Access To ART Research Articles

The changing epidemiology of HIV in 2013

We sought to review the recent epidemiology of HIV-1 and to identify emerging challenges in HIV surveillance and epidemic control. There is increasing evidence that HIV epidemics are in decline among general populations worldwide. Critical exceptions to these trends are HIV epidemics among key populations globally; the HIV epidemics in Eastern Europe and Central Asia in injecting drug using populations; the continued high burden epidemics of sexually transmitted HIV among young women and girls in southern sub-Saharan Africa, and young men who have sex in men (MSM) in the America, Asia, and Africa. In the new era of ART access, prevalence measures over time are less reliable and new approaches to the measurement of incident infection will be critical to assess trends. The implementation of expanded options for HIV prevention, reducing vertical transmission, and treatment as prevention, will shift focus from individuals to population-level impact. Strong surveillance and information systems will be necessary to meet these expanded surveillance needs. The epidemiology of HIV infection is changing, dynamic, complex, and progress in epidemic control remains markedly uneven. Without addressing the components of global HIV, in which disease rates continue to expand, current efforts are unlikely to succeed.

Art as a Mechanism for Enhancing Social Accessibility

“Art Access and Advocacy,” the theme of Urban Research Plaza’s 11 th international forum, implies the development of access channels through the arts, which enable the participation of socially disadvantaged persons in social activities and ultimately result in the making of a highly communal society. In this article, I will discuss the social context from which this theme emerged. In addition, I will consider the importance of arts management in a few concrete examples.

High viremia and low level of transmitted drug resistance in anti-retroviral therapy-naïve perinatally-infected children and adolescents with HIV-1 subtype C infection

BackgroundHigh plasma viremia in HIV-1 infection is associated with rapid CD4 cell decline and faster disease progression. Children with HIV infection have high viral loads, particularly in early childhood. In this study we sought to understand the relationship between duration of HIV-1 infection and viral dynamics among perinatally-infected children and adolescents in India along with transmitted drug resistance in this population.MethodsDuring 2007–2011, cross-sectional samples were collected from ART-naïve children (n = 105) with perinatally-acquired HIV infection, aged 2–16 years from Bangalore, India. CD4 counts, viral load and in-house genotyping were performed and transmitted drug resistance mutations were identified using the World Health Organization recommendations for Surveillance of Drug Resistance Mutations (SDRM_2009) list.ResultsAmong 105 children studied, 73.3% (77/105) were asymptomatic, but had a median viral load of 5.24 log copies/mL (IQR 4.62-5.66). In the adolescent age group, 54% (21/39) had high levels of viremia (median 5.14 log copies/mL) but were asymptomatic. HIV-1 subtyping identified 98% strains (103/105) as subtype C; one A1 and one unique recombinant form (URF). Transmitted NRTI resistance was 1.9% (2/105); NNRTI resistance was 4.8% (5/105) and overall prevalence of transmitted drug resistance was 5.7% (6/105).ConclusionsThe high burden of plasma viremia found among untreated asymptomatic adolescents needs to be addressed both from an individual angle to halt disease progression, and from a public health perspective to arrest horizontal transmission. The low level of transmitted drug resistance among perinatally-infected children is reassuring; however with improving ART access globally, regular genotyping surveillance is indicated.

Review of life expectancy in people with HIV in settings with optimal ART access: what we know and what we don't

Life expectancy (LE) is an important indicator of health used widely by government and healthcare agencies to monitor trends over time and to determine resource allocation, as well as by insurance companies and pension providers. LE of the HIV-positive population has increased dramatically since the introduction of combination antiretroviral therapy (cART); indeed, it is now believed that LE may be similar to that of the general population in some subgroups. There are, however, specific subgroups in which LE remains substantially impaired. The impact of HIV and of cART on mortality may be expressed in several ways. LE itself provides an estimate of the average additional number of years that an individual would be expected to live beyond a particular age. However, the detrimental impact of HIV may also be described in terms of the number of years of life lost or the gains in LE if HIV were to be eliminated as a cause of morbidity in the population. My presentation will start with a description of the different methods that researchers have used to describe the mortality outcomes of those with HIV, and the impact of cART on these. I will then consider how LE in the HIV-positive population has changed over time and will describe the impact of demographic factors (e.g. gender, age, ethnic group) on LE. To investigate the circumstances under which LE may return to normal levels, I will also consider the potential impact of timely diagnosis and linkage into care, continued engagement with care, optimal initiation of cART and maintenance of viral suppression on LE. Finally, I will discuss some of the limitations of the approaches used to estimate LE, with particular emphasis on the confounding effects of lifestyle and behavioural factors when making any comparison with LE in the general population.

HIV status and participation in HIV surveillance in the era of antiretroviral treatment: a study of linked population‐based and clinical data in rural South Africa

ObjectiveTo examine whether HIV status affects participation in a population-based longitudinal HIV surveillance in the context of an expanding HIV treatment and care programme in rural South Africa.MethodWe regressed consent to participate in the HIV surveillance during the most recent fieldworker visit on HIV status (based on previous surveillance participation or enrolment in pre-antiretroviral treatment (pre-ART) care or ART in the local HIV treatment and care programme), controlling for sex, age and year of the visit (N = 25 940). We then repeated the regression using the same sample but, in one model, stratifying HIV-infected persons into three groups (neither enrolled in pre-ART care nor receiving ART; enrolled in pre-ART care but not receiving ART; receiving ART) and, in another model, additionally stratifying the group enrolled in pre-ART and the group receiving ART into those with CD4 count ≤200/μl (i.e. the ART eligibility threshold at the time) vs. those with CD4 count >200/μl.ResultsHIV-infected individuals were significantly less likely to consent to participate in the surveillance than HIV-uninfected individuals [adjusted odds ratio (aOR), 0.74; 95% confidence interval, 0.70–0.79, P < 0.001], controlling for other factors. Persons who were receiving ART were less likely to consent to participate (aOR, 0.75, 0.68–0.84, P < 0.001) than those who had never sought HIV treatment or care (aOR, 0.82, 0.75–0.89, P < 0.001), but more likely to consent than persons enrolled in pre-ART care (aOR 0.62, 0.56–0.69, P < 0.001). Those with CD4 count ≤200/μl were significantly less likely to consent to participate than those with CD4 count >200/μl in both the group enrolled in pre-ART and the group receiving ART.ConclusionAs HIV test results are not made available to participants in the HIV surveillance, our findings agree with the hypothesis that HIV-infected persons are less likely than HIV-uninfected persons to participate in HIV surveillance because they fear the negative consequences of others learning about their HIV infection. Our results further suggest that the increased knowledge of HIV status that accompanies improved ART access can reduce surveillance participation of HIV-infected persons, but that this effect decreases after ART initiation, in particular in successfully treated patients.

Neurocognitive Impairment Related to HIV Infection in Nigeria (P01.259)

Objective: To examine outcomes on neuropsychological (NP) testing among individuals at risk for developing HIV-related neurocognitive impairment (NCI) in Nigeria. Background With 3.3 million infected, Nigeria has the 2 nd highest burden of HIV/AIDS. In the pre-antiretroviral therapy (ART) era up to 50% of infected individuals manifested NCI. In the context of expanded ART access in Nigeria and other low income countries understanding the prevalence and longitudinal impacts of NCI on patient outcomes is vital to sustainable programs. Design/Methods: ART-naive seropositive (SP) and seronegative (SN) control subjects are recruited at two antiretroviral treatment clinics in Nigeria. NP test data obtained at the time of study enrollment were analyzed. Multiple regression analyses were performed with HIV serological status, education, and ethnicity included as covariates. Effect sizes were determined by estimation of the Cohen9s d statistic. Results: 30 SP (23 in WHO stage I, four in stage II, three in stage III and one in stage IV) and 51 SN subjects were enrolled. The mean age and sex ratios were similar for the two groups; however, the SP group had a lower level of education (p=0.03). Significant relationships were found for HIV serostatus with performance on the overall NP battery (p=0.0096) and on tests of learning (p=0.0085), speed of information processing (p=0.01); executive function (p=0.01); and memory (p=0.02). Effect sizes for these analyses ranged between 0.34-0.36. On the full battery, 14 SP (46%) had scores >1 SD below the mean of the controls; of these, 7 (23%) had scores >2 SD below the mean. Ethnicity and education did not impact performance on the tests. Conclusions: HIV- related neurocognitive abnormalities were frequent in this patient group, who overall presented in the earlier stages of infection. Additional studies are underway to further define the clinical and virological associations for NCI with HIV infection in Nigeria. Supported by: National Institute of Mental Health, NIH. Disclosure: Dr. Royal has received personal compensation for activities with MedImpact Healthcare Systems, Inc.Dr. Royal received research support from EMD-Serono, Inc., Genzyme, Teva Neuroscience, Biogen and Novartis. Dr. Blattner has nothing to disclose. Dr. Cherner has nothing to disclose. Dr. Abimiku has nothing to disclose. Dr. Adebamowo has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Alabi has nothing to disclose. Dr. Alkali has nothing to disclose. Dr. Mamadu has nothing to disclose. Dr. Okwuasaba has nothing to disclose. Dr. Agala has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Hendrix has nothing to disclose. Dr. Eyzaguirre has nothing to disclose. Dr. Aragbada has nothing to disclose. Dr. Ojo has nothing to disclose. Dr. Adebiyi has nothing to disclose.

The politics and policies of HIV prevention in sex work

Decades into the HIV epidemic, we know surprisingly little about the relative burden of HIV among sex workers. UNAIDS estimates that less than 50% of sex workers have access to HIV prevention programmes worldwide.1 HIV prevalence among sex workers is highly heterogeneous both across and within regions. In addition to individual and biological drivers (eg, the epidemic structure, co-infection with other sexually transmitted infections [STIs], and antiretroviral therapy [ART] coverage), structural features continue to play a crucial part in shaping risk of infection among sex workers and their clients, including work environment, violence, stigma, and the legal, cultural, and political contexts of sex work.2 and 3 In The Lancet Infectious Diseases, Stefan Baral and colleagues4 report a systematic review and meta-analysis of HIV burden among female sex workers in 50 low-income and middle-income countries. Female sex workers had an overall increased odds of HIV infection (odds ratio 13·5, 95% CI 10·0–18·1) relative to the general female population of reproductive age, with the highest odds in Asia (29·2, 95% CI 22·2–38·4) and lowest in Latin America and the Caribbean (12·0, 95% 7·3–19·7). Baral and colleagues show substantially high HIV prevalence levels across geographical regions and epidemic structures, including both concentrated epidemics and mature, generalised epidemics, as in sub-Saharan Africa where the pooled HIV prevalence was 36·9% (95% CI 36·2–37·5). The heavy HIV burden points to the crucial need for urgent scale-up of comprehensive initiatives simultaneously targeting HIV prevention, ART access, and care among female sex workers, especially in view of the established role of treatment as prevention. Of concern, two-thirds of countries have no data on HIV burden in this group. As Baral and colleagues suggest, the dearth of data can be attributed in large part to the same structural conditions that increase risk of HIV and prevent engagement in interventions among female sex workers, including criminalised legal and policy environments, violence, stigma, and restrictive funding policies.5 and 6 All too often moral debates dominate the public health response among sex workers, and science continues to take a backseat to punitive approaches and raid and rescue operations aimed at eliminating sex work. The US antiprostitution pledge enacted in 2003 continues to prevent non-governmental organisations from accessing funds from the US Presidents Emergency Plan for AIDS Relief if they did not oppose sex work. Evidence suggests that in settings where sex work is criminalised or heavily sanctioned (eg, mandatory testing), sex workers are pushed outside the public health system.6 and 7 The common threat of violence towards sex workers by clients and third parties (eg, police, exploitative managers, pimps) are associated with increased risk for HIV infection.8 Enforcement efforts (eg, police crackdowns, raids), punitive sanctions, and the threat of violence can deter sex workers from accessing HIV prevention services, constrain their ability to negotiate condom use, and prevent the roll-out and rigorous assessment of HIV interventions.6 Individual country and programme successes have made important progress regionally, but for the most part have not been met with global backing from international and governmental bodies, and face the same structural barriers to large-scale implementation and rigorous assessment. A systematic review9 of HIV and STI intervention studies among female sex workers in low-resource settings showed significant use of multicomponent and structural interventions (policy change and sex-work collectivisation), with only modest effects reported for behavioural interventions alone. Multipronged HIV-prevention strategies have been adopted in several countries (eg, safer sex-work environments),2 with the most well documented structural HIV interventions being those led by sex workers in India (Songachi and Avahan models).10 and 11 The results stand as an important marker of the sheer scale of the HIV epidemic among female sex workers worldwide, and a call to action, both for investment in science and scale-up of evidence-based HIV-prevention interventions. With efforts to better characterise the epidemic in sex work and the response to it, research and interventions among the male client population and other subpopulations of sex workers (eg, male and transgender sex workers, migrant workers) are also crucial. As the epidemic matures in many settings, with some countries already reporting over 50% of sex workers living with HIV, comprehensive initiatives simultaneously targeting HIV prevention, ART access, and care are increasingly vital. As highlighted in a recent report by the UNAIDS advisory on sex work and HIV,12 removal of structural barriers (eg, criminalised laws and policies, violence) remains a necessary precondition to an effective HIV response in sex work worldwide.

Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa?

Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong adherence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staff. We developed a conceptual framework to analyse how PLWHA can become expert patients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs fit the concept of the expert patient and describe how community-embedded ART programs can be effective and improve the accessibility and affordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better fitting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS.

INVITED SESSION, SESSION 67: EQUAL AND SAFE ACCESS TO ART Wednesday 6 July 2011 12:00 - 13:00

INVITED SESSION, SESSION 67: EQUAL AND SAFE ACCESS TO ART Wednesday 6 July 2011 12:00 - 13:00

Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya.

BackgroundAntiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi.MethodsThis is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence.ResultsOverall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%) reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019) and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-4.408, p = 0.011) predicted non-adherence.ConclusionsThe study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients' ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.

Hepatitis B, C seroprevalence and delta viruses in HIV‐1 Senegalese patients at HAART initiation (retrospective study)

The aim of this study was to determine hepatitis co-infection in a cohort of HIV infected patients at their inclusion in the Senegalese Initiative of ART Access. B, C, and D Hepatitis viruses serological markers were checked retrospectively on 363 stored plasma. For HBV, the Abbott laboratories equipment IMx was used to detect HBs Ag and anti Core Ab on negative HBs Ag samples. For HDV, anti Delta Ab was performed using the Abbott Murex Kit on all HBs Ag positive samples. For HCV, anti HCV Ab was detected by IMx as double screening test and confirmed by INNO-LIA(TM) HCV Core of Innogenetics laboratories. The statistical analysis was done with STATA V8. The study population was composed of 164 men and 199 women aged between 16 and 66 years. The immune and virological markers averages at their enrollment were 154 cell/mm(3) for TLCD4+ (n = 355 patients) and 4.9 log for viral load (n = 277 patients). HBs Ag was found in 61 patients or 16.8% and the prevalence of anti-HBc Ab was 83.2% (252/295). 2 patients or 3% on HBs Ag positive sample presents HBV/HDV co-infection Ab anti HCV was detects in 6 patients or 1.6% after confirmation and 2 patients had triple infection with HBV. These results showed that the prevalence of HBV and HCV in the population of persons living with HIV/AIDS in Senegal is similar to that found in the general population. Our data indicated that hepatitis pathology in the PLwHIV was essentially due to HBV. Further studies are needed to diagnose occult hepatitis in order to set up therapeutic strategies taking into account co-infections by hepatitis viruses in the ART programmes.

Home care as a possibility of art expression, creativity and access to technology: An analysis on the subject

This study is a reflection about art, creativity and technologies applied to nursing, within the process of contemporary care, particularly about the home care user and in the light on integral care. Over the last decades, the Brazilian Public Health System has gone through deep changes in its political, judicial and organizational elements, with an expressive expansion of the health assistance given to the population. The Home Care Policy comes as an initiative to implement new assistance logics, focusing on the promotion of the health and the prevention of health problems, aiming to overcome the “hospital-centered” model and in favor of the autonomy. We have realized that this policy is a possibility to express a broader way to understand health, in a search to organize the different skills and multi-professional practices and the interaction with the users. The concepts of art, creativity and technology are developed, relating them to the home care in the user’s perspective

One big picture – 12,000 little pictures: the Auckland Art Gallery collection management and access programme

Using the resources available through the Auckland City Council, the Auckland Art Gallery has managed to turn a simple database upgrade into a programme of work with much greater impact on the way information about the gallery’s collection is delivered to the public. The Council has adopted a value management methodology which identifies wide programme aims, costs and benefits for new initiatives. Although initially time‐consuming, the methodology allowed the programme to gain good management support and funding far greater than that originally envisaged. As well as migrating the collection database to a new system, staff have managed a range of projects including digitising the entire collection of 12,000 works, clearing copyrights as required, and cataloguing and scanning ephemera related to key areas of the collection. Work has also been carried out on Web‐based access to collection information as part of a re‐designed gallery Web site. This work raises questions about a shift in the role of a traditional art gallery and the necessity to employ additional skills to meet the opportunities offered by the digital environment.

Voices in the ART access debate

This article analyses the recent controversy over single and lesbian women’s right to access reproductive technology. It focuses on the McBain case in relation to the Sex Discrimination Act. As well, it attempts to bring voices that have been ignored into the debate, and reflect on the values that they express.

Australian visual arts: libraries and the new technologies

Electronic networking has been welcomed in Australia not least because of its potential to help solve problems of distances within Australia and of the isolation of Australia. In the world as a whole, the Internet, and the World Wide Web in particular, is transforming the communication of art information and access to art images. Three Australian Web servers focus on the visual arts: Art Serve, Diva, and AusArts. A number of initiatives intended to provide online bibliographic databases devoted to Australian art were launched in the 1980s. More recently a number of CD-ROMs have been published. As elsewhere, art librarians in Australia need new skills to integrate these products of new technology into the art library, and to transform the latter into a multimedia resource centre.

Russian Children's Literature Before and After Perestroika

Russian Children's Literature Before and After Perestroika Maria Nikolajeva (bio) Several years ago Boris Yeltsin, the president of Russia, declared flatly that Russian cultural issues are not a high priority compared to the more urgent question of the Russian economy. Such a statement would be a catastrophe for any civilized nation; but it is especially disturbing that at a time of great changes in post-Soviet Russia, an enormously important field is being totally ignored, namely children's culture. This circumstance is all the more remarkable given that during the seventy years of the Soviet regime, one of the official slogans was "All the best for our children." Children were declared the only privileged class in the classless socialist society.1 During the last ten years, since Mikhail Gorbachov's proclamation of reconstruction ("perestroika") and openness ("glasnost"), one has been able to learn from the Russian media, among many other hideous disclosures, about hundreds of thousands of children in orphanages and at least as many homeless runaways, about children who contract HIV in hospitals, about children damaged in the wake of Chernobyl, about physically and mentally disabled children living under abominable conditions, and most recently about children affected by the war in Chechnya. It is altogether too easy to forget that even children who lead a relatively protected life with both parents, enjoying a fairly decent living standard and regular schooling, are beginning to suffer from rapidly deteriorating cultural facilities. It is impossible to understand the political situation in Russia today without looking back into Soviet as well as earlier Russian history, sometimes as far back as the eighteenth century. It is equally impossible to understand the cultural situation and the drastic changes that perestroika brought to children's culture unless we set them in a broader context. The history of Soviet children's literature is as artificial and misshapen as the Soviet state itself.2 Russian children's literature has always been privileged to number great authors among its practitioners. Indeed, Russia's most famous writers, such as Alexander Pushkin or Leo Tolstoy, have contributed to children's literature, often finding inspiration in folklore.3 In the years immediately preceding 1917, however, children's literature in Russia was dominated by sentimental and moralistic stories and verses, often written by authors of little talent. The views on children and education during that time dictated the norms of writing for children: the world of children's literature was restricted to the nursery, and the characters were sugar-sweet, well-behaved children in starched clothes. Turn-of-the-century writers were far from folk poetry and thus also from the classical heritage. Thus it was not until the 1920s that children's literature in Russia stood on the threshold of renewal. The reason was the general change in artistic norms brought about by the process of building up the new "socialist" culture in the new Soviet state. The primary principle for this transformed society was to repudiate every old, "bourgeois" form in art. The Russian working class was to create its own "socially pure" culture. This is probably one of the most obvious cases in the history of human culture of how artistic norms may be directly guided by social and political circumstances.4 As there were no available models for the new forms in art, the 1920s in Russia became a period of ardent experiments in every creative field. Education and propaganda were the two most important missions. Many Russians were illiterate or semiliterate; it was essential that art should be comprehensible by the masses and therefore primarily visual. As a direct result of this new concept of art, it was during the 1920s that the first Russian picture books were produced. Early Soviet picture books, such as The Ice Cream Man (1925), written by Samuil Marshak and illustrated by Vladimir Lebedev, were strikingly similar to contemporary political posters. Such stylistic resemblances do not occur merely because many poster artists, Lebedev among them, also produced picture books for children. More important still is the general orientation of postrevolutionary art toward the concrete. Because the aim was to increase art's accessibility by making both text and illustration concise and loud...

Active Library Instruction for Art Educators:

In the busy academic world in which many demands compete for the time and attention of art education students, learning about library inquiry skills may not be a high priority for these students. Although art education students initially may question the relevance of libary instruction for their field, librarians can help these future teachers understand how library skills will help solve their immediate and future problems. Librarians can take advantage of the inquisitive and creative nature of art education students and involve them in researching typical problems facing art teachers today. With some guidance, students can interpret problems, try various research techniques, analyze the results of thie research, and consider other potential applications. As they learn about art education materials and access while research actual problems, future art educators prepare to enter the classroom with some practical and useful inquiry skills.

Speaking the silence: contemporary poems on paintings

Abstract Although the current vogue of poems on paintings undoubtedly owes a lot to the fact that in our age of mechanical reproduction of the work of art access to the painter's work is virtually unlimited, this is an insufficient explanation for the popularity of the genre.1 If, as John Dixon Hunt speculates, paintings are for many poets ‘just like any other subject matter, resonant experiences such as reading Spinoza, falling in love or the smell of cooking and therefore apt as material for poetry’, then poems on paintings do not even have a better claim of constituting a distinct genre than poems on battles, butterflies or railway journeys.2

Art and Context: A Personal View

The unification of art and context has been a motivating force in the author’s work since 1980. She defines context as the relationship of art to its place, to its public and to a time. This philosophy has led her to consider the various hypotheses that inform her work, some of which include the primacy of site, accessibility of art to the public and art’s position in the social and economic system of today.

The Rationalization of Anthropology and Administration

Science is the worst nuisance and the greatest calamity of our days. It has made us into robots, into standardized interchangeable parts of an enormous mechanism; it pushes us with a relentless persistence and a terrible acceleration towards new forms of existence; it changes the world around us; it transforms our inner selves with an uncannily thoroughgoing penetration. An ever-increasing speed in communication; accessibility of superficial knowledge and meretricious art; endless opportunities in cheap and mean forms of enjoyment; leisure to do a thousand irrelevant things—these, from the side of human consumption and enjoyment, are the benefits of our modern civilization. Kept down intellectually by journalism; moving and feeling to the rhythm of jazz; united by the world-wide net of broadcasting—modern man has indefinitely to increase his passive receptivity. He has to start with a standardized level of taste and to develop an indefinitely elastic nervous system, all at the cost of originality and spontaneous life. This may be the extreme pessimistic view of ‘progress’, but many of us feel it strongly and see a menace to all real spiritual and artistic values in the aimless drive of modern mechanization.