>I honestly don’t know why everyone who is sexually active isn’t on PrEP

Side effects. People generally don't like to take drugs to prevent things if the chances of acquiring the illness is minimal. For example, if we had an approved vaccine for Malaria, we wouldn't just give it to everybody in the USA, and even if we did, many would not take it.

I had a physician explain that you need to treat the whole person (ie. address symptoms, serious issues, anything demonstrably problematic) because otherwise almost every person could be diagnosed with something and prescribed medications for. If you look for physiological abnormalities, you’ll find some. It’s why he said doctors discourage loading up on useless tests for no reason.

And then you risk creating more side effects in an otherwise healthy, complaint-free person.

A for-profit healthcare system wants this. Which is probably why the States medicates and prescribes so much more compared to other regions.

Small correction: PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are both protocols for using drugs to prevent infection. You generally take PrEP drugs every day if you think you're in danger of being exposed, or alternatively take PEP if you think you have been exposed to HIV without any kind of protection, sort of like a morning after pill (but every day for a whole month).

Something I learned today: PrEP also works "on demand", so for some people it may not be necessary to take it every day.

https://www.aidsmap.com/news/jul-2020/demand-prep-highly-eff...

> ...sort of like a morning after pill (but every day for a whole month).

Does this mean that there is a cure, but it only works if taken shortly after exposure (and for a whole month)?

It's a post-exposure treatment, don't think that qualifies as a cure. Same thing with the rabies vaccine, it'll only save your life if given before any symptoms occur (and the disease has entrenched itself in the body).

Not a cure, as that implies recovery from a full infection. It's preventing your body from becoming fully infected.

I agree in that no straight people (that i know) consider PrEP, although according to a quick search the HIV prevalence rate is twenty times lower in my country compared to the US.

Obviously the human brain statistician goes out the window when comparing a lifelong illness with a few hours of discomfort, but would it be generally safe/worth it to put the entire population on PrEP during sexual activity? I heard that HIV patients have noticable side effects with their meds.

As a person on PrEP, it is only recommended for people at higher risk of HIV. In the West, that does not include sexually active straight people unless you have other confounding factors (e.g. IV drug use, partners who are at higher risk, etc.). Essentially all gay men (or, more accurately, "men who have sex with men") are at higher risk, which is why it is recommended for them.

Gay men living in cities also have many more sexual partners than the rest of the populous.

The men I’ve met who have had 1000+ partners is exclusive to gay men. I’ve yet to meet a straight man who isn’t a celebrity that has gotten anywhere near that. Yet this order of magnitude (100-1000) is common among gay men.

The risk levels for your average young straight man in the west are obscenely low these days. You’ll have sex with maybe 10 people in your entire life if you’re a try hard. Chances are astronomically low for most straights - especially if you practice safe sex until both parties are tested and monogamous.

Straight people aren’t concerned because they’re simply not having that many sexual partners.

Less than 10% of all male HIV cases came from having sex with a woman. Yet men who have sex with women are 95%+ of the population. There’s a risk but it’s really low. And I think it’s even lower now with the ways things are going - straight male millennials and zoomers are having less sex than any generation before it that we know of.

A lot of this is grossly exaggerated and anecdotal, and actually rooted in homophobic tropes from the Reagan era so as to dismiss HIV as a “human disease” and instead condemn it as a “gay disease” that the LGBTQ+ had coming its way. The average US gay man has had no significant number of sexual partners more than the US straight man, and this has been backed up by study after study. Do you have actual sources?

http://www.medicalnewstoday.com/articles/82330.php

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936006

You know, let me link the whole Wikipedia article on this very topic: https://en.m.wikipedia.org/wiki/Promiscuity#Gay_men_(homosex...

Anyways, in absolute numbers now there’s more heterosexual people who are testing positive for HIV than gay people in the West (and it’s been the case globally for a while, too)

https://www.independent.co.uk/life-style/health-and-families...

I would also add East Asia (China, Japan, South Korea, Taiwan, Hongkong, Macao) to that list. The rate of HIV positive ("seropositive") status is still incredibly low. Ignore China for a moment because it is hard to believe any of their official gov't stats! These countries are definitely much more sexually active (more lifetime partners) than more socially conservative neighbors in South Asia (Indian subcontinent).

Interestingly, in these countries, there is still ready access to sex workers in any medium-sized city and above, yet infection rates are still very low.

I must confess: I wrote the above post strictly about heterosexuals. I have never read anything seropositive rates for gay men in these regions. (I write the last sentence with the assumption that gay women have a tiny risk to contract and spread HIV.)

More about "seropositive": https://en.wikipedia.org/wiki/HIV-positive_people

Well, in absolute numbers, recently heterosexual people are more prevalently diagnosed with HIV. Likely because they don’t know about PrEP in the first place, and then decided whether or not it’s for you. https://www.independent.co.uk/life-style/health-and-families...

It depends on the sexual activities undertaken.

HIV/AIDS is extremely rarely (maybe never) sexually transmitted in female-female intercourse. The CDC notes a "negligible" risk of transmission from sex toys.

HIV/AIDS is contagious through vaginal intercourse. Transmission is fairly low, though certainly not risk free, because most people aren't bursting blood vessels during typical vaginal intercourse. It does happen, though.

HIV/AIDS is most contagious through anal intercourse, and especially for the receptive partner. This is, as far as I know, regardless of the sexual orientation of the participants (presuming there's an actual penis involved and not a toy).

The CDC has data at https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

Long story short, it's probably not worth it for most people unless they're engaging in unprotected anal sex with people who have unknown HIV status.

>a lifelong illness

Another thing to consider is it isn't a life long illness anymore. It's a life long subscription to a drug which neutralizes the threat and lets you live an entirely normal life without any problems other than having to take the drug periodically forever.

Certainly not ideal but its not like you suffer illness.

I see the point but you could argue the same for nicotine dependence, diabetes, depression & anxiety, vision problems, allergies, etc.

Maybe you can't afford the treatment, maybe you have side effects, maybe you don't know you need it...

Most of these things the medication only helps some amount. For HIV it's meant to be 100% effective and makes it undetectable to testing. All active HIV is killed and only inactive HIV remains but inactive HIV doesn't harm you, it only seeds a new active infection.

And in most countries the treatment is funded by the government.

Because most straight people don't need it, risk is much lower. Truvada is nephrotoxic and that's bad in the long term, many drugs are bad if taken for long periods. Condoms have no such side effects.

Discovy is not, or much less so.

Truvada can be a bit hard on the kidneys. Before starting it you generally have to have some blood work done to check to see if you're likely to have issues, and at least for a period after starting it they usually want to do blood tests regularly to ensure the kidneys are functioning properly. So it's certainly not something that everyone can get.

Descovy appears to be better, but I think it's not approved everywhere yet.

'should be as common practice as wearing a condom and birth control, yet its existence isn’t even known to many people (especially among straight people).' - not sure if you've seen who HIV effects, but if it especially effected straight people in the west (straight people in africa know full well about it) they would know about it.