5 ms·

Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, an

Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, and the only reason HIV transmission is high in poor countries is because, well, they're poor. We (humanity as a whole) have plenty of money, we could fund these things, we simply choose not to. I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did. > So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still. This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.

jcul 2mo ago
I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide. It's quite sad and difficult to read at times.
- everforward 2mo ago
  Tuberculosis is different, in a very dark, utilitarian way. 4% of new TB cases are multi-drug resistant (19% of recurrences). Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing. Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets. They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse. TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
  - attila-lendvai 2mo ago
    > TB is also shockingly infectious let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework. if you feel the urge to fight this: i lived with someone infected with TB. e.g. measles is shockingly infectious. TB is not.
    - jquery 2mo ago
      A single, untreated person with TB will infect 1.5 to 4 people if public health interventions don’t happen. Measles sits at 12 to 18 people per infected person. In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
      - attila-lendvai 2mo ago
        don't forget that untreated TB runs for years, sometimes for many years. measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).
      - attila-lendvai 2mo ago
        also note the exponential function here... and an exponent of 2 and 12 are very different animals.
    - everforward 2mo ago
      Depends heavily on whether we're measuring in practical terms, or in "no medical intervention" terms. If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious. If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio. Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does. I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt. > i lived with someone infected with TB. If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.
shadowtree 2mo ago
"the only reason HIV transmission is high in poor countries is because, well, they're poor." This is factually untrue. Being poor does not equal a HIV transmission rate. There is no 1:1 correlation. A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom. Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female. The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk. Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.
- xenospn 2mo ago
  I’ve never heard that before. That explains a lot.
- dahinds 2mo ago
  I don't think the original assertion is "punching down" on poor people. While you're correct that poverty isn't the "only reason" for high HIV transmission, poverty certainly contributes to it, via lack of access to health care and lack of access to education. How is it less "punching down" to attribute it to social behavior and culture? Isn't needle sharing associated with poverty, or would you also call that "culture"?
  - shadowtree 2mo ago
    I was poor, grew up in social housing. I did not use drugs. "I share needles because I can't afford my own" is an INSANE take. Don't shoot drugs in the first place! Poor people are normal humans, they have willpower, agency. It is a rich people myth that poor people are cattle, devoid of any chance of doing the right thing. It is culture, behavior, social norms. Being poor does not force you to abandon the nuclear family, does not force you to engage in criminal acts. (there is reverse causality though) In the early 1960s South Korea had a per capita income lower than those of Haiti, Ethiopia, and Yemen, and about 40% below India's. Did all South Koreans become heroin addicts with HIV?
deleted 2mo ago
[deleted]

jcul 2mo ago

I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide. It's quite sad and difficult to read at times.

everforward 2mo ago
Tuberculosis is different, in a very dark, utilitarian way. 4% of new TB cases are multi-drug resistant (19% of recurrences). Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing. Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets. They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse. TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
- attila-lendvai 2mo ago
  > TB is also shockingly infectious let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework. if you feel the urge to fight this: i lived with someone infected with TB. e.g. measles is shockingly infectious. TB is not.
  - jquery 2mo ago
    A single, untreated person with TB will infect 1.5 to 4 people if public health interventions don’t happen. Measles sits at 12 to 18 people per infected person. In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
    - attila-lendvai 2mo ago
      don't forget that untreated TB runs for years, sometimes for many years. measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).
    - attila-lendvai 2mo ago
      also note the exponential function here... and an exponent of 2 and 12 are very different animals.
  - everforward 2mo ago
    Depends heavily on whether we're measuring in practical terms, or in "no medical intervention" terms. If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious. If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio. Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does. I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt. > i lived with someone infected with TB. If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.

shadowtree 2mo ago

"the only reason HIV transmission is high in poor countries is because, well, they're poor." This is factually untrue. Being poor does not equal a HIV transmission rate. There is no 1:1 correlation. A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom. Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female. The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk. Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.

xenospn 2mo ago
I’ve never heard that before. That explains a lot.
dahinds 2mo ago
I don't think the original assertion is "punching down" on poor people. While you're correct that poverty isn't the "only reason" for high HIV transmission, poverty certainly contributes to it, via lack of access to health care and lack of access to education. How is it less "punching down" to attribute it to social behavior and culture? Isn't needle sharing associated with poverty, or would you also call that "culture"?
- shadowtree 2mo ago
  I was poor, grew up in social housing. I did not use drugs. "I share needles because I can't afford my own" is an INSANE take. Don't shoot drugs in the first place! Poor people are normal humans, they have willpower, agency. It is a rich people myth that poor people are cattle, devoid of any chance of doing the right thing. It is culture, behavior, social norms. Being poor does not force you to abandon the nuclear family, does not force you to engage in criminal acts. (there is reverse causality though) In the early 1960s South Korea had a per capita income lower than those of Haiti, Ethiopia, and Yemen, and about 40% below India's. Did all South Koreans become heroin addicts with HIV?

deleted 2mo ago

[deleted]