University of Minnesota College of Liberal Arts

Honors Seminar--Winter Quarter, 1998

AIDS: Biological and Sociocultural Perspectives on an Epidemic

General Information

4 credit hours

Tues and Thurs 11:15-12:30 pm

Moos Tower 2-146

Course Coordinators

Dr. Jamie Feldman
Email: feldm010@tc.umn.edu
Voice mail: 624-8426

D-408 Mayo

Office hours by appointment; usually in office Tues 9-11:30

Dr. Tim Schacker
Email: schac008@tc.umn.edu
Voice mail: 624-9955

Teaching assistants: Andrea Gehrz

Course Description

This interdisciplinary seminar will explore the biological and sociocultural aspects of AIDS, which affects millions of people worldwide. The origins of the epidemic are rooted in the interaction of viruses and people, as well as the interaction of people and societies. Understanding AIDS involves understanding such diverse issues as the immune system, sexuality, virology, addiction, the process of scientific research, politics and cultural differences, as well as how they affect one another. The HIV/AIDS Seminar will introduce you to interdisciplinary thinking about a complex phenomenon, along with basic concepts from epidemiology, virology, medicine and the social sciences.

Required Readings

Readings will be listed in the syllabus for each week. The amount of reading will be variable, but should be no more than 45 pages per week. Most readings will be found in the course packet, available at Copies on Campus or on reserve at the biomedical library. The course packet will also be available on reserve at the biomedical library. Certain readings will be handed out at the first day of class or at the lecture. One set of readings will be located at web sites on the Internet. Below is a list of places on campus where computers and Internet access are available. There are also optional readings, for those students who wish to cover a topic in more depth.

Methodology and Faculty

There will be two sessions each week, examining a particular issue in the AIDS epidemic. One session will approach the topic from a more biological perspective, while the other session will take a sociocultural approach. Topics include: the history of the epidemic, what we know about AIDS and HIV infection (and how we know what we know), sex and drugs, AIDS and the impact on medicine, politics, policy and the media. The last week will include a free-wheeling discussion bringing together information from the previous weeks to explore the epidemic in an integrated way.

The course will consist of both lectures and discussions. Question and answer sessions will accompany each lecture, while some classes may focus entirely on group discussion. The material will be presented by a variety of academic and health professionals, including Dr. Feldman and Dr. Schacker (course coordinators). Since the field of HIV/AIDS is fast changing and often part of current events, feel free to bring in articles (or bring up events) covered by the lay and academic media.

Assignments and Evaluation

1) Required reading should be done prior to class. Attendance will be taken at each class. Since this is a small class, participation is also key. If you are unable to attend class for an extended period (more than 1 week) due to illness or emergency, notify one of the coordinators or teaching assistants.

2) There will 3 short, multiple choice/fill in the blank quizzes. If you are unable to attend on a quiz day, you must notify one of the coordinators no less than one day in advance. In case of illness or emergency, you must notify a coordinator within a day of the event. Arrangements for make-up quizzes will be made only if the coordinators are notified in a timely fashion. Quizzes will be graded on a percentage basis.

3) Each student will be required to write an 8-10 page paper on any aspect of the AIDS epidemic, but the topic must first be cleared with Dr. Feldman (sociocultural topics) or Dr. Schacker (biomedical topics). Papers must be typed (or printed out via LEGIBLE computer printer). Reasonable standards for spelling, sentence construction and comprehensible flow of ideas will be considered in the final paper grade. You should utilize at least two sources for your paper and cite ALL sources. If you are unsure how to provide appropriate citations, please consult a style manual (such as Strunk and White) or talk with a course coordinator. We are unable to accept your paper via fax or email. Papers are due March 3, 1998. If you are unable to complete your paper on time, contact a course coordinator. Late papers may result in a downgraded grade for the paper or an incomplete for the course. If we do not receive your paper prior to the end of the course, and no other arrangements have been made, a grade of A zero will be assigned to the paper.

The grade for the seminar will be calculated as follows: Class attendance/participation 40%, paper 40%, and total quizzes 20%. If you need accommodations for attendance, quizzes or paper, please notify a course coordinator as soon as possible, so that we can meet your needs in a timely fashion.

Course Schedule—Brief

Week One: 1/6 and 1/8

Introduction--T. Schacker and J. Feldman

Basic Science of HIV Infection--T. Schacker

Week Two: 1/13 and 1/15

Epidemiology/History (1)--J. Rothenberger (University of Minnesota, Division of Epidemiology)

Epidemiology/History (2)--J. Rothenberger

Week Three--1/20 (quiz) and 1/22

Transmission (1)--T. Schacker

Sexuality--S. Rosser (University of Minnesota, Dept. Of Family Practice, Program for Human Sexuality)

Week Four: 1/27 and 1/29

Transmission (2)/Prevention-- T. Schacker

Media and the representation of the epidemic--M. Herbert (Hamline University, Dept. Of Sociology)

Week Five: 2/3 and 2/5

Clinical Issues in AIDS-- TBA

Ethical Issues at the end of life--D. Bartels (University of Minnesota, Biomedical Ethics)

Week Six--2/10 and 2/12 (quiz)

Antiretroviral treatments--K. Henry (Dept. Of Infections Disease, Regions Hospital, St. Paul)

Culture of science--J. Feldman

Week Seven: 2/17 and 2/19

Medical issues at the end of life--T. Peterson (Healthspan Home Care and Hospice)

Medical Models of HIV Disease--J. Feldman

Week Eight: 2/24 and 2/26

Research agendas--panel discussion

AIDS and Politics--J. Hanson and B. Tracy (Minnesota AIDS Project)

Week Nine-- 3/3 (papers due) and 3/5 (quiz)

International perspectives, biomedical--A. Lifson (University of Minnesota, Division of Epidemiology)

International perspectives, sociocultural--W. Rowe (University of Minnesota, Dept. Of Anthropology)

Week Ten: 3/10 and 3/12

Addiction and AIDS--C. Hogan (University of Minnesota,Coordinating Centers for Biometric Research )

Conclusion--T. Schacker and J. Feldman

Course Outline and Readings--Detailed

Week One

1/6 Introduction

Objectives: Introduction to course. To develop a glossary of HIV/AIDS related terms and ideas. To explore students= experiences ideas about HIV in a group discussion.

Readings: none

1/8 Basic Science of HIV Infection

Objectives: To understand the basic virology and pathophysiology of HIV infection. To identify the basic terminology relevant to HIV infection and set the stage for understanding where antiretroviral treatments interact with HIV.

Readings:

1. Robertson, Michael and Michael Emmerman 1996 AChapter 1: Pathogenesis in The HIV Manual D. Spach and T. Hooton, eds. pp. 3-13

2. Pantaleo, Guiseppe et al. Date ?, AChapter 4: Immunopathogenesis of Human Immunodeficiency Virus Infection in AIDS: Etiology, Diagnosis, Treatment and Prevention 4th ed. V. DeVita et al. Eds. pp. 75-89

These readings will be on reserve in the Biomedical Library

Week Two

1/13 Epidemiology/History (1)

Objectives: To understand the epidemiology of the epidemic on a national and global scale. To discuss social, political and geographic/climatic events with the evolution of the epidemic, identifying historical events relevant to the epidemic 1981-1987

Readings:

1. Stine, Gerald 1997 AInto the First 16 Years of HIV/AIDSin AIDS Update: 1997 pp.xviii-xxii Prentice Hall: Upper Saddle River, NJ

2. Grmek, Mirko 1990. AChapter 1: Proclaim a New Disease and AChapter 3: The First Stirrings in Europe in The History of AIDS pp: 3-12, 21-30 Princeton University Press: Princeton, NJ

1/15 Epidemiology/History (2)

Readings:

1. Grmek, Mirko 1990 AChapter 4: AIDS/SIDA--The Four-H Disease and Chapter 6: The Discovery of the AIDS Viruss in The History of AIDS pp.31-43, 60-70

Week Three

1/20 (quiz) Transmission (1)

Objectives: To understand HIV is transmitted, both on a behavioral and biological/cellular level. To explore what we don’t know about transmission.

Readings:

1. Mastro, et al. 1994 AProbability of female to male transmission of HIV-1 in Thailand Lancet Vol 343: 204‑207

2. Plummer et al. 1991 ACofactors in male to female sexual transmission of HIV type 1" Journal of Infectious Disease Vol 163: 233‑239

3. Telzak et al.1993 AHIV-1 Seroconversion in patients with and without genital ulcer disease Annals of Internal Medicine Vol 119:1181‑1186

4. Stamm et al. 1988 A The Association between genital ulcer disease and acquisition of HIV infection in homosexual men JAMA 260:1429‑1433.

The Plummer article is not in your course packet--a summary will be provided and the article will be on reserve at the Biomedical library

1/22 Sexuality: Past Present and Future Directions in HIV Prevention

Objectives: To understand the historical context that discrimination played in enabling transmission of HIV in the U.S. To examine the role of HIV as a sexually transmitted disease and the impact of this on national and international patterns of transmission. To compare responses to HIV by affected communities, public health, governmental and medical agencies. To study the impact of new treatments on changing patterns of HIV transmission, and future directions in prevention.

Readings:

1. National Institutes of Health Feb. 1997 AConsensus Statement on Interventions to Prevent HIV Risk Behaviors. NIH, Bethesda MD

2. Rosser, BRS 1997 AThe Impact of new advances in treatment on HIV prevention: Implications of the International AIDS conference on future prevention directions Sexual Health Today 1(2):1-4

3. Rosser, BRS 1997 ANew directions in HIV prevention. SIECUS Reports 26(2) (in press)

4. Rosser BRS, Short, B, Ross MW, Bockting WO 1998 AThe Relationship Between Internalized Homophobia and Unsafe Sex in Homosexual Men Journal Of Clinical and Consulting Psychology (in press, using abstract only)

Optional Reading:

Shilts, Randy 1987 And the Band Played On: Politics, People, and the AIDS Epidemic Penguin: New York

Week Four

1/27 Transmission (2)/Prevention

Objectives: To understand how knowledge of transmission (biological and behavioral) helps develop prevention strategies. To discuss safer sex, needle exchange, teen and minority prevention strategies. To identify barriers to behavior change, implementation of prevention programs.

Readings: None

1/29 Media and the representation of the epidemic

Objectives: To discuss role of the media in representing the AIDS epidemic. To understand the historical context and identify change in media approaches over time. To discuss mainstream versus alternativemedia, and the relationship between media and science/medicine, media and policy making.

Readings:

1. http://www.startribune.com/aids/--web site based on Brian Peterson’s article on life of Minnesota family coping with AIDS. Work through all chapters of site

2. http://www.poz.com POZ magazine web site. Read as much as possible.

Locations and phone numbers of the computer labs are at the end of the syllabus.

Week Five

2/3 Clinical Issues in AIDS

Objectives: To understand the natural history of HIV disease and how current treatments can improve outcomes. To discuss different approaches to treatment, and the associated uncertainties. To explore the issues of viral resistence and patient compliance.

Readings:

1. Miles 1997 (title) JAIDS Vol 16 Suppl 1, S1‑S2

2. Saag 1997 (title) JAIDS Vol 16 Suppl 1, S3‑S13

3. Chaisson, et al. 1997 (title) JAIDS Vol 16 Suppl 1, S14‑S23

These articles are not in the course packet, but will be on reserve at the Biomedical library

2/5 Ethical issues as the end of life

Objectives: To explore the legal, social and ethical issues surrounding end of life. To understand the distinctions and controversies regarding withholding treatments, passive vs. active euthanasia, physician-assisted suicide, and problems implementing advanced directives. To identify the lessons AIDS care has for other diseases at end of life.

Readings:

1. Slomka, Jacquelyn 1992 The Negotiation of Death: Clinical decision making at the end of life Social Science and Medicine Vol 35, No 3:251-259

Week Six

2/10 Antiretroviral treatments

Objectives: To explore how antiretroviral treatments were developed and how they target HIV. To understand the role of viral load measurements, combination therapy, issues of resistance/compliance, and clinical trials.

Readings:

TBA

2/12 (quiz) Culture of science

Objectives: To understand how knowledge/facts are constructed in the scientific enterprise, using AIDS as example. To explore science as culturally-based activity, as well as the economic, political, and social forces which shape research.

Readings:

1. Fish, Stanley 1980 AChap. 15: What makes an interpretation acceptable? in Is There a Text in This Class? pp. 338, 342-343

2. Grmek, Mirko 1990 AChapter 7: Solution to a Controversy in The History of AIDS

pp. 71-77

3. Feldman, Jamie 1992 AGallo, Montagnier and the Debate Over HIV: A narrative analysis Camera Obscura No. 28 (special issue):101-1124

3. ASettling the AIDS virus dispute 1987 Nature Vol 326: 425-426

4. AThe Chronology of AIDS Research 1987 Nature Vol 326:435-436

5. Fujimara, Joan and Danny Chou 1994 ADissent in Science: Styles of scientific practice and the controversy over the cause of AIDS@ Social Science and Medicine Vol 38 No. 8--read pp. 1017-1018, 1021-1025, 1030-1031

Optional Reading:

Crewdson, John 1989 ASpecial Report: The Great AIDS Quest, Chicago Tribune Section 5, Nov. 19: 1-16

Week Seven

2/17 Medical Issues at the end of life

Objectives: To explore biomedical end of life issues in context of AIDS. To understand the definition of dying, the role of palliative care/hospice, pain management, and advanced directives.

Readings:

1. Hospice Care: A Physician’s Guide pp.5-26, 45-48

2. Is Hospice an Option for Me? (pamphlet)

3. Choosing Hospice (pamphlet)

All will be handed out the first day of class.

2/19 Medical Models of HIV Disease

Objectives: To explore the concepts of Acultural construction of disease and medicine as cultural system, in relationship to AIDS. To identify the historical evolution of medical models, how they are influenced by culture, role of ambiguity and the drive to standardization. Explore the current models (cancer, diabetes) of HIV and their implications for patient care.

Readings:

1. Hunter, Kathryn 1991 AIntroduction: Interpreting Medicine pp. xvii-xix, AChapter Two: A Science of Individuals pp. 47-48 in Doctor’s Stories: The Narrative Structure of Medical Knowledge Princeton University Press: Princeton NJ

2. Feldman, Jamie 1995 AChapter Four: The Building Blocks of AIDS@ pp. 55-58, 70-82. In Plague Doctors: Responding to the AIDS Epidemic in France and America Bergin and Garvey: Westport CT

Week Eight

2/24 Research agenda

Objectives: To explore the process of biomedical research in the context of AIDS using a panel discussion format, To identify how research questions are formulated, agendas developed and research begun. To examine why some questions are asked vs. others, funding, the role of pharmaceutical companies, and clinical trials

Readings: None

2/26 Politics

Objectives: To understand how various political agendas have impacted and been impacted by AIDS. To discuss areas including: prevention, recognition of AIDS as a national problem, evolution of grass-roots activist groups and their impact on public policy.

Readings:

1.. Crimp, Douglas (ed.) 1988 AIDS: Cultural Analysis, Cultural Activism pp. 148-149 MIT Press: Boston

2. Kayal, Philip 1993 Introduction pp 1-10, Epilogue pp. 227-235 in Bearing Witness: GMHC and the Politics of AIDS Westview Press: Oxford

3. Wanted, Simon 1994 The Politics of AIDSp. 31-35 in Practices of Freedom: Selected Writings on HIV/AIDS Duke University Press?

Optional

Burkett, Elinor 1995 Chap. 12: Strike a Pose pp. 315-347 in The Gravest Show on Earth: America in the Age of AIDS Houghton Mifflin Co.:New York

Week Nine

3/3 PAPERS DUE

International perspective, biomedical

Objectives: To understand how AIDS presents around the world and how different countries approach it given limited resources. To explore the areas of diagnosis, treatment, vaccine trials.

Readings:

1. Quinn T et al. 1996 AGlobal Burden of the HIV pandemic. Lancet 348:99‑105.

2. Cruz‑Groot D ET al. 1996 Prevention of HIV infection in developing countries. Lancet 348:1071‑74.

3. Coates TJ et al. 1996 Prevention of HIV infection in developed countries. Lancet 348:1143‑48.

4. Lifson AR. 1994 Preventing HIV: Have we lost our way? Lancet 343:1306‑7.

5. Lifson AR. 1995 Preventing AIDS: Have we lost our way? Lancet 346:262‑3.

3/5 (quiz) International perspective, sociocultural

Objectives: To understand how AIDS affects non-Western societies, such as Southeast Asia and Africa. To explore how various countries have approached prevention compared to the United States, and how AIDS may be as an AAfrican disease in one country and an AAmerican disease in another.

Readings:

Farmer, Paul ed. 1996 Chapter 2: A Global Perceptive in Women, Poverty and AIDS pp. 39-90 Common Courage Press: Monroe Me. --read as much as possible

Week Ten

3/10 Addiction

Objectives: To explore the history of addiction in the United States and its role in the AIDS epidemic. To discuss issues of needle exchange, drug treatment, minority communities and addiction, tuberculosis, and the role of non-IV drug use in the epidemic

Readings:

1. Tilleraas P 1990 Introduction, Chap. 1", Chap. 2" in Circle of Hope Hazelden Books, Center City, MN

2. Besch, CL 1995 "Compliance in clinical trials" AIDS 9:1‑10

3. Sawyer RC; Brown LS Jr; Bailey J et al. 1993 "Drug abuse treatment programs as centers for HIV‑related research and treatment" Journal of Addict Dis. 12(4):121‑9

4. Friedland GH, Saltzman B, Vileno J. 1991 "Survival differences in persons with AIDS" Journal of AIDS 4:144‑153

Optional readings

a. Selwyn PA, Alcabe P, Hartel D. 1992 "Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus" New England Journal of Medicine 24:1967‑1703 (strongly encouraged)

b. Rosenthal E. 1993 "Patients in pain find relief, not addiction in Narcotics" New York Times 3/28/93

c. Greenberg AE, Thomas TA, Landesmann SH et al. 1992 "The spectrum of HIV‑1 related disease among outpatients in New York City" AIDS 6:849‑859

d. Kassirer, Jerome P 1997 "Federal Foolishness and Marijuana" New England Journal of Medicine 336:366

e. Fitzgerald B; Hart J; Mobile AIDS Resource 1992 "Treating IVDUS with HIV: an educational response to medical provider stresses. International Conference on AIDS Jul. 19‑24;8(2):D483 (abstract no. PoD 5576).

f. Prendergast ML; Grella C; Perry SM; Anglin MD. 1995 "Levo‑alpha‑acetylmethadol (LAAM): clinical, research, and policy issues of a new pharmacotherapy for opioid addiction"

Journal of Psychoactive Drugs Jul‑Sep;27(3):239‑47.

3/12 Conclusion

Objectives: To integrate material and issues from entire course through group discussion. To explore how AIDS is both similar and different from other epidemics, as well as the biological and social difficulties that remain.