Behaviour change interventions in HIV prevention: is there still a place for them?

Face-to-face interventions work best says Gus Cairns

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Background to the analysis
Results
Devising a modern behavioural intervention
Reference

A meta-analysis of studies of brief interventions to reduce HIV risk behaviour in HIV-negative gay men has concluded that there is evidence that such techniques did have a significant impact on the behaviours they were designed to change.

It also found evidence that the best way to conduct such interventions was face-to-face, i.e. not via the internet, telephone or phone apps, and that immediately or shortly after HIV testing was an ideal “learning moment” to conduct them.

Interventions that helped participants set goals for themselves, and ones that helped them understand and restructure self-justifying or contradictory thinking, were the ones most likely to result in behaviour change. Programmes worked better if they involved participants feeling differently about themselves and their behavioural risk, rather than receiving new information. Interventions worked better if they were based explicitly on a theory of behaviour change.

However, while the analysis did find positive evidence for such interventions producing behaviour change, the writers also conclude that the HIV prevention “landscape” has changed radically in the last few years. The studies were published between 2002 and 2014 and probably gathered their data at least two years before their publication date. None included as measurable outcomes serosorting or seropositioning (i.e. basing condom use or sex role on a partner’s perceived status), pre-exposure prophylaxis (PrEP) use, decisions based on partners’ viral load, or the use of negotiated safety arrangements, even though the authors tried to find studies that measured these.

There was just one outcome measure that was sufficiently universal across the studies for the authors to make a statistical generalisation about study effectiveness: whether the interventions reduced condomless anal sex. Even though this was measured in various ways (number of condomless acts, number of condomless sex partners, whether they occurred with primary or casual partners, the HIV status or assumed status of the partner, and so on) and was measured over different time periods, the general reduction in condomless sex acts after the eleven interventions was 25%.

Background to the analysis

Compared with the comprehensive effectiveness of both PrEP and immediate HIV treatment as prevention, this may sound like a small reduction in HIV risk. But, as lead author Paul Flowers of Glasgow Caledonian University told aidsmap.com: “Behaviour change interventions boost and complement biomedical technologies rather than competing with them. Getting people on to PrEP and getting people to test regularly is what behaviour change interventions can and should be doing.”

He explained that the impetus behind this meta-analysis of behaviour-change interventions was that he and other academics were involved in writing two sets of new prevention guidelines, for the British Association for Sexual Health and HIV (BASHH) and for Health Protection Scotland.

They were confronted with the lack of an up-to-date evidence base that would indicate how and when to use such interventions to help people at risk of HIV reduce their risk. As well as much of the research being out of date, the field suffers from the fact that most of the research has been done in the US, where effective behavioural interventions are collated at a site run by the US Centers for Disease Control and Prevention (CDC).

Because of this, they were commissioned by the UK’s National Institute for Health Research (NIHR) to investigate the evidence for what worked and then devise an intervention based on that evidence, which could be 'transferable' enough to produce positive effects on other behaviours such as PrEP use or testing.

There have been a fair number of meta-analyses of behaviour change interventions published. Flowers and colleagues counted 19 published since 2000. These vary by the publication date of the studies they included, by whether they only included specific populations, and by whether they only used certain methods. Because of this, they vary enormously in size, from a systematic review of three studies using cognitive behavioural therapy (CBT) in US gay men who inject drugs, to a huge 2005 synthesis of 354 studies that were published between 1988 and 2003.

Results

Flowers and colleagues drew tight criteria for inclusion in their meta-analysis. They only included studies in which at least 60% of participants were HIV-negative men who have sex with men; they only included studies published since 2000, as they wanted to exclude studies conducted in the days before effective antiretroviral therapy (ART) became available; and they only included studies of brief interventions, which meant five sessions or fewer. The latter was because the commissioning call from NIHR required the evidence for brief interventions.

They found eleven studies in all, which varied greatly in their methodology. Some were online and/or used novel intervention strategies: a graphic novel, a telephone intervention, or an informational video added to counselling sessions. Others were face-to-face. Six out of the eleven studies used a version of Personalised Cognitive Counselling (PCC), an adaptation of CBT for single or brief interventions, designed to be used at the time of or close to HIV testing. In addition to the six PCC-based interventions, there were two peer-delivered interventions where the basis of the intervention is not stated. Four were delivered at an HIV testing appointment (three after the negative result was given, one while waiting for the result); two were given during or after testing to both HIV-positive and negative test recipients; and four, primarily the online interventions, were given to people who recorded themselves as being HIV-negative and not at a testing appointment. The follow-up period over which the effect of the intervention was measured varied from two to ten months, with six studies using six months.

As we said above, the eleven studies produced an overall reduction in condomless sex (measured in various ways) of 25% (95% confidence interval, 9% to 38%). Six out of the eleven produced statistically significant reductions.

This agrees well with the second-largest meta-analysis of behavioural interventions, which included 102 studies and was published in 2013: this found a 27-30% reduction in condomless sex among its study recipients, which included HIV-positive and HIV-negative gay and heterosexual men. The largest meta-analysis, the 354-study one mentioned above, found a 38% reduction in condomless sex among recipients of ‘active’ prevention methods, i.e. ones with a counselling component, and 19% in ones without a counselling component such as videos and information sessions.

Flowers’ findings were therefore broadly in line with these. The problem is, however, that the behaviours that interventions may wish to change are now different. The crucial question then, is whether the skills and rethinks taught by the studies involve the kind of learning that might also encourage people to seek and adhere to PrEP, test for HIV regularly, and so on.

As clues to devising an intervention that could reinforce these behaviours as well as condom use, Flowers’ team did some sub-analyses of factors associated with significant reductions in condomless sex.

They found that two methods were associated with significant reductions. The first was using goal-setting and action-planning as part of the method, to get recipients to set behavioural targets. The second was using methods that drew attention to contradictions and justifications in participants’ thinking and thus helped them to feel more understanding, positive and capable about their ability to change. Taken together, these methods were 34% effective. Other methods such as information-giving, social support and an emphasis on threat or danger were not associated with effectiveness.

Interventions delivered via telephone or online were not effective. In contrast interventions delivered face-to-face were 34% effective. If the intervention was delivered immediately after receiving a test result, the average effectiveness was 36%; delivered longer after the result, interventions were not effective.

Although these factors were not quantified, the study found also that interventions were effective if they were delivered by professionals, but ones with clear and contemporary knowledge of the gay scene and MSM sex.

Devising a modern behavioural intervention

As a result, Flowers and colleagues drew up a specification for a suggested modern behavioural intervention for gay men.

It would include:
An initial ‘peer-oriented visual aid’ which would not just talk about health risk but also address the complexity of modern HIV risk and talk about emotions and feelings, serosorting, condomless sex, PrEP, treatment as prevention and drug and alcohol use.

This would segue into a one-to-one counselling session that would:
Focus initially on a single event seen by the client as risky or unhelpful (not using a condom, missing a PrEP dose, etc)
Refer back to the visual aid to put the client’s actual risk and the processes that led to taking a risk (emotional need, intoxication, being too busy, etc) in perspective
Invite the client to think about weighing up the pros and cons of different behaviours/strategies and how they might do things differently
Help the client draw up an action plan to help reduce risk or encourage health-seeking behaviours for the future.

Paul Flowers and colleagues are hopeful that this intervention could be the subject of a study of a behavioural intervention truly adapted to the new world of HIV prevention.

“We definitely think it is time for studies to embrace diverse outcome measures – it’s long overdue. We can’t speak for NIHR but we think it’s worth considering post-test interventions to increase frequent testing among those who need it and to encourage the consideration of PrEP. There will be challenges as HIV testing diversifies into self-testing and so on and we’ve written another paper on that.

But an HIV test represents a ‘teachable moment’ for some people and we want to help them sustain positive changes they might be motivated to make at that moment.”

Reference

Flowers P et al. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technology Assessment 21(5): DOI 10.3310/hta21050. See full report here.

Guns kill people ............

Owen Blakka Ellis

In an ideal world, Christians are supposed to be completely safe and protected from potential violence, especially while attending a prayer meeting inside a church. And nobody would challenge me if I say that in a sane universe, children should be totally safe and free from harm while learning and playing in school.

Patrons watching a movie in a cinema in a civilised society should also expect that if any shooting is going to happen, it would happen exclusively on the big screen. And one would have thought that in 2016 gay, lesbian, transsexual and queer people would be safe and happy in gay night club in the United States of America. But things are not the way they should be.

Why? The answer is partly in the simple but powerful message of that 1980 tune by Eddie Fitzroy that says, "di gun, di gun, di gun it is a dangerous weapon. Di gun, di gun, di gun it is a wicked invention." Yeah man, is true. And acquiring that wicked invention in the US appears to be about as easy as getting good ganja to buy in Jamaica. The thing though, is that guns...well, simply put, guns kill people.

added in solidarity

Yes people, and what happened with guns in the hands of a sick man in Orlando over the weekend is beyond wrong. No ifs, no buts, no maybe or because. It just damn downright immoral and scary. Yuh nuh agree? I don't know any of the victims or survivors, but God knows I feel for them and their family.

hate and terror

And I join all the people of conscience in condemning the attack that has been aptly labelled by US president Barrack Obama as 'an act of hate and terror'.

I have to join the chorus. What's the point of having a voice, if I did not add my voice today, to the millions all over the world expressing sorrow, anger and outrage over the senseless loss of lives? What's the purpose of having a heart if you're not touched by the palpable pain and grief that one man inflicted on so many people who never did him any harm?

The Orlando shooter's father reportedly suggested in an interview that the murderous rampage he went on may have been triggered after seeing two men kiss in public. How that affect him? I have said this before, and I will say it again for all the self-appointed judges and arbiters of other people's sexual morality: what another consenting adult does sexually should only be your business if you intend to have sex with him or her! It should not be the basis for war. And right now, it feels like we're in the midst of a war.

suffer more

Fi real peeps, it feels like we are living in a world at war with itself. And all of us suffer the collateral consequences - although some suffer more than others. My heart goes out to all the already maligned and marginalised gay people whose sense of security is now further compromised by the tragedy in Florida. And my heart goes out to the genuine, devout Muslims who will now face more discrimination and be unfairly judged by the actions of one cowardly and deranged man who chose to dress up his ugly hate in the garment of radical religious rhetoric.

Look here nuh, I'm not about to join the bright people who are busy drawing battle lines and taking positions on either sides of the debates around homophobia versus LGBTQ rights or US gun control policies and second amendments rights, etc. But I have to wonder how a man who has been investigated by the FBI for possible links to terrorism can legally buy semi-automatic weaponry easy, easy so. If this world nuh crazy, me mad!

ENDS

I agree with Owen here but the madness that has since ensued has clouded the very thing that should be the focus.

#IstandwithOrlando

Also see from GJW:

My heart & prayers go out to the Pulse victims & their families

Gay club killing unlikely in Ja .........

Dormant anti gay feelings resurface in Florida shooting aftermath

Attorney General Malahoo Forte condemned for comments on US Embassy's rainbow flag

Rainbow flags vs Jamaicans murdered which is more important?

On female masturbation as natural

Prepared by Dr Shelly Ann Weeks

Every cell on your body tingles, your heart feels like it's going to burst out of your chest, you struggle to breath and you are shaking.

You start to move your hands faster as you feel the tension build and then - WHOOSH! Fireworks go off as you feel like the only thing keeping you together is your skin. Your pelvis pulsates as you feel the most amazing sensations you have ever experienced. You hear your heartbeat in your ears and your body is in frenzy as you struggle to find consciousness while recovering from your orgasm.

For so many women, the first orgasm is achieved during masturbation, and it makes sense, because who knows more about pleasing a person than that individual herself? As a sex educator, I advocate for people, especially women to masturbate. I stress more on women because there is still a lot of stigma when it comes to female masturbation. Too many women are still feeling ashamed of touching themselves because of the perceived assumptions that are made about women who masturbate.

She is lonely and no one wants her

This assumption is ridiculous because it implies that a woman is only validated by her ability to find a suitable partner.

Furthermore, having a partner doesn't stop her from masturbating. There is no rule that says that the only reason to masturbate is out of necessity because when is lonely and desolate.

She's in a relationship and it's not allowed

If a woman is in a relationship where she is forbidden from masturbating, then that relationship has bigger problems than sex. She is free to pleasure her body however and whenever she chooses with or without a partner.

Her partner is not satisfying her properly

Women who masturbate are more interested in sexual pleasure, and she will also want more frequent sexual encounters. The skills of her partner will not stop her from enjoying her own body.

It's nasty

If a woman is disgusted by the thought of touching her own body, what kind of response does she expect from a partner? Masturbation is not only a function of pleasure, it's also familiarising oneself to the beauty and wonder that is the human body. Having full knowledge of the body, how it works, what areas feel extra wonderful when it's stimulated, are all necessary for the full enjoyment of sexual encounters with a partner.

When we look at male masturbation, it's not hard to convince men to masturbate because it's accepted in society that they need to do it. As a baby, a little boy takes off his diaper and discovers his penis and spends minutes pulling and tugging at it, while his mother squeals with delight and marvels at how cute he is. On the other hand, little girls are reprimanded if she even thinks of taking off any article of clothing. It is clear that our socialisation has affected the way we look at our sexuality, especially masturbation.

It has been a personal quest of mine to get individuals to see the value of having a satisfactory sex life. Masturbation is a great tool to help individuals learn their bodies, and as a result, become more in tune with the pleasure experience for both themselves and their partners. So ladies, it's your body, touch yourself. 

Personally, I never understand people who say they don't masturbate. It's like owning the most amazing car and the only way you get to enjoy it is if you are chauffeur driven. It's your car, jump behind the wheel and take it for a ride! Masturbation is not only natural, it's necessary. So give yourself some well deserved love today. And if you don't feel comfortable touching yourself now, do it until it feels good.

Orgasms can improve your health ..........

Dr Shelly Ann Weeks share more advice

I know that when we talk about sex, many persons have different opinions about its necessity outside of procreation. The fact is that while the sexual act is necessary to procreate, that's not the only, or dare I say it, the most important function that this activity has. Before I get into the other necessary functions of sex, let me first take a look at the various stages that the body goes through when we have sex.

The sexual response cycle

The sexual cycle starts with excitement or arousal which is when the body starts to prepare for intercourse. During this stage foreplay is essential to get the blood flowing to the various organs and to put the body in the right mood. The excitement phase leads to the plateau phase where the body is aroused and heart and breathing rates are elevated and so is the blood pressure. During this phase the skin is extra sensitive and the erogenous zones (lips, nipples, genitals, neck, etc.) are even more so. It's during the plateau phase that intercourse happens and the genitals are stimulated to create friction that will lead to orgasm. For some persons one orgasm is enough, but some persons are multi-orgasmic and may require further stimulation and orgasms to be satiated.

photo added for effect from the net

I started off talking about orgasms, so let's get back to it. There are many persons who have difficulties achieving orgasm and the reasons are variable. But having an orgasm a day can actually improve your overall health and even your quality of life.

STRESS RELIEF

Orgasms are your body's built stress reliever. When someone orgasms the hormone oxytocin is released from nerve cells in the hypothalamus (a region of the brain) into the bloodstream. This hormone is also known as the 'feel good hormone' and it helps to stimulate feelings of warmth and relaxation.

HAPPIER RELATIONSHIP

More frequent orgasms might make it harder for your partner to cheat. The hormone oxytocin is also known as the 'love hormone' and studies have shown that its frequent release strengthens the bond between a couple and makes them less likely to go outside of the relationship for their sexual pleasure.

BETTER SLEEP

With the fast paced, busy life that most of us lead, sometimes it's hard to settle down and get a good night's rest. Having an orgasm before you go to sleep is a great way to fall asleep and improve the overall quality of your rest.

Pain relief

The magical chemicals (oxytocin, endorphins) released in the brain during orgasms are excellent pain relievers. Women who orgasm during child birth report better management of pain. Even women who orgasm during her menstrual cycle have less discomfort.

BUILDS IMMUNE SYSTEM

Having frequent orgasms will increase the production of 'killer' cells called leukocytes which are essential in helping the body fight off infection.

Orgasms feel really good and they are good for you, so I didn't think I needed to give too many reasons why you should try to have at least one a day. Think of it like taking your vitamins. After all, the benefits speak for themselves. Remember also that even though it's great to share the experience with someone, there is nothing stopping you from enjoying orgasms solo. Have fun and stay sexy.

Send your questions or comments to sexychatwithshelly@gmail.com or Tweet me@drsexyann or Facebook www.facebook.com/allaboutthesexy Website:www.drsexyann.com

Blakka Ellis: Let's talk about sex and sexuality

"Let's talk sex baby, let's talk about you and me, let's talk about all the good things and the bad things that may be, let's talk about sex..." Who remember those lyrics from the 1991 hit by Salt-N-Pepa?

Well between, you and me, is that kind of meditation I man a pree. Yuh nuh waan pree di meds and reason wid me?

Whether you call it the battle of the sexes, the great gender debate, or plain old 'man an woman business', the discussion around gender, romance, sex and sexuality is always topical, often trending, always relevant and never ending. Yeah man, everybody likes to talk about it, especially those people who are probably not doing it!

So, where, when and how then do you join the conversation? What's your favoured angle of entry? Me, I love to deal with things up front.

And that I'm doing with help of an amazing cast and crew in 'He Said, She said'. The riotous revue opened at Courtleigh Auditorium last Friday, and from the opening song, Too Much Sex, the audience was comically aroused and arrested. 'He Said, She Said' is an adults-only production that enters the sometimes delightful and sometimes disturbing sex/gender dialogue from a place of playful provocation. It's an eclectic collection of skits, songs, poetry and parodies that delve into some popular perceptions, tease out touchy taboos, and confront common contradictions. And di actors dem dweet good - the onstage performances!

From the night club to the bedroom, from the corner shop to the front lawn and from various other intimate and public spaces in between, they stroke some pun, poke some fun and 'tek some bad ting mek laugh'. They expertly engage the exhilarating edge of 'naughty' with entertaining stuff that will make you laugh, think and talk. And, well, if you do anything else, don't attribute that to the show. So wah yuh say, when yuh coming?

rumour

In fact, I'm not really sure, but I think I kinda hear that there is a 'students-only' two-for-one special for tertiary students with ID at the show on Friday. Like ah said, mi nuh sure, but shhhh ... Look here nuh, don't tell dem say mi tell yuh this, but even if it never really go so, if yuh call call the ticket line at 542-4160 and tell dem dat is Blakka spreading the rumour, dem will have to sell yuh di ticket! So come check it out.

Another great thing to check out this week is the annual Kingston Book Festival (KBF) - a full week of events for readers, writers, publishers, distributors, buyers, sellers of all things 'bookish' - whether fiction, non-fiction, poetry or play writing. This year's festival started on Sunday with 'Love Affair with Literature' at UWI. It is continuing with a number of events all over, including visits to school - where students get to talk and interact with writers about what it means to be a writer. I had the pleasure of being part of a KBF 2016 event on Monday, as I joined novelist Melanie Schwapp, poet and entertainment journalist Mel Cooke and writer/publisher Tanya Batson-Savage in a lively chat with some very bright and engaging grade eight students at Dunoon Park Technical High School in Kingston and it was a blast!

There's a fresh and innovative KBF event on today as well, called 'Literary Lunch' put on by Susumba's Book Bag. And tomorrow night is 'Late Night Lit' at Red Bones Blues Cafe in New Kingston. It will feature saucy satire and provocative poetry and prose from Andrew Stone, Carla Moore, Karen Carpenter, Michael Abrahams and Tony 'Paleface' Hendriks. Fun week in city Kingston, eh?

Working towards gender equality

Owen Blakka Ellis

So massah Owen is back at it and bowls off with this piece today:

Contributed Blakka Ellis (second left) and Ava-Gail Gardner from Jamaica are flanked by Dr Tracie Rogers (left) and Mark Lawrence (right) from Trinidad & Tobago.

Howdy, peeps! What a gwaan with you? Or to be more pointed, what's currently popping in your box? Me, I'm here 'boxing' you from the beautiful Spice Isles Grenada in the Eastern Caribbean.

And although I'm admittedly having somewhat of an exhilarating time, I'm not on a vacation. In fact, now that I think about it, it's really interesting how many parts of th world I've visited in my over half-century of existence, and I have never ever really had a vacation. Vacation? I don't even know wah name so - but that is a different 'bickle' for a different box.

I'm really here for work. And I have often heard that if you work on the stuff you're really passionate about, then work won't feel like work. Frankly, that is true for me. This is still work, though - definitely difficult, but relevant and rewarding work around gender.

Yes, friends. I am here engaged in discussions and activities around one of my favourite topics, intellectually and emotionally grappling around in the old gender box. I'm enjoying a vibrant and vital learning experience as one of several participants in a training-of-trainers programme for Caribbean gender advocates.

The participants are diverse. We are men and women from a fairly wide range of ages, and from very different social, spiritual ,and professional backgrounds - artists, activists, attorneys, teachers, social workers, and more - from about nine different countries in the region. What we all share is a commitment to and a common interest in expanding our understanding of the complexities, contradictions, and manifestations that arise from the different gender boxes that we inherit and inhabit.

So, we are involved in some exciting interrogations and critical reflections on social justice, power, privilege, and subconscious biases. We are exploring key concepts related to gender and the idea of gender equality. We're also analysing ideas around masculinities and femininities. Yes, the pluralisation is deliberate because in case you never realized it, there is a range of different expressions of masculinity and femininity depending on generational, geographical, cultural, and other factors.

GENDER JUSTICE

The overarching purpose of our work, of course, is to contribute to the important objective of achieving gender justice and eradicating all forms of gender-based violence. And, as you and I [and all of us who're willing to admit the truth] know, gender-based violence is a serious problem all over the world. And whether it takes the form of bullying, harassment, domestic abuse, or rape, etc., the victims are mostly women and girls.

The four-day training workshop has been organised by United Nations Entity for Gender Equality and the Empowerment of Women - also known as UN Women - in collaboration with the Canadian Fund for Local Initiatives and is part of the 'HeForShe' initiative. What name so? Well, according to a handout on the initiative, HeForShe is a global solidarity movement for gender equality that engages men and boys to work in partnership with women and girls as advocates and stakeholders to break the silence, raise their voices, and take action for the achievement of gender equality.

The movement aims at enabling men to identify with the issues of gender equality and to recognize the important role we can play towards ending the persistent and pervasive inequality faced by women and girls worldwide.

Yeah, bro! Woman is our mother, wife, daughter, sister, and friend. So I'm definitely a 'he' who's proud to be standing in solidarity and working in harmony with 'she'. Wah yuh a say? Yuh nuh come join hands with 'we'?

box-mi-back@hotmail.com

Ethics of Emergency Access to Unregistered Medical Interventions & Clinical Trial Designs ........

also see: New single-tablet HIV treatment Genvoya wins FDA approval

Ethical considerations from Bio Ethics Professor

Udo Schuklenk

The mass media excitement about Ebola has receded. The 2014-2015 West African outbreak has been brought under control not thanks to the deployment of successful treatment regimes, because there are none that are known to work. I participated recently in an international meeting of experts debating the ethical and methodological issues pertaining to trial designs for emerging infectious diseases like Ebola. It was both astounding and also immensely frustrating that to a large extent the controversies that exercised the minds of the delegates of this meeting exercised the minds of many an AIDS activist and clinical trials’ expert prior to the advent of highly active antiretroviral therapy, a good quarter of a century ago.[1] [2]Are placebo controls an ethically defensible methodological tool when patients face a terminal illness? Different alternative trial designs involving placebo controls, adaptive trial designs, and multi-stage approaches involving active controls were discussed during the meeting. The heated nature of some of these debates reminded me strongly of the passion that was on display during the early HIV trials. It turns out, despite decades of informed debate about these issues, a number of significant normative questions have not been settled.

A cluster of difficult ethical questions that engendered justifiably a lot of debate has to do with the use of placebo controls in trials involving patients facing a very high mortality risk (some in excess of 90%) and a fast-acting infection resulting in the death of these patient within 2-8 days after admission to a treatment centre. This scenario mirrors the sobering reality faced by a subset of Ebola Virus Disease patients. This issue was already highly contentious during the early HIV trials, and then patients and clinical investigators were faced with a virus that was nowhere near as fast-acting as the Ebola virus. The ethical conflict that arises here is this: We know that those randomized into the placebo arm face the same greater-than-90%-risk of death within a few days as those who receive the standard of care treatment. In some trial design the placebo control arm could be identical to the gold standard of (unsuccessful) clinical care provided in a particular clinical setting. Given that those who are randomized into the arm featuring the unregistered medical intervention might do better, or might do worse, or might do roughly as badly as those in the placebo control arm, the ethical question remains whether a trial design featuring a placebo control is ethically justifiable, given the almost certainty of imminent death faced by those randomized into the placebo arm. During the meeting I alluded to earlier a fairly contentious debate arose also over the question of whether trials producing less reliable results than placebo controlled trials might be acceptable under such circumstances.

What exacerbates the ethical challenges for those who undertake such trials is that their trial participants are arguably not true volunteers. Their – dying - trial participants are not given the opportunity to choose between participating in the placebo controlled randomized trial versus accessing the unregistered medical intervention on their own volition outside the trial process. It is perfectly conceivable that some patients might choose to participate in such trials in order to facilitate the development of a successful intervention capable of helping future patients like them. Or they might accept that there exists true clinical equipoise between the trial arms and they might be volunteering to be randomized under such circumstances. In the absence of alternative access routes to the unregistered medical intervention, we can never be certain that the patients agreeing to be randomized are not simply responding to what constitutes a coercive offer.

Clinical investigators colluding in this process, and arguably benefiting from it, are not absolved of their ethical responsibilities because they did not create the regulatory frameworks that gave rise to the problem. It is true that they did not create the regulatory framework under which they operate, but they undoubtedly benefit from its existence. We could respond to this kind of argument by pointing to the societal need for sound trial designs and the detrimental impact of permitting patients to access unregistered medical interventions outside the clinical trials’ system. The likely impact of permitting patients access, as a senior biostatistician attending the workshop rightly pointed out to me, would be a significant slowing-down in the trial recruitment process. Some trials might never be able to recruit sufficient patients, because most patients might be voting with their feet and opt to take their chances with the unregistered medical intervention. Surely that is not quite what is in the best interest of any society battling an emerging infectious disease such as Ebola. Does this justify coercing dying people into particular trial designs? I do not think so, but this is a contentious issue where reasonable, well-informed people can justifiably differ. A WHO panel looking at this question argued that while it would be ethically defensible to offer emergency access to unregistered medical interventions to Ebola patients, this should be subject to that emergency access not slowing down trial recruitment.[3] The panelists (not featuring a single expert or disease survivor from the affected countries) took a policy line here that mirrors US regulations. Other countries, including Canada and South Africa do not make this a threshold condition for emergency access. As it is with these sorts of panels, the advice it rendered on this controversial topic is not actually reasoned for, so policy makers and regulators as well as patient rights advocates aiming to balance the competing interests of access versus trial recruitment in a fair manner will be left wondering about the ethical reasons for this policy stance taken by the WHO panel, assuming there are any.

There are other ethical issues that arise in this context: Some experimental agents existed at the time only in insufficient quantities, for instance ZMapp, an unregistered medical intervention composed of monoclonal antibodies, was only available in very limited quantities. In light of this situation, is it acceptable to prioritize patients in comparable clinical circumstances who are willing to be randomized in a placebo controlled trial over patients clamoring for direct emergency access, given that the available quantities of this unregistered medical intervention would have been used up in the placebo controlled trial?

And here is another difficult question: While the AIDS activists of days gone by were highly educated about their disease and about the available unregistered medical interventions considered for expanded access programs, this is not quite the case with regard to the average West African Ebola patient. These patients were unlikely able to provide valid first person informed consent, because they were unable to demonstrate a reasonable person understanding of what was known about the unregistered medical intervention, about their options and so on and so forth. This is the case both because of educational limitations as well as disease progression. Are short-cuts to informed consent ethically justifiable under such circumstances? Given that time is of the essence and proxy consent might not be feasible due to family members being deceased or in a far-away village, are our informed consent requirements reasonable under such emergency 
circumstances?

[1] U Schuklenk, C Lowry. 2009. Terminal illness and access to Phase 1 experimental agents, surgeries and devices: reviewing the ethical arguments. British Medical Bulletin 89: 7-22.

[2] U Schuklenk, C Hogan. 1996. Patient access to experimental drugs and AIDS clinical trial designs: ethical issues. Cambridge Quarterly of Health Care Ethics 5: 400-409.

[3] WHO. 2014. Ethical considerations for the use of unregistered interventions for Ebola virus disease. WHO: Geneva 2014: p. 5.
More HERE

Leighton Levy on Gays are not our problem .... JCHS told to check the mirror

Leighton Levy's sojourn from anti gay to reasonably tolerant and reflective is to be commended and I have been keeping my eye on his articles since three or so years now, here comes one more though some months behind I think it is worth revisiting as to the question of selectivity by antigay voices and groups.

Once again, I am being left to wonder if some of these so-called advocacy groups ever stop to take stock of the hypocrisy they practise each and every day in this country.

I direct my ire at the Jamaica Coalition for a Healthy Society that issued a release this week stating their objection to the visit of Randy Berry, the US Special Envoy for the Human Rights of Lesbian, Gay, Bisexual, Transgender (LGBT) people, to Jamaica.

According to media reports, Berry is to visit the island from May 21- 23. USAID senior LGBT coordinator Todd Larson is also on the island and leaves this weekend.

According to the coalition, "Berry and Larson are here to get the Jamaican Government and people to accept that all sexual activities are to be considered as normal and good. This is the US Foreign Policy: Exporting Buggery and Sexual Confusion."

The kicker for me is when they say the visit represents a new form of imperialism to accept a lifestyle, which is "illogical and demonstrably harmful to our society and particularly to our children.

Jamaica's children are already suffering from the effects of poor family life. We do not need to add the further harms of experimenting with same-sex parenting."

Now, before I go on, let me say that I know that a large majority of Jamaicans agree with the coalition's stance, but that is not what annoys the hell out of me. Note the last thing they said:"Jamaica's children are already suffering from the effects of poor family life." If they believe that to be true, why are we only now hearing about this, and only in the context of homosexual influence?

Why are we not hearing about this in regards to the thousands of paedophiles among us, raping, impregnating and murdering our young girls? Those three pregnant 12-year-old school girls who were impregnated and murdered - was it gay people who did that to them? Those kids that were shot execution style in Clarendon recently - was that a part of the gay agenda?

What are we really saying?

A healthy society allows the raping and killing of our little girls?

Are we saying that a healthy society is one in which we have more than a thousand murders a year for more than 20 years now? Are we saying that rampant corruption within the halls of Government is a hallmark of a healthy society? Is the coalition saying that in a healthy society, people can't find decent jobs that will allow them to take care of their families?

If this is so then ostensibly, according to the coalition, the only way our society becomes unhealthy is when same-sex couples are allowed to have sexual congress within the privacy of their own homes.

crime and corruption

Great! Just great! I guess we are an extremely healthy society then, because we have a healthy dose of unemployment and underemployment, healthy doses of crime and corruption, and extremely healthy doses of child abuse and human trafficking.

That is the only reason I can come up with why we haven't been hearing from

them all this time, while all these things have been happening in our society.

Now I understand why they have been silent on all these issues. All it took was for Mr Berry and Mr Larson to visit and, all of a sudden, our 'healthy' society is threatened.

This is the hypocrisy that sickens me. All this ridiculous chatter espousing hate against people just because they're different while deliberately ignoring the muck right underneath our noses. All of this to me is just another healthy dose of BS.

Here is a little secret I would like to share with the Jamaica Coalition for a Healthy Society: Homosexuals are not our problem. You want to know what our real problem is? Take a look in the mirror.

Previous Levy rantings:

Gay Hypocrisy in Jamaica 2011

Our children are at risk 2011

What goes on in the minds of the overly religious? 2013

Lyrics, not gays, tearing down reggae or dancehall 2015

Silent madness on the rise (Star feature) 2011

Al Jazeera's documentary on children in Jamaica

Peace and tolerance

H

Upcoming FTM Fitness World Conference 2015

Monica Roberts

My trans brothers have been asking me why I haven't been covering the news from their half of the community lately, and they have a point. I do need to do a better job of it since I have the only continuous publishing blog dealing with trans issues from an African-American trans perspective.

And covering trans issues from an African-American perspective means I not only need to cover the stuff that happens on the trans feminine end, it also means I need to cover the issues and developments on the trans masculine end, too.

But you trans brothers also need to step up and let Monica know what's happening, and what you think I need to be talking about that you think needs to be brought to our attention for a wider discussion across Trans World.

Commentary over, now let's segue to what this post is about.

This weekend in the ATL the FTM Fitness World Conference will be taking place October 1-3 at the Ramada Plaza -Downtown Atlanta (Capitol Park) with the 2015 theme of The Warrior Within You.

The event was founded by Neo Sandja with the goal of bringing the trans community and trans masculine men together who want more out of life through workshops, activities, exhibits, partnerships, networking and entertainment.

It also made a little history in the process. In 2014 The FTM Fitness Conference hosted the first ever bodybuilding competition for men of trans experience.

The FTM Fitness World Conference has two goals, The first one is to embrace diversity by focusing on what unites us instead of what separates us and bridging the gap between us based on age, sexual orientation, socio-economic background, religious affiliation and more.

The second on is to empower our community. It seeks to do so by inspiring attendees to push for excellence while rejecting mediocrity. It wishes to inspire attendees to be the change they wish to see in their local communities and realize they possess the tools to succeed in every area of their lives while focusing on what united the trans community.

The emcee of this year's event will be my lovely Houston homegirl Diamond Stylz, and keynote speakers will not only include FTM Fitness World Con founder Neo Sandja, but also Dr. Kortney Ziegler, Ryan Salinas, Tracee McDaniel, and Buck Angel,

And yes, the 2nd annual FTM Fitness World Bodybuilding Competition will be a part of this year's event.

If you wish to learn more about #FTMFitCon15 you can go to ftmfitnessconference.com for further information.

Revenge Porn Now Recognised As Abuse, By Blogger

Revenge porn is sexually explicit media that is distributed without the consent of the individual(s) involved. In the wake of civil lawsuits, legislation has been passed in various countries and jurisdictions to criminalize this practice as well as to define it.

The term "revenge porn" is generally used to indicate content uploaded by intimate partners with the intention of humiliating the partner depicted (hence "revenge" when uploaded by an ex-partner). The term is also often misused to describe non 'revenge' scenarios, including nonconsensual pornography distributed by hackers or by individuals seeking profit or notoriety. The images are usually accompanied by sufficient information to identify the pictured individual, typically their name and location, and can include links to social media profiles, home addresses and workplaces.

Victims' lives can be ruined as a result, the victims exposed to cyber-stalking and physical attack as well as facing difficulties in their workplace should their images become known as a result of routine checks by employers. Some have lost their jobs, while others have been unable to find work at all. Copyright law cannot help if the person who publishes the image also made it.

Jurisdictions which have passed laws against revenge porn include Israel, Germany, the United Kingdom, and twenty-three states within the United States

Recently, Google publicised advice about a new type of abuse that may be reportable, when present in a Blogger blog.

Our philosophy has always been that Search should reflect the whole web. But revenge porn images are intensely personal and emotionally damaging, and serve only to degrade the victims—predominantly women. So going forward, we’ll honor requests from people to remove nude or sexually explicit images shared without their consent from Google Search results. This is a narrow and limited policy, similar to how we treat removal requests for other highly sensitive personal information, such as bank account numbers and signatures, that may surface in our search results.Supposedly, "revenge porn" mitigation is limited to removal from Google Search. In one forum discussion, however, the new classification appears to have successfully resulted in an offensive blog being removed from Blogger.

It appears that "revenge porn" is now part of the "Remove information from Google" reporting process.

You may use the "Remove information ..." form, to report "revenge porn".
If you are offended by a Blogger blog - and if the contents of the blog reflect the description
nude or sexually explicit images shared without their consent.

You may use the "Remove information from Google" form, to cite malicious blog content.

Please be aware that these reports will be evaluated carefully.
Please consider reality, however. Since this is a new abuse category, any reports most likely will be evaluated very carefully by the staff who process the complaints.

Don't try to stretch the definition, by what you "believe", or what might be considered the case, in extreme circumstances. Submit a complaint, only when the complaint fits the definition of the new abuse category.

Do the right thing, and report "revenge porn" only when it is righteous.

Unlike bogus DMCA complaints, I don't see any suggestion of any penalties for malicious misuse of the form. However, if you intentionally misuse this new abuse category, consider that your doing so may make one of the legal staff spend time evaluating your complaint, while another, genuinely worthy complaint may wait, unattended.

Do the right thing - and only cite the new category when it is, honestly, necessary.

Peace & tolerance

H

Trans Models Represent During NYFW 2015

by Monica Roberts

"As a transgender person of color, as an immigrant who grew up poor in a tiny little alley in the Philippines, and here I am in New York City doing the biggest fashion show... for a young trans person to see that, it changes that person's life.. To finally see that it's possible for a young trans person to pursue his or her dream to be the person whoever that you want to be."
--Geena Rocero

Even if that dream is to strut a catwalk during New York Fashion Week

We had a few trans models representing our community during the recently concluded New York Fashion Week, and I couldn't be prouder of all of them that did so and worked hard during that September 12-17 period. And even better, I'm proud to call some of those amazing people my friends.

It was cool to see Isis King, Geena Rocero, Ines-Loan Rau, Arisce Wanzer and others strutting catwalks in the various shows during NYFW while others were in the audience cheering them on.

They are heirs to an incredible legacy of trans women from around the world who have been walking fashion runways since April Ashley did so in the early 60's.
And with Apple Model Management opening up and specifically being focused on trans models, it is a major step forward in ensuring that trans models aren't just the latest fashion trend or flavor of the season, but an accepted part of the fashion world.

That long stylish line of trans models continues into the 21st century, and some have become advocates and leaders in our community when they aren't doing their day job.

By doing so, they are also doing their part to expand the horizons, serving as possibility models, and slaying stereotypes in addition to continuing the long and proud legacy of trans models.

Caroyln Cooper on Unwelcome same gender advances 'I Don’t Want Women To Proposition Me!'

Also see the patois version HERE, ever since her support for LGBT issues was made known by the goodly professor aka the Patois Doctor and her about face on sexual orientation issues in some respects it would seem she has been approached by females identifying as same gender loving, I wonder if it's due to her balled head and her strong personality that causes the attraction to her? 

humph, let me not be factitious.

also see Dr Leachim Semaj's response: 

Sexual Situationships vs. Bona fide Love Relationships 

(The Crisis in All Shades of Grey Relationships)

and

Ageing And Lovesick? Don’t Chase Sex Fantasies

Truth is the LGBT population or some parts of it need to recognise that support from prominent persons in particular does not necessarily means they are LGBT and frankly such inappropriate advances my have us loose said support or whither away tolerance as persons may walk away feeling all LGBT persons are interested in is getting into their clothes for sex. The predatory construct or perception held by some is also what drives some homophobes as they feel justified in their anti gay position but then again Miss Cooper's image does have that stereotypical lesbian look that of a mow-hawk hairdo sadly associated with more middle class lesbian or gay men coupled with her personality as mentioned above. Yes there is a look!

Professor Carolyn Cooper

sorry girls no luck with Miss Cooper lol

Ms Cooper's previous blog entry Coming Out In Jamaica – Dead Or Alive seems to have triggered off the approaches as well, have a read of her latest entry/Gleaner piece excerpted below:

At every turn, I’m under attack. I’ve been trying so hard to emancipate myself from mental slavery. I’ve been defending gay rights in Jamaica. But it seems as if I might have to stop and start minding my own business. I can’t take on other people’s troubles.
All of us in Jamaica were raised on the Bible. As children, we were told by adults that sex was not for minors. As we grew older, we were taught that heterosexuality was the norm. Homosexuality was condemned by God: that’s what the Bible says.
I can still remember the first gay man I became aware of. He worked in a beauty parlour on the same road where I lived. 

I was about eight or nine years old at the time. And I came to realise he wasn’t ‘normal’. He walked with a swing in his hips and his hair was straightened. And he was a hairdresser! Those days, that was women’s work.
I can’t remember the first gay woman I became aware of. It seems as if we’re not so obsessed about them in Jamaica. It’s gay men who are constantly scrutinised. And since women are open about friendship and love to embrace each other, they could be gay and no one would be any the wiser.

‘BRAZEN PROPOSITION’

All that to say, I did get another email from ‘Jordan’ last week. It was funny. But I wan’t amused.Now I know how men feel when a man tries to have sex with them and they don’t want it. I’m an adult. I can make up my own mind. I’m not going to uncritically accept any interpretation of the Bible that claims we should call down hellfire on gay people. I have friends who are lesbian. But I’m not having sex with them. I’m not gay and I don’t want to be propositioned by women.

Here’s the email: “Good day Prof Cooper, how are you? I took a look at your blog it’s nicely set up. The articles are interesting.The patois makes me dizzy though as we read only english during my time at UWI. I know you don’t remember me but we ‘met’ briefly on the jogging trail a few mornings. I’ve always hoped you were gay but i never had the courage as a student to make such a brazen proposition!

“It would be good to have intelligent gay role models for homosexual youth in Jamaica, however i don’t think our society is ready for this.The PM seems to share the same sentiment as evidenced by her apparent avoidance of the issue which i believe to be a wise decision at this time. Developing a thriving economy and minimising corruption should be top priority …. well things may change unexpectedly … look what happened in Brazil a few years ago! Anyhow take care and keep up the exercise …. you look good girl !”

People take liberties with you if you’re not careful. It looks as if I’m going to have to stop writing for the Gleaner and reclaim my privacy. If it’s not abuse, it’s unwelcome advances. The only person I want to proposition me is a suitable gentleman of an appropriate age. No young boy. No old man. No married man. No man who is having sex with men and woman. You have to be literate.

You must have teeth. If you qualify, you can make an offer.  

Otherwise, please leave me in peace!

ENDS

also see from sister blog Gay Jamaica Watch: Inmate attacks alleged gay prisoner of challenges with what can be deemed inappropriate advances.

New Kingston Shoemaker Gully Homeless Gays Accused of Inappropriate Advance Towards Teen .......

or More Pastoral Inappropriateness & Under-aged Victims... Silence from The Selective Religious Anti Gay Fundamentalists? and Rev Clinton Chisholm on "Consensual Sex Revisited" 2011

WANNABE TIVOLI DON KILLED - Was warned to reconsider his desires 

Homophobic Killing or What? 

Peace and tolerance

H

"'Curing Intersex Is Damaging and Common": Great Piece by OII-Australia Member, Morgan Carpenter

One of the key human rights issues for intersex people is not the existence of binary genders, but what is done medically to make them conform to those norms, writes Morgan Carpenter.

Intersex, the I in LGBTI, is often invisible, assumed to be about sexual orientation or gender identity. In fact, intersex has more to do with the body.

Intersex people are born with sex characteristics that don’t fit stereotypical expectations for males or females. There are at least 40 known intersex variations, each different, with no homogenous intersex body or identity. Some intersex variations can result in visibly ambiguous genitalia, others don’t. Diagnosis can happen any time from prenatal testing through to adulthood.

Historically, intersex people have been regarded as something “other”, sideshow freaks or medical curiosities, objects for stigmatisation and discrimination. In more recent times, people with intersex bodies have been regarded as “disordered”.

One of our key human rights issues is not really the existence of binary genders, but what is done medically to make us conform to those norms. Over the last 60 years, diagnosis has led to surgical and hormonal interventions, often in infancy or childhood. For much of that time, a diagnosis was thought so shameful it often wasn’t disclosed.

It would be easy to imagine these issues are all in the past, a legacy of previous practices. We heard Dr. Shubha Srinivasan say how practices in the past were harmful, and how she hopes things have changed. She’s right, but there’s been no attempt at reparations.

As intersex advocates and peer support workers, we hear from adults with long histories of sexual and intimacy issues caused by “obsolete” surgical methods. We hear of attempts to recover childhood medical information, and even discrimination due to overt physical differences.

Not only do people with intersex variations suffer a legacy of clinical secrecy, of shame and stigma, we also suffer trauma due to medical intervention. And even so, this is not the full story.

The Australian parliament recognised our existence in 2013, with the inclusion of “intersex status” in anti-discrimination law, and a world-first parliamentary report into intersex health, and coerced sterilisation. We’re still waiting for a government response to that report, but we know a lot about current practices because of it.

Today, the testes of women like Bonnie are no longer routinely removed before puberty. Clinicians are better at diagnosis, and more likely to recommend a sex assignment based on “likely” future gender identity than surgical ease. There’s no longer a culture of secrecy around diagnosis itself. But much hasn’t changed.

The clinical language of “disorders of sex development”, rejected by community-led organisations, ensures that an intersex pregnancy and birth is still a problem to be “fixed”.

A Senate committee heard from clinicians that infants and children with ambiguous genitalia still face early surgeries. These happen when a clitoris is deemed “too big”, or a boy can’t stand to pee.

We regularly hear from parents with newborn infants. We hear how their child might be described as healthy - except for their intersex characteristics. Parents get a prompt referral to a surgeon, and maybe a late referral to a counsellor or psych. They might get a referral to a Toronto hospital website for background information, but no referral to an Australian support group.

We’ve seen medical papers that talk of the “pros and cons” of surgery, but only detail its necessity. That necessity is often based on stigma towards intersex people. Surgeries have the dubious aims of helping parents to love their children, preventing issues with baby-sitters or bullying in the changing room, and even improving marriage prospects. Genital surgeries aim narrowly to ensure heterosexual sexual performance.

Maybe surgeries do prevent some of those problems, some of the time, but there’s no firm evidence they do. Most often, treating a healthy body as a surgical problem is itself stigmatising. I know from my own experience that it’s not a good feeling to know that your body had to be modified to be acceptable to your family, and to society.

The science supporting current medical practice is contradictory and inadequate. Australian doctors themselves told the Senate they have “particular concern” about sexual function and sensation after cosmetic genital surgeries. One Australian hospital says that outcomes from current surgeries “remain to be established”, and yet there is no long term follow-up in this country.

Our National Health and Medical Research Council has heard that intersex variations are abnormal, disordered, defects, and people with them suffer psychological trauma. $5.5 million in public funds has just been invested in genetic research and testing - but no money goes to fund peer and family support.

We can’t keep removing the stigma of cosmetic differences with a surgical knife. It comes at the cost of future sexual function and choice. The Senate report said the status quo must change, and international human rights bodies are beginning to pay attention. Non-essential surgeries must be delayed until an individual can consent for themselves. Peer support must be integrated into clinical practice.

It’s ok to be intersex. The diversity of our bodies and identities are good things. We add to the richness of human existence. As the parent in The Feed’s interview said about us, “Let them enjoy their bodies, celebrate that difference”.

Morgan Carpenter is the president of organisation Intersex International Australia, a community organisation that promotes human rights and bodily autonomy for intersex people.

Misinterpreting Marley's 'Who the cap fit' .......... Man To Man is So Unjust as Anti Gay

Blakka Ellis 

Hear wha mi a say today. Call me a nerd, or whatever, but I have a fascination with literary analysis and lyrical interpretation. Yes, exploring the meanings, themes and ideas in poems, songs and stories was probably the single most enjoyable aspect of my life as a student. Mi kinda weird, doh? Yeah, man, and that also was the most fulfilling part of my work in a former life as a teacher of high school Literature.

So when one of my nephews sought to engage me in a conversation some years ago, about the meaning of the lyrics in some of Bob Marley's songs, I was pleased as punch and ready to reason.

The pleasure soon evaporated though, when the youngster reluctantly accepted that although my arguments and explanations made sense, he still held on firmly to the view that Marley actually spoke out against homosexuality in his music. And the example he cited was 'man to man is so unjust, you don't know who to trust' - the opening lyrics from the song Who The Cap Fit.

Well, I felt that such a gross misinterpretation of Marley's lyrics was probably forgivable in the case of my nephew because he, admittedly, had never, ever yet 'read off a whole book' yet, and didn't pay much attention in school.

It was much harder to forgive an educated man, MP Dr. Dayton Campbell, who used the same flawed interpretation when he quoted Marley in a twitter rail against American singer Frank Ocean after his performance on the Grammy Awards show last year. According to news sources at the time, the MP tweeted "Frank Ocean man fi have ooman pon dem mind. How di hell man end up on your mind massah?? 

Bob done tell you say man to man is so unjust!!!"

Of course, the tweet lit up a mini firestorm about the politician's perceived anti-gay stance, and appropriateness of his comments etc. with biting remarks and fighting words coming from both attacking and defending poles. But that area is not my focus. My issue is with the literary analysis and what I see as misinterpretation of Marley's words. And guess what, I'm now discovering that Dr Campbell and my nephew are not alone in their 'misconscrewed' view. Well, students, teacha say a never dat Bob mean by 'man to man is so unjust'. No hyah!

OK, I can stretch my brain enough to maybe imagine how the idea of 'man to man is so unjust' could vaguely possibly be about sex and sexuality. Here's how. Like, for instance in the case of say, some lonely heterosexual women now, who could understandably be justified in feeling that it's unfair or 'unjust' for men to be going with other men, when they are there willing, able, available and horny, but unable to get men to go with them. But that's a hell of a stretch. I don't think Mr Marley was singing from that standpoint.

Anyone who attempts a serious interpretation of the song [one that takes into account the other verses and chorus] would agree with me that those initial lines are referring to the unfair and [bad mind] ways in which human beings deal with each other. And although the word used is 'man', the song is clearly [as in the case of plenty biblical references] using man to refer to all human beings.

Di song a talk about people generally, woman, man and 'others', and how dem wicked and deceptive. Marley was reminding unnu say 'your worst enemy, could be your best friend and your best friend your worst enemy', so watch some a dem, how dem 'eat and drink with you, then behind dem su-su pon yu'.

Is that kind of unjust way, how man deal wid man, Bob Marley did a pree! So stop twist and mix up the words of the Gong. 

What? 

Who me a talk? 

Who di cap fit!