Discussion #8

Discussion #8

 

Week #8 Discussion due Sun 10/24

Be sure to read the Week #8 Overview page before completing the Week #8 Discussion assignment.

For the Week #8 Discussion, you will need to pull ideas together from across Kendi’s book. You will have a few different options for this assignment:

  • Option 1: Explain how segregationists, assimilationists, and antiracists approach three different issues, as presented by Kendi. Focus on three examples from different chapters/issues from the first third, middle third, and final third of Kendi’s book.
  • Option 2: Describe three different stages on Kendi’s journey, and analyze how he uses his own story to illustrate a larger issue (three different issues). Select anecdotes from the first third, middle third, and final third of Kendi’s book.
  • Option 3: Analyze some of the historical examples that Kendi provides to illustrate the evolution of three different issues from three separate chapters in the first third, middle third, and final third of Kendi’s book.

Whatever option you choose, your write-up should include:

  • At least nine quotes from Kendi’s book (a minimum of three from each chapter you are analyzing). (You should make sure to include some new sections that you have not previously written about in previous Discussions.)
  • Statistics from each of the three Kendi chapters you are analyzing). (These may overlap with the nine minimum quotes, or may be in addition to them.)
  • At least one definition used by Kendi, and/or one example of parallelism or repetition, used by Kendi. (This may also overlap with your quotes, or may be in addition to them.) (This can be included anywhere in the write-up.)

All of these items should be used to help illustrate Kendi’s ideas in each of the three chapters you are analyzing. Your analysis should come together to make a larger overall point in your write-up, which can be expressed at the beginning and/or in the conclusion.

(Approx. 450-500 words, total; more is fine.)

**You will also need to respond to another’s student’s post. 

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Week #8: Kendi, Chapters 16, 17, and 18

Chapter 16, “Failure”

What to Look For:

In this chapter, Kendi analyzes how and why efforts to combat systemic racism have failed in the past, and are still failing today. He provides a personal anecdote to help illustrate this frustration among many activists. What incident occurred that prompted Kendi to attempt to organize a protest? Why was his idea not well-received by his fellow students? What ended up happening?

What, according to Kendi, is the reason for persistent failure to enact change surrounding systemic racism? How does he explain the problem with focusing on “educational and moral and uplift suasion” (203-205) as a means of ending widespread policies that perpetuate race-based inequities? What does Kendi say we should focus on instead? What historical examples does Kendi provide to help show how key figures, such as W.E.B. Du Bois and Martin Luther King Jr., eventually felt the need to shift focus and tactics in the struggle to combat racism? How and why does Kendi differentiate between “protests” and “demonstrations”?

Chapter 17, “Success”

What to Look For:

In this chapter, Kendi blends his experiences after getting his doctoral degree, teaching and publishing his first book, and working on his second book, Stamped From the Beginning, an overview of the dueling histories of racist and antiracist ideas, with the events surrounding the killing of Trayvon Martin in Florida in 2012, and the subsequent acquittal of George Zimmerman. He notes the birth of the Black Lives Matter movement in the wake of the Trayvon Martin incident, reigniting the movement which was to follow, and which persists to this day.

Kendi also differentiates in this chapter between “overt and covert” racism (221-222), and provides the historical background on the idea of “institutional racism” (219-220). What term does Kendi prefer to use in place of “institutional racism” (222-223), and why does he think it is important to be clear on what it is we mean when we use these terms? Note Kendi’s list towards the end of this chapter on the actions he describes as being integral to his own “lifelong mission to be antiracist” (226). As we read these steps, which all begin with “I” (“I stop…,” “I admit…,” “I confess…,” “I accept…,” etc.), we can see that he intends this as a formula for all of us, if we are to commit to the same journey towards becoming an antiracist in our own lives. Throughout Kendi’s book, we are encouraged to self-reflect on our own attitudes and actions in terms of racism and inequity in the world. Kendi has led us through his own journey, as a Black man who self-identifies as an individual who has struggled to shed his own racist ideas and to re-orient his own thinking around racism and racist policies, providing us with a model for how we, too, can commit to this journey and transform our own ways of thinking, being, and acting in the world.

Chapter 18, “Survival”

What to Look For:

Kendi ends his book with a description of his wife Sadiqa’s battle with cancer, and with his mother’s cancer, and his own battle with cancer. How does he draw parallels between cancer and racism in this chapter? What point does Kendi make about “denial” in regards to both cancer and racism?

What list of actions does Kendi present in this chapter, like in the previous chapter, that “we can all take to eliminate racial inequity in our spaces” (231)? What is the focus of “the Antiracist Research and Policy Center (Links to an external site.)” (231) that Kendi founded at American University in Washington D.C.? What led him to create this organization?

As we end Kendi’s book, we can reflect on our own spaces of influence in our own lives. What small steps can each of us take, in our own spheres of influence, to combat racist inequity?

Where is Kendi Now?

In 2019, right around the time his book How to Be an Antiracist was published, Kendi transferred to Boston University, where he has created a similar institution to the one he founded at American University, the Boston University Center for Antiracist Research. (Links to an external site.) You can read his founding statement here. (Links to an external site.) Kendi is also a regular contributing writer at The Atlantic. You can access his articles here. (Links to an external site.)

Week #8 Discussion due Sun 10/24

Congratulations! You have made it to the end of Kendi’s book! The Week #8 Discussion will ask you to analyze ideas from several chapters across the book. See the Week #8 Discussion assignment for the specific criteria for the assignment. The Week #8 Discussion will be due Sun 10/24, by 11:59pm.

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Following the recent
ruling that pre-exposure prophylaxis (PrEP) can be prescribed for the
prevention of HIV within the National Health Service, what potential impact
might this have for individuals, health care and society?

Introduction

Pre-exposure
prophylaxis (PrEP) is medication taken by individuals without a diagnosis of
HIV, in order to reduce the risk of contracting the virus (Spinner et al.,
2016). The regimen of PrEP is typically composed of antiretrovirals in a
combined pill, typically tenofovir disoproxil fumarate and emtricitabine
(Brydon, 2018). In HIV-infected individuals, these antiretrovirals serve to
treat the infection, reducing the viral load of the patient; lifelong therapy
is needed with antiretrovirals to prevent clinical disease (i.e. AIDS) (Kelen
and Cresswell, 2017). In HIV-negative individuals the purpose of PrEP is not to
prevent viral transmission or entry into the body, but to reduce viral
replication to a level whereby the immune system can eradicate infected cells,
preventing established HIV infection (Brydon, 2018).

The evidence base
supporting the use of PrEP is substantial, indicating a reduction in HIV
transmission, particularly in men who have sex with men (MSM), a key target
population (e.g. Volk et al., 2015; LeVasseur et al., 2018). Therefore, PrEP
can be considered an effective preventative approach, along with other
strategies to prevent HIV infection, such as condom use (barriers methods) and
male circumcision (Dolling et al., 2014). This has led to the approval of PrEP
for the prevention of HIV within the National Health Service (NHS) within the
last year, building on the availability of PrEP in Scotland (Nandwani, 2017).
The remainder of this paper will consider the potential impact of this approval
process, focusing on individual, health care, and societal outcomes.

Individuals

The changes in availability and use of PrEP can have massive
effects on the individual. Firstly, NHS funding of PrEP can increase access to
the drugs and affordability of these drugs (Nichols and Meyer-Rath, 2017). PrEP
was only available through third parties and pharmacies from other nations,
increasing the cost of this preventative strategy and the risk of unreliable
sourcing from online companies (Brydon, 2018). Affordability and access are
particularly important in vulnerable groups and socioeconomically disadvantaged
members of the population, who may be at a higher risk of HIV infection
(Spinner et al., 2016).

One of the main individual benefits of the availability of PrEP
is the expansion of options available for those who are at-risk of HIV. Current
preventative strategies can have significant limitations, which limit their
practical application (Frankis et al., 2016). For instance, condom use requires
access to condoms and positive attitudes to their use, which are not always
present due to perceptions of diminished sexual pleasure (Dolling et all.,
2014). In these individuals, PrEP can provide an alternative to condom use and
ultimately empowers individuals to manage health risk (Frankis et al., 2016).

Other factors that interfere with traditional HIV prevention
practices, including religious beliefs, cultural factors and personal attitudes
to condom use, may lead to an acceptance of PrEP, increasing the power of the
individual to prevent HIV transmission (Stewart, 2016). Providing increased
opportunities and options for individuals to prevent HIV transmission is vital
in promoting heathier sexual behaviours, while increasing individual autonomy
and self-efficacy (Harawa et al., 2017). Therefore, the impact of PrEP approval
within the NHS may benefit those at greatest risk, while broadening access and
availability of preventative measures.

It is important to note that PrEP use does not protect against
sexually transmitted infections (STIs) and that the role of condoms in
preventing both HIV and STIs remains important and should be communicated to
individuals interested in PrEP (Storholm et al., 2017). Furthermore, individual
benefits are only possible if adherence to PrEP is likely to be optimal;
non-adherence reduces the effectiveness of the drug combination and can
increase risk of HIV transmission (Storholm et al., 2017). Therefore, selection
of the target population and individual education on PrEP use will be essential
in ensuring benefits. At present, 10,000 people are enrolled onto the PrEP
IMPACT evaluation in England and the results of this trial will provide
valuable insights into the individual benefits of the use of PrEP (NHS England,
2018).

Health care

From a health care perspective, the funding of PrEP by the NHS
can be considered beneficial in a number of ways. Principally, PrEP has been
shown to have a significant impact on HIV transmission rates in trials and ‘real-world’
evaluations, which may translate into a reduced HIV burden in the population
(Fonner et al., 2016; McCormack et al., 2016; Sagaon-Teyssier et al., 2016).
HIV infection is still associated with significant morbidity and mortality in
the population and therefore prevention can have significant benefits in how
health services manage population health (Hankins et al., 2015).

Furthermore, one of the most important impacts of PrEP use in
MSM from a health service perspective is the potential for cost savings in the
short and/or long term due to reduced rates of HIV infection. A
cost-effectiveness and modelling analysis has shown that PrEP in MSM is
associated with cost savings, based on an initial rollout of 4000 men within
the first year (Cambiano et al., 2018). Similar analyses have been performed
and are associated with cost savings with PrEP use, depending on the length of
time the projections are designed, the use of condoms within the target
population, the rate of STIs in the target population and the cost of
antiretroviral drugs (Drabo et al., 2016; Cambiano et al., 2018; Fu et al.,
2018).

Possible negative effects of PrEP have been considered in the
literature, with a predominant focus on an anticipated decline in condom use,
rise in STIs and the costs associated with these conditions (Kelen and
Cresswell, 2017). Although the relationship between condom use and PrEP use is
complex, there is no clear evidence that PrEP reduces condom use during sex,
although up to 30% of HIV-negative men with HIV-positive partners suggested
that they may be less likely to use condoms if PrEP were available in one study
(Hoff et al., 2015). However, in the context of committed couples, this may not
translate to an increased risk of STIs, although the risk of HIV transmission
needs to be considered in individuals who are less likely to use condoms (Hoff
et al., 2015). Furthermore, the IPERGAY (Intervention Préventive de
l’Exposition aux Risques avec et pour les Gays) study found equal rates of STIs
in patients using PrEP and those not using PrEP to prevent HIV transmission,
suggesting that risk-taking may not be associated with PrEP use
(Sagayon-Teyssier et al., 2016).

The cost-effectiveness of PrEP use in the NHS will partly depend
on the potential for an increase in condomless sex and STIs, suggesting that
this possibility should be closely monitored to ensure cost savings and
population health (Cambiano et al., 2018). More data will be needed to assess
the health care impact of PrEP use, particularly as the target population
becomes more clearly defined and expansion of PrEP use in England occurs (NHS
England, 2018).

Society

Finally, on a societal level, there is an important need to
consider the wider ethical, social and cultural aspects of PrEP use and the
impact of PrEP. Indeed, views on HIV and HIV management are often highly
polarized in society and within the British media (Jaspal and Nerlich, 2017).
HIV is associated with a significant level of stigma and any strategies used to
combat infection rates and to reduce the risks of relationships between
HIV-negative and HIV-positive individuals may serve to reduce stigma to some
extent (Grace et al., 2018). The psychological toll of stigma should not be
underestimated and strategies that alleviate stigma can have significant
benefits for quality of life and wellbeing (Grace et al., 2018).

However, part of the polarized perception of HIV management in
society associates negative connotations with the use of PrEP. An argument
against PrEP use for the prevention of HIV in the general population is the
perception that the medication could be seen as an invitation to promiscuity or
condomless sex, with negative moral and health implications (Knight et al.,
2016; Brydon, 2018). Similar arguments are generally proposed for all advances
in sexual health services (e.g. oral contraception) but are not generally
supported by the research evidence (Calabrese et al., 2016).

Therefore, it is important to ensure that public awareness and
education of the role of PrEP and the massive potential benefits of the
approach are not obscured by misinformation or unfounded claims in the media
(Jaspal and Nerlich, 2017). Health care professionals are well-placed to inform
the public and address such sources of misinformation but need to be supported
by policy makers and national guidance (Calabrese et al., 2016; Desai et al.,
2016). However, wider societal attitudes and stigma associated with HIV needs
to be challenged through policy and law-making to ensure individuals at-risk of
HIV have access to PrEP (Serrant, 2016).

Conclusion

In summary, the use of PrEP for the prevention of HIV infections
in the UK is supported by the evidence base and has become an important aspect
of NHS-funded interventions for those at-risk of HIV infection. The potential
impact of PrEP can be seen on an individual, health care and society level,
with reductions in HIV infections, cost savings, and improved availability and
access to health services. The implementation of PrEP needs to be closely
monitored to ensure public awareness and education is facilitated to prevent
negative health behaviors and risks. 

 

 

 

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