Seroadaptive Strategies of Vancouver Gay and Bisexual Men in a Treatment as Prevention Environment

British Columbia’s treatment as prevention policy has provided free access to highly active antiretroviral therapy (HAART) to all HIV-positive provincial residents since 1996. One outcome is an increase in HIV-positive gay and bisexual men (GBM) with suppressed viral loads. Previous cross-sectional analyses indicated that some Vancouver GBM now recognize condomless anal sex with men on HAART who report a suppressed viral load as a seroadaptive strategy. To test the hypothesis that this new strategy, termed viral load sorting (VLS), is recognized and used among by GBM in the Momentum Health Study, we analyzed longitudinal data for HIV-negative/unknown (n = 556) and HIV-positive (n = 218) serostatus participants. Analyses indicated that both groups reported VLS, and that serostatus and Treatment Optimism Scale scores were significant determinants in frequency and use. Results exemplify the medicalization of sex and Rogers’ Diffusion Of Preventative Innovations Model, and they have important implications for HIV research and GBM sexual decision-making.     

Twitter,incivility, and presidential communication: A theoretical incursion into spectacle and power

ABSTRACT

By approaching civility as an operational logic for democracy, we ask how incivility is a strategy related to power and domination, particularly from the president of the United States. We propose that Twitter is part of an infrastructure of incivility, through which structures and discursive mechanisms contribute to a devaluation of normative democratic discourses. Spectacle provides a theoretical framework to contextualize the forces at play in mediating our relations. Using President Trump’s Twitter use as a case study, we offer four propositions that together formulate a framework for theorizing the strategic use and deployment of incivility as an increasingly legitimate, yet problematic tool for democratic governance.     

Poverty and educational achievement in the US: A less-biased estimate using PISA 2012 data

In the current paper, we employ the most recent Programme for International Student Assessment (PISA) data to calculate a less-biased estimate of poverty on US achievement. The PISA was specifically chosen as it is an assessment removed from a specific curriculum and instead focuses on concepts that students should know in order to participate in a global economy. Using a propensity score matching approach, our findings suggest that US students in poverty have notable educational attainment deficiencies compared to a matched group of students who are not in poverty. In other words, when we select two students who have a great deal in common but for the fact that one comes from a poverty background, the student in poverty is expected to perform nearly 28 points, or about a quarter of a standard deviation lower, on the PISA assessment. In real terms, this puts math achievement for children not in poverty on-par with the Organisation for Economic Co-operation and Development (OECD) average, while children in poverty are well below the OECD average.     

When do stories change our minds? Narrative persuasion about social problems

Scholars in a number of disciplines have sought to assess the power of reading or viewing a personal story to modify people's beliefs. However, the research, which has been pursued under diverse programs, has produced conflicting findings. We focus on the persuasiveness of personal stories about problems that are structural (rather than individual) and whose solution requires government action. Overall, the research suggests that although personal stories can overcome people's tendency to resist new information, they often do not do so. People's preexisting beliefs, assumptions, and stereotypes affect their willingness to be absorbed by a story, to empathize with the stories' protagonists, and to endorse the message communicated by the story. We argue also for a sociological perspective on narrative persuasion, one which, unlike the mostly experimental research conducted so far, pays attention to the context in which people encounter stories and to the norms shaping people's assessment of a story as credible, relevant, and important.     

Graphical representation of survival curves in the presence of time-dependent categorical covariates with application to liver transplantation

Graphical representation of survival curves is often used to illustrate associations between exposures and time-to-event outcomes. However, when exposures are time-dependent, calculation of survival probabilities is not straightforward. Our aim was to develop a method to estimate time-dependent survival probabilities and represent them graphically. Cox models with time-dependent indicators to represent state changes were fitted, and survival probabilities were plotted using pre-specified times of state changes. Time-varying hazard ratios for the state change were also explored. The method was applied to data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Survival curves showing a ‘split’ at a pre-specified time t allow for the qualitative comparison of survival probabilities between patients with similar baseline covariates who do and do not experience a state change at time t. Time since state change interactions can be visually represented to reflect changing hazard ratios over time. A2ALL study results showed differences in survival probabilities among those who did not receive a transplant, received a living donor transplant, and received a deceased donor transplant. These graphical representations of survival curves with time-dependent indicators improve upon previous methods and allow for clinically meaningful interpretation.