As a gay man well into middle age, whenever I get somewhat depressed about the state of human affairs, I think about the incredible improvements in AIDS treatment and prevention and I feel a little better.
It's hard for people who didn't live through it to really understand what a terrifying time the 80s and 90s were. First off, the general message of sexual education was pretty much "If you have sex, it's probably going to kill you." There's some hyperbole there, but not much. There was really no such thing as "sex-positive messaging", and even many years later it took me time to realize how much I had internalized "sex is a bad, dangerous thing". More importantly, though, is that an HIV diagnosis really was seen as a death sentence. If you're in your 20s, imagine a situation where tons of your friends had died, and there was an ever-present fear that you might be next. I honestly believe everyone who lived through that time in that situation has some level of PTSD.
So yes, there is still a lot to do as this article points out, but it is really amazing to see how far we've come. Even a lot of the issues pointed out in the article had less to do with technology and (honestly to my surprise) economic access than with shitty cultural practices (e.g. overall misogyny and men refusing to get tested). It's important to not lose vigilance, but I think it's also important to indulge in a moment of gratitude every now and then to all the warriors (both in the medical and research fields, and the many patients who lost their lives) who have accomplished so much for all of humanity.
I have spent my adult life in a community that experiences higher-than-average HIV/HepC exposure, and well remember the "Great Die-Off" of the early-to-mid 1990s.
To anyone that missed out, dying of AIDs is horrible. The West has the luxury of expensive drugs to treat it, but much of the developing world doesn't have that, and they are still dying like flies, with very little of the transmission happening through homosexual contact.
Africa has a big problem with that, and misogyny also plays into it, as the article mentions.
The thing that disgusted me the most, was the "Good riddance" attitude of many folks. I see echoes of that, in the Fentanylopocalypse, going on, now. As soon as Muffy and Biff start popping their clogs, though, it becomes a "national tragedy."
> The West has the luxury of expensive drugs to treat it, but much of the developing world doesn't have that, and they are still dying like flies
That's not really true, as the article points out. PEPFAR has really done amazing work lowering the HIV mortality rate in developing countries. And a reminder of who may keep this program from being reauthorized: https://www.washingtonpost.com/health/2023/07/29/pepfar-aids...
> but much of the developing world doesn't have that, and they are still dying like flies,
Fortunately life expectancies are steadily rising even in the African countries hardest hit by HIV. Eswatini for instance has over 25% of the population HIV positive, but the life expectancy is now up to around 60 years (it was around 40 two decades ago), only 5 years behind Pakistan.
I feel like that “good riddance” attitude is a left over from an earlier time in human history. When the struggle for resources was life or death, and the survival of your community sometimes meant going to war with another community and killing other human beings, it was probably extremely useful to be able to mentally put those other other humans into a “not people” category. Now we’re living in a different world where survival doesn’t work like that anymore, but we still have the machinery in our heads that wants to classify The Other Group as less than human.
I am afraid to ask but what is similar between AIDS and Fentanylopocalypse? Surely no one choses to get HIV. Surely drug usage is a choice once made. What is the link between the two I am missing here?
If anything, people hate addicts, even more than gays, so there's a significant portion of the population that celebrates overdose deaths; just like they danced with glee over gays dying of AIDS.
But these days, people are lacing pot with fentanyl, so when Thurston Howell XIV smokes a joint at a Harvard frat party, he might well be dead, by the time he hits the floor.
The article mentions that women are afraid to take prophylactic treatments, because their husbands/boyfriends will take umbrage. It's not uncommon for men to have multiple sexual partners, and transmission is often accomplished that way.
There's also a fairly pervasive problem with sexual violence. Women tend to bear a lot of the pain.
There's something so morally depraved about punishing someone for insisting on protecting themselves. It really is unspeakably and irredeemably evil in my view to insist someone disregard their boundaries so thoroughly that they leave themself open to a lethal devastating virus just to satisfy someone else's ego in tandem with their nihilistic desire for short-term gratification.
Thanks for sharing this. One of my major motivations when I was in high school- around the time that AIDS was starting to grow rapidly, was to go into drug discovery to find medicines that could cure HIV infection/reduce the impact of AIDS on patients.
At the time (about 5-6 years later) we were working on reverse transcriptase inhibitors, which I think eventually turned out to work pretty well as an early treatment. But boy, was the process slow... decades of basic and applied biology... to get where we are today.
It's so painful to watch COVID vax deniers today because it's hard enough to stay motivated over long periods of time... but when people just sort of crap all over the important scientific and medical work to get to where we are, it reminds me of some of the aggressive groups, such as Act Up SF (which actively fought against the establishment, including Fauci, who was a critical ally to HIV-infected patients at the time): https://www.nytimes.com/2022/12/31/opinion/anthony-fauci-hiv...
Part of it is literally seeing the ladder being pulled up just as we reached for it. Not just for jobs or college tuition, but also sexually -- the previous generation had a pretty good time and the worst that was on offer was herpes. Puberty starts rumbling around and we're wondering what the future looks like and suddenly "GRID." And we were flailing around, is it viral? (There was, most people do not know, a period wherein it was thought that this was some kind of weird immune reaction to getting semen, any semen, into the bloodstream, which seemed unlikely to me even as a tween) How transmissible is it? Okay so maybe kissing doesn't do anything. And by the time that we figured out that it isn't exactly Ebola in terms of transmissibility, some damage was done.
So, Sex = Death, rain is acid, the bees are coming, the nukes will eradicate us all. Gen X has been waiting for the other shoe to drop for decades and AIDS was just one facet of it.
There's this idea that every generation bitches about the generation that comes after it, but I submit to you that every generation apparently also has people in it that see themselves as a special victim, as if the generations that came before it didn't also have their own challenges.
I point out that the eighties got so bad that George Michael, known mostly for writing happy celebratory songs, very nearly released a 'whole world is going to end' song in 1990's "Praying for Time"
It's hard to love / there's so much to hate / hanging on to hope / when there is no hope to speak of / And the wounded skies above / say it's much too late / So maybe we should all be praying for time.
They released that on the radio, it went to #1 on the Billboard charts, and stayed on the charts for 10 weeks. All while the First Gulf War was starting. Which he wouldn't have known when he was writing it.
That's not true. Both can cause infertility in women. One of my friends is an ob/gyn and they say that one of the saddest parts of their jobs is telling a couple that the wife is infertile because of an STI she contracted (almost always Chlamydia or Gonorrhea) at some time in the past. Both of these STIs can go undetected in females for years. They just don't have any outward symptoms. By the time they find out, it is too late.
It's the detection that is the problem. Ideally people will get checked regularly, but with the state of healthcare in the USA, we know that does not happen.
Herpes is permanent. While there are some stubborn antibiotic-resistant versions of the other two, they weren't that bad back then. So, yes, herpes is the worst thing.
Except, there is limited evidence that Herpes causes infertility in women while the other two definitely cause female infertility. I'd say the other two are worse since they often go undetected in women until the damage is already done.
They are treatable if a person knows they have it, but they often go undetected in women. Women often have no outward symptoms and by the time they are diagnosed, the damage is done and they are infertile. This is permanent damage that is devastating news to couples trying to get pregnant.
Except, we all know that doesn't happen, mostly because of the state of healthcare in the USA. My brother got colon cancer, so I tried to get a colonoscopy (I'm over 50), they refused unless I saw a primary care doctor first, well the first available appointment was 6 months out. After that I got a colonoscopy appointment, another 6 months out. Ridiculous reality.
One Medical makes it easy to get tested for STDs; it's not a colonoscopy, which is a specialist procedure. Looking at my app, the next available appointment with my PCP is two days away, at which point she'll put in a lab order. I go down the hall, they draw blood, and I give them a urine sample, and a few days later I get a pdf of results in the app.
Not just for my own peace of mind, but potential partners have asked to see it in the past. Different cultures I guess. ¯\_(ツ)_/¯
I think there are plenty of problems with US healthcare, but I don't think this is one of them. Standard of care in the US is to get screened for STDs at least annually for sexually active people, and more frequently depending on your risk factors. Being on PrEP involves mandatory testing for STDs every 3 months. There are also tons of free clinics where people can get checked for STDs.
One of the (younger) queer creators I follow posted about how they'll occasionally stumble upon pictures of the famous "NO OBITS" newspaper headline[1], and feel a surge of hope for our species.
I suspect you've blotted out some of the worst of the early years, when lots of people didn't understand that it could only transmit through bodily fluids. People were afraid of the idea of being in the same room with someone with HIV. We had education campaigns about this. PSAs. Character arcs in prime time TV shows. Maybe that period was short in California, but it was spread out over years in the midwest.
I'm not convinced that the trauma of Covid for some adults wasn't re-experiencing the trauma of the AIDS epidemic. Here's another scary disease and we don't know how it's communicated and it's killing people and ruining their lives. Will it still be killing people in ten years? Ebola and a few others threatened to do the same, but they never actually arrived.
Aids is definitely the strongest sexually transmitted virus out there. But don't you think that there will always be sexually transmitted diseases associated with promiscuity? Not to say that aids is only transmitted through promiscuity, but superspreading is highly relevant.
It is my understanding that gay people have more sex partners than than straight people, so it's likely that these diseases will disproportionately affect gay men.
I think that limiting amount of partners is a vital part to combating sexually transmitted diseases, and that some people will have sex until they encounter the physical limitation of STDs. Not sure "sex-positive" messaging is quite helpful in this sense.
The difference with AIDS is that AIDS at the time condemned you to a slow, horrible, visible decline, in which your death was celebrated via a radio talk show host that at the time had an entire regular segment to name and mock the people who died.
Like, this doesn't apply to people who get cervical cancer from HPV or other similarly tragic outcomes of acquiring an STD. The cruelty on the scale is way above anything.
As painful a read as that was, I think it's really important to understand what the social norms were at that time. Thousands of people had died and the reaction, not just from the press secretary but from the press pool at large, was to laugh and joke. Really the only widely socially acceptable response to even the mere thought of gay male sexuality was complete and utter disgust. If you were a man, to not express disgust at this thought opened the door to "you might be a fairy too", which is why you see so many of these displays of "the banality of evil".
Unfortunately you're buying into a lot of propaganda that persists to this day.
Straight sex workers exist. Given straight people outnumber gay people by (let's say) 10:1, there is almost certainly a higher absolute number of straight promiscuous potential superspreaders than there are gay ones.
Even in the middle of the bell curve, nearly 50% of American babies are born to unmarried parents, so it's not like strict monogamy is the norm among straight people [0]
The reason that HIV transmitted so well in gay male populations is because receptive anal sex has a 20x higher likelihood of transmission than receptive vaginal sex and a 40x higher likelihood of transmission vs. insertive sex.[1]
Within the gay community, you have plenty of men who engage in that relatively high risk act of receptive anal sex, who then go on to be the insertive party in another interaction.
Within straight populations, the potential spreaders are just much less likely to contract HIV in the first place.
Sorry to be so specific about something sexual, but I have always found it odd that this very practical information has not been put into the mainstream. I guess it's the imperfect middleground - people who want to shame gay men don't care about the data and people who support gay men don't want to stigmatize receptive anal sex. But unfortunately, I bet it's led to a lot of needlessly risky behaviors.
>I think that limiting amount of partners is a vital part to combating sexually transmitted diseases
It's much more important to have safe sex. Condoms and PrEP work.
Every thread on HN about HIV/AIDS seems to attract at least one person who feels obliged to say something about how promiscuous gay people are. I don't think these comments often come from a good place. (For example, you have previously made a rather insensitive joke about 'pozzing' on this site.)
I was super impressed when I went to see my PCP for my annual physical and when I mentioned I'm non monogamous (which apparently triggers a diagnostic code for "high risk sexual behavior") she said, "We can put you on PrEP if you want, just to be sure. Cheap insurance." Cheap insurance indeed.
It's really amazing how much that attitude has changed in a decade or so. I asked my PCP at the time (and this was the last time I saw this doctor, FWIW) about PrEP when it was relatively new, and basically got a "I don't want to encourage dangerous behavior" lecture.
> Every thread on HN about HIV/AIDS seems to attract at least one person who feels obliged to say something about how promiscuous gay people are. I don't think these comments often come from a good place.
Just the one? If only.
Every time there is a story on HN that is even tangentially related to either HIV or LGBTQ+ sexual health, it inevitably devolves into a morass of misinformation and thinly-veiled homophobia. There are different degrees of it - some is presented in a more "civil" veneer, which helps it stay upvoted, but at its core, it's all coming from the same place.
Public health professionals who specialize in HIV and LGBTQ+ sexual health are actually pretty unanimous in their position on this topic, but somehow that never sways these folks (which should be a pretty good sign that they're not arguing in good faith).
Knowing what public health professionals think about this topic is pretty much table stakes for being able to make any sensible kind of contribution to the discussion. Otherwise it is like arguing the finer points of Rust lifetimes with people who couldn’t write ‘Hello World’ in Python.
In this case I think the relevant position is widely known. Supporting people to have safe sex works, whereas shaming them for having more than some vaguely specified maximum number of acceptable sexual partners does not work.
HN isn’t the place to argue about public health policy in relation to HIV/AIDS unless you have something new or interesting to add to the topic. Literally every time this topic comes up on HN we have stacks of comments making the same repetitive talking points about gay male promiscuity. Quite apart from the rather odious and obvious agenda behind these comments (which surely don’t stem from any serious concern about gay men’s health), this is incredibly tedious. I might also add that your point, such as it is, has SFA to do with TFA - which is largely focused on Africa.
The reality is that they are generally more promiscuous and generally under worse circumstances.
This is a statement of fact, please stop mistaking it as a moral judgement that we need to fight against. You cannot help mitigate or solve a problem without accepting reality.
As someone living promiscuously, I'd say it's a correlation.
Some factors that lead people to a promiscuous livestyle also lead them to high risk behaviours, probably because they see promiscuous sexual behaviour also as risky and, in turn, desirable.
I met many that would frown upon condoms, but I also met many that would see them as no big deal.
I for one would count myself as risk averse, and got to that lifestyle through other motivations, and in turn, always ensured to stay safe.
The point I try to get across is to separate "promiscuity is inherently bad" from "sex can have serious negative consequences that you should appropriately plan for depending on your risk tolerance."
Another way to think of it: it's also highly likely that if you go to a crowded event that there are tons of diseases you can expose yourself to. Pre-COVID, people used to talk about getting "SXSW flu", e.g. with so many crowded events at SXSW it was nearly impossible to avoid getting sick. Importantly, at some times (obviously when there was a high prevalence of COVID), I think this risk is too great and crowds should be avoided. At other times, though, I think it's utterly reasonable to think that the risk of a cold or flu is worth it to go to a bunch of fun concerts. Nobody ever talks about "You know, there will always be a ton of dangerous diseases associated with concert-going, so you should always avoid them."
So when it comes to sex, I find it totally reasonable to adjust your behavior based on the risk at the time. Currently, e.g. for a gay man on PrEP, lets look at potential risks:
1. HIV risk is extremely low for those who adhere to PrEP.
2. Most bacterial infections can be cured straightforwardly with antibiotics.
3. The biggest risks are then (a) lifetime viral diseases, primarily Herpes, and (b) at this point, multi-drug resistant gonorrhea.
Thus, I think it's important to be aware of #3 and to take precautions, again relevant to your risk level, accordingly. What I don't think makes sense is to say "But you never know what could spring up!" That's true, but if you look at the recent monkeypox outbreak, I think a lot of people had the right approach: when the outbreak was publicized, many people (a) stopped or reduced their number of sexual partners and then (b) got vaccinated as quickly as possible.
The primary point I'm making is to disentangle the real risks associated with sex (and to treat them dispassionately) from the the moralizing around "you're a dirty whore if you have sex a lot."
Regarding concert going, I've certainly met people so risk averse that they don't join a concert mass outdoors, and a lot more that don't do so indoors. This is especially more common before important events like a trip.
That said, the respiratory route is very distinct from the oral, genital and anal route.
On a spectrum of frequency of contact, respiratory is the most frequent, then comes oral/digestive, then genital, and finally anal.
The more frequent and vital a route is, the more natural and artificial resources we can allocate to combat infections.
So infections spread by talking to each other, being vital, gets a vaccine developed in less than a year, and gets diverse natural antibodies.
On the other hand, a disease that spreads among adults who seek pleasure, will be allocated less resources, more so if it spreads preferentially through non reproductive sex.
Aids on the respiratory system would be fucking deadly, but my guess is that it would never spread there because there's more protection mechanisms, respiratory is like a process running unprivileged on an open port 80. Genital is port 22 and anal-genital is rdp or teamviewer with admin privileges on a server.
> but my guess is that it would never spread there because there's more protection mechanisms, respiratory is like a process running unprivileged on an open port 80. Genital is port 22 and anal-genital is rdp or teamviewer with admin privileges on a server.
Dude, considering we're not even done yet with a worldwide pandemic caused by a deadly respiratory virus, I'd probably stop with the bad analogies.
Promiscuity does not propagate sexually transmitted diseases. You are working off of a false stereotype which has limited the capacity of your rational thought, and as a result, you imagine a world which does not exist, and propose solutions which will not work. This is a common problem with HN people. They come up with this one idea that kind-of makes sense, and then stop thinking, and shape their whole thought process around this false premise.
Did you take a second to google this idea you had to see if it made sense? No; because if you had, you'd have found that HIV is spread by blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk. People who inject hormones, silicone, steroids, and drugs, can get or transmit HIV by sharing needles, syringes, or other injection equipment. It can be spread through pregnancy or stepping on an infected needle at the beach. It's often spread by not using protection during sex. And straight and gay people both get it.
Gay people do not have more sex partners than straight people. Promiscuous people do have more partners than non-promiscuous people. Gay, straight, bi, queer, etc, can all be promiscuous, just like they can all also be monogamous or even asexual. You may not like that de-simplification, but it exposes the flaw in this notion that gay people are sluts and sluts get STDs. It just doesn't work that way. Safe sex, even if you fuck a lot of people, makes you much less likely to get an STD than if you only occasionally had sex and never use protection. In countries with limited access to safe sex, all people across all demographics contract it. It's not just poor Africans and gay men, despite that being the unfortunately common misconception.
> Promiscuity does not propagate sexually transmitted diseases.
Of course not, they are propagated by poneis and unicorns. Nothing to do with having sex with multiple partners.
> Gay people do not have more sex partners than straight people.
You are deluded. Not only gay people have higher median number of sexual partners, but our sexual network is tighter, since fewer people are gay compared to straight. That's a perfect environment for sexual diseases to spread, which was the case with AIDS and more recently MPox.
"Although needle-sharing among drug addicts was one of the main reasons the disease spread so quickly, most HIV transmissions in Russia — 57 percent — are now a result of heterosexual sex. Drug use is responsible for 40 percent, while gay sex accounts for around 3 percent, according to Russia’s Federal Research Center for AIDS Prevention and Control in Moscow."
The majority of people living with HIV worldwide are straight women (52%):
I agree with you that the claim from some people to make like sex and number of sexual partners has nothing to do with STDs is ridiculous. It annoys me a great deal.
Gay men are disproportionately at risk and affected due to number of partners and type of sex. But most people with AIDS are straight.
Anyway your LGB link is funny because it claims (I think out of confusion) that lesbians have more partners as well. But lesbians also have the lowest std rates of any group. Making them obviously the best and most morally superior of the orientations.
In particular though, anal sex has a higher chance of passing on specific STDs. Gay women have a statistically lower (but not zero) chance of passing on STDs.
STDs are spread through sexual activity, and the more partners you have will increase the transmission rate. Gay men are well documented to have on average more sexual partners than other sexualities. Both of these are… obvious and well documented, depending on your experience or understanding of the literature (take your pick).
Obviously HIV can be spread by other vectors, that doesn’t make what I’ve said above not true. This is one of the most illogical comments I’ve seen in awhile, purely wishful thinking. Promiscuity is fine, but don’t be naive.
I'm willing to bet you're a white male, because on average, most HN users are. Given that, would it be okay if I said most white people are imperialistic, colonizing abusers who oppress women and minorities? Because on average they have been exactly that.
Once you're on the receiving end of these "averaged" generalizations, you realize that it's not a great idea to think that way or to try to rationalize using them. It's like the people that say things like "on average, black people commit more crime" and then use that oversimplification to justify racial bias.
(and yeah, i'm probably gonna be flagged for pointing out the logical fallacies that get propagated to justify systemic racism, misogyny, homophobia and slut-shaming, but i'm not gonna censor myself to avoid pointing out fallacious tropes in common discourse)
I'm sorry if you're not comfortable with dealing with averages. It's not that I don't understand that the average doesn't define all or most members of a group.
No. New HIV diagnoses in the US are 67% male-to-male sexual contact, 22% heterosexual contact, and 7% injection drug use. (BTW, I have no agenda here except accurate statistics.)
According to [0] in 2020, MSM accounted for 71% of new HIV diagnoses, while people who inject drugs (PWID) accounted for 7% of new HIV infections. AFAIK similar stats are also for western and central Europe. These are population-level stats, not relative risks, but If we disregard PWID and scale to population size, MSM are still one to two orders of magnitude more at risk than non-MSM, non-PWID population, so they are clearly disproportionately affected.
> They can take pre-exposure prophylaxis (prep), a kind of drug that reduces their chance of contracting it by 99% or so. This comes as a daily pill, and is popular among gay men in rich countries.
The article takes a global focus (which makes sense since most new HIV diagnoses happen outside of the United States), but even the United States has over 30,000 new HIV infections per year.
In 2021 feds mandated that insurance companies must include PrEP as free preventative care, but that doesn't help the most at risk who are young and may not be insured (30-day supply of generic PrEP costs ~$2,500, and every 3 months people must have doctor visit and bloodwork to check HIV and STIs, and for potential liver and kidney damage).
In 2022 a federal judge ruled that they can not require Christian companies to cover PrEP as this violates their religious rights under federal law[1]. This will likely make it's way up to the Supreme Court, and there's a high risk that as a result people in the United States will then need to pay out of pocket for PrEP.
Er, no, generic Truvada costs $30-$60/month, although it was not available as a generic in 2019, which is when the mandate for free PrEP without cost-sharing was first issued. (The mandate was issued in 2019, but it did not fully go into effect until 2021).
That said, the drug costs aren't the only (or even biggest) costs associated with PrEP - the doctors' vists and labwork are much more. Under the ACA, those were required to be covered for free on all insurance plans, but a judge in Amarillo, TX blocked that as part of a ruling on a lawsuit against abortion care.
> and for potential liver and kidney damage
They aren't checking for liver damage. They do check for indications that the drug isn't being absorbed correctly, which is done via a test for kidney functioning, but kidney issues for both Truvada and Descovy as PrEP are extremely rare. And there are no liver concerns associated with either one.
I guess I don't fully understand U.S. healthcare system (I'm an immigrant from a country with universal healthcare, and this is the first time in my life that I've had a medication prescribed other than short-term antibiotics).
I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).
> I guess I don't fully understand U.S. healthcare system
Yes, it's confusing.
> I pay a $10 co-pay for generic with my insurance, but when I pick up from pharmacy the receipt says "you insurance saved you $1888" (you're right it's not ~$2500/month - I just checked and that's a different prescription I have that I get filled at the same time).
As a rule, the "your insurance saved you $X" is a meaningless statement.
It's actually worse than meaningless - it's effectively an advertisement for health insurance, not an actual statement of fact. It's calculated based on the difference between what you paid and the list price for a drug, which almost nobody is paying (and your insurer is definitely not paying).
Your insurance pays some other negotiated rate for drugs - they will basically never pay list price. Even if you were getting it without insurance, you still would likely not be paying list price. If you were paying out of pocket, you'd probably be using a discount coupon (which usually works as a third party functioning as a pseudo-PBM, a ridiculous concept which I will not bother to try to explain in this post). Or your doctor would explicitly prescribe the branded version ("dispense as written") and you'd be using the Gilead copay assistance coupon to pay for it.
Since there's no situation in which the list price is what you'd be paying, it's completely meaningless to say "you saved $X off the list price". I'm half of the mind that these statements should be banned by the FTC as a deceptive trade practice - that's how misleading they are.
I'm completely of the mind that it should be banned. With recent (though deeply flawed) efforts toward transparency in pricing, we might even see it some day!
For a rich person by global standards, HIV is a solved problem in the US right?
PreP for people trying to inhibit both progression and transmission of HIV and PeP for those that don't have it
The article talked about a new 3 month lasting version of PeP as well
when we’re not talking about uninsured and poor people, this is done now, right?
cishet men dont have anything near the vulnerability surface as other populations, if I’m understanding correctly. just test and move on or react accordingly. anybody that was subject to the traumatic sex-scare education of the 80s to early 2000s should just get updated education.
I hear of it, but typically it's only taken by those who engage in high risk activities. There are potential issues with the liver and kidney that make it not worthwhile if one isn't at moderate to high risk.
More than 1/5 of HIV transmissions are heterosexual in the US. Additionally, prep requires quarterly testing to monitor any potential issues you mentioned (Which are pretty rare), and they also run an STD panel.
Just having a quarterly panel would be a huge boon to anyone with more than one partner. Normalizing prep for anyone who thinks they might need it would be a major step forward.
Yes, I don't disagree. It's just that most of the people that I know that have multiple partners are only on prep if those partners are seeing untested other folks.
Said differently, those I know on prep are taking it because they cannot account for the extent of the sexual network of their partners. Those that aren't on prep have multiple partners, but they all test and have complete information on the status of everyone involved in the sexual network graph.
I see it as a good choice if you cannot attest for accurate, recent results of every possible connection in your sexual network.
1. Many people who use PrEP have only one partner. They're using PrEP because their partner has HIV.
2. The alternative is letting people get AIDs. This is more expensive than PrEP.
3. Insurance doesn't pay the full list price of drugs, they pay a lower, negotiated rate. CostPlus Drug Company charges about $20/month for PrEP. This is probably closer to what insurance companies actually pay.
Other methods of protection fail. People lie about the status. People don't know their status.
Know what's ridiculous is that these drugs cost so much money and companies like Gilead can engage in "revenue maximization" schemes at the cost of the health of US citizens... and then apparently win lawsuits with their Big Pharma war chests.
The options aren't shell out $30k/year or let people get AIDs. There's a missing third option: don't let drug companies charge so much money, especially when the government paid for the development of the drug!
I don't think that attending "100% bareback, no loads denied" orgies regularly is a good idea, yet a bunch of my queer friends do exactly that on a fairly regular basis.
I know it's not popular, but AIDS is just what we have now. If people continue living like this, there will be another, and it might be worse. Hell, we probably already dodged a bullet with Monkeypox due to concomitant COVID precautions.
Lol, no one was observing COVID precautions at that point. It was dodged because people got vaccinated for it and observed spacing requested in a responsible manner.
Hell, in the UK heterosexual cases of AIDs overtook homosexual cases because of adherence to medication and good practice. [1]
I have a friend who does work (mostly manual labor, handyman stuff, etc) for me in our house. In his early 60s, strong as an ox, and he's been HIV-positive since the 80s. That deserves an asterisk, as his levels are below detectability (and I believe transmissibility), and have been for a long time.
That's fantastic! I was recently doing some research and learnt that with ART people who are HIV+ can actually expect to live a little longer than people who are HIV-. I think it's because they have more regular check ups to make sure that treatment is being maintained.
I mean I get a bottle of pills mailed to me every quarter, i don’t have insurance at the moment and Costco only charges me like $100 for that supply - and all I have to do is pop one Truvada a day, and I’m practically immune to AIDS.
How could AIDS hope to persist with that kind of treatment so readily available? (Other than in poverty and mental illness, where all kinds of things stick around because people don’t have the wherewithal to undertake treatment obviously)
As an older millennial, it’s interesting to me observe the difference with which HIV/AIDS and COVID has been treated. While untreated HIV infection is more lethal than COVID, COVID has killed more people in the past 4 years than HIV/AIDS did in the past 40+.
My childhood was filled with warnings and media depicting the tragedy of HIV/AIDS, the surrounding bigotry, and the history of this pandemic still has some cache. COVID, conversely, has all but disappeared from the national stage, despite still actively killing large numbers of people. Pointing this out even now is likely to draw accusals of one being a terrified nut or obsessive. It’s such a drastic change, that it’s hard to reconcile a past where public health and the moral dimensions around our practice of it played such a prominent part in our culture with the disregard and denial of the present.
EDIT:
To clarify, I’m speaking about my experience of both pandemics in the US. Worldwide, AIDS has of course killed more people than COVID.
> …COVID has killed more people in the past 4 years than HIV/AIDS did in the past 40+.
Ok, so that’s wrong by an order of magnitude. AIDS has killed ~85.6 million [64.8 million–113.0 million] people, and it’s plausible that could be a huge undercount. COVID has killed ~7M people, which is also bad but nowhere near “more”.
There are also a lot of reasons these aren’t really comparable pandemics, and the responses to them are similarly difficult to compare, but I’m not going to bother with that conversation here.
You copied info from that first page incorrectly; 85.6M is their estimate on number of infections and 40.4 million [32.9 million–51.3 million] is their estimate on deaths.
As abeppu points out, this is their death estimate: 40.4 million [32.9 million–51.3 million] is their estimate on deaths.
Further, covid deaths are severely undercounted. Our world in data reports 26 million excess deaths to date, about 5 million in the past year. That's with three years of data, vs. three decades for HIV.
There's surely some HIV undercount too, but it's a reasonable bet that covid will exceed HIV in terms of deaths long run.
No, they are severely overcounted. We were literally counting people who died of motorcycle accidents as COVID deaths if they tested positive for COVID in the emergency room. The PCR tests were dialed up to 40 cycles, which caused a huge amount of "false positives" as well.
The health authorities admitted that over 90% of the COVID deaths had pre-existing conditions and the actual cause of death wasn't really COVID. The IFR of COVID is less than a bad flu season.
How does the WorldMeters site reach the covid 7M figure? I know that deciding how to attribute deaths to covid is not that trivial (e.g. as opposed to deaths with covid; or people who did not get tested, i.e. unconfirmed deaths etc.)
With COVID, pretty much everyone would get it just by going about their normal day-to-day life. It effected everyone.
In contrast, many people in the US lead a lifestyle that puts them at almost no risk for AIDS. Furthermore, a large majority / plurality of Americans are Christians where the religion actively encourages monogamy. (And this is my opinion,) the large group of people who practice monogamy consider the lifestyle so easy that "oh, we should just encourage monogamy as a solution" is a snap judgement with a clear lack of empathy for people who aren't monogamous.
(I should point out that even though I am monogamous, I've had circles of friends that are very promiscuous. Each group has a lot of trouble empathizing with the other lifestyle. I had a lot of ridicule in college and at Burning Man for not being promiscuous; and both my father and grandfather encountered the same thing in the US Navy.)
So, it's taken awhile for the monogamous majority / plurality to really understand that the solution for the AIDS crisis isn't to just promote monogamy. One example is very clear in George W. Bush's memoir. Even though he is conservative, Christian, (and I assume monogamous,) his stated goal in his presidency was to solve the AIDS crisis; and he implied that purely teaching monogamy wasn't going to work. He had a lot of regret that incidents in his presidency took his focus away from the AIDS crisis.
> My childhood was filled with warnings and media depicting the tragedy of HIV/AIDS, the surrounding bigotry, and the history of this pandemic still has some cache
... but for years, the HIV/AIDS crisis _was_ ignored, or even laughed at by critical people in government. When you say your childhood was filled with warnings about the tragedy of HIV/AIDS, I think you must be talking about the early 90s, a decade after the crisis got started? I think the fairer comparison will be to however we talk about COVID in the 2030s.
> When you say your childhood was filled with warnings about the tragedy of HIV/AIDS, I think you must be talking about the early 90s
I see the GP’s edit that he is indeed from the USA, but I still think it should be emphasized that what you write wasn’t necessary true for HN readers from some other countries. I just watched Agnès Varda’s film Kung-Fu Master, which was made in 1986 and incorporates some documentary aspects: it shows UK television already replete with coverage of HIV-AIDS and how to have safe sex, and AIDS-prevention activists addressing passersby on the streets of Paris. Fear of AIDS was a mere sideshow in the film’s plot, but this all gave the film considerable value as an insight into that era.
While this is correct, my point was that the experience of the HIV/AIDS seemingly had no impact on our handling of COVID. But Reagan/AIDS, Trump/COVID, is a pretty bleak manifestation of “first as tragedy, then as a farce.”
I guess, how did you want the HIV/AIDS experience to inform the COVID response? I don't want to defend Trump and his bleach-injection suggestions etc, but we did:
- develop vaccines at a really rapid pace (it's too bad they aren't more effective)
- learn a lot about how to treat COVID
- shut down broad categories of activity which would have contributed to spread
- gave everyone free vaccines and tests (I think this is the only 'free for everyone' health care I've seen in my life)
Trump _wasn't_ able to ignore the crisis the way Reagan did for years.
But we landed at a place where the vaccines help but don't offer good immunity from infection, and where many people are more comfortable getting infected repeatedly than they are cutting out shared space and public events. It's not clear to me what lessons we're supposed to draw from the HIV/AIDS experience now. Do you think that a generation of people should have fastidious habits around mask use?
By contrast, with HIV/AIDS, 'taking it seriously' in the 90s meant doing research, and messaging about being paranoid about sex and drugs. Most people did not need to disrupt their lives. And frankly, they could watch a TV special about the crisis, victim-blame quietly, and cheaply virtue-signal by talking about how important it all was. But if slowing down HIV/AIDS transmission had required that most people inconvenience themselves, or behave differently for even a week, I think the story would have been very different.
> But if slowing down HIV/AIDS transmission had required that most people inconvenience themselves, or behave differently for even a week, I think the story would have been very different.
Here, I would ask you to compare changes in behavior around condom usage to the near blanket rejection of wearing a mask in healthcare settings. Irrationality and denialism has fully won out, despite the former being a more intrusive constraint on one’s behavior.
The 'worst' that Trump/COVID did was lose him the election. If he had a lick of sense, he would have won in a landslide.
All he did was what he always does - act like an easily-distracted petulant child on television. It had next to no bearing on vaccine development, distribution, or uptake.
Just about everyone already made up their mind on those three questions, without his input. There's a lot he can be blamed for, but this really isn't one of them.
I've noticed the same thing, and I'm pretty sure it's because COVID no longer features as part of identity politics. It's the identity politics that drove the AIDS discussion, and it's been the identify politics that drove the COVID discussion. Now that has passed, COVID is no longer a topic people care to discuss regularly, while AIDS is still a forefront topic.
More like identity politics is why AIDS was completely neglected. With COVID it's clear that capital couldn't stomach the effects treating it properly would have on the labor market. What a ham-handed way to compare two wildly unsimilar scenarios.
While this may be true to an extent, it doesn’t address why fighting AIDS outside the context of its impact on the LGBTQ community, e.g. in the developing world, still figures so prominently in American culture and public policy. I expect that the real reason is actually something more sinister, where the politics of the US have devolved to a point where almost everyone will accept the “they deserved it” narrative that was used to vilify those with HIV/AIDS, whether it be of the “they’re were old/fat/weak” or “unvaccinated” variety.
Or possibly it’s like the hole in the ozone layer, which has also faded from public discourse, because thanks to that huge amount of press and action it’s been largely addressed.
You’re basically saying “why is this thing we’re all working so hard to prevent not happening enough to justify prevention?”.
I’m not sure what’s been addressed? All the interventions beside vaccination have been taken apart and we’re on track to kill 200K people this year. I suppose that’s better than the outset, but would’ve been considered catastrophic for any other disease, prior to COVID. If HIV/AIDS was killing this many people in the US in 2023, it would be considered a national disgrace, for example.
Short answer - no. Even if they achieve their ambitious plan, 5% is still a large number. Look at how hard it has been to eradicate the last of polio, and that has a lifelong vaccine.
It's also a self-balancing system. As HIV becomes rarer, fewer people will be concerned about it, and therefore fewer will bother taking Prep daily. In turn, HIV becomes more infectious, and more people contract it.
It will probably stabilize with about 0.4% of humans being infected.
Lots of things affect about 0.4% of people, because that's rare enough that most people don't have any friend or colleague affected, and therefore don't take precautions.
No - just a guess based on the fact that me and the people around me tend to know ~250 people. Ie. there are probably 250 people who would find out if I got diabetes and died. Those people would then probably take a little more care of their health, and take steps to avoid the same fate.
> Ie. there are probably 250 people who would find out if I got diabetes and died. Those people would then probably take a little more care of their health
Around 14% of Americans have diabetes, so I don't think that really pans out.
At this point, even if a genuine vaccine/cure for AIDS were developed; most people wouldn't even know until a loved one directly affected or afflicted told them.
The "breakthrough in AIDS research" or "cure in sight" headlines are so recurrent at this point that people are just numb to a real breakthrough.
A tangent: if an article's title is a question, the answer, vast majority of time, is either "no", or not a clear answer at all. I'm sure articles that answer the title with "yes" exist, but I cannot even remember one.
> Betteridge's law of headlines is an adage that states: "Any headline that ends in a question mark can be answered by the word no." [0]
It's a lot more manageable now than when Annette Funicello was diagnosed. People who stay on their treatment regimen can live decades of productive life with the disease.
To an American audience, yeah, it's definitely better in all caps.
However, The Economist is British, and sometimes in British English they capitalize acronyms that way. Only "true" (pronounceable) acronyms, though, so they'll write Nato ("nay toh") and BBC ("bee bee see").
This was likely the HN title autoformatter at work. I knew what the title was trying to say, but I couldn't help but think of that South Park episode :)
