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The global fight against HIV is at risk
- huytersd 3y agoI’m going to be very mad if there is a resurgence in HIV because of the asinine GOP. If people have to be worried again about their next sexual contact (condoms only offer between 70-90% protection against HIV), we will return to a prudish lifestyle again at a time the west can least afford it with falling birth rates.
- monlockandkey 3y agoA prudish lifestyle means marriage instead of promiscuity, abortions will decrease and the birth rate will rise.
- RajT88 3y agoNot really. Most abortions are women who already have children. Once upon a time, this meant that most abortions were carried out by married women (marriage itself is less common now). The connection between marriage and abortion isn't what you think it is.
- monlockandkey 3y agohttps://www.statista.com/statistics/656516/abortion-distribution-united-states-by-relationship-status/ https://www.statista.com/statistics/656516/abortion-distribu... 77% of abortions done by people who are not married and 46% done by women who are not married and not even cohabiting. Abortion is a symptom of a problem which is the lack of marriage and the highly promiscuous lifestyle that is sold to us. Married people when there is a child on the way (planned or unplanned), there is little to no reason to get an abortion. Sleeping around lifestyle, of course the first thing that happens when pregnant, abortion...
- chowells 3y agoAbortion is a symptom of preventing conception being too much hassle. Nothing more, nothing less. And you realize that people of every age group are having less sex than any time in the last 30 years, right? It's almost like this "promiscuous lifestyle" you're so terrified of doesn't exist.
- RajT88 3y agoNot to mention a host of societal factors leading to more autonomy for women which in turn leads to (you guessed it) sex outside of marriage. To make more women married, we would have to roll back the clock on all those hard won freedoms. Let's not do that, let's maybe just make birth control more accessible, effective and affordable. Boom! Abortion problem solved. The person I was responding to initially clearly does not want to solve abortion this way.
- powersnail 3y agoIs a prudish lifestyle going to affect birth rate all that much? I can’t imagine the solution for falling birth rate to be that people need to sleep around more. If that were true, it wouldn’t have fallen in the first place.
- malux85 3y agoExactly, myself, and all of my straight peers are not having children because they are expensive, for all of us it's cost of living (well, and I'm gay, but there's ways around that :P)
- jimbob45 3y agocondoms only offer between 70-90% protection against HIV PrEP offers 100% protection against HIV.
- redserk 3y agoAt least in the US, PrEP can be very expensive.
- jasonjei 3y agoIf you have healthcare, I believe prep is required coverage.
- alwa 3y agoCan be, and certainly is on paper, but in practice most everybody professionally involved with this problem knows that the groups at the most risk also tend to be among the most economically vulnerable. I know a lot of USians on Prep, none of whom pay out of pocket for it. It’s heavily subsidized through public health channels, manufacturer rebate programs to help with high deductibles for insured people, and grant organizations like the PAN Foundation. Truvada has a generic now. Plus, in 2019 the federal government designated it as a preventative therapy that ~all insurance plans must cover without copay or deductible [0]. Now, it’s true that not everybody is insured (though people who are economically vulnerable tend to qualify for heavily subsidized insurance under the ACA or Medicaid). Still, the costs of Prep specifically in the US, while very high, don’t tend to be borne by the patients directly. [0] [PDF] https://nastad.org/sites/default/files/2021-12/PDF-PrEP-Coverage-Brief.pdf https://nastad.org/sites/default/files/2021-12/PDF-PrEP-Cove...
- huytersd 3y agoAs an aside, how do you know so many people on prep? Are you gay?
- deleted 3y ago[deleted]
- huytersd 3y ago
- Throw83858 3y ago[flagged]
- striking 3y agoYou've got this so twisted that I'm not sure where to begin explaining. Maybe this CDC link can help you: https://www.cdc.gov/hiv/policies/law/states/exposure.html https://www.cdc.gov/hiv/policies/law/states/exposure.html A relevant quote: > Many of these state laws, then and now, criminalize actions that cannot transmit HIV – such as biting or spitting – and apply regardless of actual transmission, or intent. After more than 40 years of HIV research and significant biomedical advancements to treat and prevent HIV transmission, many state laws are now outdated and do not reflect our current understanding of HIV. In many cases, this same standard is not applied to other infectious, treatable diseases. Further, these laws have been shown to increase stigma, exacerbate disparities, and may discourage HIV testing.
- Throw83858 3y ago[flagged]
- striking 3y agoIf not for your benefit, then for everyone else's; here are the DOJ's recommendations for modernization[1], from a sub-link of the above: > Generally, the best practice would be for states to reform these laws to eliminate HIV- specific criminal penalties except in two distinct circumstances. First, states may wish to retain criminal liability when a person who knows he/she is HIV positive commits a (non-HIV specific) sex crime where there is a risk of transmission (e.g., rape or other sexual assault). The second circumstance is where the individual knows he/she is HIV positive and the evidence clearly demonstrates that individual’s intent was to transmit the virus and that the behavior engaged in had a significant risk of transmission, whether or not transmission actually occurred. > For states that choose to retain HIV-specific criminal laws or penalty enhancements beyond these two limited circumstances, the best practice would be to reform and modernize them so that they accurately reflect the current science of risk and modes of transmission, the quality of life and life span of individuals who are living with HIV, account for circumstances where the failure to disclose is directly related to intimate partner violence, and ensure they are the desired vehicle to achieve the states’ intended purpose in enacting them initially or retaining them in modernized form. [The document continues with specific, scientifically backed advice that would help inform HIV-specific statutes.] 1: https://www.hivlawandpolicy.org/sites/default/files/DOj-HIV-Criminal-Law-Best-Practices-Guide.pdf https://www.hivlawandpolicy.org/sites/default/files/DOj-HIV-... --- As for you in particular, I'm not sure who's culture warring here. Maybe this discussion would be more interesting if you provided a tangible argument based in health or science rather than vague political gesturing.
- deleted 3y ago[deleted]
- totetsu 3y agoNot just chastity but also poverty. Imagine how much economic damage a global HIV pandemic would do that can be avoided by keeping it suppressed. What it the opposition to continuing this program thinking? The article mentions wrongly associating it with abortions, .. and maybe some support goes to at risk people which includes mentioning transgender… they would tank the global economy and ruin their own lives on this principle? I don’t get it.
- gottorf 3y ago> Not just chastity but also poverty. Virtually every cultural subgroup in history had their birthrates plummet once they reached a certain amount of wealth. Evidence indicates that if anything, poverty is good for population growth.
- totetsu 3y agoBut how does that work out in places with untreated endemic HIV?
- Tanoc 3y agoIt's a combination of desperation, fear, and willful ignorance (one might even say self-induced stupidity). You've had forty years of propaganda at this point, and the old management who designed that propaganda for their followers are retiring or dying and being replaced by younger generations who were or are the followers of that propaganda. In essence these newer generations don't know the lies aren't real, and have been in so deep for most of their lives that they refuse to shatter their worldviews. And so when those worldviews keep being shut down or outright disproven they become more reactive, doing anything they can to keep their understanding of the world intact. They believe that their opposition are creating lies and using systems of information and governance to support those lies, and so to destroy their opposition they are willing to destroy the very systems they themselves work in and rely on to dispel the supposed lies. They believe they are the only sane men and women in a world of shadows and madness because that's the only way they can continue to function. There is no reasoning with someone who's gone that far. The veneer of egalitarianism that politics in the U.S. has prevents anyone from actually doing anything to stop this increasingly volatile group lest the intervening mediators be seen by their peers both within the volatile group and without as aggressive savages who would subvert well established conventions. The potential mediators must let themselves be stabbed and reply with "That is quite impolite" or else they lose all trust from said peers.
- Grazester 3y agoIf a condom doesn't break then it's 100% effective. When a condom breaks you fails in a manner that you will know it failed and then there is PEP.
- huytersd 3y agoI think there’s a chance of getting it if the condom rolls/bunches up as well.
- Grazester 3y agoThis usually the result of poor condom use/knowledge, like condom breakage. If the condom is too big this can happen or you become flaccid(it's a thing to also check to make use that this isn't happening during intercourse), and condoms can break when you don't use lubricant or the incorrect lubricant(e.g. petroleum jelly based lubricant).
- FFP999 3y agoThere's no such thing as "100% effective".
- Grazester 3y agoAbstinence is as they like to tell you. But really most of the margin for infection for condoms is the result of poor use.
- FFP999 3y agoOk sure, abstinence, but talk about cutting off your nose to spite your face.
- deleted 3y ago[deleted]
- Gibbon1 3y agoYes the quoted effectiveness is based on the average in practice. Anecdotally what I've seen is the failure of condoms is usually got drunk and didn't use one. In particular substance abuse is highly correlated with unsafe sex and HIV infection. I'm pretty sure it's also correlated with birth control failure.
- missedthecue 3y agoBirth rates were higher back when lifestyles were more prudish. Hypergamy seems to have very little positive affect on the production and growth of healthy families and children.
- John23832 3y agoBirthrates have been falling ever since the invention of the pill. Children (often multiple) could no longer be forced upon women. This, along with women becoming their own economic units meant that they no longer have to risk their life and bodies in return for food and shelter from a man.
- xienze 3y ago[flagged]
- John23832 3y agoIt has not. Not providing a society the cultivates the families that create and cultivate children has. Providing a system that helps parents raise children rather than be wage slaves makes people want to have kids.
- HideousKojima 3y ago>Providing a system that helps parents raise children rather than be wage slaves makes people want to have kids. Cool, I take it you'll join my anti-immigration and anti-women-in-the-workforce rally then? It's my simple solution to raise wages so that families are affordable on a single income.
- fzeroracer 3y agoYou have a very literal example in Japan and last I checked I don't think they were doing very well either. I don't think your simple solution is quite so simple.
- bakugo 3y ago> If people have to be worried again about their next sexual contact (condoms only offer between 70-90% protection against HIV), we will return to a prudish lifestyle again at a time the west can least afford it with falling birth rates. Are you really trying to imply that a "prudish lifestyle" where people actually have long-term relationships and marry is bad for birthrates, and more casual sex is good?
- amanaplanacanal 3y agoOk I’ll bite. Yes. Forcing people to marry early and stay in abusive relationships is bad. Having options is good.
- huytersd 3y agoAbusive is too wide of term that covers too many things. Marriages can be hard if it’s a partnership of equals. It needs to move back to the paradigm where the husband is the primary dominant and makes all the decisions. The wife needs to be submissive. Marriages of this variety are easy. We already have domestic violence laws in place so there are safeguards in place against actual abuse.
- amanaplanacanal 3y agoGood god no. That kind is patriarchal bullshit is on its way out, and good riddance. I kind of suspect you are just trolling here.
- bakugo 3y ago> That kind is patriarchal bullshit is on its way out And so are birthrates, as a result.
- huytersd 3y agoI wasn’t trolling. It’s probably my least progressive viewpoint but honestly I don’t see a society that can continue to make technological progress without it. The patriarchy isn’t going anywhere, if anything it is only growing in the US GOP, East Asia, South Asia, Eastern Europe and Russia, the Middle East, Australia, Africa and Latin America.
- dudul 3y agoI dont think promiscuous lifestyle translates into more babies. Sorry, but this is a plain stupid assertion.
- faeriechangling 3y agoPrEP exists and is 99% effective. I've absolutely heard of people who use PrEP and have sex with people with HIV/AIDS bareback. Not sure if I'd recommend doing that, but people will find a way to screw if they can.
- huytersd 3y agoPrEP takes preplanning and atleast several hours before someone can have sex even if they have the pills on them. That’s not really going to work for casual hookups.
- ProfessorLayton 3y agoNo it doesn't. Other than the first few days after getting a prescription where one needs to wait for it to build up in the body, it's 1 pill/day with no further planning.
- huytersd 3y agoWell that’s even worse. You have to be on it continuously? I thought it was just before any planned sexual encounters? They’re basically ARTs and wreak havoc on the body (10x increase in cancers- that’s a 1000%, neurological damage etc.) over time.
- ProfessorLayton 3y agoNope, prep is well tolerated by the vast majority of individuals, although in rare cases it can reduce kidney function and bone density — However, the prescription requires regular lab testing (Where they also run STI tests as well), and if issues are found, there's two options: 1: Getting off prep, in which case kidney/bones should return to normal. 2: Switching to a newer version of prep called Descovy (in the US), which is has less of the aforementioned side effects, but is more expensive because there is no generic for it yet, and may not be covered by some insurances. Although technically not sanctioned in the US (IIRC), the 2-1-1 method can also be an option for planned encounters: 2 pills 24hrs before the encounter, and 1/day for 2 days after the encounter.
- photochemsyn 3y agoThe main issue is not even mentioned - cheap anti-HIV drugs require escape from patents and promotion of generic manufacturing to reduce costs to the level that poor countries can afford to buy or produce the necessary retrovirals. https://academic.oup.com/cid/article/75/Supplement_4/S557/6835715 https://academic.oup.com/cid/article/75/Supplement_4/S557/68... > "Critical to the therapeutics market has been the role of generic drug manufacturers’ ability to supply low- and middle-income (LMIC) markets with off-patent and licensed products at a high volume and relatively low cost." HIV patients in wealthy countries are a cash cow for the pharmaceutical industry, at least for as long as a permanent one-shot cure is not discovered, but there's no profit in making drugs for people who can't afford to pay for them. As Goldman Sachs noted, discovery of a cure would destroy the market. Isn't capitalism great? https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...
- mnau 3y agoWhen a cure for hepatitis c was discovered (solvating iirc), everyone started screaming give it away for free instead of paying the price (~$100k). That price was half the cost of existing treatment and very high chance of success. If capitalism actually worked, they would sell their cheaper and better pill. No shocker there, it didn’t happen (generics in India and so in). If I was CEO of a drug company, I would certainly incorporate that (I won’t reap benefits) in research budget allocations.
- mistrial9 3y agodrug research overall falls into a "natural oligopoly" .. the research is lengthy and expensive, yet the occasional "winner" can be generations of income. IIR a book on the industry is called "The Billion Dollar Molecule" meanwhile, some of the obnoxiously, obscenely wealthy individuals in the USA are running small pharm brands, either supplements or critical medicines. This wealth-crowbar was exposed to the public by the "pharma-bro" guy not long ago
- mnau 3y ago
- Throw83858 3y agoIt is also crisis of trust. Western medical companies, Bill Gates foundations etc do not have best reputation in Africa. There were all sorts of experiments done on people, some medications were not as effective as promised... And there is a heavy political and cultural interference, that is just not acceptable in Africa!
- throwaway6734 3y ago>And there is a heavy political and cultural interference, that is just not acceptable in Africa! Like what?
- avazhi 3y ago[flagged]
- asveikau 3y agoThis is a shocking lack of empathy and understanding of the connectedness of the planet.
- Brigand 3y agoThe empathy overdrive is on track to bring down civil live in many cities of the us, maybe the country as a whole.
- asveikau 3y agoYou say empathy overdrive, I say empathy baseline. Refusing to see others who suffer as human because you think it doesn't affect your bubble (and the latter part is usually false) doesn't meet the minimum. I'm not saying we should intervene in 100% of people who suffer, because we will not succeed at such an impossible task. But solving HIV and other critical diseases in less developed parts of the world is a relatively small investment with a high success rate, per TFA. Yet some will say "I don't care because it won't affect me". Seems pretty weak to me. Does not strike me as wisdom or emotional maturity to be honest.
- mnau 3y agoDon’t share needles and don’t engage in casual sex don’t seem like a too high bar. There is a lot rape, but Botswana has 25% of population infected and per UNICEF > While there is increased awareness of HIV in general, comprehensive knowledge of HIV remains low, condom use among sexually active young people is declining, and rates of forced sex and teenage pregnancy are ominously high.
- asveikau 3y ago> Don’t share needles and don’t engage in casual sex don’t seem like a too high bar. Very close to what Americans said about AIDS in the 80s. This is now regarded to have been stupid at best, discriminatory and bigoted at worst.
- lionkor 3y ago> global fight it sounds like this is mostly about the US?
- imagainstit 3y agoIt is about PEPFAR, a massively successful US foreign aid program. https://en.m.wikipedia.org/wiki/President's_Emergency_Plan_for_AIDS_Relief https://en.m.wikipedia.org/wiki/President's_Emergency_Plan_f...
- sargun 3y agoOne thing I'm confused about is why HIV at-home tests are not more available. There's Oraquick (https://oraquick.com/ https://oraquick.com/), which in bulk is $15/test, whereas its about $40 retail. On the other hand, we've gotten COVID tests down to something like $5 retail. On top of that, it's relatively easy to get free COVID tests. Imagine if you could test for this right before you "got down." I imagine that'd change the game. Although, a terrible part of me wonders if the condom debate will become the same as masks.
- dudul 3y agoI dont understand the last paragraph. Condoms have been widely used for decades, is there a debate similar to masks?
- jksflkjl3jk3 3y agoHave you had much casual sex lately? Anecdotally, condom use is down significantly over the last couple decades now that HIV is no longer a death sentence.
- dudul 3y agoNot lately no, been married 12 years. But I don't remember ever hearing about debates as heated as masks around condoms. Yeah there are fringe groups advocating for no birth control and all, but what's really their market share? Doesn't sound similar to the big divide we had a few years ago over masks.
- stemlord 3y agoI am a millennial but my understanding is that many gay men scoffed at condom use pre-AIDS, in the 70s, the same way many today scoff at mask use. This is the way it's generally been described by older gay men I know and documentaries and movies. Not to necessarily equate the health risk between the two scenarios, just equating the public sentiment during the beginning stages of a major public health crisis. It is why from my perspective the gay community at large has an intimate relationship with the phrase "new normal" because it seems like gay men's cultural understanding of what a healthy sex life looks like truly changed more or less permanently since the AIDS epidemic.
- loeg 3y agoThe tl;dr portion relevant to the title is buried in the middle of one of the paragraphs: > Yet, current reauthorization is at an impasse because of misperceptions and inaccurate assertions that have no bearing whatsoever on PEPFAR’s purpose and work. Some conservative voices contend that PEPFAR funds support access to abortions, assertions that PEPFAR staff and public health leaders repeatedly affirm are groundless. Other concerns point to PEPFAR language regarding groups that scientific data have shown to be at-risk for HIV and whose members need HIV prevention and treatment services, including transgender people and sex workers.
- graphe 3y agoThe title should be "consideration for the reallocation of funds to more beneficial uses". HIV infections in the US are easily preventable even with current treatments.
- loeg 3y ago> HIV infections in the US are easily preventable even with current treatments. Yes, but that's sort of irrelevant for PEPFAR, which is a foreign aid program.
- thenerdhead 3y ago> Scientists, health care experts, global health leaders, and advocates must stand up at this critical moment, learn more about PEPFAR, and articulate with clarity what the program does and does not do. Now is the time to meet and share information with lawmakers and Congressional staff. Write letters. Speak out. The lives of millions hang in the balance. It is at risk. 20 years of investment have gone into it. Now, many renowned HIV researchers seem to be pivoting to help covid / long covid efforts, an epidemic within the pandemic. And they are finding it is similar to HIV - the only reason we cannot cure HIV is because the virus hides where the HIV drugs can’t go in. Leading to high inflammation. Many researchers believe that if we go all in on one of these, it is possible we can make breakthroughs in HIV, ME/CFS, and post-acute infection syndromes (PAIS) in general. I remain hopeful. We need a real moonshot here for many things. i.e. similar to what long covid is trying right now https://www.nature.com/articles/d41586-023-03225-w https://www.nature.com/articles/d41586-023-03225-w