9 ms·

While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and

by RGS1811 2mo ago

While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.

XorNot 2mo ago
Who's waiting? The problem is the populations we need to distribute it to can least afford it. 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.
Varelion 2mo ago
Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.
- RajT88 2mo ago
  Long history of not wanting to address the epidemic: https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS
evilfred 2mo ago
prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver
- SoftTalker 2mo ago
  Which one do you suppose the pharmaceutical companies would prefer?
  - mtoner23 2mo ago
    I'm sure they will gladly sell us both
  - ChadNauseam 2mo ago
    I’d guess the ones developing the vaccine would rather you take the vaccine
  - evilfred 2mo ago
    who do you expect to create pharmaceuticals other than pharmaceutical companies? sheesh
  - wat10000 2mo ago
    The company making the expensive pill you take forever would prefer the pill. Competitors who don't make those pills would love to develop a vaccine and put that first company out of business.
greggsy 2mo ago
Isn’t prep more like a prophylactic, as opposed to a a vaccine? I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
- RGS1811 2mo ago
  The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
- fluoridation 2mo ago
  "Prophylactic" is a broad-enough word to encompass vaccines, as well, so I'm not sure what you're getting at. It just means something that defends against disease.
  - greggsy 2mo ago
    Vaccines can be singled out as a specific type of prophylaxis. 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.
    - fluoridation 2mo ago
      I have no idea what you're trying to say. An antiviral drug will destroy the pathogen just as much as the body would; that's how it prevents the disease from manifesting. What do you think would otherwise happen to HIV particles in your bloodstream? They just hang in there until the antiviral effects run out?
      - greggsy 2mo ago
        The difference is that your body doesn’t make antiviral drugs. It does make antibodies after it has been trained to do so with a vaccine.
nerdjon 2mo ago
Cost and compliance are still 2 major factors that have not been solved. 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.
- abirch 2mo ago
  Compliance is the big thing. Vaccines are the "an ounce of prevention is worth a pound of cure"
- bluGill 2mo ago
  PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you. 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).
  - nerdjon 2mo ago
    > If you are not doing risky sex it isn't for you. 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.
ChrisRR 2mo ago
There's still a huge difference between a one off injection and lifelong tablets.
- mathgeek 2mo ago
  From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.
niceguy1827 2mo ago
This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?
- mohamedkoubaa 2mo ago
  "Grandma needs to stop taking her statins and just exercise" type shi
cogman10 2mo ago
It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out). 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.
- compass_copium 2mo ago
  This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
  - matharmin 2mo ago
    That PrEP is in some ways similar to a vaccine, and there is still a lot of value in getting a better vaccine (cheaper and/or lasting longer).
  - SietrixDev 2mo ago
    Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant. "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/access-to-LEN https://www.doctorswithoutborders.org/latest/campaigns/acces...
    - sroussey 2mo ago
      The shots are expensive, but the pills are free in the USA. They do have adverse kidney issues over prolonged use (more for some people than others).
      - cguess 2mo ago
smcg 2mo ago
Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.
- gadders 2mo ago
  Is it not available in pharmacies?
  - freeone3000 2mo ago
    Very dependent on locality. Mine requires a prescription for every refill, and I must continually meet certain risk criteria to qualify.
est31 2mo ago
For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc. 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.
- compass_copium 2mo ago
  Again, inaccurate. You can get a PrEP shot twice a year now. 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.
  - thinkcontext 2mo ago
    > 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?
  - Muromec 2mo ago
    Or maybe we should solve poverty which is a proxy to all kinds of solved problems that somehow still exist
- lizknope 2mo ago
  I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
  - SoftTalker 2mo ago
    He doesn't have AIDS, he's HIV-positive.
fhdkweig 2mo ago
It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.
- tpolm 2mo ago
  HIV did not exist in human population before XX centiry. Crossings from SIV are extremely rare - vaccinations is about HIV, not SIV
- inemesitaffia 2mo ago
  >The reason they eat bushmeat is the because they are poor This doesn't cover all the reasons
ajsnigrutin 2mo ago
It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide. Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
- SoftTalker 2mo ago
  > Somehow we still need... 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.
- wat10000 2mo ago
  If only Isaac Asimov had worn a condom, he might still be with us today.
  - ebruchez 2mo ago
    I got here to mention Asimov. For those unaware, it was revealed 10 years after his death that he had actually died of HIV, contracted from a blood transfusion during a heart operation. It's quite tragic.
- OkayPhysicist 2mo ago
  And they suck. Everyone who's ever worn one knows they suck. If they're too big they completely kill all sensation, if they're too small they cut off circulation, leading to, you guessed it, total loss of sensation. Topped off with the fact that they fail during higher friction activities (you know, exactly the kind that drastically increase HIV transmission risk), they're never going to be an adequate solution, because there will always be people who'll risk it, because what's the point in having sex if you're not going to feel it anyway?
Telemakhos 2mo ago
[flagged]
- felixg3 2mo ago
  Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
  - dyauspitr 2mo ago
    Is that a huge problem? Doesn’t almost everything else have a prophylactic and is curable? Hep-C might be the only other one I believe and I’m unaware if it’s treatable or not.
    - gib444 2mo ago
      Antibiotic resistant syphilis and ghonerrea don't sound like a fun time
      - wat10000 2mo ago
        More or less fun than dying of AIDS?
        gib444 2mo ago
        Don't move the conversation goalposts (and we don't do "gotchas" here, as you well know) And AIDS is not considered a death sentence btw. It's not the 1980s
        wat10000 2mo ago
        This subthread is specifically about better HIV treatments leading to an increase in other STIs. Did you forget about what you were replying to?
giantg2 2mo ago
"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education." 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.
- simonask 2mo ago
  As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
  - giantg2 2mo ago
    Then why aren't STDs, TB, etc, eliminted. Even heavily vaccinated diseases are still around and pop back up occasionally. The only one eliminted was smallpox.
    - OkayPhysicist 2mo ago
      Most STDs we don't have vaccines for, and the ones that have survived to the modern day are the ones that can be good at hiding. Syphilis, for example, has the nasty habit of seemingly going away by itself, only to pop up again years later. Chlamydia and Gonorrhea can be asymptomatic. 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.
jonathanlydall 2mo ago
You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents. 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.
- cj 2mo ago
  Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it. 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.
  - egeozcan 2mo ago
    All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions. 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.
Der_Einzige 2mo ago
[flagged]
xutopia 2mo ago
PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.
skybrian 2mo ago
There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard. 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.
- wat10000 2mo ago
  > If your solution to some problem relies on “If everyone would just...” then you do not have a solution. Everyone is not going to just. At not time in the history of the universe has everyone just, and they’re not going to start now. https://www.tumblr.com/squareallworthy/163790039847/everyone-will-not-just https://www.tumblr.com/squareallworthy/163790039847/everyone...
cucumber3732842 2mo ago
Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).
alittlebee 2mo ago
My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!
a-dub 2mo ago
it's actually an interesting question: is there a point where the long acting prep injections have effective durations that look like vaccines and boosters. and yes, sadly, it appears that convenience and some of the psychological aspects of marketing play outsized roles in public health. either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.
tonnydourado 2mo ago
Transportation was a solved problem with horses, doesn't mean the car isn't a good idea. Same for internal combustion and EVs. 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.
- someguydave 2mo ago
  In the meanwhile everyone infected with HIV should be permanently quarantined like in Cuba
leptons 2mo ago
This isn't just about HIV, it's about finding new ways to approach viruses. HIV wasn't the first and won't be the last virus we don't have a way to stop. This research adds to our knowledge about ways to attack some of the trickier viruses.
alightsoul 2mo ago
In the global south a significant barrier is the lack of sex education, driven by local christian associations, which have significant power in local societies. They see it as "gender ideology" or as preventing births and thus being against the bible.
deleted 2mo ago
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fortran77 2mo ago
It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.
jitl 2mo ago
A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.
kosh2 2mo ago
Are people still getting infected? Yes? Then it is not a solved problem.
j2j8 2mo ago
In exchange for accelerated ageing for being on lifelong HIV drugs. That side effect could be because the reverse transcriptase in humans is telomerase.
ElProlactin 2mo ago
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.
raxxorraxor 2mo ago
I disagree that this is a solution. Being dependent on life long medication isn't a trivial problem and transmission must still be seen as serious. But of course it should be available to all that need it.
rsynnott 2mo ago
While that’s _kind_ of true, in practice compliance is going to be an issue. People are bad at taking medication, especially on an indefinite basis. As is, a lot of people use ‘event-based PrEP’ (dosing only before and a couple days after potential infection). There’s a lot of room for error. A working vaccine would definitely be preferable.

by RGS1811 2mo ago

XorNot 2mo ago

Who's waiting? The problem is the populations we need to distribute it to can least afford it. 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.

Varelion 2mo ago

Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.

RajT88 2mo ago
Long history of not wanting to address the epidemic: https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS

evilfred 2mo ago

prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver

SoftTalker 2mo ago
Which one do you suppose the pharmaceutical companies would prefer?
- mtoner23 2mo ago
  I'm sure they will gladly sell us both
- ChadNauseam 2mo ago
  I’d guess the ones developing the vaccine would rather you take the vaccine
- evilfred 2mo ago
  who do you expect to create pharmaceuticals other than pharmaceutical companies? sheesh
- wat10000 2mo ago
  The company making the expensive pill you take forever would prefer the pill. Competitors who don't make those pills would love to develop a vaccine and put that first company out of business.

greggsy 2mo ago

Isn’t prep more like a prophylactic, as opposed to a a vaccine? I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.

RGS1811 2mo ago
The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
fluoridation 2mo ago
"Prophylactic" is a broad-enough word to encompass vaccines, as well, so I'm not sure what you're getting at. It just means something that defends against disease.
- greggsy 2mo ago
  Vaccines can be singled out as a specific type of prophylaxis. 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.
  - fluoridation 2mo ago
    I have no idea what you're trying to say. An antiviral drug will destroy the pathogen just as much as the body would; that's how it prevents the disease from manifesting. What do you think would otherwise happen to HIV particles in your bloodstream? They just hang in there until the antiviral effects run out?
    - greggsy 2mo ago
      The difference is that your body doesn’t make antiviral drugs. It does make antibodies after it has been trained to do so with a vaccine.

nerdjon 2mo ago

Cost and compliance are still 2 major factors that have not been solved. 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.

abirch 2mo ago
Compliance is the big thing. Vaccines are the "an ounce of prevention is worth a pound of cure"
bluGill 2mo ago
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you. 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).
- nerdjon 2mo ago
  > If you are not doing risky sex it isn't for you. 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.

ChrisRR 2mo ago

There's still a huge difference between a one off injection and lifelong tablets.

mathgeek 2mo ago
From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.

niceguy1827 2mo ago

This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?

mohamedkoubaa 2mo ago
"Grandma needs to stop taking her statins and just exercise" type shi

cogman10 2mo ago

It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out). 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.

compass_copium 2mo ago
This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
- matharmin 2mo ago
  That PrEP is in some ways similar to a vaccine, and there is still a lot of value in getting a better vaccine (cheaper and/or lasting longer).
- SietrixDev 2mo ago
  Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant. "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/access-to-LEN https://www.doctorswithoutborders.org/latest/campaigns/acces...
  - sroussey 2mo ago
    The shots are expensive, but the pills are free in the USA. They do have adverse kidney issues over prolonged use (more for some people than others).
    - cguess 2mo ago

smcg 2mo ago

Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.

gadders 2mo ago
Is it not available in pharmacies?
- freeone3000 2mo ago
  Very dependent on locality. Mine requires a prescription for every refill, and I must continually meet certain risk criteria to qualify.

est31 2mo ago

For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc. 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.

compass_copium 2mo ago
Again, inaccurate. You can get a PrEP shot twice a year now. 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.
- thinkcontext 2mo ago
  > 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?
- Muromec 2mo ago
  Or maybe we should solve poverty which is a proxy to all kinds of solved problems that somehow still exist
lizknope 2mo ago
I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
- SoftTalker 2mo ago
  He doesn't have AIDS, he's HIV-positive.

fhdkweig 2mo ago

It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.

tpolm 2mo ago
HIV did not exist in human population before XX centiry. Crossings from SIV are extremely rare - vaccinations is about HIV, not SIV
inemesitaffia 2mo ago
>The reason they eat bushmeat is the because they are poor This doesn't cover all the reasons

ajsnigrutin 2mo ago

It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide. Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.

SoftTalker 2mo ago
> Somehow we still need... 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.
wat10000 2mo ago
If only Isaac Asimov had worn a condom, he might still be with us today.
- ebruchez 2mo ago
  I got here to mention Asimov. For those unaware, it was revealed 10 years after his death that he had actually died of HIV, contracted from a blood transfusion during a heart operation. It's quite tragic.
OkayPhysicist 2mo ago
And they suck. Everyone who's ever worn one knows they suck. If they're too big they completely kill all sensation, if they're too small they cut off circulation, leading to, you guessed it, total loss of sensation. Topped off with the fact that they fail during higher friction activities (you know, exactly the kind that drastically increase HIV transmission risk), they're never going to be an adequate solution, because there will always be people who'll risk it, because what's the point in having sex if you're not going to feel it anyway?

Telemakhos 2mo ago

[flagged]

felixg3 2mo ago
Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
- dyauspitr 2mo ago
  Is that a huge problem? Doesn’t almost everything else have a prophylactic and is curable? Hep-C might be the only other one I believe and I’m unaware if it’s treatable or not.
  - gib444 2mo ago
    Antibiotic resistant syphilis and ghonerrea don't sound like a fun time
    - wat10000 2mo ago
      More or less fun than dying of AIDS?
      - gib444 2mo ago
        Don't move the conversation goalposts (and we don't do "gotchas" here, as you well know) And AIDS is not considered a death sentence btw. It's not the 1980s
        wat10000 2mo ago
        This subthread is specifically about better HIV treatments leading to an increase in other STIs. Did you forget about what you were replying to?

giantg2 2mo ago

"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education." 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.

simonask 2mo ago
As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
- giantg2 2mo ago
  Then why aren't STDs, TB, etc, eliminted. Even heavily vaccinated diseases are still around and pop back up occasionally. The only one eliminted was smallpox.
  - OkayPhysicist 2mo ago
    Most STDs we don't have vaccines for, and the ones that have survived to the modern day are the ones that can be good at hiding. Syphilis, for example, has the nasty habit of seemingly going away by itself, only to pop up again years later. Chlamydia and Gonorrhea can be asymptomatic. 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.

jonathanlydall 2mo ago

You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents. 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.

cj 2mo ago
Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it. 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.
- egeozcan 2mo ago
  All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions. 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.

Der_Einzige 2mo ago

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xutopia 2mo ago

PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.

skybrian 2mo ago

There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard. 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.

wat10000 2mo ago
> If your solution to some problem relies on “If everyone would just...” then you do not have a solution. Everyone is not going to just. At not time in the history of the universe has everyone just, and they’re not going to start now. https://www.tumblr.com/squareallworthy/163790039847/everyone-will-not-just https://www.tumblr.com/squareallworthy/163790039847/everyone...

cucumber3732842 2mo ago

Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).

alittlebee 2mo ago

My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!

a-dub 2mo ago

it's actually an interesting question: is there a point where the long acting prep injections have effective durations that look like vaccines and boosters. and yes, sadly, it appears that convenience and some of the psychological aspects of marketing play outsized roles in public health. either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.

tonnydourado 2mo ago

Transportation was a solved problem with horses, doesn't mean the car isn't a good idea. Same for internal combustion and EVs. 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.

someguydave 2mo ago
In the meanwhile everyone infected with HIV should be permanently quarantined like in Cuba

leptons 2mo ago

This isn't just about HIV, it's about finding new ways to approach viruses. HIV wasn't the first and won't be the last virus we don't have a way to stop. This research adds to our knowledge about ways to attack some of the trickier viruses.

alightsoul 2mo ago

In the global south a significant barrier is the lack of sex education, driven by local christian associations, which have significant power in local societies. They see it as "gender ideology" or as preventing births and thus being against the bible.

deleted 2mo ago

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fortran77 2mo ago

It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.

jitl 2mo ago

A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.

kosh2 2mo ago

Are people still getting infected? Yes? Then it is not a solved problem.

j2j8 2mo ago

In exchange for accelerated ageing for being on lifelong HIV drugs. That side effect could be because the reverse transcriptase in humans is telomerase.

ElProlactin 2mo ago

> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.

raxxorraxor 2mo ago

I disagree that this is a solution. Being dependent on life long medication isn't a trivial problem and transmission must still be seen as serious. But of course it should be available to all that need it.

rsynnott 2mo ago

While that’s _kind_ of true, in practice compliance is going to be an issue. People are bad at taking medication, especially on an indefinite basis. As is, a lot of people use ‘event-based PrEP’ (dosing only before and a couple days after potential infection). There’s a lot of room for error. A working vaccine would definitely be preferable.