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EDITORIAL

We Are People, Not Clusters!
Edwin J. Bernard, Alexander McClelland, Barb Cardell, Cecilia Chung, Marco Castro-Bojorquez, Martin French, Devin Hursey, Naina Khanna, Mx Brian Minalga, Andrew Spieldenner & Sean Strub

As advocates and scholars, including people living with HIV, we have been engaged in a critical debate over molecular HIV surveillance (MHS), as well as its antecedent and future practices. We have elaborated our concerns on the ethical implications and potential harms MHS poses to our communities, in academic fora (Bernard et al. 2007; Chung et al. 2019; Dawson et al. 2020; Gilbert et al....

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Fourth Pillar or “Third Rail?:” Towards a Community-Centered Understanding of the Role of Molecular HIV Surveillance in Ending the HIV Epidemic in the United States
Justin C. Smith

Molldrem and Smith’s (2020) thoughtful article “Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice,” calls attention to vitally important considerations in the implementation of molecular HIV surveillance (MHS) in HIV cluster detection response (CDR) efforts. The authors are rightly concerned with the myriad ethical ques...

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Ambulance Charters during the COVID-19 Pandemic and Equitable Access to Scarce Resources
Daniel Du Pont & Jill Baren

The novel coronavirus outbreak, like any pandemic, has brought with it many difficult choices. When demand for medical resources exceeds supply, healthcare providers have to make excruciating decisions about which patients will be offered treatment—not just intensive treatments, but any basic life support measures. The fundamental problem of rationing is that the distribution of hospital resourc...

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Target Article

Reassessing the Ethics of Molecular HIV Surveillance in the Era of Cluster Detection and Response: Toward HIV Data Justice
Stephen Molldrem & Anthony K J Smith

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in “clusters” of others with genetically similar strains. This is called “molecular ...

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Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality
Arnold H. Levinson, M. Franci Crepeau-Hobson, Marilyn E. Coors, Jacqueline J. Glover, Daniel S. Goldberg & Matthew K. Wynia

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to i...

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