Asking God about the date you will die: HIV testing as a zone of uncertainty in rural Malawi

Testing for HIV is becoming more available in Africa. Global advocates of testing see it as key to AIDS prevention. However, testing is not always perceived as a good thing by people at risk. Here, we consider testing from the perspective of people in a high-prevalence community. Using qualitative data from rural Malawi, we show that the decision to test is not as straightforward as suggested in the testing advocacy literature, but is marked by uncertainty and ambivalence. Reluctance to test is connected to the perception that testing inevitably leads to a positive diagnosis, and subsequent deterioration and death. This fear is in turn linked to overestimation of the transmissibility of HIV. We recommend that testing advocates address this concern that being tested means having a death sentence pronounced, and emphasize the benefits of testing for the majority who are HIV-negative, as well as the minority who are HIV-positive.ambivalence, HIV testing, Malawi

Before Showtime

In this piece of creative nonfiction, I reflect on the experience of having time on my hands in peri-urban spaces that are characterized by transience, liminality, and contingency, while waiting for performance time at youth cheerleading competitions. I describe walking around these places, specifically Las Vegas and Abbotsford (BC). I connect my experience to other accounts of aimless wandering, such as the derive of psychogeography, and note the ways in which the exercises of power and potential world-ending catastrophe are present, but latent, in these landscapes. In particular, I consider the historic cold-war threat of a nuclear bomb as well as the present-day threat of catastrophic flooding

Fellow cows and conflicting farmers: Public perceptions of dairy farming uncovered through frame analysis

Divergence in opinion over how farm animals should be cared for is creating a disconnect between livestock farming and the public that risks a loss of “social license” to farm. One proposed solution for the dairy farming community is to engage more constructively with the public to develop a shared vision of the industry's future; however, farmers and veterinarians remain reluctant to validate public opinions on farm animal care, in particular, often viewing them as naïve or impractical. Understanding the interpretive frames through which people make sense of dairy farming could help the dairy farming community engage more constructively with public opinion, thereby reducing conflict and providing opportunities to change communication or practice. Hence, frame analysis was conducted on transcripts of 60 face-to-face interviews with members of the UK public, first defining frames using reflexive thematic analysis, then considering the effect of these frames on those holding them. The results showed that dairy farming was mainly characterized by two entities: the cow and the farmer. Three frames were developed for the cow: she was perceived as i) enduring, which induced a sense of moral responsibility for her well-being among participants; ii) a fellow or companion, which led to feelings of a shared or parallel life with her; and iii) a force of nature, where the cow's connection with the natural world and “otherness” was appreciated, or even longed for. These connections were unexpectedly widespread within the sample, with many participants simultaneously holding two or even three frames. The farmer was seen through two frames: i) traditional; or ii) modernizing, but both frames had positive and negative narratives depending on the perceived care of the cow, causing confusion or even conflict about the care the farmer actually delivered. These findings provide new insights into the interpretive lenses through which the public makes sense of the dairy cow and her care, not least the bond the public themselves feel with the animal. They offer fresh opportunities for the dairy industry to improve engagement through more reflexive communication or modification of farming practices to better fit societal expectations about dairy cow welfare

Is it just about grazing? UK citizens have diverse preferences for how dairy cows should be managed

© 2020 American Dairy Science Association Conflicting views between the dairy industry and the public about how dairy cows should be managed, together with an increase in the availability of alternatives to dairy foods, challenge future markets for milk producers. Members of the public value animal welfare as well as naturalness and grazing, but neither the relative importance of specific aspects of management nor the diversity of views underlying these preferences have been established. To better understand these issues, 2,054 UK citizens recruited through a research panel took part in an online survey. They were asked to rank 17 attributes relating to dairy cow management and milk production through the novel application of best–worst scaling, a discrete choice methodology that allows a trade-off between items. Hierarchical Bayesian analysis of the results revealed 3 attributes of equal top importance: (1) access to grazing, (2) cow health and welfare, and (3) cow comfort. Alongside this overarching ranking, underlying differences in preferences were identified in 6 approximately equally sized citizen groups within the sample, which were identified through latent class analysis. Each latent class expressed significantly different priorities from the other, and each had different indicative sociodemographic, attitudinal, experiential, and value-oriented characteristics, as established through a multinomial logistic model. If the diversity of preference between the citizen groups found in the sample is reflected within wider populations, there may be opportunities for the dairy industry to improve communication about positive practices, develop new dairy product markets, and consider changes to dairy farming systems to better meet different citizens' needs. Furthermore, the defining characteristics and priorities of each group raise the question of whether grazing in particular, but also other attributes presented within the study, is understood in different ways by different subgroups of citizens

Understanding public preferences for different dairy farming systems using a mixed-methods approach

Global production of milk has doubled over the past 50 yr, yet dairy farming in high-income countries faces scrutiny over practices perceived to affect animal welfare. One such practice is housing dairy cows year-round without access to pasture, which is the norm across North America and increasing within Europe, despite evidence of significant public support for grazing. Diverging opinion between the farming community and the public about what animal welfare means could be a key factor; however, lack of insight into the understanding and motivations underpinning public preferences for grazing could also hamper resolution. On the basis that more information could increase engagement between parties, 60 members of the public across the United Kingdom were interviewed to understand their perspectives of 3 dairy farming scenarios incorporating different amounts of grazing or housing. Their responses were analyzed using a mixed-methods approach combining reflexive thematic analysis with linguistic analysis. The integrated results indicated participants had a dual vision of the cow, seeing her as both domestic and wild. A scenario with housing in winter and grazing in summer therefore suited her, providing both protection and naturalness, and was most associated with analytic thinking. Interviewees also confessed ignorance about the cow's needs, either deferring to others' judgment—including the cow herself—or using familiarity and anthropomorphism to assess the scenarios. This again resulted in most optimism, confidence, and positivity for housing in winter and grazing in summer, and most negativity for housing cows year-round. Grazing was aspirational, but keeping cows outside in winter was confusing and concerning. These findings offer opportunities for the dairy industry to adapt communication or systems to better meet societal views; for example, incorporating access to pasture or increasing cow choice

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment