Linking Science and Social Issues

Links to SENCER Ideals

We have identified eight “ideals” that we hope SENCER courses and programs will embrace. In this section, the ideals are identified in bold italic and the developer suggests how the course reflects them in plain text.

SENCER robustly connects science and civic engagement by teaching “through” complex, contested, capacious, current, and unresolved public issues “to” basic science.

Biomedical Issues of HIV/AIDS uses the phenomenon of AIDS and HIV to connect biomedical principles with the public policy issues around HIV. These issues include, but are not limited to, as access to medical and social services, treatment opportunities, prevention and risk reduction strategies, activism, and understanding the processes that create these policies. Students learn the biomedical principles to help them make better-informed decisions in personal, political and organizational issues.

SENCER invites students to put scientific knowledge and scientific method to immediate use on matters of immediate interest to
students.

Students are constantly challenged to re-examine their experiences in the light of new scientific information presented in the course materials. Issues of infectious disease and epidemiology give students a framework in which to discuss sexually transmitted diseases in the context of their lives and relationships. Students use scientific knowledge and scientific method as they address the context of the topic of their research papers. They collect primary resources to present a clear definition of a population with an HIV/AIDS problem. Students are guided in how to apply the information to a detailed solution plan that is then reviewed and assessed by an educator, health-care practitioner, or other professional.

SENCER helps reveal the limits of science by identifying the elements of public issues where science doesn’t help us decide what to do. (To be sure, a good SENCER course would also help students identify what kinds of knowledge would help.)

Biomedical facts prevent people from being overly influenced by irrational fears when addressing difficult social issues, such as HIV+ children in schools, needle exchange programs, xenophobia and homophobia. Biomedical principles and data help students understand the vulnerability of all humans to infection, the risks associated with various behaviors, and the drug toxicities that influence decisions made by individuals who need to consider, not just how long to live, but the quality of the life they are living. The value of knowledge is clear, but knowledge needs to be applied to circumstances and conditions unique to the situation demanding the decision. Throughout the course, but especially in the latter lectures and the guest presentations, the students are introduced to the critical analysis and interpretation of facts and situations in which there are no “right” – or, at least, still unclear “scientific” – answers.

SENCER shows the power of science by identifying the dimensions of a public issue that can be better understood with certain mathematical and scientific ways of knowing, thus illuminating those elements with that knowledge.

HIV/AIDS elicits a plethora of opinions, not all of them rational, that can drive public policy. Scientific ways of knowing can inform students of the data collected, such as the efficacy of needle exchange programs, treatment strategies, and target funding. However, objective statistics and rational numbers do not affect “not in my back yard” reactions, the concern for quality of life in treatment considerations, and the detrimental effects of insufficient funding in areas of great need. Examining and discussing research findings challenge students to restructure their own value systems with objective mathematical and scientific reasoning. In many cases, the dissonance created between rational scientific results and personal opinions is very uncomfortable, requiring new structures to replace old, and new feelings to replace old.

The trends in the demographics of HIV/AIDS have indicated that education and prevention programs have been valuable in certain populations, e.g. the gay community. However, these gains have not, unfortunately, resulted in “permanent cures,” as the evidence of increasing infection rates among young gay men powerfully illustrates. One variable that seems unchanged is the high risk of infection among lower socioeconomic groups. Here students need to grasp that, while biomedicine can explain the process of infection, other factors will determine risk. These factors include access to prevention strategies, advocacy programs, the incorporation of prevention measures into various cultures, social determinants, and personal behaviors.

The understanding of the pathogenicity of HIV infection, the universal vulnerability of humans, and the history of molecular biology and virology are important in understanding the risk factors facing all people. Trust is an important issue. Many students come to the course with long term beliefs that AIDS is “the government’s” or “The Establishment’s” secret plan to eliminate minority populations.

One of the oldest beliefs that affects attitudes about HIV/AIDS is that having AIDS is a shamethe idea that infection occurred due to personal failure or immoral and illegal acts. These ideas are sometimes changed when students actually meet more HIV+ guest speakers.

SENCER conceives the intellectual project as practical and engaged from the start, as opposed to science education models that view the mind as a kind of “storage shed” where abstract knowledge may be secreted for vague potential uses.

Most students come to a course on HIV/AIDS with many questions and practical problems. The first session is usually dedicated to answering their questions. Anxiety and fear are hidden in the typical questions: “I have friend who…” “Can you get AIDS from…” and “Why is there no cure?” Using these student-driven needs for information, the course helps students discover answers to their questions.

With each topic introduced and discussed, the “why” is explained. For example, why are we learning about the structure of viruses? We stress the connection because their structure is important to understand strategies for vaccine preparations, the efficacy of disinfection of injection mechanisms in minimizing transmission, the viral infection process, some theories explaining the selective death of T-helper cells. Another example is the inflammation process: we learn about that because the steps in the process are consistent regardless of the cause of tissue damage that initiates the inflammation process. The swelling in the lymph nodes associated with early stages of HIV infection, the runny nose of a cold, and redness of a sunburn are all manifestations of the inflammatory response.

SENCER seeks to extract from the immediate issues, the larger, common lessons about scientific processes and methods, as well as
more “transcendental” – or at least less time-bound – scientific concepts.

Many of the discussions of HIV/AIDS issues are associated with “fast-track” drug testing, the rapid treatment of infected individuals with “highly active antiretroviral treatments,” and the need for immediate post-exposure prophylactic treatment of “needle-stick” accidents. All these anxiety-producing, immediate problems still need to be grounded in sound scientific method. The “fast-track” drugs may provide high levels of immediate efficacy, but without some long-term testing, unanticipated side effects such as lipodystrophy are likely to occur. Again, the student finds the need to balance the desire to provide effective new drug treatments quickly with the risk of incurring unknown side-effects and how these new conditions impact on the patient’s quality of care and quality of life. Another anxiety-laden issue is the risk of infection to health care workers. Students must consider the fact that exposure to blood-borne pathogens is very real for health care workers. These workers who take post-exposure prophylactic treatment may also suffer from adverse side effects of drugs used and from psychological stress due to the threat of infection following an exposure incident.

The immediate issues that demand attention and rapid “fixes” can sway students to ignore the common lessons of scientific method-the careful, deliberate and sometimes time-consuming studies that reduce the risks of treatment. In an age of rapid delivery of information, students expect cures to be delivered with the same ease and speed. Careful thought, deliberate studies, replicated and validated results have always been the foundation of scientific method. Students can appreciate some of this deliberateness and care as we review the history of the epidemic. The collection of symptoms that were first used to identify an infected individual, through the international race to identify and name the viral causative agent, all illustrate the need for step-by-step, bit-by-bit, accumulation of information that marks good scientific method. Following fact-collection comes the development of a framework to link the new knowledge to the existing body of knowledge and the examination of concurrence of this new knowledge with the system of thinking already established.

SENCER locates the responsibility (the burdens and the pleasures) of discovery as the work of the student.

Teachers present information, but learning does not happen until students take in the information, process it, relate it to information they already know and come to have an understanding of its relative value in their universe of meaning. Knowledge is valuable only when it can be used to explain ideas, theories, and the world. Teachers can teach, but learning does not happen until the student uses the information. The joy of discovery comes when the student works through the effort of understanding information, relating it, and using it in a way that makes the outcome only the desire for more discoveries.

In Biomedical Issues of HIV/AIDS there are many opportunities for students to process information, relate it to previous knowledge, find value and investigate further. Beyond the usual learning environments of the classroom and personal study, there is a major research writing assignment. Students are asked to find original scholarly works on several aspects of a question of their own choice regarding a population with a problem with HIV disease (see section on Writing Assignment). When students discover that they have the ability to find information that helps to answer their own questions, they are empowered in several ways. First, they find that their questions are not trivial, but are of concern to the scholarly community. The students realize that there are many sources of information, but the validity and authenticity depend on the source. For example, statistical studies of successful prevention programs published in peer-reviewed journals are more reliable than opinion columns on activist web sites, even though both may argue for the same interventions, such as needle exchange programs. Lastly students find that their own ideas for solutions may have solid foundations in psychosocial theories so that they too are contributing to the body of knowledge, especially when they share their solutions with professionals practicing in the field.

Other places for students to use and value their new knowledge is through the online discussions hosted on the WebCT page supporting the course. The students are challenged to offer their opinions on provocative questions, such as “Should the HIV status of children be disclosed to their teachers?” “Should mothers who deliver HIV+ infants be told of their HIV status?” “Should HIV+ athletes be permitted to compete when bodily fluid exposure is likely?” Students find that debates frequently challenge their opinions and knowledge. These lively discussions have proven very valuable to students when surveyed on end-of-course questionnaires. An active engagement with the information transforms it into knowledge. The need to use this knowledge to examine and defend points of view makes it valuable.

Students also have the opportunity to earn extra credit by writing a critique of three forms of communication of HIV/AIDS information that are not prose text. Students find songs, poetry, art, performance, and advertising that sends a message about AIDS. They analyze the presentation and decide the value and appropriateness of the message to the intended audience. Then they share these critiques with three friends, who are asked if the student’s analysis, interpretation, and insight are accessible to others with less formal knowledge of AIDS. Students report that they enjoy the challenge of finding AIDS information in less traditional media. They also enjoy the opportunity to engage others in conversation about what they themselves are learning.

SENCER, by focusing on contested issues, encourages student engagement with “multidisciplinary trouble” and with civic questions
that require attention now. By doing so, SENCER hopes to help students overcome both unfounded fears and unquestioning awe of
science.

As most students begin the course, they have great levels of respect for “science,” not realizing that the very story of AIDS demonstrates more accurately the “doing of science” than the “dogma of science.” As the course unfolds with the history of the AIDS epidemic, students discover that many ideas about the disease were initially wrong and have been discarded or revised. Thus, the sense of science as a permanent, unchanging collection of facts is quickly debunked. HIV changed the central theory of the flow of genetic information. No longer could the central dogma be that genetic information flowed from DNA to RNA to protein, not when HIV replicated via RNA to DNA to RNA to protein. Science is, rather, a dynamic collection of tested hypotheses that are always under revision and subject to the next discovery.

Science can inform our thinking, but it cannot solve our problems, especially in the case of AIDS. Biology and medicine can explain the disease, its transmission, even its treatment, but the “multidisciplinary trouble” of AIDS, as June described it, is far beyond the boundaries of mere science. Science cannot address definitively the hotly contested issues of ethical treatment. Neither can it provide equal access to treatment or deal with irrational reactions and fears. The “multidisciplinary trouble” of AIDS weaves issues of social, psychological, economic, legal, political, and geographical impact into a major challenge to our aspirations for social justice. The awesome power of science does little for HIV+ orphans.

Knowledge brings responsibility to inform others. Many of the students in the course find venues for activism beyond the classroom. They find themselves talking to peers about their papers, finding professionals to review their solution plans, getting involved in campus health advocacy programs, volunteering with the Children’s’ AIDS Network, New Jersey Women and AIDS Network, or other organizations throughout the state, country and world.

Integrating Science and Civic Questions

We asked each course developer to comment on the connections between their course’s basic science content and the civic issues within which their course is framed.

This course was a groundbreaking effort to present a critical public policy issue, preventing the spread of HIV infection, in the context of biology. The content of the course was deliberately selected to define the scientific principles and topics that explained and presented the rationale for the public policy evolving around the issues of HIV/AIDS. The inclusion of guest speakers, who were public policy experts, lawyers, and AIDS activists, brought the issues clearly to the students. But the framework ofmedical and human health context was developed concurrently to demonstrate the
inseparable reality of human health and public policy.

The scientific principles and topics presented in this biology class are many and varied, as one might expect. Imbedded in the delivery of content on HIV, including epidemiology, sexually transmitted infections, host defense mechanisms, the immune response, virology, and the detection, diagnosis, and treatment, are a myriad of opportunities to link to public policy issues. Discussions of epidemiology and sexually transmitted infections and the reporting of diseases to local health departments and identification of contacts, raise important political questions about privacy and First Amendment rights. Many of the details of the immune response are critical, not only tounderstand the phenomenon of AIDS, but to see the directions and strategies for treatment and prevention. For example, vaccine procedures are the directed and controlled use of antigens to reinforce the anamnestic response. But in what population can we test these vaccines, and where would such testing be “ethical”? Without a clear understanding of how a virus replicates, how can the student understand the efficacy of the highly active anti-retroviral treatments? This question, in turn, leads to a discussion of why the administration of such drugs reduces transmission to the fetus and the need to inform HIV+ women of their options. It also raises the difficult issues of testing theefficacy of treatment on unknowing populations. Many questions of public policy are continually addressed by the students, both in and out of class, particularly on the “Discussion Forum” component of the course web page. To view the web page go to

Homepage of Monica A. Devanas

and follow the links to the WebCT course and the discussion groups there.