Journal articles on the topic 'HIV-positive persons – Canada – Social conditions'

Background: Social aspects play an important role in individual health and should be taken into consideration in the long-term care for people with multimorbidity. Purposes: To describe social vulnerability, to examine its correlation with the number of chronic conditions, and to investigate which chronic conditions were significantly associated with the most socially vulnerable state in patients with multimorbidity. Methods: Cross-sectional analysis from the baseline data of the Patient-Centred Innovations for Persons with Multimorbidity (PACEinMM) Study. Participants were patients attending primary healthcare settings in Quebec, Canada. A social vulnerability index was applied to identify social vulnerability level. The index value ranges from 0 to 1 (1 as the most vulnerable). Spearman’s rank correlation coefficient was calculated for the correlation between the social vulnerability index and the number of chronic conditions. Logistic regression was applied to investigate which chronic conditions were independently associated with the most socially vulnerable state. Results: There were 301 participants, mean age 61.0 ± 10.5, 53.2% female. The mean number of chronic health conditions was 5.01 ± 1.82, with the most common being hyperlipidemia (78.1%), hypertension (69.4%), and obesity (54.2%). The social vulnerability index had a median value of 0.13 (range 0.00–0.78). There was a positive correlation between the social vulnerability index and the number of chronic conditions (r = 0.24, p < 0.001). Obesity, depression/anxiety, and cardiovascular diseases were significantly associated with the most socially vulnerable patients with multimorbidity. Conclusions: There was a significant correlation between social vulnerability and the total number of chronic conditions, with depression/anxiety, obesity, and cardiovascular diseases being the most related to social vulnerability.

Objectives: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. Methods: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. Results: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. Discussion: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

Background Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. Objective The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. Methods This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. Results After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. Conclusions There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.

Aim. Determine the social profile of persons with positive immune blotting to HIV infection based on the results of cadaveric blood tests in the period from 2018 to 2020. Materials and methods. The work used retrospective, analytical, descriptive, evaluative and epidemiological research methods. The social characteristics of individuals were combined into a database based on a number of criteria. The patient’s personal data was encrypted with an alphanumeric code. The materials obtained during the research were analyzed and statistically processed in Microsoft Excel. Results. The results of the study made it possible to determine the social portrait of people with a posthumously positive HIV test result: 41.2 year-old men, unmarried, with a secondary vocational education, unemployed. Women, 43.8 years old, predominantly unmarried, secondary vocational education. Conclusion. Due to the fact that epidemiological investigations are not separately regulated when a positive immune blotting to HIV is detected based on the results of epidemiological investigations conducted by specialists in epidemiological studies. Thus, there is an urgent need to develop regulatory documents governing laboratory studies in conditions of positive immune blotting to HIV results of cadaveric blood tests.

Over the past several decades, understandings of what it means to have contracted the human immunodeficiency virus (HIV) have shifted so that an infection once viewed as deadly and ultimately terminal is now largely regarded as chronic and manageable, at least in the West. Yet, the shift has not been complete. There are arenas of discourse where understandings of what health implications HIV carries with it are contested. One such space is the debate concerning the appropriate response to cases of HIV non-disclosure, that is, situations where individuals who are HIV-positive do not disclose their health status to intimate partners. This paper examines the competing constructions of HIV found within this debate, particularly as it has unfolded in Canada. Those who oppose the criminalization of non-disclosure tend to construct HIV as an infection that is chronic and manageable for those who have contracted it, not unlike diabetes. Those who support criminalization have mobilized a discourse that frames the infection as harmful and deadly. We use the case of the HIV non-disclosure debate to make the argument that representations of health conditions can become mired in larger social problems debates in ways that lead to contests over how to understand the fundamental nature of those conditions.

Abstract Setting Syndemics occur when two or more health conditions interact to increase morbidity and mortality and are exacerbated by social, economic, environmental, and political factors. Routine provincial surveillance in Ontario assesses and reports on the epidemiology of single infectious diseases separately. Therefore, we aimed to develop a method that allows disease overlaps to be examined routinely as a path to better understanding and addressing syndemics in Ontario. Intervention We extracted data for individuals with a record of chlamydia, gonorrhea, infectious syphilis, hepatitis B and C, HIV/AIDS, invasive group A streptococcal disease (iGAS), or tuberculosis in Ontario’s reportable disease database from 1990 to 2018. We transformed the data into a person-based integrated surveillance dataset retaining individuals (clients) with at least one record between 2006 and 2018. Outcomes The resulting dataset had 659,136 unique disease records among 470,673 unique clients. Of those clients, 23.1% had multiple disease records with 50 being the most for one client. We described the frequency of disease overlaps; for example, 34.7% of clients with a syphilis record had a gonorrhea record. We quantified known overlaps, finding 1274 clients had gonorrhea, infectious syphilis, and HIV/AIDS records, and potentially emerging overlaps, finding 59 clients had HIV/AIDS, hepatitis C, and iGAS records. Implications Our novel person-based integrated surveillance dataset represents a platform for ongoing in-depth assessment of disease overlaps such as the relative timing of disease records. It enables a more client-focused approach, is a step towards improved characterization of syndemics in Ontario, and could inform other jurisdictions interested in adopting similar approaches.

Despite significant advances in antiretroviral therapy, unmet basic needs can negatively impact health-related quality of life (HRQoL) in people living with HIV, especially as they age. We aimed to examine the effect of unmet basic needs across age groups on changes in HRQoL over a 4-year period in persons with HIV. Physical and mental HRQoL scores from the Positive Spaces, Healthy Spaces cohort interviewed in 2006 (n = 538), 2007 (n = 506), and 2009 (n = 406) were examined across three age groups according to their unmet needs for food, clothing, and housing. Individual growth curve model analyses were used to investigate changes over time, adjusting for demographics, employment, living conditions, social supports, HIV status, and health behavior risks. Low scores on physical and mental HRQoL were positively associated with higher number of unmet basic needs (β = −6.40, standard error (SE) = 0.87, p < 0.001 and β = −7.39, SE = 1.00, p < 0.001, respectively). There was a slight improvement in physical and mental HRQoL over 4 years in this HIV cohort, but the burden of unmet basic needs took its toll on those over 50 years of age. Regularly assessing unmet basic needs is recommended given the impact these can have on HRQOL for people living with HIV. Recognition of unmet needs is vital, as is the development of timely interventions.

Abstract Background The rapid spread of COVID-19 in recent months has caused local and regional governments to enact protective measures that have hindered economies and imposed demanding restrictions on daily life. Households may be experiencing physical, psychological, social, and economic challenges due to these preventative measures. Populations with fewer resources and/or pre-existing conditions may be at higher risk for these negative, life-altering effects. Therefore, we investigated COVID-19 impact on daily life among persons living with HIV (PLH) in Chicago’s under-resourced, largely minority, west and southwest side communities. Methods We modified the EPII, a survey designed to measure pandemic disease impact over nine domains of life, to assess how COVID-19 affected PLH receiving outpatient HIV care. From 5/11–29/2020, participants (n=49) completed the survey online or over the phone and received a $10 grocery gift card. We present the proportion of respondents who reported that they or any household member was impacted by select survey items. Results More than half of respondents reported a household member getting laid off and/or furloughed (63%), increased mental health (45%) or sleep problems (51%), less physical activity (61%), and increased screen time (82%); 45% were unable to pay important bills. Positive changes included eating healthier foods (53%), more time for enjoyable activities (63%), more quality time with friends or family (65%), and paying more attention to personal health (76%). We observed differences by gender, age, and race/ethnicity over all domains (Table 1). Finally, 80% of those who participated in telehealth services were satisfied with their experience. Table 1. Conclusion Overall, respondents struggled with employment, emotional and physical health effects of COVID-19, yet also experienced aspects of positive life change. In the future, these results should be compared with results from a general population to determine whether PLH are disproportionately burdened. Regardless, COVID-19 has negatively impacted daily life for everyone, including PLH, and these individuals may need additional resources compared to their less resource-challenged counterparts. Disclosures All Authors: No reported disclosures

(1) Background: Although HIV has not diminished in importance in Canada, the field of HIV research remains small, and the graduate students who decide to pursue careers within it feel isolated and uncertain about their professional skills and opportunities. Universities Without Walls (UWW) was created in 2009 to help redress these shortcomings. This paper presents a case study of UWW, a non-credit training program for emerging HIV researchers in Canada. In particular, we focus on the possibilities of experiential learning via online and blended delivery. UWW uses both online and in-person teaching modalities to teach engaged scholarship, interdisciplinarity, community-based research (CBR), intervention research, and ethics. (2) Methods: Using a case study, we elucidated the research question: “What are the factors that make Universities Without Walls a viable training environment in the contemporary HIV/AIDS field?” Focus groups were conducted with 13 UWW key stakeholders in 2012 during a program mid-point evaluation; in 2014, telephone or in-person interviews with the three directors were conducted by a UWW fellow (the 4th author of this paper), and in 2019 the authors analyzed the information and anecdotal evidence, which had been incorporated as thick description. In addition, fellows’ self-assessments via portfolio and results from formal learning assessments were included. We also thematically analyzed 65 student self-reports (2009–2015). (3) Results and Discussion: Each UWW cohort lasted 9 months to one year and was comprised of: a) sustained mentorship from the co-directors (e.g., phone conversations, assistance with grant writing, letters of reference, etc.); b) fortnightly online webinars that aim to develop fellows’ knowledge of community-based research (CBR), research ethics, intervention research, and interdisciplinary research; c) community service learning in the form of a “field mentoring placement”; d) face-to-face engagement with fellows and mentors, most notably at the week-long culminating learning institute; e) a stipend for fellows to carry out their training activities. The UWW pedagogical framework features experiential learning, critical pedagogy, and heutagogy made manifest in the field mentoring placements (community service learning), mentorship mediated by technologies, and in-person learning institutes. Our analysis showed that experiential learning was imparted by UWW’s a) transparency about its “implicit curriculum”, the attitudes, values, character, and professional identity imparted in the program as well as the overarching programmatic elements, such as commitment to diversity, the inclusion of those with lived experience, the flexible admissions policies and procedures, interdisciplinary faculty, flexible team, administrative structure, and valuing of technology in conducting research, learning, and teaching; b) curriculum co-designing and co-teaching, and c) sustaining a community of practice. The main results reported in our case study included significant “soft outcomes” for UWW fellows, such as developing a “social presence” as a precursor to lasting professional connections; learning to experience community-based research, intersectionality, and interdisciplinarity by interacting online with persons living with HIV, leaders in the field, and a variety of stakeholders (including nonprofit staff and policymakers). (4) Limitations: While fellows’ self-evaluation data were collected by an independent assessor and anonymized to the extent this was possible, the co-authors inevitably bring their preconceptions and positive biases to UWW’s assessment. As UWW was developed to function outside of traditional academic structures, it is unlikely that the UWW program could be transferred to a post-secondary environment in its entirety. UWW was also built for the socio-political environment of HIV health research. (5) Conclusions: The experiences of those involved with UWW demonstrate that explicit curricular components—such as interdisciplinarity, community-based research, intervention research, and applied ethics—can be learned through a blended delivery when combined with opportunities to apply the knowledge in ways, such as a field mentoring placement and a learning institute. Related to this outcome, our case study describes that implicit curricular components in the formation of a professional—the sense of self in the field as a researcher, student, and community member—can also be delivered through a blended model. However, the tools and activities need to be tailored to each student for their context, while pushing their disciplinarian and professional boundaries.

If screening had been a drug, it would have been withdrawn from the market. Thus, which country will be first to stop mammography screening? (Peter C. Gøtzsche) 1This issue of RBMFC addresses the subject of medical ethics, the backbone that should guide both the demands in health services and health technologies provision, as well as the practice of family and community physicians. As a stimulus for reflection, the Debate section tackles the “Preventive mandatory mammography” policy in Uruguay, while in the Section Essays, Jamoulle and Gomez discuss the concept of quaternary prevention: action that aims to offer ethically acceptable alternatives to patients in order to prevent the excess of medical interventions.2 Despite considerable technological and social transformations that directly affect people’s health, ethics in medicine continues to morally shape health problems and health policy decisions with implications for patients, physicians and health institutions.In a practical analytical and easy to understand guidance for health professionals, Gillon3 discusses the four principles and scope of medical ethics: autonomy, beneficence, non-maleficence and justice. The latter encompasses the distributive justice, individual right justice and legal justice. These four principles provide a baseline for dialogue across different cultures, religious beliefs and political positions, as these principles are considered to be prima facie: a duty which is compulsory on all occasions unless it is in conflict with equal or stronger duties.4 Thus, based on these four principles that underlie ethics in medicine and consequently the application of the quaternary prevention, cancer screening programme will be critically analysed as a preventative strategy.Screening programmes entails the use of an initial selective tool or a sieve phase (i.e. mammography) to separate asymptomatic persons within the target population, that will need to undergo a classificatory or diagnostic phase - which involves a ‘gold standard’ for defining a disease (i.e. anatomopathology) – to finally offer patients a definitive preventive treatment for the condition screened.5 Since this type of intervention is performed on healthy individuals, the ethical requirements in the cases of screening programmes are very high, because the risks of damage are not balanced against real suffering (a clinically manifested disease), but are anchored in a potential future of illness and death. In this case, the principle of non-maleficence (do not harm) prevails over the principle of beneficence (the desire to promote the patients’ wellbeing), since asymptomatic persons, who perceive themselves as healthy, may have their health perception shaken indefinitely due to a biomedical intervention. The most often cited damages in the literature are psychological (due to the uncertainties of false positives, false assurance of false negatives, and borderline conditions that require a closer monitoring such as Cervical Intraepithelial Neoplasia - CIN I, II, III), as well as the physical consequences resulting from treatment itself, such as impotence or urinary incontinence, in the case of screening and treatment of prostate cancer.Since in the screening and/or health check ups the intervention is usually a ‘mirage-guided’ or ‘probability-guided’, it can result in ‘damage without the potential benefits’,6 as in the case of invasive procedures (to clarify ‘images’ or ‘positive’ exam results produced in the selective or sieving phase) which can result in complications, but the biopsy turnout to be normal. For instance, colonoscopy, laparoscopy, biopsies (liver, kidney, prostate), in which those procedures may end up producing complications (intestinal perforation, anaesthesia complications, major artery perforation, sepsis) with the potential to scale up into hospital readmission, with stress for patients and families and/or an even worse scenario: patients’ death with a benign finding. Therefore, screening programmes intrinsically carry the potential to convert healthy people into sick individuals at the population level, and consequently are highly iatrogenic and could be summarized as follows: “For many are called, but few are chosen…,” but many will need to suffer for to very few be cured.This is particularly true in the case of breast cancer screening with mammography, which renders physiopathologically insignificant cancers (overdiagnosis) exposing previously healthy women to significant damages due to radiotherapy. Gotzsche et al.7 highlighted important risks of adverse effects as consequence of radiotherapy, such as heart failure (27%) from circulatory cardiac damage and/or induction of lung cancer (78%). Furthermore, a recently published systematic review in the British Medical Journal8 on the adverse effects of cancer screening, found that only a third of randomized controlled clinical trials was concerned in measuring and controlling for potential harms of screening intervention. This article is very important because it has a direct effect upon the practice of health professionals, who cannot address security parameters on cancer screening interventions with their patients, since there is an information selection bias that emphasizes only the positive aspects of screening, for lack of controlling and monitoring of potential harms in most screening clinical trials.From an ethical stance, this context of uncertainty undermines the patients’ autonomy, creating false empowerment, since women do not have a more complete view on the potential harms and benefits of breast cancer screening programmes.9 To truly empower women and strengthen their autonomy for deciding upon interventions that directly affect their health, there is a need for information to be more transparent and also to reveal potential harms of the interventions. Moreover, the language used for the dissemination of information should be neutral, of simple understanding, culturally accessible, so that the users of the health system can better decide about their own health.3From the perspective of public health, distributive ethic justice, and limited healthcare budget - that any health system faces - screening programmes diverts financial resources - which should primarily be allocated to the treatment and care of sick individuals - towards healthy people, with the potential to produce new real patients, due to the damage of the interventions on healthy bodies, generating more costs to the health system and society in general.Fortunately, screening programmes are increasingly losing their strength, especially in Europe. For instance, the Swiss Medical Board10 found no scientific rational for the maintenance of breast screening programmes in light of current available scientific evidence. In Denmark, the rate of mortality attributable to breast cancer have not reduced due to the implementation of systematic breast cancer screening programme with mammography over 17 years follow up,11 however, it has produced an overdiagnosis rate of 33%.12 Similar trends in mortality over the last 30 years were also observed in the United States,13 as well as in Canada, the accumulated 25 years monitoring of the effects of breast cancer screening, did not render reduction in mortality from breast cancer, but resulted in 22% of overdiagnosis.14 Thus, to Peter C. Gotzsche,1 one of the world ‘s leading authorities on the subject, the best method we have to reduce the occurrence of breast cancer is to stop screening with mammography.From an ethical and scientific point of view,10 screening programmes should be discontinued or restricted to high-risk groups or very specific situations, and the focus of prevention should be redirected towards interventions on early-symptomatic patients, since breast cancer treatment has improved considerably in recent decades, and this is likely to be the responsible for improving the quality of life of affected women.1 The Canadian Task Force15 on preventive health care in their last update (2011) regarded as weak recommendation the breast cancer screening with mammography every 2-3 years in age group 50-69 years-old, because they considered the evidence for screening only of moderate quality. The Brazilian Ministry of Health16 also acted correctly in limiting the financial incentives for breast cancer screening for the age group 50-69 years.Therefore, ‘there is nothing wrong saying no to mammography’,9 because when acting upon asymptomatic healthy people, the principle of non-maleficence should override the principle of beneficence. Thus, the challenge left for family and community doctors is to individualize each case in this ‘sea of uncertainty’, sharing with their patients the often hidden potential harms attributed to cancer screening in order to operationalize in daily practice the concept of quaternary prevention.

The culturological analysis of the content of the basic models of the artistic education in the leading countries of the world, in particular, Japan, China, the USA, Canada, and Germany is done. Considering the object and the purpose of education, we can define the artistic education as the formation of a man’s artistic attitude to the reality. Combining human, epochal, regional, national, professional and individual features its content keeps a historically certain level of humanity. The author emphasises that the formation of a person’s ability to associate with reality is the multidisciplinary process vertically (from perception to artistic transformation) as well as horizontally (from the formation of an artistic attitude to nature — to the formation of the self-attitude). The latter is determined by the specifics of the values in different spheres of reality, which bring some features in the aesthetic familiarization of these spheres of the social life. The author pays attention to the following meanings of the artistic education and upbringing: 1) the provision of the broad opportunities to percept the diversity of contemporary artistic culture in its national identity and to open the world artistic processes; 2) the formation of the need for the creative self-realization of the individual in the sociocultural and artistic life of the society; 3) the upbringing and getting the necessary skills of the professional activities in the field of culture and art. The purposes of the article are to analyse the specific features of the functioning of the arts education system in the leading countries of the world and to highlight the main value concepts of its content. The methodology of the research includes the interdisciplinary approach to the theorizing of the identified issue in the field of cultural studies, philosophy, aesthetics, art studies, and pedagogy. The application of the methods of the comparative analysis, the artistic comparativism has allowed us to characterize the cultural field of the problem. The methods of abstraction and analysis have allowed the author to reveal the similarities and differences in the approaches of the essence of artistic education in the educational practices of the leading countries of the world. The scientific novelty of the work is fact that the analysis of the basic models of the artistic education of the leading countries allows us to state that artistic education opens the new aspects, and parameters. In addition, it is also contributed to the formation of the higher rationality. Therefore, the artistic education is the positive guiding spiritual activity that produces rather positive things and enriches the humankind with new accomplishments, ensures the development of civilization. In the process of the artistic education, the higher spiritual powers of the person find their place and develop his/her ability, mind, will, moderation, elegance, ethics, tolerance, and integrity. Finally, we can define the process of the artistic education and upbringing as the impact on the human development, which is determined by the combination of the institutional and non-institutional circumstances. They are the different spheres of the culture of the society, which involve each new generation in certain activities, defining its general conditions, character and content. Thanks to them it assimilates the public experience, produces certain views, ideals, etc.

Background. As of the end of December 2019, the list of priority areas of research and development of WHO included coronavirus of severe acute respiratory distress syndrome, coronavirus of the Middle East respiratory syndrome and mycobacterium tuberculosis (TB). In January, a new coronavirus SARS-CoV-2 was added to this list. The COVID-19 pandemic puts enormous pressure on the health systems of all countries, including those with a high TB burden, including Ukraine. Objective. To describe the condition of TB care in the context of the COVID-19 pandemic and to analyze the prospects for the consequences of the interaction between COVID-19 and TB. Materials and methods. Analysis of literature and statistics on this issue. Results and discussion. As a result of social distancing and staying at home, it is difficult to provide quality TB care: the level of timely diagnosis decreases, treatment control deteriorates, the number of undetected side effects in outpatients increases, the proportion of patients with uncontrolled or interrupted TB treatment increases. These processes can have serious adverse consequences. A comparison of TB incidence, including relapses, found out that in Ukraine in the first half of 2020 the TB incidence decreased by 27.4 % compared to the same period in 2019. Unfortunately, this most likely does not indicate a true decrease in incidence, but the reduction of the TB detection due to quarantine measures. The largest difference between 2019 and 2020 is observed in Zhytomyr, Ivano-Frankivsk, Rivne, Ternopil and Chernivtsi regions, which roughly corresponds to the distribution map of COVID-19. The incidence of TB in combination with HIV/AIDS in 2020 is also lower than in 2019 (by 28.4 %). Advanced cases have started to be registered more and more often, and in the conditions of strict quarantine patients with active bacterial excretion pose a serious threat to contact persons, first of all, to risk groups for COVID-19. Coronavirus infection can accelerate the activation of latent TB. According to the WHO, latent TB affects a quarter of the world’s population, so if the activation is accelerated, the process can easily get out of control. All viral infections, including COVID-19, also have an immunosuppressive effect that promotes TB progression. In case of co-existence, COVID-19 and TB have a mutually reinforcing effect, which reduces the likelihood of favourable outcomes for the patient. The interruption of TB treatment on the background of COVID-19 is an additional danger. Patients with TB, COVID-19 and diabetes are the most difficult to treat. In a pandemic, the feasibility of using intravenous forms of anti-TB drugs, which can intensify treatment, dramatically increases. On the positive side, the response of the medical community to COVID-19 can help the long-term efforts to combat TB through infection prevention and control, the development of a contact control system, surveillance and monitoring. The WHO recommends continuing to vaccinate newborns with the BCG vaccine. Clinical trials of the BCG vaccine for the prevention of coronavirus infection are currently underway. Conclusions. 1. The detection of TB in Ukraine in 2020 compared to 2019 decreased by 27.4 %, in children – by 34.5 %. 2. Coronavirus infection accelerates the activation of latent TB, has an immunosuppressive effect, promotes the progression of TB. 3. To improve TB treatment during a pandemic, electronic monitoring of drug circulation and treatment outcomes should be actively introduced. 4. TB treatment in people with and without coronavirus infection does not have any differences. 5. In a pandemic, the feasibility of using intravenous forms of anti-TB drugs is growing.

Background: Improved survivorship among persons living with HIV translates into higher risk of medical comorbidities. Objective : We assessed the association between intersection of physical (HIV) and mental health (psychiatric) conditions and intermediate outcomes. Methods: Cross-sectional study of Medical Expenditure Panel Survey (MEPS)-Household Component between 1996 and 2016. We created four groups for persons aged ≥18: (1) HIV + psychiatric comorbidity, (2) HIV, (3) psychiatric comorbidity, and (4) no-HIV/no-psychiatric comorbidity. We compared the burden of medical comorbidities (metabolic disorders, cardiovascular disease, cancers, infectious diseases, pain, and substance use) across groups using chi square tests. We used logistic regression to determine the association between group status and medical comorbidity. Results: Of 218,133,630 (weighted) persons aged ≥18, 0.18% were HIV-positive. Forty-three percent of HIV group and 19% of no-HIV group had psychiatric comorbidities. Half of the HIV+ psychiatric disorder group had at least one medical comorbidity. Compared to the no-HIV/no-psychiatric comorbidity group, the HIV + psychiatric comorbidity group had highest odds of medical comorbidity (OR= 3.69, 95% CI = 2.99, 4.52). Conclusion: Persons presenting with HIV + psychiatric comorbidity had higher odds of medical comorbidities of pain, cancer, cardiovascular disease, substance use, metabolic disorders and infectious diseases, beyond that experienced by persons with HIV infection or psychiatric disorders, independently. Future research will focus on the mediating effects of social determinants and biological factors on outcomes as quality of life, cost and mortality. This will facilitate a shift away from the single-disease framework and compress morbidity of the aging cohort of HIV-infected persons.

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

Summary Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.

In the era of current globalization, when the whole world is faced with the qualitatively new economic crisis, for the purpose of raising the living standards of population the great importance is attached to ensuring their effective employment. The latter belongs to the major social-economic issues and poses quite a serious challenge to a country. The aforesaid is also conditioned by the fact that at the current stage of formation and operation of labour market the unemployment is regarded as the key factor causing poverty. Under the conditions of coronomics the problem is more exacerbated by thousands of workplaces having been temporarily suspended and lost due to the spread of Covid19 within the country. In such a situation it would be difficult to cope with the unemployment and make progress in effective employment without developing the socio-labour relations and applying its qualitatively new forms. Occasioned by the above mentioned, the paper aims at the profound study of peculiarities of the forms of distance employment, which are widespread in the international practice, and focuses on the formulation of certain directions and recommendations relating to the potential and prospects of their utilization in the country. In particular, on the basis of the research and analysis conducted the following key recommendations and conclusions have been reached: 1. In the contemporary world the expansion of non-standard employment including the distance employment has radically changed the tendencies of developing the labour market. The mentioned forms of employment are characterized by: labour flexibility; the application of non-standard organizational-legal forms of labour; the adaptation of employers and employees to the constantly changing economic conditions; the realization of their interests, etc.; 2. In the developed countries the distance employment greatly contributes to the increase in the overall level and scales of employment. Its main distinctive mark is the existence of workplaces out of enterprise (outworks). Accordingly, the distance employment is examined in the context of non-standard employment represented as the form of long-term labour relations with a single employer, which diverges from the standard model of full, regulated and open employment according to one or several criteria (performance, labour regime, labour hours, working conditions, work outcomes, working hours, work place and its location, social protection, the correlation between the subjects of labour relations, etc.); 3. Based on its attractiveness as well as by popular demand, the distance employment is recently developing and enhancing at a fast pace all over the world. For instance, while at the outset of the 2000s approximately 30.0 million people were employed on distance jobs in the USA and EU countries, in the second decade of XXI century their number increased to 55.0 – 60.0 million. The quantity of distance employers is annually growing by 20%-30% worldwide. In 2019, the number of outworking employees equaled to 39.0% all over the world. In addition, 28% more of employees had the right to distance jobs. The USA, Canada, Finland, Denmark and Sweden lead this sphere; 4. The advantages of distance employment are as follows: 1. On behalf of employees: flexible working hours; the standard, comfortable conditions of employment; the opportunity to get education and participate in the socially useful activities; extra income; contracts with outer organizations; the possibility to schedule the working time and the labour optimization; the provision of high efficiency and quality of work; the maintenance of the personal rhythm, resting and working time and their protection; saving of expenses; the decrease in time of communications; comfortable working space; the lack of corporate culture; the distance employment is the basis of creative self-realization, pleasure and satisfaction for a number of employers. 2.On behalf of employers: employing the professionals and providing the flexibility of personnel; raising the labour productivity and efficiency; ensuring the personnel loyalty; providing the clients with round –the-clock information services; forming the flexible organizational structure for enterprises; work site arrangement, saving rental costs. 3. On behalf of a state: the increase in the level of employment and the decrease in the level of unemployment; the development of distance employment involving the disabled persons; the decrease in traffic in the country; the increase in the number of economically active population; scaling down the migration; 5. Apart from the positive points, the expansion of distance employment is related to the significant risk factors, which necessitate the introduction of their controlling mechanism by the state. It should be focused on reducing the aforesaid riskfactors to minimum level and protecting social and legal rights of employees; 6. Occasioned by the goals of ensuring the effective employment as well as according to National Strategy for Labour Market and Employment Policy of Georgia 2019-2023, the provision of developing the non-standard forms of employment assumes the great importance in the country. It is also essential to regularly conduct the impact assessment defining the scales of distance jobs and the pace of their expansion at the level of total employment; 7. In order to conduct the comprehensive analysis and evaluation of distance employment at the overall level of employment, we deem it expedient to make its classification not in terms of the scope of fields but according to the professions, which are currently singled out as being in great demand. Currently, at the labour market of Georgia the following specialties are most demanded by employers: 1. A specialist in marketing; 2. Sales manager; 3. The specialist in the area of internet-technologies; 4. A web-designer; 5. A programmer; 6. Distributer; 7. Tourism ( where the demands have, accordingly, increased on the specialties such as a waiter, a barman, a hotel manager, a guide); 8. Audit; 9. Accountant – financier; 10. A doctor; 11. A lawyer; 12. A teacher; 13. A construction manager; 14. Translator, etc. Exactly the mentioned professions are attractive in terms of developing the distance employment in a number of developed countries abroad; 8. With the aim of raising the efficiency of state programs for employment and regulating the distance employment, the regular researches should be necessarily implemented in the direction of determining the real demands on working forces at the labour market. This is the only way offering the real prospects for developing the distance employment and their involvement in the state and regional programs of employment. The latter will considerably contribute to improving the quality of working life of population and ultimately, the raise of living standards.

Abstract Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.

Abstract Background Women living with hepatitis C virus (HCV) are rarely addressed in research and may be overrepresented within key populations requiring additional support to access HCV care and treatment. We constructed the HCV care cascade among people diagnosed with HCV in British Columbia, Canada, as of 2019 to compare progress in care and treatment and to assess sex/gender gaps in HCV treatment access. Methods The BC Hepatitis Testers Cohort includes 1.7 million people who tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 2000 to 2019. Test results were linked to medical visits, hospitalizations, cancers, prescription drugs, and mortality data. Six HCV care cascade stages were identified: (1) antibody diagnosed; (2) RNA tested; (3) RNA positive; (4) genotyped; (5) initiated treatment; and (6) achieved sustained virologic response (SVR). HCV care cascade results were assessed for women, and an ‘inverse’ cascade was created to assess gaps, including not being RNA tested, genotyped, or treatment initiated, stratified by sex. Results In 2019, 52,638 people with known sex were anti-HCV positive in BC; 37% (19,522) were women. Confirmatory RNA tests were received by 86% (16,797/19,522) of anti-HCV positive women and 83% (27,353/33,116) of men. Among people who had been genotyped, 68% (6756/10,008) of women and 67% (12,640/18,828) of men initiated treatment, with 94% (5023/5364) of women and 92% (9147/9897) of men achieving SVR. Among the 3252 women and 6188 men not yet treated, higher proportions of women compared to men were born after 1975 (30% vs. 21%), had a mental health diagnosis (42% vs. 34%) and had used injection drugs (50% vs. 45%). Among 1619 women and 2780 men who had used injection drugs and were not yet treated, higher proportions of women than men used stimulants (64% vs. 57%), and opiates (67% vs. 60%). Conclusions Women and men appear to be equally engaged into the HCV care cascade; however, women with concurrent social and health conditions are being left behind. Treatment access may be improved with approaches that meet the needs of younger women, those with mental health diagnoses, and women who use drugs.

Introduction The counterculture that arose during the 1960s and 1970s left lasting social and political reverberations in developed nations. This was a time of increasing affluence and liberalisation which opened up remarkable political opportunities for social change. Within this context, an array of new social movements were a vital ingredient of the ferment that saw existing norms challenged and the establishment of new rights for many oppressed groups. An expanding arena of concerns included the environmental damage caused by 200 years of industrial capitalism. This article examines one aspect of a current environment movement in Australia, the anti-Coal Seam Gas (CSG) movement, and the part played by participants. In particular, the focus is upon one action that emerged during the recent Bentley Blockade, which was a regional mobilisation against proposed unconventional gas mining (UGM) near Lismore, NSW. Over the course of the blockade, the conventional ritual of waving at passers-by was transformed into a mechanism for garnering broad community support. Arguably, this was a crucial factor in the eventual outcome. In this case, we contend that the wave, rather than a countercultural artefact being appropriated by the mainstream, represents an everyday behaviour that builds social solidarity, which is subverted to become an effective part of the repertoire of the movement. At a more general level, this article examines how counterculture and mainstream interact via the subversion of “ordinary” citizens and the role of certain cultural understandings for that purpose. We will begin by examining the nature of the counterculture and its relationship to social movements before discussing the character of the anti-CSG movement in general and the Bentley Blockade in particular, using the personal experience of one of the writers. We will then be able to explore our thesis in detail and make some concluding remarks. The Counterculture and Social Movements In this article, we follow Cox’s understanding of the counterculture as a kind of meta-movement within which specific social movements are situated. For Cox (105), the counterculture that flourished during the 1960s and 1970s was an overarching movement in which existing social relations—in particular the family—were rejected by a younger generation, who succeeded in effectively fusing previously separate political and cultural spheres of dissent into one. Cox (103-04) points out that the precondition for such a phenomenon is “free space”—conditions under which counter-hegemonic activity can occur—for example, being liberated from the constraints of working to subsist, something which the unprecedented prosperity of the post WWII years allowed. Hence, in the 1960s and 1970s, as the counterculture emerged, a wave of activism arose in the western world which later came to be referred to as new social movements. These included the civil rights movement, women’s liberation, pacifism and the anti-nuclear and environment movements. The new movements rejected established power and organisational structures and tended, some scholars argued, to cross class lines, basing their claims on non-material issues. Della Porta and Diani claim this wave of movements is characterised by: a critical ideology in relation to modernism and progress; decentralized and participatory organizational structures; defense of interpersonal solidarity against the great bureaucracies; and the reclamation of autonomous spaces, rather than material advantages. (9) This depiction clearly announces the countercultural nature of the new social movements. As Carter (91) avers, these movements attempted to bypass the state and instead mobilise civil society, employing a range of innovative tactics and strategies—the repertoire of action—which may involve breaking laws. It should be noted that over time, some of these movements did shift towards accommodation of existing power structures and became more reformist in nature, to the point of forming political parties in the case of the Greens. However, inasmuch as the counterculture represented a merging of distinctively non-mainstream ways of life with the practice of actively challenging social arrangements at a political level (Cox 18–19; Grossberg 15–18;), the tactic of mobilising civil society to join social movements demonstrates in fact a reverse direction: large numbers of people are transfigured in radical ways by their involvement in social movements. One important principle underlying much of the repertoire of action of these new movements was non-violence. Again, this signals countercultural norms of the period. As Sharp (583–86) wrote at the time, non-violence is crucial in that it denies the aggressor their rationale for violent repression. This principle is founded on the liberal notion, whose legacy goes back to Locke, that the legitimacy of the government rests upon the consent of the governed—that is, the people can withdraw their consent (Locke in Ball & Dagger 92). Ghandi also relied upon this idea when formulating his non-violent approach to conflict, satyagraha (Sharp 83–84). Thus an idea that upholds the modern state is adopted by the counterculture in order to undermine it (the state), again demonstrating an instance of counterflow from the mainstream. Non-violence does not mean non-resistance. In fact, it usually involves non-compliance with a government or other authority and when practised in large numbers, can be very effective, as Ghandi and those in the civil rights movement showed. The result will be either that the government enters into negotiation with the protestors, or they can engage in violence to suppress them, which generally alienates the wider population, leading to a loss of support (Finley & Soifer 104–105). Tarrow (88) makes the important point that the less threatening an action, the harder it is to repress. As a result, democratic states have generally modified their response towards the “strategic weapon of nonviolent protest and even moved towards accommodation and recognition of this tactic as legitimate” (Tarrow 172). Nevertheless, the potential for state violence remains, and the freedom to protest is proscribed by various laws. One of the key figures to emerge from the new social movements that formed an integral part of the counterculture was Bill Moyer, who, in conjunction with colleagues produced a seminal text for theorising and organising social movements (Moyer et al.). Many contemporary social movements have been significantly influenced by Moyer’s Movement Action Plan (MAP), which describes not only key theoretical concepts but is also a practical guide to movement building and achieving aims. Moyer’s model was utilised in training the Northern Rivers community in the anti-CSG movement in conjunction with the non-violent direct action (NVDA) model developed by the North-East Forest Alliance (NEFA) that resisted logging in the forests of north-eastern NSW during the late 1980s and 1990s (Ricketts 138–40). Indeed, the Northern Rivers region of NSW—dubbed the Rainbow Region—is celebrated, as a “‘meeting place’ of countercultures and for the articulation of social and environmental ideals that challenge mainstream practice” (Ward and van Vuuren 63). As Bible (6–7) outlines, the Northern Rivers’ place in countercultural history is cemented by the holding of the Aquarius Festival in Nimbin in 1973 and the consequent decision of many attendees to stay on and settle in the region. They formed new kinds of communities based on an alternative ethics that eschewed a consumerist, individualist agenda in favour of modes of existence that emphasised living in harmony with the environment. The Terania Creek campaign of the late 1970s made the region famous for its environmental activism, when the new settlers resisted the logging of Nightcap National Park using nonviolent methods (Bible 5). It was also instrumental in developing an array of ingenious actions that were used in subsequent campaigns such as the Franklin Dam blockade in Tasmania in the early 1980s (Kelly 116). Indeed, many of these earlier activists were key figures in the anti-CSG movement that has developed in the Rainbow Region over the last few years. The Anti-CSG Movement Despite opposition to other forms of UGM, such as tight sands and shale oil extraction techniques, the term anti-CSG is used here, as it still seems to attract wide recognition. Unconventional gas extraction usually involves a process called fracking, which is the injection at high pressure of water, sand and a number of highly toxic chemicals underground to release the gas that is trapped in rock formations. Among the risks attributed to fracking are contamination of aquifers, air pollution from fugitive emissions and exposure to radioactive particles with resultant threats to human and animal health, as well as an increased risk of earthquakes (Ellsworth; Hand 13; Sovacool 254–260). Additionally, the vast amount of water that is extracted in the fracking process is saline and may contain residues of the fracking chemicals, heavy metals and radioactive matter. This produced water must either be stored or treated (Howarth 273–73; Sovacool 255). Further, there is potential for accidents and incidents and there are many reports—particularly in the United States where the practice is well established—of adverse events such as compressors exploding, leaks and spills, and water from taps catching fire (Sovacool 255–257). Despite an abundance of anecdotal evidence, until recently authorities and academics believed there was not enough “rigorous evidence” to make a definitive judgment of harm to animal and human health as a result of fracking (Mitka 2135). For example, in Australia, the Queensland Government was unable to find a clear link between fracking and health complaints in the Tara gasfield (Thompson 56), even though it is known that there are fugitive emissions from these gasfields (Tait et al. 3099-103). It is within this context that grassroots opposition to UGM began in Australia. The largest and most sustained challenge has come from the Northern Rivers of New South Wales, where a company called Metgasco has been attempting to engage in UGM for a number of years. Stiff community opposition has developed over this time, with activists training, co-ordinating and organising using the principles of Moyer’s MAP and NEFA’s NVDA. Numerous community and affinity groups opposing UGM sprang up including the Lock the Gate Alliance (LTG), a grassroots organisation opposing coal and gas mining, which formed in 2010 (Lock the Gate Alliance online). The movement put up sustained resistance to Metgasco’s attempts to establish wells at Glenugie, near Grafton and Doubtful Creek, near Kyogle in 2012 and 2013, despite the use of a substantial police presence at both locations. In the event, neither site was used for production despite exploratory wells being sunk (ABC News; Dobney). Metgasco announced it would be withdrawing its operations following new Federal and State government regulations at the time of the Doubtful Creek blockade. However it returned to the fray with a formal announcement in February 2014 (Metgasco), that it would drill at Bentley, 12 kilometres west of Lismore. It was widely believed this would occur with a view to production on an industrial scale should initial exploration prove fruitful. The Bentley Blockade It was known well before the formal announcement that Metgasco planned to drill at Bentley and community actions such as flash mobs, media releases and planning meetings were part of the build-up to direct action at the site. One of the authors of this article was actively involved in the movement and participated in a variety of these actions. By the end of January 2014 it was decided to hold an ongoing vigil at the site, which was still entirely undeveloped. Participants, including one author, volunteered for four-hour shifts which began at 5 a.m. each day and before long, were lasting into the night. The purpose of a vigil is to bear witness, maintain a presence and express a point of view. It thus accords well with the principle of non-violence. Eventually the site mushroomed into a tent village with three gates being blockaded. The main gate, Gate A, sprouted a variety of poles, tripods and other installations together with colourful tents and shelters, peopled by protesters on a 24-hour basis. The vigils persisted on all three gates for the duration of the blockade. As the number of blockaders swelled, popular support grew, lending weight to the notion that countercultural ideas and practices were spreading throughout the community. In response, Metgasco called on the State Government to provide police to coincide with the arrival of equipment. It was rumoured that 200 police would be drafted to defend the site in late April. When alerts were sent out to the community warning of imminent police action, an estimated crowd of 2000 people attended in the early hours of the morning and the police called off their operation (Feliu). As the weeks wore on, training was stepped up, attendees were educated in non-violent resistance and protestors willing to act as police liaison persons were placed on a rotating roster. In May, the State Government was preparing to send up to 800 police and the Riot Squad to break the blockade (NSW Hansard in Buckingham). Local farmers (now a part of the movement) and activist leaders had gone to Sydney in an effort to find a political solution in order to avoid what threatened to be a clash that would involve police violence. A confluence of events, such as: the sudden resignation of the Premier; revelations via the Independent Commission against Corruption about nefarious dealings and undue influence of the coal industry upon the government; a radio interview with locals by a popular broadcaster in Sydney; and the reputed hesitation of the police themselves in engaging with a group of possibly 7,000 to 10,000 protestors, resulted in the Office for Coal Seam Gas suspending Metgasco’s drilling licence on 15 May (NSW Department of Resources & Energy). The grounds were that the company had not adequately fulfilled its obligations to consult with the community. At the date of writing, the suspension still holds. The Wave The repertoire of contention at the Bentley Blockade was expansive, comprising most of the standard actions and strategies developed in earlier environmental struggles. These included direct blocking tactics in addition to the use of more carnivalesque actions like music and theatre, as well as the use of various media to reach a broader public. Non-violence was at the core of all actions, but we would tentatively suggest that Bentley may have provided a novel addition to the repertoire, stemming originally from the vigil, which brought the first protestors to the site. At the beginning of the vigil, which was initially held near the entrance to the proposed drilling site atop a cutting, occupants of passing vehicles below would demonstrate their support by sounding their horns and/or waving to the vigil-keepers, who at first were few in number. There was a precedent for this behaviour in the campaign leading up to the blockade. Activist groups such as the Knitting Nannas against Gas had encouraged vehicles to show support by sounding their horns. So when the motorists tooted spontaneously at Bentley, we waved back. Occupants of other vehicles would show disapproval by means of rude gestures and/or yelling and we would wave to them as well. After some weeks, as a presence began to be established at the site, it became routine for vigil keepers to smile and wave at all passing vehicles. This often elicited a positive response. After the first mass call-out discussed above, a number of us migrated to another gate, where numbers were much sparser and there was a perceived need for a greater presence. At this point, the participating writer had begun to act as a police liaison person, but the practice of waving routinely was continued. Those protecting this gate usually included protestors ready to block access, the police liaison person, a legal observer, vigil-keepers and a passing parade of visitors. Because this location was directly on the road, it was possible to see the drivers of vehicles and make eye contact more easily. Certain vehicles became familiar, passing at regular times, on the way to work or school, for example. As time passed, most of those protecting the gate also joined the waving ritual to the point where it became like a game to try to prise a signal of acknowledgement from the passing motorists, or even to win over a disapprover. Police vehicles, some of which passed at set intervals, were included in this game. Mostly they waved cheerfully. There were some we never managed to win over, but waving and making direct eye contact with regular motorists over time created a sense of community and an acknowledgement of the work we were doing, as they increasingly responded in kind. Motorists could hardly feel threatened when they encountered smiling, waving protestors. By including the disapprovers, we acted inclusively and our determined good humour seemed to de-escalate demonstrated hostility. Locals who did not want drilling to go ahead but who were nevertheless unwilling to join a direct action were thus able to participate in the resistance in a way that may have felt safe for them. Some of them even stopped and visited the site, voicing their support. Standing on the side of the road and waving to passers-by may seem peripheral to the “real” action, even trivial. But we would argue it is a valuable adjunct to a blockade (which is situated near a road) when one of the strategies of the overall campaign is to win popular backing. Hence waving, whilst not a completely new part of the repertoire, constitutes what Tilly (41–45) would call innovation at the margins, something he asserts is necessary to maintain the effectiveness and vitality of contentious action. In this case, it is arguable that the sheer size of community support probably helped to concentrate the minds of the state government politicians in Sydney, particularly as they contemplated initiating a massive, taxpayer-funded police action against the people for the benefit of a commercial operation. Waving is a symbolic gesture indicating acknowledgement and goodwill. It fits well within a repertoire based on the principle of non-violence. Moreover, it is a conventional social norm and everyday behaviour that is so innocuous that it is difficult to see how it could be suppressed by police or other authorities. Therein lies its subversiveness. For in communicating our common humanity in a spirit of friendliness, we drew attention to the fact that we were without rancour and tacitly invited others to join us and to explore our concerns. In this way, the counterculture drew upon a mainstream custom to develop and extend upon a new form of dissent. This constitutes a reversal of the more usual phenomenon of countercultural artefacts—such as “hippie clothing”—being appropriated or co-opted by the prevailing culture (see Reading). But it also fits with the more general phenomenon that we have argued was occurring; that of enticing ordinary residents into joining together in countercultural activity, via the pathway of a social movement. Conclusion The anti-CSG movement in the Northern Rivers was developed and organised by countercultural participants of previous contentious challenges. It was highly effective in building popular support whilst at the same time forging a loose coalition of various activist groups. We have surveyed one practice—the wave—that evolved out of mainstream culture over the course of the Bentley Blockade and suggested it may come to be seen as part of the repertoire of actions that can be beneficially employed under suitable conditions. Waving to passers-by invites them to become part of the movement in a non-threatening and inclusive way. It thus envelops supporters and non-supporters alike, and its very innocuousness makes it difficult to suppress. We have argued that this instance can be referenced to a similar reverse movement at a broader level—that of co-opting liberal notions and involving the general populace in new practices and activities that undermine the status quo. The ability of the counterculture in general and environment movements in particular to innovate in the quest to challenge and change what it perceives as damaging or unethical practices demonstrates its ingenuity and spirit. This movement is testament to its dynamic nature. References ABC News. Metgasco Has No CSG Extraction Plans for Glenugie. 2013. 30 July 2014 ‹http://www.abc.net.au/news/2013-01-22/metgasco-says-no-csg-extraction-planned-for-glenugie/4477652›. Bible, Vanessa. 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Staples of early United States Internet meme culture were sold via digital auctions for cryptocurrency (except one, which was sold for cash) throughout 2021. Through these transactions, Internet memes, or “the linguistic, image, audio, and video texts created, circulated, and transformed by countless cultural participants across vast networks and collectives” (Milner 1), were “minted” as non-fungible tokens—a marker within cryptocurrency economy that denotes the level of originality or irreplaceability of an (often digital) artifact (Wired). Early 2021 saw Internet memes (memes, hereafter) and non-fungible tokens (NFTs, hereafter) articulated to one another when a series of trades ignited a “buying frenzy”. In February 2021, the original animation file of the Nyan Cat meme (a rendering of a flying cat with a Pop-Tart body) was sold for 300 Ethereum, or US$600,000 (Griffith; Kay); in April 2021, the original photo file of the Disaster Girl meme (an image of a smiling child in front of a burning home) sold for 180 ETH, or nearly US$500,000 (BBC News); in May 2021, the original video file of the viral YouTube video “Charlie Bit My Finger” (wherein an infant bites the finger of their older sibling with glee) was sold for US$760,999, but no cryptocurrency was exchanged for this auction (Evans); in June 2021, the original image of the Shiba Inu who became Doge (image of a dog looking contemplative, often with text around the dog’s face) was sold for a record-breaking (for memes) 1,696.9 ETH, or US$4 million (Rosenblatt). Other notable memes were sold around this time, such as Bad Luck Brian (an unflattering school picture of a teenager who became synonymous with embarrassing social situations), Overly Attached Girlfriend (wide-eyed teenager who was portrayed as obsessive over their significant other), and Success Kid (an infant clenching their fist with a sense of achievement), but for lower prices (Wired; Dash; Gallagher). All the memes sold during this frenzy feature either animals or white individuals, and none of the creators or subjects of the original files are Black. That said, mainstream Internet culture, specifically within the United States, is predicated upon the Othering and exploitation of Black cultural production (Brock 97, 124; Benjamin). The fungible constitution of US Black culture is replete within digital cultures, from contemporary discussions of digital blackface in white use of memes featuring Black folks to express emotion (J.L. Green; Jackson, “Digital Blackface”, White Negroes) and/or using imagery featuring Black folks without permission (J.L. Green; Nakamura; Matamoros-Fernández). The advent of meme-based NFTs, however, offers new areas of inquiry into the triangulation of race, fungibility, and US digital cultures. I approach this cultural phenomenon with two general queries: What cultural and racial legacies of non/fungibility are present in the dynamics of memes becoming NFTs? What are the implications in digital media and US culture? Fungibility and Black Cultural Production As this issue explores, fungibility is a quality of interchangeable, performing persons or objects, but a turn to US Afro-pessimism illustrates how fungibility is a central quality to racialisation. (Continental African scholars coined Afro-pessimism, and its original formulation was markedly different from the US counterpart, which emerged with little to no engagement with the existing African canon. Afropessimism 1.0, as Greg Thomas names it, focusses on the postcolonial economic conditions across the continent. Importantly, there is an undergirding optimism, “the urge to positive social change”, to the inquiries into the poverty, colonial extractivism, and more; Amrah qtd. in Thomas 283; Rieff; de B’béri and Louw.) Fungibility, in US-borne Afro-pessimist literature, is used to describe (1) a major tenet of slavery wherein Black bodies are treated as interchangeable objects rather than human actors, and (2) how the afterlife of slavery continues to structure everyday experiences for Black folks (Bilge; Hartman; Wilderson, III et al.). US Afro-pessimism argues that slavery instantiated an ontological structure that articulates humanity as irreconcilable with Blackness and further articulates whiteness as for what (or whom) the Black body performs and labours (Bilge; Douglass et al.; Wilderson, III and Soong). Within the US, the fungibility of the Black body means it is always already vulnerable to and violable by “the whims of the [non-Black] world” (Wilderson, III 56; see also: Hartman; Lindsey). Indeed, Wilderson, building off Hartman, asserts, “the violence-induced fungibility of Blackness allows for its appropriation by White psyches as ‘property of enjoyment’” (89). The fungibility of Blackness aides in white “transpos[ition of Black] cultural gestures, the stuff of symbolic intervention onto another worldly good, a commodity of style” (Wilderson, III 56). This expropriation of Black digital “imaginative labour” by US white mainstream culture is part and parcel to Internet practices (Iloh; Lockett; Jackson). bell hooks argues white US mainstream culture treats Black cultural production as the “spice, [the] seasoning that can liven up the dull dish that is mainstream white culture” (21). By the same token, US white mainstream culture “desire[s] … sustained ‘labor’ … of a dark Other” that seeks to contiunously exploit fungible Black production (31). The constitutive fungibility of Blackness enriches, even if just affectively, the non-fungibility of whiteness; this parasitic relationship has extended to digital culture, with white actors extracting Black meme culture. Internet memes, until the advent of NFTs, did not necessarily provide monetary gain for the creators or original owners. For example, the creator of the iconic phrase “on fleek”, Kayla Newman (aka Peaches Monroee) is regularly discussed when considering the exploitation of Black digital culture (Parham; Maguire; Hazlehurst). The term came from a Vine of Newman hyping herself up in the front-facing camera of her smartphone—“We in this bitch! Finna get crunk. Eyebrows on fleek. Da fuq”—and quickly went viral. Maguire’s insightful analysis of Newman’s viral fame underscores the exploitation and appropriation of Black girl cultural production within the US. Maguire turns toward the legal intricacies of copyright and property as Newman sought ownership of her iconic phrase; however, Vats’s work on the legal rhetorics of intellectual property note its racial exclusivity in the US. (Moreton-Robinson traces similar white supremacist ownership within Australian contexts.) Meaning, only white actors benefit from such legal rhetorics. These forbearances point to the larger cultural legacies of fungibility that alienate Black bodies from their cultural production. US Black digital culture is alienated from the individuals who perform the imaginative labour that benefits and enriches whiteness (Wilderson, III; hooks). The legacies of mass enslavement fundamentally structured the capital and libidinal economies of US culture (Wilderson, III et al.; Spillers; Brock), therefore it stands to reason, like other forms of hegemonic ideologies, that such structuring logics of anti-Blackness are foundational to digital US culture (Benjamin; Brock; Towns; Matamoros-Fernández). Iloh, Williams, and Michele Jackson separately argue that the foundation of mainstream US Internet culture is indebted to the labour of Black users. However, as Brock argues, US Internet culture is a medium by which whiteness marks itself as the default even though Black labour, individuals, and culture are regularly exploited to perpetuate white engagement. Jackson specifically notes that the white performance of US Black culture “financially, artistically, socially, and intellectually” rewards white and other non-Black actors for demonstrating their understanding of Black cultural productions (Jackson, White Negroes 5; see also: hooks; Nakamura). Black individuals are not (fairly) compensated for this labour, even as white individuals gain clout. Newman’s term “on fleek” became a staple of US Vine and broader Internet culture, spawning a hashtag (#EyebrowsOnFleek) and being featured in multiple brand commercials (Maguire). Newman notes that she did not consider trademarking the term because she did not realise how quickly it would spread, allowing corporations and other actors to capitalise on her term free of charge (Hazlehurst; Maguire). Usage of the term became a signpost of the in-crowd within US millennial popular culture (Maguire). However, when Newman later launched a hair extensions company utilising her phrase (On Fleek Hair Extensions), she was resoundingly criticised. During a GoFundMe campaign to jumpstart the business, white digital actors accused Newman of milking her fame (Parham; Hazlehurst; Maguire). Mainstream digital actors forbade Newman’s ownership of her own labour after exploiting her creation throughout its popularity, marking her imaginative labour as fungible. These cultural dynamics exemplify of how anti-Blackness proliferates US digital culture, marking Black cultural labour as fungible and as the (shared) property of white actors. Whiteness regularly dichotomises itself against Blackness, needing the denigration and de-humanisation of Blackness to constitute whiteness’s perceived racial superiority (Wilderson, III et al.; Hartman; Thomas). Since Blackness has been constituted as fungible, alienating the labouring bodies from their production, whiteness (implicitly) constitutes itself as non-fungible. Thus, under this paradigm, white actors, their bodies, and their (property’s) cultural production are constituted as non-fungible, as the foil to fungible Blackness. Of course, anti-Blackness uses fungibility as a means of enriching whiteness, first evidenced by the logics of the Atlantic Slave Trade and extending throughout contemporary US culture. Newman’s iconic “on fleek” was easily detached from her (removing product from labourer) for the benefit of celebrities and companies. I argue that NFTs further these logics; as the next section explores, non-fungible tokens capacitate white monetisation of Black cultural labour. Non-Fungibility and Non-Black Cultural Agency The sale of meme-based NFTs offers a modern illustration of the fungibility of Black cultural production. Importantly, every seller of meme-based NFTs has been non-Black, with most being white or white-passing. NFTs, thus, seemingly give non-Black actors the agency to “reclaim” meme imagery via monetisation. Contemporary US meme culture is directly created by, influenced by, and appropriated from US Black (digital) culture (Jackson, White Negroes; Iloh; Brock; J.L. Green; Nakamura). Black cultural actors used memes largely as a space to share the joys and pains of Black US life (Brock); however, the connectivity of the Internet offered avenues for extraction and appropriation by non-Black actors (Iloh; Nakamura; J.L. Green; Matamoros-Fernández). Meme-based NFTs extend these anti-Black logics by monetising the cultural impact of certain memes. Specifically, memes are considered valuable only when minted as an NFT, which seeks to transform the fungible by a non-fungible agent. This section turns to the tensions between non-Black cultural agency over Black cultural influence within US Internet culture, using the Disaster Girl meme as an illustration. Memes, because of their participatory nature, require a certain level of fungibility to perpetuate circulation (Milner; Moreno-Almeida; Shifman). While certain digital actors proffer the original textual (e.g. #UKnowUrBlackWhen, a popular hashtag for Black users sharing experiences specific to US Black culture), graphic (e.g. Fail/Win, a popular meme genre for posting images of everyday chores tagged as Fail or Win), and/or contextual (e.g. Pepper Spray Cop, a meme genre where a police officer is pepper spraying protestors is photoshopped into different scenes) facets of a meme, these same characteristics must be manipulable for the meme to flourish (Parham; Jenkins; Huntington). Further, original creators must have an alienable relation to their cultural production, a “letting go” of the meme, so it may become part of broader cultural milieu, ever-evolving (Shifman; Jenkins). Minting memes into NFTs, however, reverses and obfuscates this cultural and imaginative labour by minting the original image. The sale of the Disaster Girl meme photograph as an NFT exhibits this erasure. The meme orginates from a photo Dave Roth took of his daughter, Zoë Roth, at a 2005 control-burn of a home in their neighbourhood (Fazio; Staff). D. Roth eventually submitted the image of his white, brown-haired daughter slyly smiling as the house burns in the background to a handful of photo contests, winning them (ibid.). The image was published online in 2008 and quickly circulated among social media platforms. Memes emerged as Internet users remixed the original image, either with text or by photoshopping Z. Roth into new disasters, thus dubbing her Disaster Girl (Green, Refinery). Since, Z. Roth’s four-year-old self has been “endlessly repurposed as a vital part of meme canon” (Fazio). Gesturing to the fungibility of meme culture, Z. Roth said she “love[s] seeing them because [she]’d never make any of them [her]self” (qtd in Fazio), meaning she (and her father) had willingly alienated themselves from the meme imagery. The agency to willingly turn over cultural production is solely attributable to non-Black bodies within the logics of fungible Blackness. Z. Roth’s non-participation did not prevent her from monetising the original meme, however. On 17 April 2021, Z. Roth sold the original photo file of the Disaster Girl meme (Fazio). Roth notes the creation and selling of an NFT is “the only thing memes can do to take control” (qtd. in Fazio). To exhibit agency of minting an NFT, Z. Roth collapses memes’ identities into the original image rather than the participation, remix, and becoming that meme culture involves. Memes, by nature, require the repeated and continual labour of digital public actors to continue circulating (Shifman; Milner; Jenkins). The stronger the meme’s circulatory impact, the more cultural heft it carries. However, the Roth family could only ever sell the original image. The minting of an NFT, for Z. Roth, “was a way for her to take control over a situation that she has felt powerless over since elementary school” (Fazio). Here, Z. Roth is further exerting non-Black agency to wilfully reclaim the previously fungible object. Ironically, the very thing Z. Roth is wanting to exert control over is what gives value to the meme in the first place. The virality and longevity of the Disaster Girl meme is its value, but given the fungibility of meme culture, this labour is easily obfuscated. As noted, memes must exhibit a certain level of fungibility to regenerate throughout digital cultures in various iterations; memes also require the fungible Black cultural production, especially within the US. Brock argues the capacity to laugh through pain or chaos is a characteristic of US Black humour and foundational to contemporary US meme humour. The Disaster Girl meme exemplifies the influences of US Black cultural humour both in the comedic frame—smiling in the face of disaster—and the composition of image—looking directly into the camera as if to break the fourth wall (Outley et al.; Brock). These facets influence the affectivity of the Disaster Girl image, or its capacity to move audiences to add their own remix to the meme. Remix is not only an inherently Black practice (Navas et al.), but it is also the lifeblood of meme culture and Internet culture more broadly. Iloh, Jackson, and Williams separately argue the proliferation of Black digital culture in the US means much of what enters mainstream US culture was shaped by Black users. Therefore, Black imaginative labour is an absent presence at the heart of Disaster Girl (or any) meme’s popularity—the popularity that made it valuable as an NFT. Minting the original image as a meme-based NFT consumes the labour of digital public actors to realise a value for the image owner. According to Cervenak, “NFTs can be seen as a tool for creators to be made whole for the work they put in” creating the original image (qtd. in Notopoulos). However, in memes the “work [being] put in”, the imaginative labour generating the memes, is that of various digital public actors. Neither the digital public actors, specifically Black public actors, nor the US Black cultural production and labour are recognised within the NFT economy. The reversion of memes back to the original image attempts to erase the Black cultural labour that generated the meme’s value. The work of digital public actors must be seen as both interchangeable and working in the service of the original “owner” of meme imagery to facilitate the trade of meme-based NFTs. Unlike Newman, Z. Roth was lauded for the monetisation of her meme-fame. Indeed, Newman’s imaginative labour needed to be obfuscated for the appropriation of “on fleek” by non-Black US culture. Z. Roth did very little labour in the invention and circulation of the Disaster Girl meme; however, her agency within anti-Black US culture created the conditions of possibility for her minting of the NFT. The dynamics of NFTs, Black US cultural labour, and anti-Blackness allow for the simultaneous obfuscation and appropriation of fungible meme-culture. Just as enslavement alienated Black bodies from the profits of their labour, NFTs similarly erase Black cultural production from the monetary benefit; NFTs (further) digitise these paradigms of anti-Blackness in US digital culture. Conclusion This essay has just barely chipped the surface on the articulations of race, fungibility, and NFTs. The arguments contained within demonstrate the legacies of fungible Blackness, which US Afro-pessimism links to the structuring logics of the Atlantic Slave Trade, and their manifestation in contemporary digital culture, specifically via meme-based NFTs. First, the essay traced the needed alienation and appropriation of Black cultural labour within US culture. Translating these practices to meme culture, the essay argues the minting of meme-based NFTs is a non-fungible agency only available to non-Black actors. There remains much to be explored, especially regarding equitable cultural practices. 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