Friday, August 10, 2012

Scholarship and Service

Scholarship and Service

As a working professional, these two often distinct "notions" of scholarship and service has been a challenge, a hard and long fought struggle, to be integrated.

One can wait for the right team, the right project, and the time to step back, reflect on what is taking place which may contribute to an expanded view of both service and science.

Scholarship implied a depth of knowledge, an ability to assimilate information, and a sound method for approaching the endeavor; lending itself to a type of “knowing.” Service suggested immediacy in responding to a need, a trajectory for personal growth, and personal satisfaction in being able to contribute in addressing a problem; this speaks to developing “compassion”.

I feel as though these very notions have come together in the course of the past seven years. Did it take that long? Yes, at least in the example to be shared. In fact, it has been more than that; if you add data analysis, developing, submitting a manuscript and then publication. Plus adding time when the project truly began, that is before applying for a grant.

The grant proposal is a distinct process and an iteration of what eventually develops and is implemented. Time is the less oft discussed variable in any project. Implementation time which starts from outreach, enrollment, participating in an intervention, through follow up from completing the intervention. Time passes. Time passes from the development of a project to its natural completion.

Meanwhile service is happening or is being provided whether through a screening, a referral, information sharing, or workshop participation through discussion and skills development practice.

Where does Science enter, when time is a factor? Science in the form of Prevention Science and Evaluation Research enters from the beginning. A sound design includes empirical and community participant level data. Science occurs in how information is collected, how it will be analyzed and how findings are shared. Science is a constant companion.

However, the limits of science, I’ve learned in my earlier working life have been its relative in-flexible nature. It requires consistency, a focus set of criteria and procedures. Often times the question or the inquiry drives the way things are to be done. After completing a graduate degree, and a period of my professional life was spent within the confines of a leading Medical Science University. There I explored service and knowledge development, using the tools gained from the social science. Early in my career, I realized service and science in the realm of academia was not where I belonged.

The process of integration, though not complete, has been to allow time, service and science to go hand in hand, each equal in stature in the act of service.

As a scholar and service developer one faces the question of fidelity i.e., are you doing the job as a model requires, or are you adding on additional activities hence deviating from the known procedures. One wrestles with relevance, not only to the community of other scholars who have published before you or the mission of the organization, but to the participant and the community being served.

One is confronted by acceptance, when you hope the community gives the service value, participates and let others know of them. Acceptance is also manifested by your peers when you talk about the project and whether a manuscript will be reviewed and subsequently published.

A culminating experience in the integration of science, service and time was a recent milestone achieved. Time allowed for maturation, the unfolding of the experience, and the focus or purpose to be solidified. The team made up of community health workers/health educators, evaluators, and myself examined the information we collected, and developed topics for the writing of manuscripts. Eventually completing the writing and subsequently having it published. It was a rush.

Friday, August 3, 2012

What I came away with from the Int'l AIDS Conf 2012

It's been a week since the closing ceremony of the nineteenth International AIDS Conference (2012). For the first time since 1990 when it was held in San Francisco California, the meeting was held in the US. At that time, American policy makers and many constituents, allowed fear to override science by banning people with HIV from coming to the United States.

In looking back, was that a smart policy? On the positive side, it limited the type of virus that can be introduced to the general or high risk population. On the other side, it made the US appear less than sterling in how we were viewed globally (read isolationist). By limiting who can come into the US, it closed our society to other influences that may have spurred innovation and creativity. This policy may have hindered the development or advances in medical, psychosocial, environmental and structural front of the epidemic. It has been twenty two years, since an international meeting of the scope had been held in the most industrialized country in the world.

The global pandemic. The very thought that 34 million people are known to have HIV/AIDS is mind blowing. It seemed as though we added over one million people every year to the registry, since the virus was discovered in 1983.

At the conference, it was clear that Sub Saharan Africa, East, West and South Africa were hard hit. Throughout the conference you were reminded of how different each nation was affected. Conversely, many nations were held up as examples of what the potential is for the uptake or scale up of certain technologies (testing, universal access to treatment, circumcision) which can save, or extended lives in the region.

Domestically, the focus was on were the epidemic has been in the past few years, namely among young African American men who have sex with other men, Black women, and MSM mostly among Caucasians. Many of the sessions addressing these populations spoke of advancement in using “test and treat,” “treatment as prevention,” or speculation on how affected communities are not embracing current technologies. The clarion call was to do more and better in targeted outreach and taking away the stigma associated with the disease.

There was politics (Regional i.e. the world looking to Arab nations to decriminalize same sex acts, condom distribution, sodomy laws, etc...). There was showmanship in glitterati style among keynote speakers. There was heavy lifting on the scientific and medical communities. There was "showcasing" of how BRICS (Brazil, Russia, India, China and South Africa) can and have done more (either in financial support or encouraging widespread adoption of civil and human rights for populations most affected by the virus). Bill Gates, Elton John, Bill and Hillary Clinton, Anthony Fauci, Phil Wilson was among the headliners.

Most notably was how often, if not at every keynote, plenary session, plus the opening and closing ceremony there was mention of the US role in the global fight against HIV/AIDS. Naming President’s Emergency Plan for AIDS Relief (PEPFAR) making life saving medication be accessible in the developing world to fight the pandemic. The often cited lifting of the travel ban by President Obama , and the billions of dollars given by both government and privately (specifically Bill and Melinda Gates Foundation) that has profoundly affected the lives of millions of people. As Americans it highlighted what we have done positively in the world, in balance to the destruction we have reeked.

There were lots to sort through, in addition to what felt like the swim upstream to the other side of the convention center when sessions ended. There were thousands of people in close proximity to one another.

Today a week later, I still feel fatigue from being overstimulated by the science, the number of people, the heat, the hope and promise of how we as a people are making advances in slowing the rate of death, decreasing mother to child transmission, and the armory of medication that has been part of the tool kit in the struggle to decrease human suffering.

I also have circling in my head how stigma and discrimination persist. Now we are devising tools for explaining what these abstract notions are, so that we may develop a strategy for decreasing stigma and eliminating discrimination which has contributed immensely in preventing people from testing or receiving treatment.

I felt an affirmation in being among the legions of people who work and experience minor triumphs in fighting the epidemic. I looked at the 21,000 delegates as a small sample of the numbers of people globally who are in this struggle for uplifting the lives of many.

I had renewed my commitment to the fight some 5 years or so ago, after taking an extended hiatus from direct involvement (read care) in the HIV/AIDS arena. Now, I am clear as to what I can contribute too. Much of my focus in the past seven years has been in prevention and education. I look at the intersection of ethnicity, language, culture, risk behavior in the area of prevention and testing, in hopes of advancing how to approach different communities with the right tools. I want to be the front line of the battle and no longer in the thick of the epidemic, where I cared, mourned and struggled on, as close friends and allies became the casualties of the fight. In their memories, I am sustained by their courage, silent support of being part of the solution, and our close friendship.