The Phenomenological, Social Network, Social Norms, and Economic Context of Substance Use and HIV Prevention and Treatment: A Poverty of Meanings

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Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

This publication resulted, in part, from research supported by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR.

Notes

¹ The reader is referred to a stimulating theses presented by the cyberneticist Heinz Von Foerster who posited that there are two types of generic questions; legitimate and illegitimate ones. The former are those for which the answer is not known and is, perhaps, even unknowable during a given state of knowledge and technology, and which is associated with knowledge breakthroughs—the effective control of man's range of “appetites” for a range of psychoactive substances, whatever their legal status An illegitimate question is one for which the answer is known, or, at the very least consensualized. The asking of illegitimate questions has been, and remains, by and large, the acculturated norm. As a useful rule of thumb any question which “invites only a yes or no answer is an illegitimate one;” one is blind to the quest that is inherent in a trek-provoking question. Heinz Von Foerster, Patricia M. Mora, and Lawrence W. Amiot, “Doomsday; Friday, 13 November, A.D, 2026,” Science, 132, 1960. pp. 1291–1295. The reader is referred to Pablo Neruda's The Book of Questions for a poetic exploration of legitimate questions. The reader may also find the work by Rittel and Webber relevant to the issues being raised in this paper. They suggested that problems can and should be usefully categorized into two types: “tame problems” and “wicked problems” The former are solved in a linear, traditional known and tried “water fall paradigm”; gather data, analyze data, formulate solution, implement solution. The latter “wicked problems” can only be responded to individually, each time anew, with no ultimate, repeatable solution. This challenges individuals, as well as systems, to do the best that we can given the available human and nonhuman resources for needed and planned interventions, the state of both the barriers and the bridges to change associated with the agendas, objectives, and operations of influential individual and systemic stakeholders; the “blockers” and the “enablers.” Rittel, Horst, and Melvin Webber, (1973) Dilemmas in a General Theory of Planning. Policy Sciences, Vol. 4, pp 155–169. Editor's note.

² The reader is referred to Hills's criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine 58: 295–300.). Editor's note.

³ The reader is referred to Robert A. Heinlein, American science writer's notion about experts and specialists: “A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.” Editor's note.

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Carl A. Latkin

Carl A. Latkin, Ph.D. Professor, Johns Hopkins Bloomberg School of Public Health, has worked in the field of substance abuse and HIV prevention and care for over two decades. The focus of his work has been on studying and utilizing social networks for developing peer based interventions that focus on impoverished urban communities in the US, Asia, and Eastern Europe.