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The recent introduction of new vaccines into the school-based immunization program in British Columbia (BC) included monitoring of adverse events following immunization (AEFI) for these new vaccines. This commentary discusses different methods used to collect AEFIs in school immunization campaigns and the effects on response rate. The results of a study using an internet-based tool inspired this paper. The study examined adverse events following human papillomavirus (HPV) vaccine given to grades 6 and 9 students. The low response rate of the internet survey resulted in insufficient findings regarding adverse events. Consequent to the analysis of the study's data, a literature review was conducted to examine survey methodologies used to collect adverse event data following school-based immunization of adolescents. A PubMed search used various combinations of the following terms: vaccine, immunization, immunization programs, reactogenicity, adverse reactions, safety, adolescent, schoolchildren, and survey. Potentially relevant papers were identified based upon the titles and abstracts and subsequently reviewed. Only four studies were deemed appropriate for comparison purposes: all were done in Canada.

Background and Objectives: With the increasing use of sentinel lymph node biopsy, a growing proportion of women with early-stage invasive breast cancer are undergoing breast conserving surgery without a formal axillary lymph node dissection. A frequent question raised is whether the level I-II axillary lymph nodes are treated with standard breast tangent fields. In an attempt to answer this question, surgical clips placed at the time of the level I-II axillary lymph node dissection were used as a surrogate for the location of the nodes and the simulator films for tangent fields of 45 patients were analyzed., Methods: Study criteria were as follows: five or more clips placed in the axilla, and all clips and the humeral head visualized on the medial tangent film. Clips were scored as "in" or "out" of the tangent field, as defined by the delineator wires. All technical parameters were analyzed to determine whether any reproducible techniques would consistently include all of the clips and, hypothetically, the axillary nodes at levels I and II., Results: All clips were included in the medial tangent breast radiation field in only 38% (17 of 45) of cases., Conclusions: The standard, two-field tangent breast fields do not reliably encompass the all level I-II axillary lymph nodes as defined by this study, but some of the nodes were treated in all 45 cases., (Copyright 2002 Wiley-Liss, Inc.)

There is a growing rift between HIV-positive and HIV-negative gay men, which finds expression in social, economic, structural and political divisiveness that, if not resolved, may 'kill' the "gay liberation movement." While disasters generally tend to create organizational solidarity, the AIDS crisis has operated in reverse, spawning a variety of competitive AIDS service organizations, alienating seropositive gays from the mainstream gay community, and in turn disenfranchising seronegative gay men as human and financial resources are redirected toward persons living with HIV and AIDS. Serostatus has become a social marker of societal status, operating in a bimodal discriminatory manner. Seronegative gay men experience discrimination from within the gay community as funding for and services to this sector diminish. Seropositive gay men (and the organizations that provide for some of their needs) have culturally, economically and socially dismissed the socio/psychological needs of seronegative gay men (survivor guilt, safer sex education, etc.) in favour of providing social and resource-based services to seropositive gay men. As the disparities in service and advocacy increase, the social distance between the gay movement and the AIDS movement correspondingly increases. If this trend continues, the social gap will serve further to push HIV-positive and HIV-negative gay men into polarized camps, resulting in a wider separation of the gay movement and the AIDS movement. The stigmatization of HIV-positive people will subsequently increase both within and outside the gay movement, and any ability to present a unified Gay Liberation front will correspondingly diminish. Additionally, the emergent notion within and without the gay communities that to be gay is to be HIV-positive will solidify. This will (a) further stigmatize all gay men in the eyes of the non-gay population, and (b) exacerbate the rift between HIV-positive and HIV-negative gay men within the gay community, reversing the stigma of HIV such that to be HIV-negative will be a marker of non-gay identity. In short, seropositivity will become the defining element of gayness.

In this second part of the trilogy, I review the concepts of panic, the Theory of Cognitive Dissonance, and how internally inconsistent opinions and attitudes can be made consistent (or consonant). The theory explains, in some measure, how AIDS has been socialized into our thinking about identity, and goes beyond a medical condition. The pervasive identification of gay men with HIV and AIDS has resulted for many in an over-identification with fears of contagion and on a societal level in a fear of all gays as pools of contagion. The conversion of dissonance to consonance has taken many forms; within the gay community it has resulted in the rejection of the "100% safe-100% of the time" safe-sex message, and the adoption (for many) of a new form of deviant label-someone who is not in conformity with the social norm of gay community sexual behavior. However, we shall see that this so-called norm is a sham-that many gay men do not, as a rule, practice safe(r) sex on a consistent basis. This information indicates that the educational efforts of the last decade have at best lost their potency, and at worst were less than efficacious to begin with. The dissonant messages have also informed both the construction of the gay community and its interpretation of what it means to be gay. The result has been a tri-lateral perception of HIV and AIDS as either a medical, political or a social phenomenon. This fragmented understanding has exacerbated the already polarized ASOs and GSOs in that each has determined its ideology based on a particular interpretation of HIV and AIDS. This polarization has been operationalized by the GSOs and ASOs primarily in the manner by which they define their target markets, and more importantly, in the manner by which they exclude certain gays from participation. At the extreme, some gay men feel entirely left out of the community, and are consequently unable to convert their dissonance regarding being gay into consonance, if only by developing some associational ties with the community. The central question of the sustainability of the gay movement is thus partly answered by restating the nature of the fractures in the community. Kiesler's determinants regarding change relate directly to the sustainability question-can GSOs and ASOs, given their pluralistic ideologies and constituencies, break free of the constraints that are posed by these determinants? Would the adherents and conscious constituents defect from their organizations, and form new ones (thus reifying the fractures that already exist)? On the other hand, is there a sense of community and identity that will function as a bonding agent to encourage coalition building and social reorganization? The matter may turn on the issue of selective rewards: can a coalition of ASOs and GSOs provide staff, volunteers and clients sufficient motivation for making the inevitable compromises? Given the selective nature of the rewards, as they now stand, the probability of being able to so do is remote. The influence of the non-gay community, as well as the attitudes and beliefs of the majority of gays who do not belong to any gay organizations, hampers success.

The task of those who seek to encourage and offer social support has become more difficult as the majority of social institutions, and the state have established, over time, stronger and more pervasive modes of communication. The intricacies of gay identity have been articulated largely by forces outside of the gay movement, with the inevitable result that GSOs and ASOs have occupied less space in the consciousness of gay men. Additionally, I hypothesize that men who are HIV-positive are engaging in fewer sexual contacts than men who are HIV-negative, and consequently lessening their attendance at venues where cruising is the main event. Financially and structurally, I shall demonstrate the disparity between GSOs and ASOs, and suggest that there is a natural intersection wherein the two SMOs could, and ought to cooperate, especially in the areas of fund-raising, joint program development, recruitment and political lobbying. However, their ideological bases appear to be sufficiently different to preclude such affiliations. These disparate ideologies are amplified by the mass media, and are consequently internalized by the members of the gay community. In the longer term, the divisiveness that manifests itself in the proliferation of numerous collectivities within the gay movement will contribute to the further isolation of gays from each other, and thwart any future attempts at coalition building, which could obviate the continued existence of a gay movement. Some writers suggest that the gay movement is going through a phase in an inevitable process of paradigm shifting, and in the end, the community will come back together-stronger and more unified than it was previously. However, if this is a phase it is clear that the gay movement is in the 'dark before the dawn' initial phase of this paradigmatic shift, and subsequent phases are by no means guaranteed. As AIDS spreads beyond marginalized groups, and infiltrates the social majority, it is possible that much of the discrimination that has positioned gay men as 'other' will be abandoned in favour of a more enlightened, pluralistic conviction of the humanity of gays as full-fledged members of a mosaic-type community structure. On the other hand, it is also possible that as AIDS spreads into mainstream Western communities, gays will be further vilified and scapegoated as the perpetrators of this deadly disease. Preventative action is required to offset this possibility-preventative action can be affected by building a strong and unified gay community ready to withstand the onslaught of the mainstream enmity. This action would frame AIDS and gayness such that this type of situation would not come about. What is required is a new mode of co-operation among ASOs and GSOs, a model which firstly puts the gay house in order, and is then suitably structured to be more inclusive of all gay men's needs, and positioned to assist in the second wave of HIV infection-the general public.