with HIV is necessary to reduce the prevalence of psychological distress, financial stress, and vulnerability to social isolation which, in turn, lead to poorer health.

Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers’ (HCP) knowledge and preparedness to prescribe PrEP remains limited. Methods: Semistructured interviews, conducted before PBS listing (October 2016–April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. Results: Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia’s universal healthcare insurance system). Conclusions: Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.

BackgroundThe number of women living with the human immunodeficiency virus (WLHIV) in Muslim-majority countries has increased significantly in the last decade. These women are often marginalized and face insecure sexual and reproductive health (SRH) needs and rights. However, little is known about the multi-faceted factors influencing these women’s fertility, contraceptive, and perinatal decisions and sexual life. This systematic mixed studies review aimed to synthesize the empirical evidence on social, cultural, and structural factors influencing the SRH of WLHIV in Muslim-majority countries.MethodsThis review provides a synthesis of quantitative, qualitative and mixed-method research findings searched from PubMed, EMBASE, Scopus, CINAHL and Cochrane databases. We screened 3452 SRH studies involving WLHIV. The studies, published in English between 2008 and 2017, were from 20 Muslim-majority countries with increased numbers of WLHIV. The quality of eligible studies was appraised using a mixed-methods appraisal tool (MMAT) version 2011. Findings were thematically analysed by a hybrid deductive-inductive approach. Two independent reviewers were involved in the study selection, data extraction, quality appraisal, and data synthesis.ResultsWe included 13 SRH-related studies involving 1748 WLHIV in eight Muslim-majority countries. Most of these studies explored fertility desire and sexual health, while only a small proportion related to contraceptive use and the perinatal-care experience. We identified that WLHIV faced neglect of their SRH rights. These rights were predominantly affected by the socio-cultural, religious and health-services context of the women’s lives, which directed them to unsafe sex practices and stressful perinatal experiences.ConclusionsThis study points to the need for SRH laws, policies, and interventions which stop WLHIV experiencing SRH discrimination violence and achieving their SRH rights.

With widespread treatment, HIV is now considered a chronic, manageable condition, yet little is known of the social networks that support people living with HIV (PLHIV) to transition toward self-management. Using a person-centred, qualitative social network approach, this study examined the role, characteristics and evolution of social support networks from the perspective of PLHIV and key support providers in Queensland, Australia. Beyond treatment and monitoring, HIV self-management involves negotiating disclosures and navigating stigma. Alongside biomedical interventions, facilitating recently diagnosed PLHIV to develop strong and sustainable personal support networks, including linkage with peers, is an important aspect of contemporary HIV care.

Ecocriticism in Irish studies, and the spatial turn which preceded it, emerged from the field’s concentration on postcolonial discourse and the inequalities inherent in Irish modernity. The focus on place as a means of establishing identity, particularly within the context of colonial and imperialist narratives, led to a dynamic discussion of literary representations of the environment in Irish studies depicting fraught relationships between land and scarcity. And yet, there was resistance to engaging with the key debates in Anglo-American ecocriticism on a systematic level. As Eóin Flannery observed in 2016, “the field of Irish cultural studies has yet to exploit fully the critical and analytical resources of ecological criticism.” So far, the discourse around depictions of space has been principally in the service of Irish cultural studies, asking how the relationship with place has made Ireland what it is today. One of the interesting aspects of the incursion of ecocriticism in the field of Irish studies is how environmental considerations have come to be recognised as a part of the identity discourse. As the title suggests, the island of Ireland is also a border country in that it encompasses a contentious border, and two distinct identities, from both Northern Ireland and the Republic. This essay examines the emergence of ecocritical discourse in Irish studies and explores the ongoing dynamic between postcolonialism and environmental criticism with respect to the Irish canon., La ecocrítica en los estudios irlandeses, y el giro espacial que le precedió, surgieron de la concentración del campo en el discurso poscolonial y las desigualdades inherentes a la modernidad irlandesa. El enfoque del lugar como forma de establecer la identidad, especialmente en el contexto de las narrativas coloniales e imperialistas, llevó a una discusión dinámica de las representaciones literarias del medio ambiente en los estudios irlandeses que describen las tensas relaciones entre la tierra y la escasez. Y, sin embargo, se resistieron a participar en los debates clave de la ecocrítica angloamericana de forma sistemática. Como observó Eóin Flannery en 2016, “el campo de los estudios culturales irlandeses aún tiene que explotar plenamente los recursos críticos y analíticos de la crítica ecológica.” Hasta ahora, el discurso en torno a las representaciones del espacio ha estado principalmente al servicio de los estudios culturales irlandeses, con la pregunta de cómo la relación con el lugar ha convertido a Irlanda en lo que es hoy. Uno de los aspectos interesantes de la incursión de la ecocrítica en el campo de los estudios irlandeses es cómo las consideraciones ambientales han llegado a ser reconocidas como parte del discurso de la identidad. Como sugiere el título, la isla de Irlanda también es un país fronterizo en el sentido de que abarca una frontera conflictiva y dos identidades distintas, tanto de Irlanda del Norte como de la República. Este ensayo examina el surgimiento del discurso ecocrítico en los estudios irlandeses y explora la dinámica actual entre el poscolonialismo y la crítica ambiental con respecto al modelo irlandés.

This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p

Cancer has become a global health concern with marked differences in the incidence and mortality rates between developing and developed countries. Understanding the factors that shape uptake of preventative and screening services is the key. We use in-depth interviews with 13 Zambian urban-based female cancer survivors to explore the facilitators and barriers to screening, diagnosis and treatment, with a particular focus on cultural influences. We identified a central theme (i.e. a story told about cancer) in all of the interviews: 'cancer is a death sentence'. Most women referenced this theme to describe their own, their family members', or community members' reactions to their diagnosis, along with references to cancer as 'contagious' and 'a shameful illness'. We also identified a theme entitled 'survivors as advocates', within which women described engaging in advocacy work to challenge stigma, misconceptions and misinformation about cancer; and advocating early detection and diagnosis, compliance with medical treatment and the sharing of success stories. This analysis points to the need for survivors to be front and center of preventative efforts. Their personal experiences, legitimacy and connections in the community, and their enthusiasm in helping others should be fostered, particularly in low-resource settings.

Ireland’s peat bogs are teeming with native species. Ensuring the ongoing biodiversity of these valuable habitats is crucial given that only 10% of the original raised bog and 28% of the blanket bo...

The perception of being abnormal, and a visceral desire to ‘feel normal again’, is a common feature of the literature on drug use and recovery. Normality is constructed, however, in response to context-dependent values and priorities, thereby legitimating certain behaviours as normative and therefore the assumed goal of people in recovery. In this paper we draw on an ethnographic study with twelve people attempting to reduce harmful methamphetamine use to explore how they engaged with ‘normality’. Semi-structured interviews and ethnographic observations were conducted across a range of settings related to participants’ recovery, including private residences, withdrawal services, doctor’s offices, counselling rooms, and court houses. We used a relational lens to conduct thematic analysis on interview transcripts and fieldnotes collected over six months, following the steps of Iterative Categorisation. Our analysis explores the central organising theme of normality as something that can be ‘preserved’, ‘achieved’, or ‘performed’ by people using methamphetamine. Findings are understood through the original concept of ‘ambient paternalism’, where neoliberal norms and values shape recovery trajectories even outside of engagement with services. Exhibiting normality enabled participants to work against the stigmatisation and moralisation of methamphetamine use by demonstrating their socio-political acceptability. Methamphetamine use could also be strategically used to enable participants to keep up with neoliberal normative standards of independent self-management. Increasing awareness of these complex repertoires of normality, and a more critical understanding of how this ideal is constructed and can impact service interactions, can support a less homogenising or coercive approach towards treatment and policy for people in methamphetamine recovery., Highlights • People using drugs can experience normality as aspirational and burdensome. • Demonstrating normality in recovery can be a form of social capital. • Normality can be a form of paternalism enacted by social services. • Performing normality helped participants reduce their marginalisation.

Background: BCMA targeted CAR T cell therapy has shown promising results in patients with relapsed/refractory multiple myeloma (RRMM), but relapses are common. Additional treatment options with novel therapeutic targets or mechanisms of action are needed. Here we report on the safety and efficacy of MCARH109, the first-in-class G Protein Coupled Receptor Class C Group 5 Member D (GPRC5D) targeted CAR T cell therapy (Smith EL et al. Sci. Trans Med 2019) in RRMM including patients who relapsed post BCMA targeted CAR T cell therapy. Methods: This is a phase I first-in-human, dose escalation trial of MCARH109; patients received lymphodepleting chemotherapy with fludarabine 30 mg/m 2 daily and cyclophosphamide 300 mg/m 2 daily for 3 days followed by a single infusion of MCARH109. The trial followed a standard 3+3 design with the following dose cohorts to date: 25X10 6, 50X10 6, 150X10 6, 450X10 6 viable CAR + T cells. The primary objective is to assess safety of MCARH109; secondary objectives include anti-myeloma efficacy, expansion and persistence of MCARH109 using quantitative polymerase chain reaction (qPCR) on peripheral blood and bone marrow samples. Results: 18 patients with RRMM were enrolled and underwent apheresis between September 15, 2020 and July 14, 2021. 12 patients have completed MCARH109 infusion to date, with 6 patients currently undergoing manufacturing and pending treatment. Of the 12 patients treated, median age was 59 (37-76) years and patients received a median of 8 (4-14) lines of therapy. 11 (92%) were penta-exposed, all patients were triple refractory, and 7 (58%) had prior treatment with BCMA targeted therapy including 6 (50%) who received prior BCMA CAR T therapy. 3 (25%) patients had non-secretory myeloma and 6(50%) patients had extramedullary plasmacytoma at baseline. 11 (92%) were refractory to last line of therapy and 11 (92%) patients received bridging therapy after apheresis prior to MCARH109 infusion; all patients were refractory to bridging therapy. There were no dose limiting toxicities. Cytokine release syndrome (CRS) grade 1-3 occurred in 11 (92%) patients with only one patient with grade 3 event; 4 (25%) patients received tocilizumab and 1 (8%) received dexamethasone for the treatment of CRS (Table). There were no neurologic toxicities reported to date; 3 (25%) patients had grade 1 nail changes possibly related to MCARH109 (Table). As of July 28, 2021, all treated patients have been followed for at least 2 weeks (median: 13.0 weeks; range: 2.0-39.1 weeks) and 10 (83%) had at least a minimal response or better (2 responses unconfirmed): 2 minimal response, 3 partial response, 3 very good partial response, 2 stringent complete response (sCR). 5 (56%) of the first 9 patients were minimal residual disease (MRD) negative in the bone marrow by multicolor flow cytometry (sensitivity: 10 -5). 6 (100%) patients with prior BCMA CAR T therapy had a response with 2 patients achieving sCR. We also noted robust MCARH109 expansion in the peripheral blood using qPCR across the first 3 dose levels with available data (peak expansion vector copy number/mL, median: 404,467; range: 44,670- 3,560,000; Table). With a median follow-up of 13 weeks, 9 (75%) patients are progression free and followed without additional therapy. Conclusions: MCARH109 is the first-in-class GPRC5D targeted CAR T cell therapy for MM and has a very manageable safety profile with no serious or unexpected toxicities; this dose escalation study is ongoing with additional patients planned for treatment at higher doses. Efficacy is promising in heavily pre-treated RRMM, reflected in high rates of clinical response as well as MRD-negativity, including at doses as low as 25x10 6 CAR T cells. Clinically important, all 6 patients who relapsed after BCMA CAR T therapy responded to GPRC5D targeted CAR T therapy, including 2 patients who achieved sCR. Figure 1 Figure 1. Disclosures Mailankody: Allogene Therapeutics: Research Funding; Physician Education Resource: Honoraria; Bristol Myers Squibb/Juno: Research Funding; Takeda Oncology: Research Funding; Fate Therapeutics: Research Funding; Jansen Oncology: Research Funding; Evicore: Consultancy; Legend Biotech: Consultancy; Plexus Communications: Honoraria. Shah: Janssen: Research Funding; Celgene/BMS: Research Funding. Lesokhin: pfizer: Consultancy, Research Funding; Iteos: Consultancy; Trillium Therapeutics: Consultancy; Genetech: Research Funding; Serametrix, Inc: Patents & Royalties; bristol myers squibb: Research Funding; Janssen: Honoraria, Research Funding; Behringer Ingelheim: Honoraria. Korde: Medimmune: Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding. Hassoun: Celgene, Takeda, Janssen: Research Funding. Hultcrantz: GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Research Funding; Daiichi Sankyo: Research Funding; Intellisphere LLC: Consultancy; Curio Science LLC: Consultancy. Shah: Amgen: Research Funding; Janssen: Research Funding. Landau: Takeda, Janssen, Caelum Biosciences, Celgene, Pfizer, Genzyme: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Genzyme: Honoraria. Scordo: Angiocrine Bioscience: Consultancy, Research Funding; Omeros Corporation: Consultancy; Kite - A Gilead Company: Membership on an entity's Board of Directors or advisory committees; i3 Health: Other: Speaker; McKinsey & Company: Consultancy. Roshal: Auron Therapeutics: Other: Ownership / Equity interests; Provision of services; Celgene: Other: Provision of services; Physicians' Education Resource: Other: Provision of services. Landgren: Janssen: Other: IDMC; Janssen: Honoraria; Janssen: Research Funding; Amgen: Honoraria; Celgene: Research Funding; Amgen: Research Funding; Takeda: Other: IDMC; GSK: Honoraria. Dogan: Physicians' Education Resource: Honoraria; Seattle Genetics: Consultancy; Peer View: Honoraria; Takeda: Consultancy, Research Funding; Roche: Consultancy, Research Funding; EUSA Pharma: Consultancy. Giralt: Actinnum: Membership on an entity's Board of Directors or advisory committees; JENSENN: Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees; AMGEN: Membership on an entity's Board of Directors or advisory committees; CELGENE: Membership on an entity's Board of Directors or advisory committees; PFIZER: Membership on an entity's Board of Directors or advisory committees; JAZZ: Membership on an entity's Board of Directors or advisory committees; SANOFI: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees. Park: Autolus: Consultancy; Kite Pharma: Consultancy; PrecisionBio: Consultancy; Minerva: Consultancy; Curocel: Consultancy; Intellia: Consultancy; Amgen: Consultancy; Affyimmune: Consultancy; Innate Pharma: Consultancy; Novartis: Consultancy; Servier: Consultancy; Kura Oncology: Consultancy; Artiva: Consultancy; BMS: Consultancy. Rivière: FloDesign Sonics: Other: Provision of Services; Juno Therapeutics: Patents & Royalties; The Georgia Tech Research Corporation (GTRC): Other: Provision of Services (uncompensated); Centre for Commercialization of Cancer Immunotherapy: Other: Provision of Services; Fate Therapeutics: Other: Provision of Services, Patents & Royalties. Brentjens: BMS: Consultancy, Patents & Royalties, Research Funding; Gracell Biotechnologies, Inc: Consultancy, Ended employment in the past 24 months; sanofi: Patents & Royalties; Caribou: Patents & Royalties. Smith: Eureka Therapeutics: Consultancy; Fate Therapeutics: Research Funding; Chimeric Therapeutics: Consultancy; Novarits: Consultancy; Sanofi: Patents & Royalties: GPRC5D antibody based therapies; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties: CAR T cells for MM. OffLabel Disclosure: MCARH109 is an experimental GPRC5D targeted CART therapy

Aims and background People living with HIV (PLHIV) have a higher rate of smoking and experience a greater burden of tobacco-related disease than the general population. This study aimed to understand the role smoking plays in the lives of PLHIV, participants’ views of traditionally available nicotine products (e.g., nicotine replacement therapy or NRT) and novel nicotine products (e.g., nicotine vaping products or NVPs) as both short-term quit aids and long-term substitutes for cigarettes. Methods Semi-structured focus groups were conducted with PLHIV who smoked. Focus groups were transcribed and analysed using a combination of deductive and inductive thematic analysis. A brief questionnaire of nicotine product use and interest was also completed and the quantitative data presented using descriptive statistics. Results Fifty-four participants took part in 11 focus groups. Participants’ views of smoking, quitting and nicotine products were diverse. Commitment to smoking and interest in quitting were categorised into three groups across a smoking-quitting continuum: committed to smoking, ambivalent about smoking and reluctantly smoking. NRT was criticised for a range of side effects and primarily considered as a short-term cessation aid. NVPs generated debate. NVPs that closely resembled cigarettes were viewed as the most acceptable product and were considered to be more suitable than NRT for long-term use. Discussion and conclusions Understanding the unique needs, goals and views of PLHIV related to smoking, quitting smoking and using nicotine products could inform development of novel and tailored smoking interventions for PLHIV. NVPs should be further examined as potential long-term substitutes for PLHIV who are ambivalent about smoking. However, traditional smoking cessation assistance (approved cessation aids and counselling) is likely to be most appropriate for PLHIV who are reluctantly smoking.

Skin cancer is disproportionately high in the youth population of the United Kingdom, as compared with other cancers, yet it is a topic which so far has received little recognition, subsequently relevant literature is relatively scarce. In the United Kingdom, malignant melanoma is now one of the commonest cancers in those aged 15–34 years. Furthermore, malignant melanoma the 7th most common cancer in men, and 5th most common cancer in women in the United Kingdom in 2013 accounting for 4% of all cancer cases in the United Kingdom. Moreover, skin cancer is currently the fastest growing cancer in the world with a five-fold increase in frequency since the 1970′s resulting in disfigurement and death. This essay explores this skin cancer age-related anomaly through the lens of public health. A scoping review combined with a thematic analysis of literature, identified risk factors including demographic and environmental risk factors within the youth population. Research suggests that 86% of cases could be prevented alleviating the current financial burden of over £100 million spent on managing skin cancer. I therefore suggest a multi primary and secondary prevention approach through education programs, whilst promoting awareness and tanning alternatives targeting both youth and parental populations. A final recommendation involves government incentives to increase sun protective factor (SPF) in creams, and imposing a complete national ban on tanning beds. All these preventions would contribute to lowering skin cancer prevalence in the youth population whilst also alleviating the financial burden of the disease.

Meeting students’ expectations associated with the provision of feedback is a perennial challenge for tertiary education. Efforts to provide comprehensive, timely feedback within our own first year undergraduate public health courses have not always met students’ expectations. In response, we sought to develop peer feedback activities to support the development of ‘self-evaluative strategies’ that would acknowledge the centrality of students in the feedback process. We describe these activities, their staged development and the qualitative and quantitative data gathered from students and the teaching teams to evaluate this. Our first steps towards embedding peer feedback with first year students indicated they are willing to engage in the process and appreciated the opportunity to provide and receive feedback, but the quality and extent of the peer feedback was largely superficial. Students’ reflections on the feedback received were also shallow. Supporting students to develop self-evaluative skil...

Introduction and Aims. Indigenous Australians experience a significant gap in life expectancy compared with non-Indigenous Australians. Indigenous communities have high-smoking prevalence and low engagement with cessation therapies. This qualitative research, conducted in an urban Australian Indigenous community, explored smokers' views on smoking, quitting and engagement with current nicotine replacement therapies. Opinions on acceptability of tobacco harm reduction were sought. We explored the acceptability of novel nicotine products, that is, new or unfamiliar products, including non-therapeutic options, such as e-cigarettes. Design and Methods. Focus groups and individual interviews with adult Indigenous daily smokers (n = 27) were used. Current and novel nicotine products were displayed and demonstrated. Discussions were audio-recorded, transcribed and analysed thematically. Results. Participants expressed interest in trying existing and novel nicotine products. Short-to-medium term use of nicotine replacement therapy for quitting was generally acceptable; views on long-term use were mixed. Interest in use of tobacco substitutes depended on their perceived effectiveness, providing a ‘kick’ and ‘relieving stress’. Desirable qualities for tobacco substitutes were identified with gender differences and product preferences noted. The unpleasant taste of existing products is a barrier to both short-term and long-term use. Discussion. We found substantial interest in trying some existing and novel nicotine products, mostly for short-term use. A number of attributes were identified that would make nicotine products potentially acceptable as a long-term substitute. Conclusions. Some participants were interested in long-term substitution if acceptable products were available. Improvements in current products and access to novel products are needed if tobacco harm reduction is to be acceptable. [Yuke K, Ford P, Foley W, Mutch A, Fitzgerald L, Gartner C. Australian urban Indigenous smokers' perspectives on nicotine products and tobacco harm reduction. Drug Alcohol Rev 2017;00:000-000]