'Pregnancy comes accidentally - like it did with me': reproductive decisions among women on ART and their partners in rural Uganda

<p>Abstract</p> <p>Background</p> <p>As highly active antiretroviral therapy (ART) restores health, fertility and sexual activity among HIV-infected adults, understanding how ART influences reproductive desires and decisions could inform interventions to reduce sexual and vertical HIV transmission risk.</p> <p>Methods</p> <p>We performed a qualitative sub-study among a Ugandan cohort of 1,000 adults on ART with four purposively selected categories of participants: pregnant, not pregnant, delivered, and aborted. In-depth interviews examined relationships between HIV, ART and pregnancy, desire for children, perceived risks and benefits of pregnancy, decision-making regarding reproduction and family planning (FP) among 29 women and 16 male partners. Analysis focused on dominant explanations for emerging themes across and within participant groups.</p> <p>Results</p> <p>Among those who had conceived, most couples stated that their pregnancy was unintentional, and often occurred because they believed that they were infertile due to HIV. Perceived reasons for women not getting pregnant included: ill health (included HIV infection and ART), having enough children, financial constraints, fear of mother-to-child HIV transmission or transmission to partner, death of a child, and health education. Most women reported FP experiences with condoms and hormonal injections only. Men had limited FP information apart from condoms.</p> <p>Conclusions</p> <p>Counselling at ART initiation may not be sufficient to enable women who do not desire children to adopt relevant family planning practices. On-going reproductive health education and FP services, with emphasis on the restoration of fertility after ART initiation, should be integrated into ART programs for men and women.</p

With a grain of salt

My intent with the title is to evoke a listening through the double meaning of “salis” implicit in Pliny’s original phrase “addito salis grano.” The word “salis” not only refers salt, it also refers to wit. I am exploring the idea that acting with wit and intelligence means we should not take our models of the world too seriously. Models and frameworks enable us to make sense in the same way that a map helps us navigate, but unlike physical maps where there is a correspondence between land and notation, our conceptual territories are cultural and dynamic, so our maps (models, frameworks) should be used with a grain of salt and we should be willing to adapt them. This adaptive cognitive process is evident in the evolution of ideas related to the adaptive cycle, namely around patterns of the development and disintegration of systems. I thus follow the evolution of some of the insights associated with the adaptive cycle. Resilient systems arise through an interplay of transformation and persistence in a shifting balance between the internal connections required for the system to be a system, and the external ones that enable it to persist in a context. As systems arise and disintegrate they do so embedded in and interacting with other dynamic systems at other spatial and temporal scales. As they intersect and interact they become a panarchy rather than a hierarchy. As a second thread I weave in an awareness that we humans are the ones who develop the concepts that I present, (including this one about developing concepts) and that we do this through our recursive and recurrent consensual coordinations of actions and ideas in language and culture. In tracing how we may have developed ever more complex sets of distinctions and how we live these as our various realities, I note that we can easily find ourselves living in a name-based and somewhat rigid sense of reality. Thus our realities may also be seen to exist as adaptive cycles. Further, in any of these realities those regularities of experience that are not named disappear from our thinking and are very difficult to re-evoke or define in language. However, I note that our cognitive abilities are not limited to language, we also exist in an internal panarchy of relationships that resonate with the external panarchy in ways that we may become aware of as we implicitly operate in a panarchic interplay of design cycles. I conclude the presentation with a deeply held desire. I would like us humans to remain the kind of beings who live in reflexive awareness of our systemic dynamic flow in a relational embeddedness

Recursive Reflections on Friendship and Conversation

As Ranulph was a friend, an with whom I had many conversations on reflection and recursion it behoves me to choose this occasion to reflect further on these topics.  The experience of friendship feels delicious and meaningful.  How is this so?  I turn to a fundamental of all living systems, that is living in a constant of structural coupling which maintains our systemic relational embeddedness wherein we change coherently with our niche which changes along with us. Our medium as a whole appears to change slower than we do, its apparent inertia resulting from its complexity of other connections.  In a conversation our immediate niche of the other, in whatever domain, changes at the same pace as we ourselves.  In friendship we have the experience of an intimate flow of these changes. In this talk I consider the implications of “chunking” and “betweens” in language, the fluid flow of entailments in meaning and emotioning, and the role of the current situation as well as the accumulation of co-epigenic coherences.  Even as we reflect on these notions in a conversation, or engage in reflexive conversation on friendship in conversation, the lived experience of conversation in friendship remains retains an aspect of mystery.  The experience of friendship happens both in our reflections and in our living; as a kind of multilayered awareness.  

A More-Than-Human Architecture

The presentation explores the relationship between human awareness and natural order in the complex, interwoven systems around us and how aesthetic awareness emerges from this relationship. We propose that the human sense of beauty arose in the context of our embeddedness in nature and is thus grounded in the forms of nature. However, in our daily lives, we have become disconnected from the natural world and have thus lost the opportunity for re-invigorating a sense of the aesthetic. Based on a studio project, the presentation explores how nature could be reintroduced into people’s urban living spaces, recreating a sense of connection that is interwoven with our consciousness. The project explores the possibility of stimulating human perception and creating new stories at the intersection of architecture and nature. This presentation is part of the Ecopoetic Formations for Transgenerational Collaboration scheme for which four junior designers were paired with four senior members of the American Society for Cybernetics. The scheme was initiated in July 2023. It aims to provide the junior designers with an introduction to the relationship between systems thinking and design and to assist them in developing aspects of their existing graduation projects by integrating systems concepts and systemic design principles. This presentation begins with an overview of the undergraduate design project and the associated essay by Puli Li (junior collaborator) on the order of nature, which serves as a basis for the collaboration with Pille Bunnell (senior collaborator). Following this introduction, the presentation reports on the ideas, designs and thoughts that have arisen through their collaboration from July onwards. As the transgenerational collaboration meetings have just begun, the main body of the submitted document comprises the essay as originally developed by the junior collaborator