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An eye-opening look at the invisible workers who protect us from seeing humanity's worst on today's commercial Internet. Social media on the Internet can be a nightmarish place. A primary shield against hateful language, violent videos, and online cruelty uploaded by users is not an algorithm. It is people. Mostly invisible by design, more than 100,000 commercial content moderators evaluate posts on mainstream social media platforms: enforcing internal policies, training artificial intelligence systems, and actively screening and removing offensive material--sometimes thousands of items per day. Sarah T. Roberts, an award-winning social media scholar, offers the first extensive ethnographic study of the commercial content moderation industry. Based on interviews with workers from Silicon Valley to the Philippines, at boutique firms and at major social media companies, she contextualizes this hidden industry and examines the emotional toll it takes on its workers. This revealing investigation of the people "behind the screen" offers insights into not only the reality of our commercial Internet but the future of globalized labor in the digital age

An eye-opening look at the invisible workers who protect us from seeing humanity's worst on today's commercial internet Social media on the internet can be a nightmarish place. A primary shield against hateful language, violent videos, and online cruelty uploaded by users is not an algorithm. It is people. Mostly invisible by design, more than 100,000 commercial content moderators evaluate posts on mainstream social media platforms: enforcing internal policies, training artificial intelligence systems, and actively screening and removing offensive material-sometimes thousands of items per day. Sarah T. Roberts, an award-winning social media scholar, offers the first extensive ethnographic study of the commercial content moderation industry. Based on interviews with workers from Silicon Valley to the Philippines, at boutique firms and at major social media companies, she contextualizes this hidden industry and examines the emotional toll it takes on its workers. This revealing investigation of the people "behind the screen" offers insights into not only the reality of our commercial internet but the future of globalized labor in the digital age

The late 2016 case of the Facebook content moderation controversy over the infamous Vietnam-era photo, "The Terror of War," is examined in this paper for both its specifics, as well as a mechanism to engage in a larger discussion of the politics and economics of the content moderation of user-generated content. In the context of mainstream commercial social media platforms, obfuscation and secrecy work together to form an operating logic of opacity, a term and concept introduced in this paper. The lack of clarity around platform policies, procedures and the values that inform them lead users to wildly different interpretations of the user experience on the same site, resulting in confusion in no small part by the platforms' own design. Platforms operationalize their content moderation practices under a complex web of nebulous rules and procedural opacity, while governments and other actors clamor for tighter controls on some material, and other members of civil society demand greater freedoms for online expression. Few parties acknowledge the fact that mainstream social media platforms are already highly regulated, albeit rarely in such a way that can be satisfactory to all. The final turn in the paper connects the functions of the commercial content moderation process on social media platforms like Facebook to their output, being either the content that appears on a site, or content that is rescinded: digital detritus. While meaning and intent of user-generated content may often be imagined to be the most important factors by which content is evaluated for a site, this paper argues that its value to the platform as a potentially revenue-generating commodity is actually the key criterion and the one to which all moderation decisions are ultimately reduced. The result is commercialized online spaces that have far less to offer in terms of political and democratic challenge to the status quo and which, in fact, may serve to reify and consolidate power rather than confront it.

The late 2016 case of the Facebook content moderation controversy over the infamous Vietnam-era photo, "The Terror of War," is examined in this paper for both its specifics, as well as a mechanism to engage in a larger discussion of the politics and economics of the content moderation of user-generated content. In the context of mainstream commercial social media platforms, obfuscation and secrecy work together to form an operating logic of opacity, a term and concept introduced in this paper. The lack of clarity around platform policies, procedures and the values that inform them lead users to wildly different interpretations of the user experience on the same site, resulting in confusion in no small part by the platforms' own design. Platforms operationalize their content moderation practices under a complex web of nebulous rules and procedural opacity, while governments and other actors clamor for tighter controls on some material, and other members of civil society demand greater freedoms for online expression. Few parties acknowledge the fact that mainstream social media platforms are already highly regulated, albeit rarely in such a way that can be satisfactory to all. The final turn in the paper connects the functions of the commercial content moderation process on social media platforms like Facebook to their output, being either the content that appears on a site, or content that is rescinded: digital detritus. While meaning and intent of user-generated content may often be imagined to be the most important factors by which content is evaluated for a site, this paper argues that its value to the platform as a potentially revenue-generating commodity is actually the key criterion and the one to which all moderation decisions are ultimately reduced. The result is commercialized online spaces that have far less to offer in terms of political and democratic challenge to the status quo and which, in fact, may serve to reify and consolidate power rather than confront it.

For this special issue of b2o, we explore Musk's SpaceX, the NSA's control room, Biosphere 2, HI-SEAS, and Apple's new "Spaceship" headquarters. In these projects and artifacts we find highly politicized deployments of Silicon Valley-style scitech, masked as concerned with escape from planet Earth while necessarily downplaying and denying their impetus: the deleterious, long-term effects of human-induced, industrial-scale problems such as resource extraction, environmental destruction, and war. Linked theoretically, conceptually, and politically, both to each other and to their unacknowledged, obfuscated philosophical origins in accelerationism and technological nihilism, these endeavors and their proponents in government and tech sectors represent the ultimate expression of reality TV's much-discussed "preppers," ready to start anew somehow and somewhere else. In a final turn, this paper contrasts such endeavors with Trump-era protectionist values (e.g., increased military spending; the detention of migrant children; entrenched, ongoing structural racism; antagonism of longtime allies) seemingly in stark opposition to these manifest desires to leave, rather than defend, the nation. Yet, when read through the lens of accelerationism, such antagonism can be more accurately identified as directly aligned with the hastening of global confrontation, chaos and the deliverance of the chosen few to a fetishized future of their making.

For this special issue of b2o, we explore Musk's SpaceX, the NSA's control room, Biosphere 2, HI-SEAS, and Apple's new "Spaceship" headquarters. In these projects and artifacts we find highly politicized deployments of Silicon Valley-style scitech, masked as concerned with escape from planet Earth while necessarily downplaying and denying their impetus: the deleterious, long-term effects of human-induced, industrial-scale problems such as resource extraction, environmental destruction, and war. Linked theoretically, conceptually, and politically, both to each other and to their unacknowledged, obfuscated philosophical origins in accelerationism and technological nihilism, these endeavors and their proponents in government and tech sectors represent the ultimate expression of reality TV's much-discussed "preppers," ready to start anew somehow and somewhere else. In a final turn, this paper contrasts such endeavors with Trump-era protectionist values (e.g., increased military spending; the detention of migrant children; entrenched, ongoing structural racism; antagonism of longtime allies) seemingly in stark opposition to these manifest desires to leave, rather than defend, the nation. Yet, when read through the lens of accelerationism, such antagonism can be more accurately identified as directly aligned with the hastening of global confrontation, chaos and the deliverance of the chosen few to a fetishized future of their making.

AbstractIntroductionStigma is a well‐known barrier to HIV testing and treatment and is an emerging barrier to pre‐exposure prophylaxis (PrEP) use. To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub‐Saharan Africa, a priority population for PrEP.MethodsA literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio‐ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; n = 20) and key influencers (14 FGDs; n = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023.ResultsThe conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high‐risk populations), health systems (e.g. youth‐friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency.ConclusionsOur PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.

AbstractIntroductionOral pre‐exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub‐Saharan Africa, a priority population for epidemic control. However, intimate partner violence (IPV) and low relationship power can create significant challenges to PrEP use. The Tu'Washindi intervention aimed to increase PrEP use by addressing relationship‐ and violence‐related barriers among AGYW enrolled in the DREAMS Initiative in Siaya County, Kenya.MethodsOur multi‐level, community‐based intervention was piloted in a cluster‐randomized controlled trial conducted at six DREAMS sites from April to December 2019 (NCT03938818). Three intervention components were delivered over 6 months: an eight‐session empowerment‐based support club, community sensitization targeted towards male partners and a couples' PrEP education event. Participants were ages 17–24, HIV negative and either eligible for, or already taking, PrEP. Over 6 months of follow‐up, we assessed IPV (months 3 and 6) and PrEP uptake and continuation (month 6) through interviewer‐administered questionnaires; PrEP adherence was assessed with Wisepill electronic monitoring devices. These outcomes were compared using adjusted Poisson and negative binomial regression models.ResultsWe enrolled 103 AGYW with median age of 22 years (IQR 20–23); one‐third were currently taking PrEP and 45% reported IPV in the past 3 months. Retention was 97% at month 6. Compared to the control arm, intervention arm participants were more likely to initiate PrEP, if not already using it at enrolment (52% vs. 24%, aRR 2.28, 95% CI 1.19–4.38, p = 0.01), and those taking PrEP had more days with device openings (25% of days vs. 13%, aRR 1.94, 95% CI 1.16–3.25, p = 0.01). Twenty percent of participants reported IPV during follow‐up. There were trends towards fewer IPV events (aIRR 0.66, 95% CI 0.27–1.62, p = 0.37) and fewer events resulting in injury (aIRR 0.21, 95% CI 0.04–1.02, p = 0.05) in the intervention versus control arm.ConclusionsTu'Washindi shows promise in promoting PrEP uptake and adherence among AGYW without concomitant increases in IPV; however, adherence was still suboptimal. Further research is needed to determine whether these gains translate to increases in the proportion of AGYW with protective levels of PrEP adherence and to evaluate the potential for the intervention to reduce IPV risk.

IntroductionAntiretroviral therapy (ART) prevents HIV transmission within HIV serodiscordant couples (SDCs), but slow implementation and low uptake has limited its impact on population‐level HIV incidence. Home HIV testing and counselling (HTC) campaigns could increase ART uptake among SDCs by incorporating couples' testing and ART referral. We estimated the reduction in adult HIV incidence achieved by incorporating universal ART for SDCs into home HTC campaigns in KwaZulu‐Natal (KZN), South Africa, and southwestern (SW) Uganda.MethodsWe constructed dynamic, stochastic, agent‐based network models for each region. We compared adult HIV incidence after 10 years under three scenarios: (1) "Current Practice," (2) "Home HTC" with linkage to ART for eligible persons (CD4 <350) and (3) "ART for SDCs" regardless of CD4, delivered alongside home HTC.ResultsART for SDCs reduced HIV incidence by 38% versus Home HTC: from 1.12 (95% CI: 0.98–1.26) to 0.68 (0.54–0.82) cases per 100 person‐years (py) in KZN, and from 0.56 (0.50–0.62) to 0.35 (0.30–0.39) cases per 100 py in SW Uganda. A quarter of incident HIV infections were averted over 10 years, and the proportion of virally suppressed HIV‐positive persons increased approximately 15%.ConclusionsUsing home HTC to identify SDCs and deliver universal ART could avert substantially more new HIV infections than home HTC alone, with a smaller number needed to treat to prevent new HIV infections. Scale‐up of home HTC will not diminish the effectiveness of targeting SDCs for treatment. Increasing rates of couples' testing, disclosure, and linkage to care is an efficient way to increase the impact of home HTC interventions on HIV incidence.

AbstractIntroductionEffective use of pre‐exposure prophylaxis (PrEP) has been low among adolescent girls and young women (AGYW) in sub‐Saharan Africa. The MTN‐034/REACH trial offered AGYW a menu of adherence support strategies and achieved high adherence to both daily oral PrEP and the monthly dapivirine vaginal ring. Understanding how these strategies promoted product use could inform the design of adherence support systems in programmatic settings.MethodsREACH was a randomized crossover trial evaluating the safety of and adherence to the ring and oral PrEP among 247 HIV‐negative AGYW (ages 16–21) in South Africa, Uganda and Zimbabwe from January 2019 to September 2021 (NCT03593655). Adherence support included monthly counselling sessions with drug‐level feedback (DLF) plus optional daily short message service (SMS) reminders, weekly phone or SMS check‐ins, peer support clubs, "peer buddies" and additional counselling. Counsellors documented adherence support choices and counselling content on standardized forms. Through focus groups, serial in‐depth interviews (IDIs) and single IDIs (n = 119 total), we explored participants' experiences with adherence support and how it encouraged product use.ResultsParticipants received counselling at nearly all visits. DLF was provided at 54.3% of sessions and, across sites, 49%–68% received results showing high adherence for oral PrEP, and 73%–89% for the ring. The most popular support strategies were in‐person clubs and weekly calls, followed by online clubs, additional counselling and SMS. Preferences differed across sites but were similar for both products. Qualitative results demonstrated that the REACH strategies supported adherence by providing information about HIV and PrEP, continually motivating participants, and supporting the development of behavioural skills and self‐efficacy, aligning with the Information, Motivation, and Behavioural Skills (IMB) model. Effectiveness was supported by three foundational pillars: strong interpersonal relationships with counsellors; ongoing, easily accessible support and resources; and establishing trust in the counsellors and study products through counsellor relationships, peer‐to‐peer exchange and DLF.ConclusionsImplementation programmes could support effective PrEP use by offering a small menu of counsellor‐ and peer‐based support options that are youth‐friendly and developmentally appropriate. The same menu options can support both ring and oral PrEP users, though content should be tailored to the individual products.

Obesity is a complex phenotype affected by genetic and environmental influences such as sociocultural factors and individual behaviors. Previously, we performed two separate genome-wide investigations for adiposity-related traits (BMI, percentage body fat (), abdominal circumference (ABDCIR), and serum leptin and serum adiponectin levels) in families from American Samoa and in families from Samoa. The two polities have a common evolutionary history but have lately been influenced by variations in economic development, leading to differences in income and wealth and in dietary and physical activity patterns. We now present a genome-wide linkage scan of the combined samples from the two polities. We adjust for environmental covariates, including polity of residence, education, cigarette smoking, and farm work, and use variance component methods to calculate univariate and bivariate multipoint lod scores. We identified a region on 9p22 with genome-wide significant linkage for the bivariate phenotypes ABDCIR– (1-d.f. lod 3.30) and BMI– (1-d.f. lod 3.31) and two regions with genome-wide suggestive linkage on 8p12 and 16q23 for adiponectin (lod 2.74) and the bivariate phenotype leptin–ABDCIR (1-d.f. lod 3.17), respectively. These three regions have previously been reported to be linked to adiposity-related phenotypes in independent studies. However, the differences in results between this study and our previous polity-specific studies suggest that environmental effects are of different importance in the samples. These results strongly encourage further genetic studies of adiposity-related phenotypes where extended sets of carefully measured environmental factors are taken into account.