One thing I'm confused about is why HIV at-home tests are not more available. There's Oraquick (https://oraquick.com/), which in bulk is $15/test, whereas its about $40 retail. On the other hand, we've gotten COVID tests down to something like $5 retail. On top of that, it's relatively easy to get free COVID tests.
Imagine if you could test for this right before you "got down." I imagine that'd change the game.
Although, a terrible part of me wonders if the condom debate will become the same as masks.
> Imagine if you could test for this right before you "got down." I imagine that'd change the game.
Unfortunately, HIV tests can't detect early infection, which is when it's most transmissible. The Oraquick FAQ says their test is accurate 3 months after exposure. So there isn't much benefit to testing right before sex vs every few months.
Fair, CUE health built RT-NAT COVID tests, and I imagine that same tech can be copied to HIV testing (provided there is a cheap-ish way to detect HIV RNA).
Have you had much casual sex lately? Anecdotally, condom use is down significantly over the last couple decades now that HIV is no longer a death sentence.
I would have to assume most sexually active women in the US are on some form of birth control or just avoid hooking up near ovulation windows. I've had exactly one woman ever ask me to use a condom, but she was french. Not sure if they're more expected there.
I'd happily raise any kid that came of it so I've never been worried.
I would think it's the opposite. Older women come from a time before widespread birth control usage and are used to condoms vs younger women who rely mostly on pills. Unless you were referring to fertility in which case yeah probably got better odds of not having unexpected kids in your 30's.
> Older women [in this context, 30s] come from a time before widespread birth control usage and are used to condoms vs younger women who rely mostly on pills.
Lol? Hormonal birth control has been around since the 1960s. Women old enough to remember a time before the pill are postmenopausal and probably not worried about conceiving. Women in their 30s today grew up in a time of omnipresent birth control.
Not lately no, been married 12 years. But I don't remember ever hearing about debates as heated as masks around condoms.
Yeah there are fringe groups advocating for no birth control and all, but what's really their market share? Doesn't sound similar to the big divide we had a few years ago over masks.
I am a millennial but my understanding is that many gay men scoffed at condom use pre-AIDS, in the 70s, the same way many today scoff at mask use. This is the way it's generally been described by older gay men I know and documentaries and movies. Not to necessarily equate the health risk between the two scenarios, just equating the public sentiment during the beginning stages of a major public health crisis.
It is why from my perspective the gay community at large has an intimate relationship with the phrase "new normal" because it seems like gay men's cultural understanding of what a healthy sex life looks like truly changed more or less permanently since the AIDS epidemic.
There has definitely been a lasting effect in that gay men who have resources tend to be very well educated and proactive about their health. Everyone is on PreP. As a result of that, condom use has definitely become the exception and not the rule again over the past five or so years.
Yeah for sure, I'm not denying that condom use is now dropping. But it requires that the daily pill gets taken or do whatever else it is that needs to be done that constitutes safe sex today.
There is, particularly around the evangelical sector in the US whom have been pushing towards banning all contraceptives (or rather, making them hard to obtain making them defacto banned). It's part of the idea that only moral approach to sex is abstinence or procreation.
Yes I'm sure it's the religious people not the fact that 'creampie' is one of the most popular genres of online pornography, that was virtually nonexistent 20 years ago, and now at the forefront of the zeitgeist.
No condoms, but the money shot was always external prior to the recent "all internal" craze. Creampies forego any and all risks. Coitus interruptus is in the minority these days.
> Scientists, health care experts, global health leaders, and advocates must stand up at this critical moment, learn more about PEPFAR, and articulate with clarity what the program does and does not do. Now is the time to meet and share information with lawmakers and Congressional staff. Write letters. Speak out. The lives of millions hang in the balance.
It is at risk. 20 years of investment have gone into it. Now, many renowned HIV researchers seem to be pivoting to help covid / long covid efforts, an epidemic within the pandemic. And they are finding it is similar to HIV - the only reason we cannot cure HIV is because the virus hides where the HIV drugs can’t go in. Leading to high inflammation.
Many researchers believe that if we go all in on one of these, it is possible we can make breakthroughs in HIV, ME/CFS, and post-acute infection syndromes (PAIS) in general. I remain hopeful.
The main issue is not even mentioned - cheap anti-HIV drugs require escape from patents and promotion of generic manufacturing to reduce costs to the level that poor countries can afford to buy or produce the necessary retrovirals.
> "Critical to the therapeutics market has been the role of generic drug manufacturers’ ability to supply low- and middle-income (LMIC) markets with off-patent and licensed products at a high volume and relatively low cost."
HIV patients in wealthy countries are a cash cow for the pharmaceutical industry, at least for as long as a permanent one-shot cure is not discovered, but there's no profit in making drugs for people who can't afford to pay for them. As Goldman Sachs noted, discovery of a cure would destroy the market. Isn't capitalism great?
Technology happens when the environment is right for it, not randomly.
A breakthrough happens because the research community, available technology and it's economics are pointing in that direction anyway, even if the exact moment can't be known: i.e. Newton and Leibniz both inventing calculus around the same time.
If you're a pharma company and you find the cure for AIDS, then the race is on: someone else is very likely to find it within the same time frame (you know, if none of your thousands of employees decides to just leak it in its entirety).
There will be no market for for product if you don't get to market first: because anyone else will conclude the same.
"Suppressing the cure" doesn't happen. There are too many people involved, and no one goes into bioscience to not help people - the actual scientists don't get paid enough for that.
drug research overall falls into a "natural oligopoly" .. the research is lengthy and expensive, yet the occasional "winner" can be generations of income. IIR a book on the industry is called "The Billion Dollar Molecule"
meanwhile, some of the obnoxiously, obscenely wealthy individuals in the USA are running small pharm brands, either supplements or critical medicines. This wealth-crowbar was exposed to the public by the "pharma-bro" guy not long ago
> Pyrimethamine has been available since 1953.[20] In 2010, GlaxoSmithKline sold the marketing rights for Daraprim to CorePharma.
If Wikipedia is correct, that drug was long ago out of patent doghouse. I don’t know why USA (government, nonprofit, bill gates I don’t care who) doesn’t just make generics. Ditto insulin, that is another glaring example of that insanity.
You could argue (very reasonably) that one of key requirements for free market is a freedom not to buy. That is a potential choice, but few billion of years of evolution says a very bad choice. Thus rather special status of healthcare in pretty much every country.
Back to the issue of capitalist drug research: maybe it’s just me, but most of the new drugs seem to come from USA. Other countries with less insane healthcare (not even sure if care is the correct word in USA context) system (e.g. NHS in UK) don’t seem to produce new drugs.
Ergo, this bad system seems less bad than others, at least as producing new stuff goes.
> maybe it’s just me, but most of the new drugs seem to come from USA.
It's just you.
What we see from the US is re-patenting. Citalopram gets a minor change and becomes escitalopram, it gets a new patent and some bullshit sales pitch to make doctors switch from a cheap generic to a more expensive branded med. Or ketamine infusion becomes eskatamine nasal spray - moved from a generic and tricky to administer med to a branded and easy to administer med (and, it turns out, much less effective).
The other thing the US does is "Me too" drugs - someone develops an SSRI and the US is then able to spin up 8 different versions of SSRIs that are different enough to get their own names and patents.
Most of the funding in the US doesn't come from big pharmaceutical companies, but is government funding.
For the new meds that are developed in the US the funding normally comes from Government (NIHR) funding, and not direct from pharmaceutical companies.
It's also difficult to work out what to measure: do we look at GERD (gross expenditure on research and development) or do we look at GDP too? DO we look at the quantity of new meds, or the impact on quality of life or years of life lost to disability? Do we focus on meds aimed at diseases that affect wealthy countries (diabetes, breast cancer, etc) or on disease that mostly affects poorer countries? Because three meds that have moderate impact for a small population are "less" than one med that has a good strong impact on a large population.
> In April 2014, U.S. House Democrats Henry Waxman, Frank Pallone Jr., and Diana DeGette wrote Gilead Sciences Inc. questioning the $84,000 price for sofosbuvir. They specifically asked Gilead CEO John Martin to "explain how the drug was priced, what discounts are being made available to low-income patients and government health programs, and the potential impact to public health by insurers blocking or delaying access to the medicine because of its cost."
The existing standard of care was a liver transplant. The price that the manufacturers set for the drug was based on what they thought various insurers would be willing to pay for it.
People definitely caterwauled about a $100,000 drug regimen, nevermind that it is often a cure and a lot better than an organ transplant.
The tl;dr portion relevant to the title is buried in the middle of one of the paragraphs:
> Yet, current reauthorization is at an impasse because of misperceptions and inaccurate assertions that have no bearing whatsoever on PEPFAR’s purpose and work. Some conservative voices contend that PEPFAR funds support access to abortions, assertions that PEPFAR staff and public health leaders repeatedly affirm are groundless. Other concerns point to PEPFAR language regarding groups that scientific data have shown to be at-risk for HIV and whose members need HIV prevention and treatment services, including transgender people and sex workers.
The title should be "consideration for the reallocation of funds to more beneficial uses". HIV infections in the US are easily preventable even with current treatments.
It is also crisis of trust. Western medical companies, Bill Gates foundations etc do not have best reputation in Africa. There were all sorts of experiments done on people, some medications were not as effective as promised... And there is a heavy political and cultural interference, that is just not acceptable in Africa!
This is like saying that gun violence is a solved problem except in the US where they believe solution to school shootings is more guns in schools and arming teachers.
It’s not false but it’s an oversimplification of the problem and doesn’t really serve to get to a solution. Naturally the regions most affected by $PROBLEM are going to have the highest concentration of nutters, correlation but not causation.
Plenty of people in America believe you can pray to heal their children and deliberately withhold medicine but we don't stereotype all Americans like that
It will become an American problem if Africans stop taking ART and start transmitting the disease for the rest of their lives (a decade or two) rather than the short 30 day window it is now. Couple that with a complete ban of contraceptives advocated by religious Americans/red states and that’s a recipe for disaster.
Don’t share needles and don’t engage in casual sex don’t seem like a too high bar. There is a lot rape, but Botswana has 25% of population infected and per UNICEF
> While there is increased awareness of HIV in general, comprehensive knowledge of HIV remains low, condom use among sexually active young people is declining, and rates of forced sex and teenage pregnancy are ominously high.
The Reagan administration didn't approve of gay people or heroin addicts. So they said they didn't have to worry about AIDS.
Guess what though? Drug addicts are people. And obviously, the entire world understands now that a disease disproportionally affecting gay people is still very fucking important.
You say empathy overdrive, I say empathy baseline. Refusing to see others who suffer as human because you think it doesn't affect your bubble (and the latter part is usually false) doesn't meet the minimum.
I'm not saying we should intervene in 100% of people who suffer, because we will not succeed at such an impossible task. But solving HIV and other critical diseases in less developed parts of the world is a relatively small investment with a high success rate, per TFA. Yet some will say "I don't care because it won't affect me". Seems pretty weak to me. Does not strike me as wisdom or emotional maturity to be honest.
There's an estimated 156,000 people in the USA that have HIV and are unaware of their status, 21% of the population believes in witchcraft here.
It's not that HIV doesn't pose a public health risk, it's just not nearly as prevelent.
I’m going to be very mad if there is a resurgence in HIV because of the asinine GOP. If people have to be worried again about their next sexual contact (condoms only offer between 70-90% protection against HIV), we will return to a prudish lifestyle again at a time the west can least afford it with falling birth rates.
Is a prudish lifestyle going to affect birth rate all that much? I can’t imagine the solution for falling birth rate to be that people need to sleep around more. If that were true, it wouldn’t have fallen in the first place.
Exactly, myself, and all of my straight peers are not having children because they are expensive, for all of us it's cost of living (well, and I'm gay, but there's ways around that :P)
Not just chastity but also poverty. Imagine how much economic damage a global HIV pandemic would do that can be avoided by keeping it suppressed. What it the opposition to continuing this program thinking? The article mentions wrongly associating it with abortions, .. and maybe some support goes to at risk people which includes mentioning transgender… they would tank the global economy and ruin their own lives on this principle? I don’t get it.
It's a combination of desperation, fear, and willful ignorance (one might even say self-induced stupidity). You've had forty years of propaganda at this point, and the old management who designed that propaganda for their followers are retiring or dying and being replaced by younger generations who were or are the followers of that propaganda. In essence these newer generations don't know the lies aren't real, and have been in so deep for most of their lives that they refuse to shatter their worldviews. And so when those worldviews keep being shut down or outright disproven they become more reactive, doing anything they can to keep their understanding of the world intact. They believe that their opposition are creating lies and using systems of information and governance to support those lies, and so to destroy their opposition they are willing to destroy the very systems they themselves work in and rely on to dispel the supposed lies.
They believe they are the only sane men and women in a world of shadows and madness because that's the only way they can continue to function. There is no reasoning with someone who's gone that far. The veneer of egalitarianism that politics in the U.S. has prevents anyone from actually doing anything to stop this increasingly volatile group lest the intervening mediators be seen by their peers both within the volatile group and without as aggressive savages who would subvert well established conventions. The potential mediators must let themselves be stabbed and reply with "That is quite impolite" or else they lose all trust from said peers.
Virtually every cultural subgroup in history had their birthrates plummet once they reached a certain amount of wealth. Evidence indicates that if anything, poverty is good for population growth.
Birth rates were higher back when lifestyles were more prudish. Hypergamy seems to have very little positive affect on the production and growth of healthy families and children.
Birthrates have been falling ever since the invention of the pill. Children (often multiple) could no longer be forced upon women. This, along with women becoming their own economic units meant that they no longer have to risk their life and bodies in return for food and shelter from a man.
Not providing a society the cultivates the families that create and cultivate children has. Providing a system that helps parents raise children rather than be wage slaves makes people want to have kids.
>Providing a system that helps parents raise children rather than be wage slaves makes people want to have kids.
Cool, I take it you'll join my anti-immigration and anti-women-in-the-workforce rally then? It's my simple solution to raise wages so that families are affordable on a single income.
> If people have to be worried again about their next sexual contact (condoms only offer between 70-90% protection against HIV), we will return to a prudish lifestyle again at a time the west can least afford it with falling birth rates.
Are you really trying to imply that a "prudish lifestyle" where people actually have long-term relationships and marry is bad for birthrates, and more casual sex is good?
Abusive is too wide of term that covers too many things. Marriages can be hard if it’s a partnership of equals. It needs to move back to the paradigm where the husband is the primary dominant and makes all the decisions. The wife needs to be submissive. Marriages of this variety are easy. We already have domestic violence laws in place so there are safeguards in place against actual abuse.
I wasn’t trolling. It’s probably my least progressive viewpoint but honestly I don’t see a society that can continue to make technological progress without it. The patriarchy isn’t going anywhere, if anything it is only growing in the US GOP, East Asia, South Asia, Eastern Europe and Russia, the Middle East, Australia, Africa and Latin America.
PrEP takes preplanning and atleast several hours before someone can have sex even if they have the pills on them. That’s not really going to work for casual hookups.
No it doesn't. Other than the first few days after getting a prescription where one needs to wait for it to build up in the body, it's 1 pill/day with no further planning.
Well that’s even worse. You have to be on it continuously? I thought it was just before any planned sexual encounters? They’re basically ARTs and wreak havoc on the body (10x increase in cancers- that’s a 1000%, neurological damage etc.) over time.
Nope, prep is well tolerated by the vast majority of individuals, although in rare cases it can reduce kidney function and bone density — However, the prescription requires regular lab testing (Where they also run STI tests as well), and if issues are found, there's two options:
1: Getting off prep, in which case kidney/bones should return to normal.
2: Switching to a newer version of prep called Descovy (in the US), which is has less of the aforementioned side effects, but is more expensive because there is no generic for it yet, and may not be covered by some insurances.
Although technically not sanctioned in the US (IIRC), the 2-1-1 method can also be an option for planned encounters: 2 pills 24hrs before the encounter, and 1/day for 2 days after the encounter.
Can be, and certainly is on paper, but in practice most everybody professionally involved with this problem knows that the groups at the most risk also tend to be among the most economically vulnerable. I know a lot of USians on Prep, none of whom pay out of pocket for it.
It’s heavily subsidized through public health channels, manufacturer rebate programs to help with high deductibles for insured people, and grant organizations like the PAN Foundation. Truvada has a generic now. Plus, in 2019 the federal government designated it as a preventative therapy that ~all insurance plans must cover without copay or deductible [0].
Now, it’s true that not everybody is insured (though people who are economically vulnerable tend to qualify for heavily subsidized insurance under the ACA or Medicaid). Still, the costs of Prep specifically in the US, while very high, don’t tend to be borne by the patients directly.
This usually the result of poor condom use/knowledge, like condom breakage.
If the condom is too big this can happen or you become flaccid(it's a thing to also check to make use that this isn't happening during intercourse), and condoms can break when you don't use lubricant or the incorrect lubricant(e.g. petroleum jelly based lubricant).
Yes the quoted effectiveness is based on the average in practice. Anecdotally what I've seen is the failure of condoms is usually got drunk and didn't use one. In particular substance abuse is highly correlated with unsafe sex and HIV infection. I'm pretty sure it's also correlated with birth control failure.
Not really. Most abortions are women who already have children. Once upon a time, this meant that most abortions were carried out by married women (marriage itself is less common now).
The connection between marriage and abortion isn't what you think it is.
77% of abortions done by people who are not married and 46% done by women who are not married and not even cohabiting.
Abortion is a symptom of a problem which is the lack of marriage and the highly promiscuous lifestyle that is sold to us. Married people when there is a child on the way (planned or unplanned), there is little to no reason to get an abortion. Sleeping around lifestyle, of course the first thing that happens when pregnant, abortion...
Abortion is a symptom of preventing conception being too much hassle. Nothing more, nothing less.
And you realize that people of every age group are having less sex than any time in the last 30 years, right? It's almost like this "promiscuous lifestyle" you're so terrified of doesn't exist.
Not to mention a host of societal factors leading to more autonomy for women which in turn leads to (you guessed it) sex outside of marriage.
To make more women married, we would have to roll back the clock on all those hard won freedoms. Let's not do that, let's maybe just make birth control more accessible, effective and affordable. Boom! Abortion problem solved.
The person I was responding to initially clearly does not want to solve abortion this way.
> Many of these state laws, then and now, criminalize actions that cannot transmit HIV – such as biting or spitting – and apply regardless of actual transmission, or intent. After more than 40 years of HIV research and significant biomedical advancements to treat and prevent HIV transmission, many state laws are now outdated and do not reflect our current understanding of HIV. In many cases, this same standard is not applied to other infectious, treatable diseases. Further, these laws have been shown to increase stigma, exacerbate disparities, and may discourage HIV testing.
If not for your benefit, then for everyone else's; here are the DOJ's recommendations for modernization[1], from a sub-link of the above:
> Generally, the best practice would be for states to reform these laws to eliminate HIV-
specific criminal penalties except in two distinct circumstances. First, states may wish to retain
criminal liability when a person who knows he/she is HIV positive commits a (non-HIV specific)
sex crime where there is a risk of transmission (e.g., rape or other sexual assault). The second
circumstance is where the individual knows he/she is HIV positive and the evidence clearly
demonstrates that individual’s intent was to transmit the virus and that the behavior engaged in
had a significant risk of transmission, whether or not transmission actually occurred.
> For states that choose to retain HIV-specific criminal laws or penalty enhancements beyond these two limited circumstances, the best practice would be to reform and modernize them so that they accurately reflect the current science of risk and modes of transmission, the quality of life and life span of individuals who are living with HIV, account for circumstances where the failure to disclose is directly related to intimate partner violence, and ensure they are the desired vehicle to achieve the states’ intended purpose in enacting them initially or retaining them in modernized form.
[The document continues with specific, scientifically backed advice that would help inform HIV-specific statutes.]
As for you in particular, I'm not sure who's culture warring here. Maybe this discussion would be more interesting if you provided a tangible argument based in health or science rather than vague political gesturing.
I think the parent may have been referring to actual laws that exist today, rather than DOJ recommendations. Like in California where it is perfectly legal for an HIV positive person to have unprotected sex with somebody else, without disclosing it, so long as it wasn’t specifically their intention to infect the other person. If it was specifically their intention to infect the other person (good luck proving that btw), then it’s a misdemeanour.
So, still a crime, even if a misdemeanor? Pretty sure it's still negligence if you actually infect someone, as per your link:
> A defendant might be negligent for infecting a partner with HIV if:
The defendant knew he or she had AIDS or was HIV-positive;
The defendant was negligent in not disclosing his/her status and/or not using a condom or dental dam; and
As a result of that negligence, the plaintiff acquired the disease through the transmission of HIV and suffered damages (such as medical bills and/or pain and suffering).
Imagine if you could test for this right before you "got down." I imagine that'd change the game.
Although, a terrible part of me wonders if the condom debate will become the same as masks.