the ugly truth that everyone knows but suppresses: ending HIV is completely impossible without massively increasing the level of human development (social, economic, industrial, medical) in the problem areas.
go ahead and throw money at the scientists; they need it and can put it to good use. go ahead and throw money at testing people for HIV. go ahead and throw money at treating people for HIV. these things are necessary but not sufficient for HIV to be conquered.
like all infectious diseases, HIV devastates the fringes, the poor, and the ignorant. without building roads, hospitals, drug factories, hygiene education programs, disease education programs, universities, etc-- without building a new, more advanced society-- the problem populations will forever be problems. without modernizing backward cultures, they cannot be saved from HIV. this, of course, is extremely patriarchal, and expensive to implement. but HIV won't be stopped otherwise.
a first-world level application of public-health force is necessary to control HIV on their home turf, nevermind end it. why would anyone think that ending HIV would require anything other than 100% organized mobilization and a long term commitment?
Hmm... I'm surprised by this. At least in the US AIDS is under much more control, is it not? My fiancee treats AIDS/HIV and has never mentioned "resistance" except when referring to antibiotics. This seems more like a funding issue, though I could be wrong.
All told, this is sad. Aids is the most easily preventable disease. Most of her patients know exactly when they got it.
First, there are a number of different forms of HIV. HIV-1 is what's most prevalent in the US; HIV-2 is mostly restricted to sub-Saharan Africa, but a lot of HIV cases in Africa are HIV-1. (These can be broken down further - for example, there are about seven groupings of HIV-1 - but HIV-1 vs. HIV-2 is the most important distinction). Treatment for HIV-1 and HIV-2 can vary, and a lot less research has been done into the types of HIV that are common in Africa and India.
Secondly, yes, AIDS (as opposed to HIV) is "mostly under control" in the US. There are still cases of AIDS in the US, but they tend to be in populations that are undertreated medically. For people who identify HIV early on, while their CD4s are still manageable, if they stick to a treatment regimen, they're far more likely to die from something else. In fact, people in the US who are HIV+ and under active treatment now live slightly longer lives than their HIV- counterparts.
> Aids is the most easily preventable disease.
AIDS is somewhat preventable (for people who already have HIV), but it requires an active and ongoing treatment regimen, as well as periodic medical care from a clinician. The funding for both of these is an issue, particularly in developing nations.
HIV itself is somewhat preventable, though, which is why pre-exposure prophylaxis (PrEP) has been met with such excitement from HIV prevention efforts[0]. Not only is it over 99.9% effective[1], but it piggybacks off of the exact same drugs that are already used for treatment of HIV. It's much more effective to utilize the same distribution network for both treatment and prevention than it is to try to have separate efforts that exist side-by-side, but do very different work.
[0] The AHF is the lone exception, but they've turned into the anti-vaxxers of HIV/AIDS prevention[2]. I don't consider them to be an HIV prevention group anymore; they've done far more work recently to worsen the HIV/AIDS epidemic than they have to stop it.
[1] There has only been one infection recorded from a patient who was actively taking PrEP, and he was on an off-label treatment (PrEP is not approved for prophylactic purposes in his country), so it's unclear how typical his medication schedule was.
> people in the US who are HIV+ and under active treatment now live slightly longer lives than their HIV- counterparts
This sounded implausible, so I looked for a source. This page says "the average life expectancy of a 20-year-old person in the U.S. or Canada who began [anti-HIV therapy] shortly after he or she became HIV positive should be around 70", which is less than the life expectancy at birth of U.S. men:
They do mention a plausible way for HIV-positive individuals to live longer, though: "compared to HIV-negative people, many HIV-positive people in Canada and similar countries are under a relatively high degree of medical scrutiny—they undergo visits to the clinic for interviews and laboratory tests several times each year. This degree of heightened medical surveillance is likely to detect any complications early on, before they can become serious"
>A study from the US has found that some groups of people with HIV, especially those treated before their CD4 count falls below 350 cells/mm3, now have life expectancies equal to or even higher than the US general population ... the sole contributor to the increased mortality in people who started ART early was AIDS.
It's probably hard to underestimate just how significant that it though. How many medically founded causes of death can be traced to something that, if caught very early, would have been treatable? If every single little "blip" was a concern worth investigating, you'd undergo a lot of testing, but you'd rarely slip through the cracks.
I think chronic kidney disease is one of them and I'm dealing with it. If they did urine test screening of the whole population every few years they could catch it in the early stages and try to keep it stable for much longer. Most of the medicines to do this are affordable generic medicines like ACE inhibitors and prednisone however once the kidney damage gets to a point where it is physically noticeable it is too late to treat or manage and costly dialysis and transplants are the only solution.
To be honest, that's more the norm for organ systems than not. The tests are mostly giant red flags, not subtle warning signs. Hopefully this is an area ripe for disruption with machine learning systems.
> AIDS is somewhat preventable (for people who already have HIV),
I think he means, much more simply, that HIV is preventable by avoiding risky behaviors. Which may well be the case in countries where AIDS/HIV prevalence is small and restricted to specific demographics, but much harder in poor areas where 10% of adults have HIV. It's going to be hard to convince one in five couples in sub-Saharian Africa not to have children.
Well, by preventable, I think I meant something different than you. I meant you could not share needles or you could always use a condom. Sex/needles are what, 99% of transmissions?
And yeah condoms break, but if HIV transfer was limited to the condom breaking that would be a step in the right direction.
can anyone speak to the efficacy of protein folding to cure AIDS?
i feel a number of pvnp conversations say, 'if found to be p=np then cures for a number of disease will be possible through a greater understanding of protein folding'
The article blames aids spread on "machismo" and discrimination against gays.
But at least on my country, aids spread is much slower among more patriarchal segments of the population, but spread quite fast, even among the rich, in groups that are more liberal, with the fastest spread I saw personally among gays and feminists.
So I wonder, what is the logic that the article used.
I know nothing abou Africa, so maybe I missed something important regarding that, but still, the article generalized the "thirld world" too, thus why I commented about what I see where I live.
>with the fastest spread I saw personally among gays and feminists
Per sexual encounter, homosexual men have a substantially higher infection risk than any other group, and heterosexual woman still have a much higher risk than heterosexual men. That's mostly caused by the different lengths of exposure to body fluids of the partner and different probabilities of skin damage in the relevant areas.
Since feminists are disproportionaly often female you would expect both gays and feminists to have a higher infection rate than the average population, regardless of their political views.
I have a family member that is very feminist, and homosexual.
and another family member, that is evangelical and very faithful.
This made me have close contact with both groups, I even loaned my apartment (when I had one), to a group of friends of the the homosexual feminist person, they were going to a party in the city where I lived, and lived in another city.
So, talking with both groups, it became clear to me, that HIV spread is not related to political belief directly, but related to how much sex (And the kind of sex) a person has.
Even among women, anal sex spread HIV faster, the evangelical group I knew, think anal sex is a sin (even heterosexual).
Meanwhile, the politically liberal group, believe sex should not be tied to marriage and monogamy, and some people in the group have lots of sex.
Of course, if you have more sex, and with more risky ways, you get more HIV.
Discrimination, has nothing to do with it (even because homosexualism here is not completely "underground" anymore, there are harsh laws against discrimination of any kind, and civil unions with gays is already allowed, with now the government thinking about authorizing gay marriage or not).
> People are not robots. Sex happens in a context. It is about power. Southern African girls and young women are infected by men who are much older than themselves. It’s about poverty. It’s also about a culture of machismo.
As I understand it, older men target girls and young women in order to reduce their own risk of infection. But many of those older men are already infected, and are either asymptomatic or in denial.
I can't imagine there's any statistics about the rate of HIV infections among feminists, but if we limit the discussion to men who have sex with men, he is correct.
None of that, of course, means discrimination is not involved. Frankly, I don't think enough attention is being paid to the problem, if we have these grand plans of ending AIDS by 2030 while 20% of a subpopulation has the disease.
He's not correct, because that's totally orthogonal to the point being made.
The issue is that when there is active discrimination against men who have sex with men, those men are more likely to contract HIV – for a whole bevy of obvious reasons.
Looking at this from the perspective of HIV spreading fastest in "groups that are more liberal" is obviously missing the whole point.
It is correct that men who have sex with men are far, far more likely to be diagnosed with HIV in developed countries – this is kind of disconnected from the issues being discussed in developing countries, where infection of young girls in particular is far more of a problem.
I don't think you can ignore the underlying fact of transmission rates being vasty different for each party and based on the type of sex. For example vaginal sex has a 4 in 10,000 chance of transmission for men, and 8 in 10,000 for women, whereas anal sex has 138 in 10,000 odds for the receiver -- worse chances than sharing a needle.
Edit: compounding makes this even worse. Having the same kind of sex 10 times makes the best case odds 16 in 10,000 but the worst case odds become 540 in 10,000.
I tried to read his comment in the most favorable light - the article is focusing on Africa, I read him as trying to make a point about more developed countries. Clearly, as the article mentions, if 60% of new infections are Africa are in women, the infection rate there has little to do with men who have sex with men; there is culture difference. I read him as insinuating that if the West had a different culture, its HIV infection rates might be lower than they are, a dubious but plausible claim which nevertheless is probably not morally acceptable.
How could discrimination against gays be the cause for the spread of HIV? Did some country sign a law that forbids the sale of condoms to gays?
Gays are at higher risk for contracting this disease because they have more sexual partners. The same is true for any person (doesn't matter if heterosexual or homosexual) that has more than average sexual partners.
You know it's called a sexually transmitted disease for a reason, so anyone that has lots and lots of sexual partners has a higher risk.
> How could discrimination against gays be the cause for the spread of HIV?
People are less likely to seek testing, diagnosis or treatment if they will or think they will be at the receiving end of discrimination. Avoiding discrimination that could put your job, living situation or life at stake could also prevent treating a disease that does the same.
> You know it's called a sexually transmitted disease for a reason, so anyone that has lots and lots of sexual partners has a higher risk.
You're right, but there's a reason that certain subpopulations have a higher risk and occurrence rate and it has little to do with number of partners.
Men who have sex with men do report having more sexual partners than heterosexual men [1]; the number of sexual partners is a factor in the rate of HIV infection among gay men.
I think it would be reasonable to speculate the other major contributing factors are (as posted elsewhere) the hugely increased likelihood to transmit HIV during anal sex vice other kinds of sex and discrimination.
If you're constantly told that your life is worthless and there's no community support for open, healthy, gay relationships, there's a tendency for more risky behavior.
Where in the West do we have a culture that tells gays that their lives are worthless? Use a condom! It's what every sane (doesn't matter if hetero or homosexual) does instead of constructing strange reason why it is always other peoples fault!
Science is for getting additional and more rigorous confirmation (or refutation) of some empirical observation or theory.
Not for forgetting to make empirical observations and thinking independently and relegating all that to "citations" in the first place.
It's not like we're inside some huge institution and we are required to have 10 levels on bureaucracy and massive statistical findings before we even attempt to discuss anything.
Anecdotal evidence can support the initial inquiry into gathering actual evidence, but isn't evidence towards a claim itself.
Everyone in my family has brown hair and is at least 5'8". This anecdote doesn't support the claim that everyone in your family is the same.
> It's not like we're inside some huge institution and we are required to have 10 levels on bureaucracy and massive statistical findings before we even attempt to discuss anything.
If you want your argument to have a leg to stand on, using facts and citations are key.
Doesn't surprise me at all that sexually transmitted diseases spread much slower among Conservatives as they tend to also much more sexually conservative.
Actually here in the West the group that was affected the most in the beginning were gays, this is a fact. After that it spread to drug abusers and prostitutes.
You can't even repeat historical facts anymore in liberal comment sections without getting down voted into oblivion because apparently so many are triggered by facts.
Next time you should consider being PC - AIDS was caused by the patriarchy.
Please keep ideological rants off HN. This kind of reply just takes the thread into tribal rhetoric and meta talk, the two things we're most trying to avoid here. Your comment doesn't even accurately describe this thread.
Nobody denies that gay men have a higher occurrence of HIV. The problem is when you turn it into a value judgement about being gay, rather than seeing it as an opportunity to exercise empathy and understand why the problem exists and how it can be improved.
The same sort of controversy existed when birth control was invented. Large sections of society argued that now nothing could control women, who were free to be "sluts" without fear of pregnancy.
Now we recognize that was a ridiculous argument. Of course women should be able to have sex without worrying about pregnancy! And, similarly, gay men should be able to have sex without worrying about a life-threatening illness.
There is no value judgement about gays in my comment! You are making this up in your head.
I call things as they are to my best of knowledge and in this particular case I know it is a fact. So when I read that "machismo" is the underlying problem with HIV then I call it nonsense because it simply isn't true.
HIV is so common in homosexual men because the risk of transmission from anal intercourse is especially high.
Being discriminated they don't have as good access to preventive measurements and treatment.
HIV is so common in drug users, because of needle sharing. You can prevent this is you provide clean needles to them. Something conservatives are usually blocking. So much about conservative superiority.
Genetic research is progressing fast, I believe 2030 target to eliminate AIDS is possible. We have good understanding howto defeat virus. It will increasingly become ethical problem.
The public freaks out when they learn that someone might have spliced a salt resistance gene into a tomato, and you think the public will accept the kind of advanced genetic manipulation you'd need to kill HIV dead?
People are afraid the genetically modified tomato will make them sick or kill them. If someone has AIDS, however, I'm sure they'd be much more willing to eat those tomatoes.
Probably, since most people are generally ignorant of how drugs are developed. We've been making synthetic insulin with recombinant DNA since the 70s and no one bats an eye.
You mean the <your local medicinal vetting institute> checked (at least I hope) products, that (at least I hope) only contain the filtered product and normally none of the DNA / unknown side effects ?
From what I've heard, in parts of Africa worst ravaged by AIDS popular opinion is that even condoms are a western conspiracy. Are you saying they would be more welcome of a genetic solution than the west?!
I am saying that Africa can create its own politics. At end it will be about paying billions to pharma companies, or fraction of that to someone in Thailand or China.
And every part of Africa uses inventions such as car or gun.
Africa (probably too diverse to discuss as a single entity anyway) certainly has its own politics. I'm not sure how well it has set it's own policies/politics historically.
As far as R&D of new treatments, prophylaxis, and cures... I didn't know there were divergent strains with specialized treatments and one that is predominant in only Africa. This saddens me greatly because arriving at a cure will take upwards of $1 trillion USD and companies (even governments) need to have a hope of return on that investment. If (and this is a big IF) curing HIV in America does not actually cure HIV in Africa, then there is no way for the US market to subsidize the rest of the world, and much less likely for a cure for the African strain to ever be created.
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go ahead and throw money at the scientists; they need it and can put it to good use. go ahead and throw money at testing people for HIV. go ahead and throw money at treating people for HIV. these things are necessary but not sufficient for HIV to be conquered.
like all infectious diseases, HIV devastates the fringes, the poor, and the ignorant. without building roads, hospitals, drug factories, hygiene education programs, disease education programs, universities, etc-- without building a new, more advanced society-- the problem populations will forever be problems. without modernizing backward cultures, they cannot be saved from HIV. this, of course, is extremely patriarchal, and expensive to implement. but HIV won't be stopped otherwise.
a first-world level application of public-health force is necessary to control HIV on their home turf, nevermind end it. why would anyone think that ending HIV would require anything other than 100% organized mobilization and a long term commitment?