[HN Gopher] Is the end of AIDS in sight?
___________________________________________________________________
Is the end of AIDS in sight?
Author : Anon84
Score : 55 points
Date : 2023-09-19 14:40 UTC (8 hours ago)
(HTM) web link (www.economist.com)
(TXT) w3m dump (www.economist.com)
| [deleted]
| giantg2 wrote:
| "Is the End of Aids in Sight?"
|
| 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.
| deaddodo wrote:
| 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.
| londons_explore wrote:
| 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.
| binarymax wrote:
| Where did you get that 0.4% number? Is this a well-
| established statistic?
| londons_explore wrote:
| 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.
| pixl97 wrote:
| > 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.
| londons_explore wrote:
| But how many Americans are aware of diabetes and take at
| least some effort to avoid it? Eg. Drinking diet coke
| instead of regular Coke? Most...
| [deleted]
| buescher wrote:
| I'm curious too. My guess - 99.7% covers three standard
| deviations assuming a normal distribution - so just within
| three sigma?
| giantg2 wrote:
| I'm curious too. I have actually heard that .04% number
| before when dealing with disease prevalence, but I don't
| remember where from.
| Simulacra wrote:
| IMO Prep has raised the risk of HIV by giving people a false
| sense of security.
| foldr wrote:
| Annual HIV diagnoses have declined (somewhat) in the US in
| recent years. So either it hasn't, or there are other
| bigger factors at play.
| burkaman wrote:
| What is false about it? It is apparently close to 100%
| effective if you take it every day, that seems like a very
| real sense of security.
| wholien wrote:
| > Short answer - no.
|
| 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]
|
| [0]:
| https://en.wikipedia.org/wiki/Betteridge%27s_law_of_headline...
| hn_throwaway_99 wrote:
| 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.
| LordDragonfang wrote:
| 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.
|
| https://www.ebar.com/story.php?ch=news&sc=news&id=280418
| TZubiri wrote:
| 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.
| civilitty wrote:
| It's not the 90s anymore. In the developed world HIV
| primarily and disproportionately effects IV drug users, not
| gay men.
|
| In the developing world, it has nothing to do with
| promiscuity but lack of education and access to preventative
| measures like condoms and PrEP.
| [deleted]
| jl6 wrote:
| This is not true. In 2018 in the US, 66% of new HIV
| diagnoses were in the transmission category of male-to-male
| sexual contact:
|
| https://www.cdc.gov/hiv/library/reports/hiv-
| surveillance/vol...
| nonce42 wrote:
| 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.)
|
| From https://www.cdc.gov/hiv/basics/statistics.html
| zajio1am wrote:
| 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.
|
| [0] https://www.hiv.gov/hiv-basics/overview/data-and-
| trends/stat...
| EatingWithForks wrote:
| 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.
| Darthy wrote:
| That's revolting. Which radio show was this?
| _jal wrote:
| Rush Limbaugh.
| wormius wrote:
| Rush Limbaugh? Or any of the right-wing radio hosts who
| mocked belittled and laughed at liberal/minority
| suffering, I'm sure.
| x0x0 wrote:
| Don't forget Reagan's press secretary mocking the so-called
| "gay plague"
|
| https://www.vox.com/2015/12/1/9828348/ronald-reagan-hiv-
| aids
| [deleted]
| foldr wrote:
| >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.)
| chimeracoder wrote:
| > 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).
| toomuchtodo wrote:
| 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.
| hn_throwaway_99 wrote:
| 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.
| anon84873628 wrote:
| The parent comment is poorly veiled moralizing and faux
| humility.
| hn_throwaway_99 wrote:
| 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."
| TZubiri wrote:
| 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.
| hn_throwaway_99 wrote:
| > 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.
| RC_ITR wrote:
| 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.
|
| [0]https://www.cdc.gov/nchs/pressroom/sosmap/unmarried/unmarr
| ie... [1] https://stanfordhealthcare.org/medical-
| conditions/sexual-and....
| 0xbadcafebee wrote:
| 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.
| rafaelero wrote:
| > 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.
| bobsmooth wrote:
| >Gay people do not have more sex partners than straight
| people.
|
| On average, gay men will have more sexual partners than
| straight men. There's no reason to deny this.
|
| https://www.psypost.org/2020/07/lgb-people-and-extraverts-
| te...
|
| >transmit HIV by sharing needles
|
| The vast majority of new infections are through gay men
| having sex. IV drug use only accounts for 7% of new
| infections
|
| https://www.hiv.gov/hiv-basics/overview/data-and-
| trends/stat...
|
| >but it exposes the flaw in this notion that gay people are
| sluts and sluts get STDs.
|
| Your insecurities don't change the facts. Gay men have more
| sex and more sex leads to more STDs.
| k__ wrote:
| 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.
| ChrisMarshallNY wrote:
| 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."
| aaomidi wrote:
| The good riddance attitude is so, so disturbing to me. And
| it's fucked that we still have that attitude today.
| logicchains wrote:
| > 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.
| hn_throwaway_99 wrote:
| > 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...
| ChrisMarshallNY wrote:
| Glad to hear that.
|
| Most of Africa is still a pretty terrible place to be gay,
| though.
| dekhn wrote:
| 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 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...
| at_a_remove wrote:
| I often mention the whole Gen X trauma thing.
|
| 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.
| TZubiri wrote:
| herpes is the worst thing? What about chlamydia, gonorrhea?
| cortesoft wrote:
| Those are both treatable and not permanent.
| irrational wrote:
| 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.
| hn_throwaway_99 wrote:
| Which is precisely why people should get regularly tested
| for STDs.
| irrational wrote:
| 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.
| fragmede wrote:
| 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. -\\_(tsu)_/-
| hn_throwaway_99 wrote:
| 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.
| dekhn wrote:
| Well, in the sense that as a retrovirus that integrates
| into your genome and then erupts unexpectedly decades
| later.... yes.
| [deleted]
| anaisbetts wrote:
| Both of those are on the same order as "a bad cold" in
| terms of health - they are straightforward to treat and are
| not at all a big deal.
| irrational wrote:
| 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.
| FuriouslyAdrift wrote:
| Gonorrhea has become drug resistant due to the overuse of
| anibiotics (both for people and animals).
|
| Prior to fairly recently, it was easily cured if
| detected.
|
| https://www.who.int/news-room/fact-sheets/detail/multi-
| drug-...
| irrational wrote:
| 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.
| at_a_remove wrote:
| 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.
| irrational wrote:
| 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.
| bdcravens wrote:
| 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.
| mathewsanders wrote:
| 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.
| bugglebeetle wrote:
| 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.
| pluto_modadic wrote:
| because one caused a moral panic, and one needed people to be
| moral.
| [deleted]
| tristor wrote:
| 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.
| bugglebeetle wrote:
| 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.
| DelaneyM wrote:
| 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?".
| bugglebeetle wrote:
| 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.
| diogenes4 wrote:
| 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.
| DelaneyM wrote:
| > ...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.
|
| [https://www.unaids.org/en/resources/fact-sheet],
| [https://www.worldometers.info/coronavirus/]
| abeppu wrote:
| 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.
| einpoklum wrote:
| 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.)
| jlmorton wrote:
| OP was probably referring to the American experience, which
| is correct. AIDS has killed about 700,000 in the USA, vs 1.1
| million Covid deaths.
| graeme wrote:
| 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.
| willmadden wrote:
| >Further, covid deaths are severely undercounted.
|
| 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.
| bugglebeetle wrote:
| Apologies, I should've clarified that I was referring to the
| US, where COVID has, in fact, killed more people than
| HIV/AIDS.
|
| https://www.scientificamerican.com/article/why-covid-
| deaths-...
| abeppu wrote:
| > 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.
|
| https://www.history.com/news/aids-epidemic-ronald-reagan
| bugglebeetle wrote:
| 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."
| vkou wrote:
| 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.
| bigbillheck wrote:
| Trump's covid response had some problems, especially early
| on, but it was infinitely better than Reagan's AIDS
| response.
| abeppu wrote:
| 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.
| mathewsanders wrote:
| > 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.
|
| [1] https://www.axios.com/2022/09/07/court-hiv-prep-
| requirement-...
| cltby wrote:
| Rather depressing that we're subsidizing wanton sexual
| indulgence to the tune of $30k/year/person.
| elil17 wrote:
| Just to dispel some myths here:
|
| 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.
| cltby wrote:
| Good comment. I concede if it's really ~$20/month it's a
| rounding error and an obvious policy win.
| Clamchop wrote:
| What motivated you to share this?
| 535188B17C93743 wrote:
| So queer people should remain celibate?
|
| 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.
| cltby wrote:
| There's wide, wide middle ground between celibacy and the
| debauched status quo.
| diogenes4 wrote:
| And where in that middle ground are you trying to insert
| yourself?
| diogenes4 wrote:
| It doesn't help that heterosexual use of prep is virtually
| unheard of.
| hellojesus wrote:
| 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.
| ProfessorLayton wrote:
| 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.
| hellojesus wrote:
| 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.
| chimeracoder wrote:
| > 30-day supply of generic PrEP costs ~$2,500
|
| 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.
| mathewsanders wrote:
| 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).
| chimeracoder wrote:
| > 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.
| teeray wrote:
| https://archive.ph/vNEMG
| ftyers wrote:
| https://archive.ph/vNEMG
| cdlopi wrote:
| [flagged]
| [deleted]
| bitwize wrote:
| When AIDS and MS are manageable diseases, you know you live in a
| miraculous society.
| amanj41 wrote:
| A little off topic, but may be beneficial to uppercase all of
| "Aids" to "AIDS" to avoid ambiguity
| dang wrote:
| Fixed now.
| adrianmonk wrote:
| 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").
| pathartl wrote:
| Clarifying what you mean, all acronyms are pronounceable,
| otherwise they're just a sparkling initialism.
| edflsafoiewq wrote:
| The article uses "AIDS". It's just the HN title mangler at
| work.
| adrianmonk wrote:
| Hah, my explanation fits the facts perfectly... except for
| one _tiny_ little detail. I often forget that the title
| mangler exists.
| [deleted]
| irreticent wrote:
| It also might be more accurate to not refer to AIDS as a virus.
| It is a syndrome caused by HIV. HIV is the virus.
| cglong wrote:
| 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 :)
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