If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.
Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
You may be thinking of STD tests and bloodwork that is done every 3-6 months depending on your risk level to ensure that you're still HIV negative and that your kidneys are functioning normally, as kidney issues is a rare but serious side effect, especially for Truvada.
Now, what I believe is correct is that most people on PrEP would love to have a vaccine instead of needing a daily pill or even 2-6 injections per year as long as they remain sexually active.
Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.
Why haven't other countries stepped up to address this pressing need? I'm sure every other western nation could easily chip in collectively to cover the roughly $34B budget USAID had. Or do they just not care about these millions of people apparently sentenced to death?
The problem is money doesn't build supply lines overnight. Nor does it hire experts both locally and globally and get them there. Much of the data collected on patients by USAID can't just be handed over to another government for a myriad of privacy issues. Patients then have to know that their old clinic no longer exists and they have to go to a new one (is it in the same village anymore?). In the meantime viral counts go up, people get sick, infect their partners or newborn children. You can't just "pick it up later" without causing real harm.
> or do they not care
Do we not? Why can't we care, why is it now someone else's problem because Musk is still mad Mandela was let off of Robin Island?
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors
- people need to make the right decisions to take HIV vaccines
We are comparing two tools, not tools versus discipline.
In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.
They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.
An effective vaccine that lasts years would be much more convenient.
Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!
1. Some people don't use tools. (For instance, we have spellcheckers, but people don't use them or ignore them.)
2. So of what use is another tool? (Why develop a grammar checker?)
See the problem? For the people who do use tools, there are useful differences among them. Some users of spell checkers will welcome the grammar checker.
Some of those who would use drugs to prevent transmission will gladly switch to the vaccine, which is more convenient for them.
But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
Sometimes when you add a different tool to the arsenal, non-users of the tool arsenal come around.
E.g. lots of DIY tinkerers use USB oscilloscopes, who have never owned a big one. The invention and marketing of the USB scope turned them into users. The vendors of that could have axed the idea by saying, what's the use of this idea: we already have oscilloscopes? Those who don't have them already are not going to be interested in this.
There are right tools for the right job, but also the right tools for the right people in the right circumstances.
This isn't quite the right analogy, because a vaccine doesn't do something different from PrEP, it just does it in a different way. At the individual level it might make a compelling case (but more of that in a bit), but for the systemic purpose of eradicating the disease, not so much; not until it's given out during childhood like other vaccines.
>But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
The fact of the matter is, HIV is a shitty virus, by which I mean it's an inefficacious one. It has a bad spreading mechanism and it has effects that are too severe and too obvious. The reason people ignore those drugs (besides them being expensive) is that HIV is so rare, and there are overall better methods to avoid catching it. So most people will likely never have sex with a carrier, and of those who would, most will already be using condoms. Among this latter group, I don't know that a vaccine is that compelling. HIV is not the only infection you can contract from unprotected sex. If you have a stranger in front of you with whom without a vaccine you would have used a condom, would you have unprotected sex with them after having been inoculated? While it might make sense to get the vaccine anyway as a second layer of defense, in all likelihood it won't have any effect on your personal safety.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 20-39 prime reproductive age cohort for those seeking it.
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person.
HN Search: lenacapavir - https://hn.algolia.com/?q=lenacapavir
US Government Overhauls Teen Pregnancy Program to Focus on Marriage and Starting Families - https://www.nytimes.com/2026/07/22/us/politics/teen-pregnanc... | https://archive.today/ - July 22nd, 2026
Teen birth rates hit another historical low in 2025, CDC says - https://www.npr.org/2026/04/09/nx-s1-5777587/teen-birth-rate... - April 9th, 2026
Private Money Saves Colorado IUD Program As Fight Continues For Public Funding - https://kffhealthnews.org/health-industry/private-money-save... - August 27th, 2015
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
My argument is simply that new tools are great, but it's not what's going to solve the HIV problem. Distribution, cost, access, stigma, etc are the larger problems to deal with. (We need to solve all the reasons why people aren't using the existing tools)
they make the experience measurably worse for a maybe insurance.
I don't know what fixes that reality other than (maybe?) mass-traumatizing youths with stories and photos of STI/HIV victims, essentially scaring them into wearing a rubber at the risk of scaring them out of sex entirely.
... which is why a vaccine sure would be nice.
Condoms? They break. More frequently than you might think.
Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).
Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.
A vaccine is the only real option for dealing with HIV for good.
I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.
> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.
It's quite sad and difficult to read at times.
Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.
Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.
They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.
TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework.
if you feel the urge to fight this: i lived with someone infected with TB.
e.g. measles is shockingly infectious. TB is not.
In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).
If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious.
If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio.
Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does.
I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt.
> i lived with someone infected with TB.
If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.
re eradicating measles: the terrain is much more complicated than presented. first, because the vaccine fades away, and without measles spreading in the young population, adults don't get natural reminders, and eventually there can be a big wave without poking everyone. and the disease is much more dangerous for adults. and all this unnecessary trouble for a disease that is not really dangerous when left alone and the population is not malnutrished.
and there's that cancer thing with measles, just to shed some light on the complexity:
MEASLES: Albonico et al found that adults are significantly protected against non-breast cancers — genital, prostate, gastrointestinal, skin, lung, ear-nose-throat, and others — if they contracted measles (odds ratio, OR = 0.45), rubella (OR = 0.38) or chickenpox (OR = 0.62) earlier in life. [Med Hypotheses 1998; 51(4): 315-20]. https://www.ncbi.nlm.nih.gov/m/pubmed/9824838/
MEASLES: Montella et al found that contracting measles in childhood reduces the risk of developing lymphatic cancer in adulthood [Leuk Res 2006; 30(8): 917-22]. http://www.lrjournal.com/.../S0145-2126(05)00466-2/abstract
https://www.ncbi.nlm.nih.gov/m/pubmed/16406019/
MEASLES: Alexander et al found that infection with measles during childhood is significantly protective — it cuts the risk in half — against developing Hodgkin’s disease (OR = 0.53) [Br J Cancer 2000; 82(5): 1117-21].
http://www.nature.com/bjc/journal/v82/n5/full/6691049a.html
https://www.ncbi.nlm.nih.gov/m/pubmed/10737396/
Measles to the Rescue: A Review of Oncolytic Measles Virus. MV Clinical trials are producing encouraging preliminary results in ovarian cancer, myeloma and cutaneous non-Hodgkin lymphoma, and the outcome of currently open trials in glioblastoma multiforme, mesothelioma and squamous cell carcinoma are eagerly anticipated. Aref S, et al. Viruses. 2016.
This is factually untrue.
Being poor does not equal a HIV transmission rate. There is no 1:1 correlation.
A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom.
Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female.
The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk.
Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.
I did not use drugs.
"I share needles because I can't afford my own" is an INSANE take. Don't shoot drugs in the first place! Poor people are normal humans, they have willpower, agency. It is a rich people myth that poor people are cattle, devoid of any chance of doing the right thing.
It is culture, behavior, social norms. Being poor does not force you to abandon the nuclear family, does not force you to engage in criminal acts. (there is reverse causality though)
In the early 1960s South Korea had a per capita income lower than those of Haiti, Ethiopia, and Yemen, and about 40% below India's. Did all South Koreans become heroin addicts with HIV?
like insulin? should a diabetic skip the insulin? In poor countries I wouldn't be surprised if the majority of HIV infections are not as preventable as you're imagining.
You can moralize, but even if only 10% of HIV infections are unavoidable, you're not contributing to solving the actual problem. (And by unavoidable I mean, unavoidable without investing in more needles, better sanitation, or prophylactics that the people "responsible" cannot afford.)
you don't have to care about the drug users at all. even if you treat them as pests rather than humans, we frequently vaccinate pests for public health measures. pathogens will spill over to populations you do care about, they'll create a drain on the healthcare system, they'll harbor other opportunistic infections. it's not sanitary.
this is completely leaving aside that some drug addicts can and do turn their life around, and that HIV is a horrible illness nobody should have to deal with, even if it's "their fault."
Not having sex and not doing drugs isn't any sort of "right thing" other than because sex and drugs are dangerous. If sex and drugs were less dangerous (or made not dangerous at all) there would be no reason to tell people not to do them.
The wealthy use drugs and have sex all the time. They just have clean needles and nice doctors. You've completely bought into the moral explanation for poverty - which is that moral decay causes poverty, but poverty does not cause moral decay. But you think that this is a defense of the poor, rather than a defense of the exploitation and contempt for the poor by the rich.
The poor are not worse than the rich even if they do drugs, have sex, or swear on Sunday.
I’ve got bad news for you about methamphetamine in postwar east Asia
This is not a celebration of human agency. When people are treated badly, they behave badly. It is completely irrelevant that you were treated badly and happened not to behave badly. People are far too complex for you to say "well, we got treated the same, we should have behaved the same".
Your comment makes it seem like a key factor when it’s not.
Forecasts to 2030 expect sub-Saharan Africa to continue having the highest incidence rates of both HIV and other STIs of any region.
How come a specific region of the globe has this issue? "Poverty"?
Many regions in India are poor. Afghanistan. Pakistan.
Love the science based debate here, btw, thank you all for the downvotes. Facts, not feelings.
Of course, and for good reason. The ones who know for a fact they are right, might in fact be wrong or malicious.
This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.
1. The drop is fertility is bad for society
2. The drop in teen pregnancy is good, despite it's contributions to 1
3. We should try to fix 1. without undoing 2.
That's not something typical outside of that one particular group, nor can you copy-paste that anywhere else.
I think in fact it's the opposite. Because of how universal below-replacement rates are in EVERY developed nation, it shows just how independent it is from factors of culture, economics, environment, etc. It takes a seriously unusual situation like the one in Kiryas Joel for below-replacement to not be the norm.
They want married teen pregnancy. By their own admission.
Of course, Israel also has a nearly identical rate of secondary and tertiary educational attainment to other OECD countries so I’m not sure that makes the argument against education.
The one thing you can do to stop teenage pregnancies is for example to educate young girls, give them menstruation support and allow them to go to school. This effect dominates vs "oh I can't put my kid in private school" that we say is the reason for no kids.
I fully believe that HIV wouldn’t exist if PrEP had come out in the 80s when public hysteria was at an all-time high and the will to eradicate it was present.
If new generations are not also given the vaccine, it will eventually return.
Probably the same with HIV, although I could see it being somewhat more difficult for that to make a resurgence. If we inoculated the entire human race against it, it could possibly eradicate HIV for several generations, if not permanently.
Either they evolved from a different human virus, or from an animal virus.
Measles for example evolved from a livestock virus called rinderpest and lost the ability to infect cattle as it became a specialized human virus.
You mean the time the US admin was intentionally neglecting the epidemic because "it's a gay disease"? Why do you think Reagan would have done anything to ensure such a medication was easily available?
At the risk of derailing this conversation from the original topic, those two things are not remotely equivalent. There's no organized political movement trying to tell people that seat belts and speed limits are immoral, and you should only drive when you're willing to accept the responsibility that comes with the risks.
And my two examples are completely arbitrary because my point applies to pretty much any problem which would be solved by people being “more careful”.
So, political/religious elements aside, teen pregnancy and road safety are the same in terms of “if people were just more disciplined, there would not be these problems” (i.e. if teens who have easy access to contraceptives planned ahead before giving into impulsiveness; if drivers were more attentive to their behaviour), which I then pointed out is naive because the reality is that people aren’t perfect, they aren’t always disciplined, we’re all only human.
Hence, we need other solutions to help with problems which don’t require ignoring that people are only human and lack perfect discipline.
I agree that some organised movements can be a problem in that they can make other problems worse.
Trying to handwave away the things we know work to prevent teen pregnancy as "just be careful" feels overly reductive, because it's way easier to do correctly than managing to drive without ever having an accident.
In South Africa we have 12,000+ road fatalities a year, by comparison Australia (renowned for strong law enforcement) with about half of our population size has 1,200 or something. (And they apparently happen to have about 4,500 teen pregnancies a year.)
Australia’s (or maybe it was New Zealand’s which I visited on the same trip) road safety campaign is called “Towards Zero”, while South Africa’s is called “Arrive Alive”.
A big part of the difference in fatalities is that Australia has much better general law enforcement (such that a lot of foreigners complain about it), while over here it’s dismal with Arrive Alive’s strategy seemingly being to always do the same thing as last year’s holiday season except with “trying harder”, while largely ignoring day-to-day traffic offences.
Due to the high chance of being caught for transgressions, Australians tend to way more often stick to the rules of the road, while over here there is horrendous amount of (to put it politely) shenanigans happening almost all the time.
And the impact of this difference in discipline shows in the above stats.
Years ago now, but my now wife spent 10 days in intensive care after a minibus taxi driving on the wrong side of the road head on collided into the car she was a passenger in. My wife was fortunately in a car with good safety features and had a medical aid plan allowing her to receive some of the best care possible in the country, but I’m doubtful that the mini bus taxi passengers (who tend to be in the poor class of the population) sent to public hospitals received care anywhere near as good, I think I heard after this article [1] was published that two people died.
Perhaps road accidents, or at least fatalities, can be reduced more than you realize.
[1]: https://www.citizen.co.za/northcliff-melville-times/222787/2...
Perhaps road accidents, or at least fatalities, can be reduced more than you realize.
I've always found this misunderstanding fascinating; it touches on the physical reality of sociological laws, the origin and purpose of morality, as well of course as supporting in part the modern political divides.
Also, I’ve found that when asked about the risk of something, most people believe that bad things only happen to other people (who also believed that, until it happened to them).
I rode in a lot of cars when I lived in Eastern Ukraine, 9/10 times or more the seatbelts had been removed or tucked behind the seats and not intended to be used. I got some very funny/annoyed looks when I first arrived and dug around in seats looking for a belt.
There's no need for a political movement when you already have the thing (no seatbelts).
Campaigning against _contraception_ feels like pretty much a dead issue, at least here; you just don’t see it anymore.
You two might be using "discipline" pretty different. Your definition of discipline would encompass constant casual sex as long as contraceptives were used and any abortions were prompt, right?
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
Source: https://www.doctorswithoutborders.org/latest/campaigns/acces...
It... was, until Musk dismantled USAID and Congress defunded PEPFAR.
So many comments by people who have never stepped foot out the Global North making wild assumptions.
PEP remains largely free in SSA post-USAID/PEPFAR cuts.
1. Know you were exposed (many many many people don't know they're HIV+)
2. Have the means to go to a clinic within 72 hours
3. Have the social capacity to go to the clinic safely (in many parts of Sub Saharan Africa doing so would insult your partner)
PEP is an emergency drug, not a prevention at all.
> I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Cure" in the sense they could become indefinitely under detectable levels. It's worth noting that to really cure a person of HIV you'd need to remove all mutated cells.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
If your drug has an elimination half-life of 1 day, then it takes about 4 days to reach the steady-state concentration if you take normal doses. With the loading dose, you immediately reach it.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
Yeah, me. What a wild statement to make. It’s a big world out there, my friend.
The word likely doesn’t make this argument any less dumb
Anecdotally, very much so - at least among the gay/MSM community.
The thing is, people generally quite like having sex. That comes with some level of risk, which can be mitigated in various different ways - and PrEP is one of those tools.
All humans engage in some level of risky behaviour; evidence suggests that moralising about “responsible behaviour” or “self control” is rarely effective at mitigating that risk.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
Maybe it isn't worth it for you in the end after that conversation, but we should also not assume that the only way you get HIV is through "risky" behavior. That is irresponsible.
At least you would know it's an option and you can make the decision yourself, I know a lot of straight people that do not know prep exists because it just isn't talked about. Or maybe they have heard about it but they don't really understand what it is. That is a problem.
Through cost plus a month's supply is $14 (which means without insurance): https://www.costplusdrugs.com/medications/emtricitabine-teno...
Yes there is the additional costs of the tests on top of that, but people should already be doing regular STD testing if they are sexually active.
Regardless, nothing about that changes that you should still be having this conversation with your doctor if you are sexually active. I do not understand how this is an argument, a conversation about prep or doxy should be in the same conversation about condoms and your general sexual health.
The worst that is going to happen from that conversation is that you don't take it, but at the very least you are educated on its existence and that decision is made between you and your doctor based on your risk factors.
Edit:
In fact, the CDC backs up this opinion: https://www.cdc.gov/hivnexus/hcp/prep/index.html
> Inform all sexually active adult and adolescent patients about PrEP.
> Prescribe PrEP to anyone who asks for it, including sexually active people who do not report HIV risk factors.
Yes, it's the exact reason that it is widely available on the NHS. 20,000 people took it, adherence was high, HIV rates dropped significantly.
> Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place
Shaming people has been tried for centuries, maybe millennia and famously _does not work_. We have ample evidence that PrEP does.
Er, I mean, a decent portion of gay men in the developed world, honestly. (I say this as a gay man in the developed world.)
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal.
Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV)
The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.
Condoms break. Partners lie. Shit happens.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
But I guess that sex without condoms is worth it, right?
And doxycycline is a PEP treatment, not a PrEP treatment; respectfully you should probably take a step back from conversations where you obviously aren’t informed about the basics.
Regarding PEP/PreP, Doxy has been researched and shown effective as PreP as well:
https://www.sciencedirect.com/science/article/pii/S120197122...
I have met doctors that recommended it to gay men, which is why I mentioned it.
Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
Vaccines are the "an ounce of prevention is worth a pound of cure"
Which countries are you talking about out of curiosity?
This doesn't cover all the reasons
The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.
https://www.tumblr.com/squareallworthy/163790039847/everyone...
I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
The distinction is that a vaccine will train your immune system to actively destroy the foreign body, while a prophylactics might just prevent it from spreading or taking hold to begin with.
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
The only reason we haven't eradicated TB is because we've failed massively in getting the vaccine to people in the poorer parts of the world. We could eliminate it just like we did smallpox, the only barrier is actually doing the damn thing. It is made more difficult by the fact that it has a rather long latent infection time, but again, could be solved by vaccinating everyone.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.
An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?
Asking here because I don't know, and I think an answer might help others know, too.
(And to clarify, I genuinely don't know, and I'm asking from a supportive POV.)
But being HIV+ is simply having a virus, not actively dying. HIV+ status also never clears - later tests that are “negative” mean your viral load is undetectable, at which point you can no longer transmit HIV to others. Undetectable = Untransmissable.
"These antibodies are very, very rare, but they can be found in blood samples from a small number of people living with HIV.
The vaccine causes the immune system to produce more of these "broadly neutralizing" antibodies.
* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Thanks for your earlier answer. I know this specific infection has lots of difficult history. It’s hard to formulate my questions without sounding suspiciously close to a sea lion or something, but I sincerely want to know. And yes, I could google it but then it wouldn’t be an interesting conversation, or one others could read and learn from.
Yes. HIV+ patients require antiretroviral treatment for the remainder of their lives. Most are able to manage with a pill regimen. This is not to say it is cheap or side effect free, but most HIV+ people are able to live normal lives with outpatient support.
(To link it back, PrEP is the same drug used to treat; ex, emtricitabine + tenofovir. Dosage, schedule differs. Other antiretrovirals may be chosen.)
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Public health does talk about Inflenza (and other viral positive) individuals. Public messaging is usually with the term “carrier” - but in jargon, this implies that the individual will likely mot develop the disease themself, and will remain asymptomatic, which is untrue for HIV. NCoV-19, recently in the public eye more than any other virus, has a lot of literature around positive tests vs disease.
2. OK, fair point.
Thanks for the info! I know HIV isn't exactly "no big deal" today, but seeing it go from "you're certain to die" to "it's annoying to have to take medicine forever" is still a wonder of modern science.
Generally if you have the influenza virus, you’ll also have the disease that that virus causes. This is true of most viruses. I’m not sure any other virus does the “undetectable and untransmissible, but still _there_” thing; generally, if you get viral load to undetectable for most viruses, it will go away entirely. HIV is unusually good at dealing with the human immune system.
That constant low level stream of HIV viruses in your body can cause the virus to return at any moment you stop the therapy. So you have to take daily pills for the rest of your life to stop that stream from exponential growth and killing all of your immune system.
The last part is what is referred to as AIDS: your immune system is so weak that even the simplest pathogens can kill you, which they usually do once you reach AIDS stage.
There are a couple of viruses that can lay dormant in you and cause problems later on. Many of them insert themselves into the DNA of long living cells.
Without therapy, HIV will progress to AIDS in a couple of years in basically 99.9% of patients. Some very rare cases are known where HIV patients survive without getting AIDS and therapy, via broadly neutralizing antibodies. But again, less than a tenth of a percent. Everyone else would die without a therapy.
Being HIV positive isn't a death sentence, if you take your meds (and started taking them early after HIV infection) you can live for as long as someone who isn't HIV positive. In fact studies show that the effect of regularly going to a doctor and getting your blood checked actually improves your life chances. HIV positive people can do 99% of the things normal people can, although they are not allowed to donate blood (for good reason).
Having AIDS though is a major impairment and you are on your way to death at that stage (1-3 years to live). So it makes sense to distinguish the two.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
We live in a messy world.
The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:
https://www.theatlantic.com/health/archive/2019/04/dental-da...
https://slate.com/human-interest/2021/08/no-condoms-gay-sex-...
https://www.washington.edu/news/2024/02/27/qa-decline-in-con...
https://www.huffingtonpost.co.uk/entry/prep-condoms-gay-sexu...
At least a portion of the amount of people "in the closet" are closeted for fear of STDs, not particularly because of social stigma risk.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
It's wired into our DNA to do this, and while we can be socialised out of it, you'll never get anywhere close to the near 100% you'd need.
And AIDS is not considered a death sentence btw. It's not the 1980s
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
It doesn’t work. Change your mind.
Getting tested is great practice, but you can’t rely on partners being diligent or consistent with that for your own safety.
If compliance with safe sex techniques were anywhere close to where it should be, this wouldn't be a problem.
Yet here we are, needing laws, cops, vaccines, and so on. Asking people to only have absolutely safe sex due to its external effects is about as useful as asking them to stop eating meat due to its external effects.
either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.
A vaccine is an objectively better solution than PrEP, just because of the time scale, PrEP needs discipline on a daily or x-monthly basis. A vaccine could last for years. Although, realistically, it's more likely to end up requiring yearly updates like COVID, because HIV is also a mutating son of a bitch.
I 100% agree that waiting for a vaccine is stupid beyond measure. The world should do both: make PrEP widely available AND keep funding vaccine research.
I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.
But of course it should be available to all that need it.