Public policy, institutional cognition, and the geographic diffusion of multiple-drug-resistant HIV in the United States

Abstract

Public policy and economic practice, both quintessential expressions of institutional cognition, create an opportunity structure constituting a tunable, highly patterned, 'nonwhite noise' in a generalized epidemiological stochastic resonance which can efficiently amplify unhealthy conditions within marginalized populations to evoke infectious disease outbreaks. This is particularly true for infections carried by socially-generated 'risk behaviors'. A number of local epidemics originating in such keystone communities may subsequently undergo a structure-driven phase transition to become a coherent pandemic, a spreading plague which can entrain more affluent populations into the disease ecology of marginalization. Here we apply this perspective, which is formally homologous to recent theoretical developments in cognitive psychology, to the forthcoming social and geographic diffusion of multiple drug resistant (MDR) HIV from current AIDS epicenters to the rest of the United States.