Poorly. I want to improve aerc in this respect. For the time being, I use a mix of my braille reader (brltty) and piping emails into vipe so I can use my vim plugin to read them.
I can understand that. I think many of us have just accepted that it has to be this way, because we're a minority and we want to have all of the advantages of using mainstream applications (economies of scale, active development, not being at an extra disadvantage compared to sighted peers, etc.).
Of course, you don't fit the profile of a "mainstream consumer" when it comes to computers. In particular, I gather that you take full advantage of the hackability of free software. So using custom TTS plugins as opposed to a clunky generic screen reader is just an extension of that overall approach to using computers.
Even 20 years ago the limitations of those options were clear to anyone who was willing to face reality. I was in denial for a while. (Note: I have limited vision, but I spent a lot of time helping blind people use Linux back then.)
Of course, Lynx and Emacs/W3 aren't the only alternatives. I think an interesting option would be a specialized browser UI based on headless Chromium.
In any case, I'm guessing Drew won't give up his free-software ideals easily, if at all. And he's a capable enough hacker that I'm sure he'll come up with a solution that works well for him.
I've found that, counter-intuitively, a fully accessible GUI program with a good GUI screen reader is easier to use than a screen-oriented terminal program with a screen reader. The trouble with the latter is that the user has to understand visual concepts like highlighting, the meaning of special characters, etc.
Of course, an application or plugin that's tailor-made for doing a particular task with speech output is better than either of those other choices -- as long as you don't have to use an application that's overall inferior (e.g. using the Emacs/W3 web browser with Emacspeak as opposed to a mainstream browser).