It's a lot to ask of someone - on both sides. How do you think someone could approach this in a way that preserves your humanity and your privacy?

It's not exactly the same, but it's not entirely different.

Even with testing, not all STD's show up on tests - this is why folks get tested regularly. Many folks won't know they have an STD (think HPV). Condoms break, get forgotten, and so on. People do stuff when they are drunk.

Rape happens (rape isn't a lack of trust but rather something else entirely).

   These aren't indicators 
   of lack of trust

- Your partner that they don't lie about taking contraception, that they have taken it as required.

- The medical sciences and medical regulatory authorities that the contraception works as expected.

- Pharmacist that they don't sell counterfeit medicine

and many others. Society is largely based on trust.

Humans happen and make mistakes. Condoms break. Therefore, plan B.

One doesn't have to be promiscuous or untrustworthy to have an STD. All that means is that you've had sex with someone. Someone might not even know they have an STD either. Even if folks have more than one partner, it doesn't actually mean they are sleeping around or that they are being dishonest, nor does it mean they'll get an STD.

In addition, if you are trusting that your partner has taken something as required, you probably are in a sexual relationship with someone you are familiar with. Otherwise, the prudent thing would be to use a condom and hope it does not break.

Contraception working as expected leaves a lot of room for error. Again, condoms break. Medications interfere with hormonal birth control and most folks don't take it like laboratory settings, which increases risk of pregnancy. This is all still "working as expected".

Note also that in interactions with humans, we generally don't have a precise probabilities.

   I'm using contraception method X

On a more practical level, I would probably go on PreP if I regularly had hookups with men. I’m actually somewhat envious of the gay scene in that regard. The option just doesn’t meaningfully exist at the mostly-hetero sex parties I’ve been at.

I mean I'd worry that they were being honest, but mistaken. I'd have to do a lot of research on the efficacy and frequency of testing beforehand (e.g. it's possible that it might be calibrated to be frequent enough to provide proper care for the patient, but not to guarantee to protect partners).

So really you need to be trusting that they are responsible enough to take their drugs every day. These days that is pretty easy, most people take 1 pill in the morning and that's it.

The fact that people don't trust it means nobody's casually taking it or taking for granted that other people are taking it. So it increases awareness of the potential for contracting HIV and underlines the need for protection. At the same time, you can independently choose to take it and provide yourself more protection. So I think it all balances out.

The amount of positive guys on PrEP or even non-positive guys on PrEP who refuse condom sex seems to be greatly increasing. And it seems like there is now discrimination the other way; can't tell you how many times I've been pressured or refused or looked down upon for refusing non-condom sex or not going on PrEP myself.

>can't tell you how many times I've been pressured or refused or looked down upon for refusing non-condom sex or not going on PrEP myself.

Seems like a great social signal that those aren't people you need to bother with having in your life.

It is simple. Do not have hookups with HIV+ people. Why are we normalizing this.

I wouldn't have a problem being in a relationship with someone with HIV, but even if his viral load is undetectable, I would still insist on protection for high risk activities.

And of course, that might mean an actual cure is detrimental to the bottom line, which might impact funding for any of these studies.

This also assumes that the only motivation is money, if a researcher came up with a cure for HIV they would become an instantaneous scientific god, immortalised in writing, films, having streets and libraries named after them. They would be a hero. That motivation is pretty powerful for many (not for all of those things, but the be a hero part).

A subset of the population will become resistant to certain classes of drugs, because people do stop taking drugs etc. And gain resistance, then pass that on, but for a specific individual their current regimen should be good for as long as they take it. Realistically people change drugs every so often as better drugs with lies side effects are released, but not because of new resistance development.

Now this did used to be a bit if an issue since people had to take multiple pills at different times a day. Having to do that makes missing doses easier, and then resistance can develop. But these days most people are on a single pill taken once a day that completely eliminates that risk.

You're thinking of this like antibiotics, when it's really not a comparable situation.

Drugs like this, and HIV as a manageable, chronic condition have the potential to vastly change the face of the HIV epidemic.

A bigger concern, in my opinion, is how you get the drugs necessary for this to a place like Uganda, where the per-capita annual health budget is $0.05.

Ugandan here, didn't know this! Or hadn't calculated. But the public health system is really terrible. It's unbelievable. However, ARVs are quite available, I know people that have no trouble getting them for free.

Like a vaccine-preventable disease near elimination, I worry a lot about people taking their foot off the gas.

And last I talked to HIV control folks in Uganda (several years ago, admittedly) there was a lot of concern about survivability meaning a dramatic increase in the prevalence of HIV, and thus the demand for ARVs.

That surely must be a typo, right?

Malaria, HIV, myriad diarrheal diseases, vaccines.

You've got a nickel per person.

It says $15 per capita.

It seems hard to get a fixed number. Doing math off the Uganda MOH budget puts it at about $4.

But it should also be noted that even the optimistic figure likely also includes things like hospital construction, money to pay healthcare workers, labs (and lab reagents), etc. that isn't what people normally think of.

I'd really like my number to be wrong though. Because even $15 per person is...dire.

Your reasoning also leaves out that a lot of health care never goes through government coffers, both in African nations but also, for example, in the US.

For that matter, if you'd like me to talk about the way non-African healthcare systems are broken, I'm happy to do that as well, that just happens to not be what this thread is about.

Also, the programs we are talking about rarely go through non-governmental sources.

http://www.mmlonline.org/uploads/08%20Health.pdf.pdf

Literally expired last night. How frustrating.

Sadly, missed by the Internet Archive.

    potentially decades away   

The virus also stay dormant within your cells, and it is not absolutely clear where, yet. Other viruses which do this (chickenpox, herpes, papillomavirus, ...) are not cleared from the body by the immune system either, but at least the immune system can control them as long as it is healthy enough.

This facts, of course, are no reason to be pessimistic about a cure/vaccine, just explains why it is taking that long. A cure might also pad the way to cure other diseases such as chickenpox and herpes, which may lead to complications later in life.

Generally, it's much easier to develop a vaccine for more stable viruses.

We might be able to target some sort of antigen on the virus that's highly conserved even with that mutation rate, but that's a big if.

We have antibiotics primarily from fungi derived substances, but there are no other class of substances we’ve been able to appropriate for our own use to treat viruses.

I find it amazing that viruses, which are supposedly “simpler” aren’t more vulnerable.

But thinking about it, prions are even simpler and have no know treatments.

This demonstrates, then, that complex systems can be quite fragile.

That's WHY they're less vulnerable. Less complexity reduces the attack surface. With microbes, there are lots of ways to disrupt their biological processes, but viruses have fewer attack vectors, making it difficult to target them.

Acyclovir definitely seemed to help when i had chickenpox!

"It can treat herpes virus infections, including shingles and genital herpes. It can also treat chickenpox. This medication does not cure herpes, but may prevent herpes sores or blisters."

How come that not wanting to risk getting STDs or HIV infection is considered a negative thing?

If we can effectively make HIV non-transmissible then it shouldn't take very long to wipe the virus out (or at least come very close) and the stigma will no longer apply.

The cure seems to be decades in the future though, so I don't really see an alternative to pushing for both.

That is, an individual that is "undetectable" (formerly HIV+ but underwent treatment so that the viral load is not detectable) is still viewed as a potential source of HIV transmission, despite assurances from the medical community that an undetectable load is unlikely to be a source of transmission.

Is it wrong for potential partners to want to know if someone carries any sexually transmitted virus (HIV or otherwise)?

Is this basically just saying trust the opinion of the current medical establishment?