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iandanforth 1 days ago [-]
The most interesting point of the article for me is that this vaccine appears to be a series of shots which act as a curriculum for the immune system. Each one slightly different and targeting a different stage of B-cell development. I've never thought of vaccine series working like that, so it was a new and impressive idea.
dist-epoch 1 days ago [-]
The way the HIV evades effective antibodies is by tricking the immune system to generate antibodies for fake decoy targets that the virus will immediately mutate.
So each turn, B-cells are presented with the latest version of the virus, they generate various antibodies to the various parts, and are graded at the end by how well the generated antibodies bind to the virus. The problem is that you have 1 million cells which bind strongly to the fake decoy targets and 1 cell which will bind not as strong to the real effective target. So this 1 cell never gets "promoted".
What this "germline targeting" multi-shot vaccine tries to do is to introduce a series of targets that stimulate that 1 in a million cell which will attack the right part of the HIV virus, so it gets "promoted", so if the real virus appears, the body will still go for the decoy targets, but will also generate a lot of these really effective 1 in a million cells, which got "promoted" previously by the vaccine.
To be more precise, you need to "guide" a lets call it B1 cell that all of us have in our repertoire to mutate into B2 then B3 than B4, because this B4 version will be capable of creating the right antibodies for HIV, the issue being that the intermediary states, B2, B3 are not naturally promoted so you very rarely get to the B4 state without this intervention.
wwweston 1 days ago [-]
A fascinating everyday arms race I had no idea was playing out around me.
pazimzadeh 22 hours ago [-]
Here’s a fun read on that arms race
The acquired immune system: a vantage from beneath
Basically saying our immune systems ensure that microbes get ever more devious
However there’s ways that we counter that, like mucus that basically slowly feeds and tames your bacteria. Doesn’t work on viruses though
Fire-Dragon-DoL 22 hours ago [-]
Everything I hear is about bacterias though. I wish we found more about viruses.
pazimzadeh 6 hours ago [-]
viruses and transposons are a major source of creativity in life. the adaptive immune system of jawed vertebrates like us, which defends against viruses, only exists because the RAG transposon inserted itself into the gonads of our fish ancestors 500 million years ago
Origin of immunoglobulins and T cell receptors: A candidate gene for invasion by the RAG transposon
All single-stranded RNA viruses do that. But it's being done to them is the more correct term. A single strand of RNA is unstable and prone to mutations due to enviromental factors.
mjevans 19 hours ago [-]
This sounds a lot like the firewall technique of port knocking. Poke this thing to enable a ruleset, then another thing in that state for a different ruleset, etc.
calf 1 days ago [-]
What's the risk of collateral damage or autoimmune issues from this kind of process, it sounds more difficult to evaluate for safety because it is more complicated.
dist-epoch 1 days ago [-]
It's still the body doing the work, the antibodies will still be tested for self-attack in the regular ways, so there shouldn't be any impact. But immunity is super-complicated, so who knows...
christkv 1 days ago [-]
This is the way a lot of modern cancer vaccines are being developed. The idea is to create custom vaccines in the future targeting the patients specific cancer. So they are therapeutic vaccines. Obviously some cancers cannot be reach by a vaccine or are so aggressive that they overwhelm the patient before they can help.
dekhn 1 days ago [-]
I work in pharma and a coworker asked if they could use my code (a model inference server). I asked what they were doing and it's an ML model for determining clinical dosing for a cancer trial. They sequence a person's cancer, then develop custom RNAs that train the immune system to eliminate that cancer (similar to https://www.nature.com/articles/s41392-026-02769-3) which they inject into the patient.
I would like to thank all the scientists who have dedicated all their hard work and ingenuity to eliminating the impact of cancer. Also, fuck cancer.
epistasis 1 days ago [-]
I'm not aware of cancer vaccines that use this sort of b-cell priming, though I've heard lots about mRNA vaccines, as well as neo-epitope based cancer therapeutic vaccines. Are you analogizing the neoepitope approaches to the B cell progression here? That is somewhat similar, but the chain of new vaccines does seem quite different and novel to me.
Well, they kind of all work that way, it's just that most of the curriculum occurs naturally through interactions with wild pathogens
mullingitover 1 days ago [-]
From what I understand, random interactions with wild pathogens can prime the immune system in the wrong way, leading it down the wrong path. This is why some people can get lucky with immunity and be super resistant to flu, because they happened to luck into a response that targets a common factor in most flu strains. Other people have bad luck and target some area that mutates frequently, and they proceed to get walloped by every flu strain, every year.
This is why it's hard to make a 'super vaccine' for flu, becuase it takes many rounds of shots to retrain some people's immune systems once they've latched on to the wrong recipe for antibodies.
pazimzadeh 23 hours ago [-]
And every time you generate an immune response you are honing your natural receptors so although they are more specific to the specific virus at hand, they lose general response, so this can backfire for example if you over-vaccinate with the wrong strain of flu and this one year the flu changes direction, mutationally.
Wait, so what are we supposed to do. If you over vaccinate is bad, if you under vaccinate is bad, but if you vaccinate a little bit you can end up on the wrong strain. Great! /s
pazimzadeh 19 hours ago [-]
actually, the 'little bit' one is probably correct, unless you are in a susceptible group like the elderly then probably vaccinate a lot
we can also get better at predicting what each year's mutations are going to be, though that takes funding
but the idea that more vaccination is always better is technically not true, especially for a virus that is extremely good at mutating/shuffling its genome like the flu does.
but the reasons given by anti-vaxxers are generally BS.
Fire-Dragon-DoL 19 hours ago [-]
Yeah I'm not in the anti-vaxxers thing, I was thinking more about the COVID vaccine we are given basically every year. After... I think 6 iterations (or 7?!) me and my family decided to go for the flu shot only, mainly because the flu shot can be given as a nasal shot, which is way less problematic.
Also the COVID shot is damn painful for some reason
mrkstu 1 days ago [-]
As someone whose had rheumatic fever, your immune system can definitely prime itself for the wrong target.
mohamedkoubaa 1 days ago [-]
Right I'm saying it's always path dependent not that it necessarily improves outcomes.
An analogy of this is having the wrong math instruction in middle school could make your math classes harder at the university level.
api 1 days ago [-]
All vaccines are training data for the immune system, which is a learning machine whose operation is a little bit like a genetic algorithm. It generates and sieves variation using a vocabulary of pre-encoded building blocks to fit the targets it's presented with.
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
parhamn 1 days ago [-]
[flagged]
the-grump 1 days ago [-]
It certainly reads like it. Bots are everywhere now.
bluechair 1 days ago [-]
Seems normal to me.
kingkawn 1 days ago [-]
“Doesn’t look like anything to me.”
Der_Einzige 1 days ago [-]
[flagged]
metalliqaz 1 days ago [-]
what does that mean?
shevy-java 1 days ago [-]
I do not see what is impressive here at all. The immune system constantly yields new antibodies targeting different epitopes - all the time. THAT is what is impressive, not multi-vaccines trying to induce shifts towards certain epitopes over others.
hydrogen7800 1 days ago [-]
Are you saying that the result of millions of years of evolution is more impressive than decades of medical research?
1 days ago [-]
RGS1811 1 days ago [-]
While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.
jonathanlydall 1 days ago [-]
You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
saghm 1 days ago [-]
> You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.
At the risk of derailing this conversation from the original topic, those two things are not remotely equivalent. There's no organized political movement trying to tell people that seat belts and speed limits are immoral, and you should only drive when you're willing to accept the responsibility that comes with the risks.
jonathanlydall 1 days ago [-]
Where I am from, organised political movements are not a factor of teen pregnancy and were not the least bit in my mind when I made my statement.
And my two examples are completely arbitrary because my point applies to pretty much any problem which would be solved by people being “more careful”.
So, political/religious elements aside, teen pregnancy and road safety are the same in terms of “if people were just more disciplined, there would not be these problems” (i.e. if teens who have easy access to contraceptives planned ahead before giving into impulsiveness; if drivers were more attentive to their behaviour), which I then pointed out is naive because the reality is that people aren’t perfect, they aren’t always disciplined, we’re all only human.
Hence, we need other solutions to help with problems which don’t require ignoring that people are only human and lack perfect discipline.
I agree that some organised movements can be a problem in that they can make other problems worse.
saghm 1 days ago [-]
My point is that teen pregnancy very much does have a solution that has empirically worked quite well at preventing it when it's actually practiced (i.e. high quality sex education and ample access to contraceptives), and pushing abstinence as a solution has demonstrably caused teen pregnancy rates in increase whenever it's used as a replacement for that; the only actual impetus for abstinence as a "solution" is ideological. I think teen pregnancy literally would be a solved problem (with instances being essentially a rounding error) in a society embracing what we actually have proven works well at preventing it; I've never seen any similarly successful mechanism at preventing injuries or deaths in automobile accidents be rejected by a society for ideological reasons.
Trying to handwave away the things we know work to prevent teen pregnancy as "just be careful" feels overly reductive, because it's way easier to do correctly than managing to drive without ever having an accident.
jonathanlydall 1 days ago [-]
Talking about road safety.
In South Africa we have 12,000+ road fatalities a year, by comparison Australia (renowned for strong law enforcement) with about half of our population size has 1,200 or something. (And they apparently happen to have about 4,500 teen pregnancies a year.)
Australia’s (or maybe it was New Zealand’s which I visited on the same trip) road safety campaign is called “Towards Zero”, while South Africa’s is called “Arrive Alive”.
A big part of the difference in fatalities is that Australia has much better general law enforcement (such that a lot of foreigners complain about it), while over here it’s dismal with Arrive Alive’s strategy seemingly being to always do the same thing as last year’s holiday season except with “trying harder”, while largely ignoring day-to-day traffic offences.
Due to the high chance of being caught for transgressions, Australians tend to way more often stick to the rules of the road, while over here there is horrendous amount of (to put it politely) shenanigans happening almost all the time.
And the impact of this difference in discipline shows in the above stats.
Years ago now, but my now wife spent 10 days in intensive care after a minibus taxi driving on the wrong side of the road head on collided into the car she was a passenger in. My wife was fortunately in a car with good safety features and had a medical aid plan allowing her to receive some of the best care possible in the country, but I’m doubtful that the mini bus taxi passengers (who tend to be in the poor class of the population) sent to public hospitals received care anywhere near as good, I think I heard after this article [1] was published that two people died.
Perhaps road accidents, or at least fatalities, can be reduced more than you realize.
Perhaps road accidents, or at least fatalities, can be reduced more than you realize.
You are talking past each others.
The exemple of Australia (or was it new Zealand?) shows that accidents can be lowered, as much as thé exemple of south Africa shows they can't.
I've always found this misunderstanding fascinating; it touches on the physical reality of sociological laws, the origin and purpose of morality, as well of course as supporting in part the modern political divides.
xnyan 21 hours ago [-]
> There's no organized political movement trying to tell people that seat belts and speed limits are immoral
I rode in a lot of cars when I lived in Eastern Ukraine, 9/10 times or more the seatbelts had been removed or tucked behind the seats and not intended to be used. I got some very funny/annoyed looks when I first arrived and dug around in seats looking for a belt.
There's no need for a political movement when you already have the thing (no seatbelts).
rsynnott 13 hours ago [-]
Seat belts, maybe not. Some of the campaigning against the new 30km/h urban speed limits here _is_ practically framing them as immoral, tho. People get weird about that stuff.
Campaigning against _contraception_ feels like pretty much a dead issue, at least here; you just don’t see it anymore.
codesnik 1 days ago [-]
derailing further, it's no organized political movement, and they don't call it immoral but in Caucasus region some men avoid using seat belts as "unmanly", and that's a very social thing. Small plugs into a seatbelt socket to shut up the car audible warning are very common, including taxis.
jonathanlydall 1 days ago [-]
Well, they do have a point on the “unmanly” aspect as there is a reason that men are statistically more likely to die before old age than women.
Also, I’ve found that when asked about the risk of something, most people believe
that bad things only happen to other people (who also believed that, until it happened to them).
kakacik 17 hours ago [-]
Literally every cigarette smoker I've spoken to about this lives in that other-people fantasy
rsynnott 12 hours ago [-]
The ultimate expression of masculinity is being hurled at speed through a windscreen.
juliendorra 1 days ago [-]
Teen pregnancy (or unwanted pregnancy at all) has been extremely low in several countries, and the factors are not discipline but was of access, focus on health instead of morality, and public service campaign. If it is high in an otherwise rich country, it’s likely not a lack of discipline from teenagers but a lack of free and easy access to contraception and abortive means, social pressure and morality campaigns, lack of sex education (often by design sometimes by negligence after some period of activity)
jasonfarnon 24 hours ago [-]
" likely not a lack of discipline from teenagers"
You two might be using "discipline" pretty different. Your definition of discipline would encompass constant casual sex as long as contraceptives were used and any abortions were prompt, right?
jquery 21 hours ago [-]
They’re talking about evidence-based solutions to the issue, yes. Discipline is probably the wrong word. Expecting teenagers to be disciplined is a fool’s errand.
kakacik 17 hours ago [-]
'Discipline to avoid teen pregnancy', is it really hard to connect those few dots to what it actually means in behavior?
jasonfarnon 39 minutes ago [-]
It's easy to connect the dots, which is that an obfuscation was being applied.
reenorap 1 days ago [-]
FYI teen pregnancy in the US is the lowest it’s ever been in the history of the country.
ElProlactin 18 hours ago [-]
The overall US fertility rate is at/near all-time lows.
tempfile 1 days ago [-]
Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, and the only reason HIV transmission is high in poor countries is because, well, they're poor. We (humanity as a whole) have plenty of money, we could fund these things, we simply choose not to.
I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.
> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.
jcul 1 days ago [-]
I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide.
It's quite sad and difficult to read at times.
everforward 1 days ago [-]
Tuberculosis is different, in a very dark, utilitarian way. 4% of new TB cases are multi-drug resistant (19% of recurrences).
Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.
Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.
They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.
TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
attila-lendvai 23 hours ago [-]
> TB is also shockingly infectious
let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework.
if you feel the urge to fight this: i lived with someone infected with TB.
e.g. measles is shockingly infectious. TB is not.
everforward 8 hours ago [-]
Depends heavily on whether we're measuring in practical terms, or in "no medical intervention" terms.
If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious.
If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio.
Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does.
I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt.
> i lived with someone infected with TB.
If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.
jquery 21 hours ago [-]
A single, untreated person with TB will infect 1.5 to 4 people if public health interventions don’t happen. Measles sits at 12 to 18 people per infected person.
In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
attila-lendvai 20 hours ago [-]
don't forget that untreated TB runs for years, sometimes for many years.
measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).
attila-lendvai 20 hours ago [-]
also note the exponential function here... and an exponent of 2 and 12 are very different animals.
1 days ago [-]
shadowtree 1 days ago [-]
"the only reason HIV transmission is high in poor countries is because, well, they're poor."
This is factually untrue.
Being poor does not equal a HIV transmission rate. There is no 1:1 correlation.
A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom.
Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female.
The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk.
Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.
dahinds 1 days ago [-]
I don't think the original assertion is "punching down" on poor people. While you're correct that poverty isn't the "only reason" for high HIV transmission, poverty certainly contributes to it, via lack of access to health care and lack of access to education. How is it less "punching down" to attribute it to social behavior and culture? Isn't needle sharing associated with poverty, or would you also call that "culture"?
shadowtree 1 days ago [-]
I was poor, grew up in social housing.
I did not use drugs.
"I share needles because I can't afford my own" is an INSANE take. Don't shoot drugs in the first place! Poor people are normal humans, they have willpower, agency. It is a rich people myth that poor people are cattle, devoid of any chance of doing the right thing.
It is culture, behavior, social norms. Being poor does not force you to abandon the nuclear family, does not force you to engage in criminal acts. (there is reverse causality though)
In the early 1960s South Korea had a per capita income lower than those of Haiti, Ethiopia, and Yemen, and about 40% below India's. Did all South Koreans become heroin addicts with HIV?
lukeschlather 1 days ago [-]
> Don't shoot drugs in the first place
like insulin? should a diabetic skip the insulin? In poor countries I wouldn't be surprised if the majority of HIV infections are not as preventable as you're imagining.
You can moralize, but even if only 10% of HIV infections are unavoidable, you're not contributing to solving the actual problem. (And by unavoidable I mean, unavoidable without investing in more needles, better sanitation, or prophylactics that the people "responsible" cannot afford.)
pibaker 1 days ago [-]
Thanks for your contribution. Gonna hop on a jet to Zambia tomorrow and tell kids with HIV there that it's their fault they were born with the virus and maybe they shouldn't have shared needles.
sterlind 1 days ago [-]
assume you have a population of IV drug users. as a society, would you prefer to spend nothing and see them develop HIV, or to spend some and control the HIV?
you don't have to care about the drug users at all. even if you treat them as pests rather than humans, we frequently vaccinate pests for public health measures. pathogens will spill over to populations you do care about, they'll create a drain on the healthcare system, they'll harbor other opportunistic infections. it's not sanitary.
this is completely leaving aside that some drug addicts can and do turn their life around, and that HIV is a horrible illness nobody should have to deal with, even if it's "their fault."
pessimizer 20 hours ago [-]
People enjoy drugs, people enjoy sex. If your solution to driving fatalities is not to drive, you have not solved anything.
Not having sex and not doing drugs isn't any sort of "right thing" other than because sex and drugs are dangerous. If sex and drugs were less dangerous (or made not dangerous at all) there would be no reason to tell people not to do them.
The wealthy use drugs and have sex all the time. They just have clean needles and nice doctors. You've completely bought into the moral explanation for poverty - which is that moral decay causes poverty, but poverty does not cause moral decay. But you think that this is a defense of the poor, rather than a defense of the exploitation and contempt for the poor by the rich.
The poor are not worse than the rich even if they do drugs, have sex, or swear on Sunday.
tempfile 13 hours ago [-]
Being poor correlates with adverse health outcomes. If you insist (as you do) that those health outcomes are due entirely to culture and willpower, then you are forced to conclude that poor people have low willpower and are less moral. This is an unprovable assertion, based entirely on your own vibes, and is frankly a cruel thing to say. It basically asserts that these people deserve the things that happen to them, because they were avoidable and entirely due to their choices.
This is not a celebration of human agency. When people are treated badly, they behave badly. It is completely irrelevant that you were treated badly and happened not to behave badly. People are far too complex for you to say "well, we got treated the same, we should have behaved the same".
jrflowers 19 hours ago [-]
Lmao “South Korea never had a severe drug problem”
I’ve got bad news for you about methamphetamine in postwar east Asia
garciasn 1 days ago [-]
Dry sex in SSA may be one of the contributing factors, but it’s never been truly proven out as a key contributor in any study I have read; they always address it but say more needs to be done to be certain.
Your comment makes it seem like a key factor when it’s not.
shadowtree 1 days ago [-]
In the Global Burden of Disease analyses, sub-Saharan Africa (SSA) had the highest age-standardized STI incidence rate of any world region — around 19,973 per 100,000 person-years, which is roughly double the global average of about 9,536 cases per 100,000.
Forecasts to 2030 expect sub-Saharan Africa to continue having the highest incidence rates of both HIV and other STIs of any region.
How come a specific region of the globe has this issue? "Poverty"?
Many regions in India are poor. Afghanistan. Pakistan.
Love the science based debate here, btw, thank you all for the downvotes. Facts, not feelings.
cwillu 1 days ago [-]
It comes with the territory; IMO if you don't occasionally have a few comments go negative, you're probably not saying anything of value.
20 hours ago [-]
jquery 20 hours ago [-]
[dead]
rsynnott 12 hours ago [-]
I mean a big part of the issue in poor countries is lack of access to PrEP.
xenospn 1 days ago [-]
I’ve never heard that before. That explains a lot.
jimbob45 1 days ago [-]
No, there will always be the threat of teen pregnancy. Conversely, we could wipe out HIV permanently if enough public will across the world was directed toward it.
I fully believe that HIV wouldn’t exist if PrEP had come out in the 80s when public hysteria was at an all-time high and the will to eradicate it was present.
sarchertech 1 days ago [-]
We haven’t even managed to wipe out polio, and that is a cheap, lifelong vaccine.
8note 1 days ago [-]
not only that, people are explicitly trying to bring back measles, and succeeding at it
BizarroLand 1 days ago [-]
If we gave every living human on the planet the polio vaccine as soon as they were able to receive it, it would still exist in the wild somewhere.
If new generations are not also given the vaccine, it will eventually return.
Probably the same with HIV, although I could see it being somewhat more difficult for that to make a resurgence. If we inoculated the entire human race against it, it could possibly eradicate HIV for several generations, if not permanently.
sarchertech 1 days ago [-]
Humans are the only reservoir for polio, so that’s not true. We could theoretically wipe out polio just like smallpox because there are no animal reservoirs.
BizarroLand 3 hours ago [-]
Huh. TIL. That boggles the mind though. Makes me wonder where it came from, or if perhaps its source was somehow killed off or otherwise destroyed, or if perhaps there is a reservoir somewhere that we simply are not aware of?
mrguyorama 1 days ago [-]
>if PrEP had come out in the 80s when public hysteria was at an all-time high
You mean the time the US admin was intentionally neglecting the epidemic because "it's a gay disease"? Why do you think Reagan would have done anything to ensure such a medication was easily available?
neonstatic 1 days ago [-]
> And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
Of course, and for good reason. The ones who know for a fact they are right, might in fact be wrong or malicious.
1 days ago [-]
maxerickson 1 days ago [-]
I thought the current panic was that young people (not necessarily teens) weren't having enough kids?
epistasis 1 days ago [-]
Which is in fact panic that teens are not having enough children, because that's where we have seen big drops...
This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.
MostlyStable 1 days ago [-]
It is entirely possible to believe multiple things at once:
1. The drop is fertility is bad for society
2. The drop in teen pregnancy is good, despite it's
contributions to 1
3. We should try to fix 1. without undoing 2.
Night_Thastus 1 days ago [-]
I agree, but I don't think #3 is possible. For a variety of reasons, both biological and societal, the older people get the less likely they are to have kids, and fewer of them.
skissane 1 days ago [-]
Kiryas Joel, New York, has astronomically high fertility, but also extremely low rates of under-18 pregnancy - which proves the combination is possible.
Night_Thastus 19 hours ago [-]
That is an exceptional outlier. It's almost entirely (>90%) made up of one religious group that has strict cultural rules about early marriage and having many children.
That's not something typical outside of that one particular group, nor can you copy-paste that anywhere else.
I think in fact it's the opposite. Because of how universal below-replacement rates are in EVERY developed nation, it shows just how independent it is from factors of culture, economics, environment, etc. It takes a seriously unusual situation like the one in Kiryas Joel for below-replacement to not be the norm.
skissane 54 minutes ago [-]
I disagree - very high fertility combined with very low rates of extramarital pregnancy are totally normal for traditionalist religious groups-not just ultra-Orthodox Jews, but also the Amish, Salafists, Deobandis, vilayet-e faqih-e faqih Twelvers, the SSPX, inter alia - what Eric Kaufmann (see his book Shall the Religious Inherit the Earth?) calls “endogenous growth sects”. There is nothing unique to Kiryas Joel about it; Kiryas Joel is simply the most easy-to-point-to example of a wider phenomenon
1 days ago [-]
mrguyorama 1 days ago [-]
Fundamentalists, and others who abhor birth control, demonstrate pretty regularly that they have no issue with Teen Pregnancy, but rather unmarried teen pregnancy.
They want married teen pregnancy. By their own admission.
philipallstar 1 days ago [-]
No, it's from the cost of living being so high that people are delaying having kids.
1 days ago [-]
vasco 1 days ago [-]
Worldwide the main thing that correlates to having less kids is being more educated. High cost of living correlates with more kids, not less.
siriusastrebe 1 days ago [-]
Worldwide being more educated means higher cost of living. Nowhere in the world is there a country with high cost of living and high birthrates
derektank 20 hours ago [-]
I suppose it depends by what you mean by “high birth rates” but Israel has a high cost of living, Tel Aviv is comparable to most American superstar cities when you account for resident’s lower incomes, but the country has a birth rate well above replacement, at roughly 3 births per woman.
Of course, Israel also has a nearly identical rate of secondary and tertiary educational attainment to other OECD countries so I’m not sure that makes the argument against education.
1 days ago [-]
vasco 17 hours ago [-]
High cost of living can happen for two reasons, either everything is expensive, or you make no money. And guess what, people with no money have way more kids than people with a lot of money in middle class lives in developed countries, who then say lack of money is why they don't have kids.
The one thing you can do to stop teenage pregnancies is for example to educate young girls, give them menstruation support and allow them to go to school. This effect dominates vs "oh I can't put my kid in private school" that we say is the reason for no kids.
cj 1 days ago [-]
Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.
cguess 1 days ago [-]
> but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
tallanvor 1 days ago [-]
That's absolutely not correct. Truvada has had the same formulation since it was introduced in 2012. Descovy hasn't changed since it was approved in 2019.
You may be thinking of STD tests and bloodwork that is done every 3-6 months depending on your risk level to ensure that you're still HIV negative and that your kidneys are functioning normally, as kidney issues is a rare but serious side effect, especially for Truvada.
Now, what I believe is correct is that most people on PrEP would love to have a vaccine instead of needing a daily pill or even 2-6 injections per year as long as they remain sexually active.
sterlind 1 days ago [-]
I think by "update" they mean "re-up," as in you need another depot injection every six months.
HappMacDonald 1 days ago [-]
That's like asking "if someone is unwilling to practice abstinence, why would they be willing to wear a condom, or to flip a magic 'not fertile right at this moment' lightswitch?"
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
ChrisMarshallNY 1 days ago [-]
It's still killing people like crazy (and spreading) in undeveloped nations. The new drugs are un-cheap.
Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.
cguess 1 days ago [-]
[flagged]
xeonmc 1 days ago [-]
Considering his family history and his weird eugenic tirades, perhaps that was the intended effect to complete his fantasy cosplaying as a Roman general.
solid_fuel 23 hours ago [-]
His actions were certainly motivated by both his racism and contempt for people from poor countries. Frankly he should spend the rest of his life in a small cell somewhere.
noir_lord 1 days ago [-]
He’s a lovely individual really, just a boon to humanity all around.
xienze 1 days ago [-]
> Musk has sentenced hundreds of thousands, if not millions, to death by dismantling USAID.
Why haven't other countries stepped up to address this pressing need? I'm sure every other western nation could easily chip in collectively to cover the roughly $34B budget USAID had. Or do they just not care about these millions of people apparently sentenced to death?
cguess 1 days ago [-]
France and England are trying.
The problem is money doesn't build supply lines overnight. Nor does it hire experts both locally and globally and get them there. Much of the data collected on patients by USAID can't just be handed over to another government for a myriad of privacy issues. Patients then have to know that their old clinic no longer exists and they have to go to a new one (is it in the same village anymore?). In the meantime viral counts go up, people get sick, infect their partners or newborn children. You can't just "pick it up later" without causing real harm.
> or do they not care
Do we not? Why can't we care, why is it now someone else's problem because Musk is still mad Mandela was let off of Robin Island?
egeozcan 1 days ago [-]
All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions.
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
toomuchtodo 1 days ago [-]
The US state of Colorado provided young women free IUDs (which are reversible and can last up to eight years) with private funds, and it was wildly successful. I argue teen pregnancy is solved assuming systems remain in place for women to have robust access to contraceptives and reproductive healthcare (which is a systems problem that is never solved completely, but reliant on defending the subject system constantly in perpetuity). The current US administration is rolling back teen pregnancy prevention programs to increase fertility rates in these age cohorts, so there is clearly work ahead to maintain the progress we've made.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 20-39 prime reproductive age cohort for those seeking it. It also decreases the risk of ovarian cancer by 42–77% (https://doi.org/10.5468/ogs.2018.61.5.542).
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person (HN Search: lenacapavir - https://hn.algolia.com/?q=lenacapavir).
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
kazinator 1 days ago [-]
I'm not following the points in the above thread.
- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors
- people need to make the right decisions to take HIV vaccines
We are comparing two tools, not tools versus discipline.
In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.
They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.
An effective vaccine that lasts years would be much more convenient.
Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!
fluoridation 1 days ago [-]
No, nothing is being compared. The question being posed is, if there are already tools to prevent HIV transmission (condoms, drugs, etc.) and someone doesn't use them, why would they use a vaccine?
throwway120385 1 days ago [-]
Because a vaccine is much easier for the doctor to administer and manage. My GP won't put condoms on me but they do have a list of shots I get basically once and then never again.
kazinator 23 hours ago [-]
Right; that's a better framing.
1. Some people don't use tools. (For instance, we have spellcheckers, but people don't use them or ignore them.)
2. So of what use is another tool? (Why develop a grammar checker?)
See the problem? For the people who do use tools, there are useful differences among them. Some users of spell checkers will welcome the grammar checker.
Some of those who would use drugs to prevent transmission will gladly switch to the vaccine, which is more convenient for them.
But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
Sometimes when you add a different tool to the arsenal, non-users of the tool arsenal come around.
E.g. lots of DIY tinkerers use USB oscilloscopes, who have never owned a big one. The invention and marketing of the USB scope turned them into users. The vendors of that could have axed the idea by saying, what's the use of this idea: we already have oscilloscopes? Those who don't have them already are not going to be interested in this.
There are right tools for the right job, but also the right tools for the right people in the right circumstances.
fluoridation 20 hours ago [-]
>2. So of what use is another tool? (Why develop a grammar checker?)
This isn't quite the right analogy, because a vaccine doesn't do something different from PrEP, it just does it in a different way. At the individual level it might make a compelling case (but more of that in a bit), but for the systemic purpose of eradicating the disease, not so much; not until it's given out during childhood like other vaccines.
>But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
The fact of the matter is, HIV is a shitty virus, by which I mean it's an inefficacious one. It has a bad spreading mechanism and it has effects that are too severe and too obvious. The reason people ignore those drugs (besides them being expensive) is that HIV is so rare, and there are overall better methods to avoid catching it. So most people will likely never have sex with a carrier, and of those who would, most will already be using condoms. Among this latter group, I don't know that a vaccine is that compelling. HIV is not the only infection you can contract from unprotected sex. If you have a stranger in front of you with whom without a vaccine you would have used a condom, would you have unprotected sex with them after having been inoculated? While it might make sense to get the vaccine anyway as a second layer of defense, in all likelihood it won't have any effect on your personal safety.
tallanvor 1 days ago [-]
Unfortunately HIV is not a solved problem.
Condoms? They break. More frequently than you might think.
Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).
Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.
A vaccine is the only real option for dealing with HIV for good.
Muromec 1 days ago [-]
The hardest problems to solve that actually matter are in humanities.
soco 1 days ago [-]
All your arguments are sound, and I'm still missing your point. Pharma is interested in doing pharma, indeed. But who's interested in your solution, assuming you have one? A significant part of the current electorate (internationally, even) seems to abhor sex ed, condoms, abortions and all that. So tell me again please how you suggest we address teen pregnancy - in THIS world.
cj 1 days ago [-]
The person I was responding to says "HIV is not a solved problem" and "we need a new tool to solve it, a vaccine!"
My argument is simply that new tools are great, but it's not what's going to solve the HIV problem. Distribution, cost, access, stigma, etc are the larger problems to deal with. (We need to solve all the reasons why people aren't using the existing tools)
serf 1 days ago [-]
people don't forego condoms in high income nations due to lack of access, distribution, cost, or stigma.
they make the experience measurably worse for a maybe insurance.
I don't know what fixes that reality other than (maybe?) mass-traumatizing youths with stories and photos of STI/HIV victims, essentially scaring them into wearing a rubber at the risk of scaring them out of sex entirely.
... which is why a vaccine sure would be nice.
cogman10 1 days ago [-]
It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
compass_copium 1 days ago [-]
This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.
SietrixDev 1 days ago [-]
Yes, it exists, but how available is it really? If I recall correctly, the injections are also not very pleasant.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
The shots are expensive, but the pills are free in the USA. They do have adverse kidney issues over prolonged use (more for some people than others).
cguess 1 days ago [-]
And clearly only the people in the USA matter.
whimsicalism 1 days ago [-]
Are you serious? I would bank money on PEP being practically free in sub-saharan Africa.
cguess 1 days ago [-]
*PrEP
It... was, until Musk dismantled USAID and Congress defunded PEPFAR.
So many comments by people who have never stepped foot out the Global North making wild assumptions.
whimsicalism 1 days ago [-]
I was explicitly referring to PEP. I'm not sure why you would make assumptions about where I have or haven't been when you have absolutely no information.
PEP remains largely free in SSA post-USAID/PEPFAR cuts.
cguess 1 days ago [-]
Ok... so you have to
1. Know you were exposed (many many many people don't know they're HIV+)
2. Have the means to go to a clinic within 72 hours
3. Have the social capacity to go to the clinic safely (in many parts of Sub Saharan Africa doing so would insult your partner)
PEP is an emergency drug, not a prevention at all.
whimsicalism 1 days ago [-]
My understanding is PrEP is also free, but I'm less certain about that post-cuts.
cguess 1 days ago [-]
It is not, at all anymore.
bongoman37 21 hours ago [-]
[dead]
matharmin 1 days ago [-]
That PrEP is in some ways similar to a vaccine, and there is still a lot of value in getting a better vaccine (cheaper and/or lasting longer).
lopis 1 days ago [-]
Also, PrEP pills can have side effects long term. And distributing huge amounts of daily pills to remote areas of the globe is much harder than the patients getting a shot on their yearly medical visit.
> I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Cure" in the sense they could become indefinitely under detectable levels. It's worth noting that to really cure a person of HIV you'd need to remove all mutated cells.
simonask 1 days ago [-]
Ad-hoc use of PrEP just requires that you take a double dose 1 hour prior to potential exposure, and follow up with another double dose 24 hours later, at least with the versions commonly prescribed to sexually active groups in my area.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
tallanvor 1 days ago [-]
At least 2 hours before, not 1, and preferably closer to 24 hours before.
jcul 1 days ago [-]
Does this double dose completely prevent infection?
matthewmacleod 1 days ago [-]
The evidence I’m aware of suggests that this method (on-demand or event-based PrEP) is broadly as effective as daily PrEP (though it’s not suitable for vaginal sex). I believe adherence rates are generally lower though, as people can find the instructions confusing, and it’s obviously easier to mis-dose than a daily regimen.
cyberax 16 hours ago [-]
It's called a "loading dose" and it's a common trick in medication dosing.
If your drug has an elimination half-life of 1 day, then it takes about 4 days to reach the steady-state concentration if you take normal doses. With the loading dose, you immediately reach it.
cyberax 16 hours ago [-]
PrEP is effective even when taken after the event. The approved protocol is to take a loading dose (2x the normal dose) and then follow up with regular doses for 3 days.
nerdjon 1 days ago [-]
Cost and compliance are still 2 major factors that have not been solved.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
bluGill 1 days ago [-]
PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
nerdjon 1 days ago [-]
> If you are not doing risky sex it isn't for you.
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
Telemakhos 1 days ago [-]
You are extremely unlikely to get HIV from anything other than risky sex. That's what "risk" means: it's another word for "probability," just a probability of negative outcomes. These probabilities are known: https://www.aidsmap.com/about-hiv/estimated-hiv-risk-exposur...
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
camphy 1 days ago [-]
> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Yeah, me. What a wild statement to make. It’s a big world out there, my friend.
vasco 1 days ago [-]
You may have missed the word likely.
camphy 1 days ago [-]
Did I also miss the part where “likely” was shown to be grounded in anything other than a prejudice about people who have “risky” sex?
vasco 1 days ago [-]
I dunno man if you want to answer claims about probability with single a data point that's up to you, but nobody can take that seriously, whatever the topic.
derektank 19 hours ago [-]
“Is someone irresponsible enough to drive a car (the second leading cause of accidental death) also likely to be responsible enough to comply with seatbelt laws?”
The word likely doesn’t make this argument any less dumb
mattjhall 1 days ago [-]
> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Yes, it's the exact reason that it is widely available on the NHS. 20,000 people took it, adherence was high, HIV rates dropped significantly.
> Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place
Shaming people has been tried for centuries, maybe millennia and famously _does not work_. We have ample evidence that PrEP does.
rsynnott 12 hours ago [-]
> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Er, I mean, a decent portion of gay men in the developed world, honestly. (I say this as a gay man in the developed world.)
matthewmacleod 1 days ago [-]
Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?
Anecdotally, very much so - at least among the gay/MSM community.
The thing is, people generally quite like having sex. That comes with some level of risk, which can be mitigated in various different ways - and PrEP is one of those tools.
All humans engage in some level of risky behaviour; evidence suggests that moralising about “responsible behaviour” or “self control” is rarely effective at mitigating that risk.
nerdjon 1 days ago [-]
> You are extremely unlikely to get HIV from anything other than risky sex.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
UltraSane 1 days ago [-]
Are you arguing that all sexually active people should take prep?
nerdjon 1 days ago [-]
I am arguing that all sexually active people (except maybe those in a fully confirmed monogamous relationship) should at a minimum have a conversation with their doctor about it and their doctor should bring it up.
Maybe it isn't worth it for you in the end after that conversation, but we should also not assume that the only way you get HIV is through "risky" behavior. That is irresponsible.
At least you would know it's an option and you can make the decision yourself, I know a lot of straight people that do not know prep exists because it just isn't talked about. Or maybe they have heard about it but they don't really understand what it is. That is a problem.
UltraSane 1 days ago [-]
In developed nations like the US, health economic models estimate that deploying PrEP across generalized heterosexual groups costs anywhere from $150,000 to over $1 million per single HIV transmission prevented.
nerdjon 1 days ago [-]
I would be very curious if that cost was before or after Truvada went generic.
Yes there is the additional costs of the tests on top of that, but people should already be doing regular STD testing if they are sexually active.
Regardless, nothing about that changes that you should still be having this conversation with your doctor if you are sexually active. I do not understand how this is an argument, a conversation about prep or doxy should be in the same conversation about condoms and your general sexual health.
The worst that is going to happen from that conversation is that you don't take it, but at the very least you are educated on its existence and that decision is made between you and your doctor based on your risk factors.
> Inform all sexually active adult and adolescent patients about PrEP.
> Prescribe PrEP to anyone who asks for it, including sexually active people who do not report HIV risk factors.
bluGill 1 days ago [-]
I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.
nerdjon 1 days ago [-]
I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
bluGill 1 days ago [-]
Someone trying to get pregnant is most likely to be low risk since odds are good they have a specific partner in mind and are having enough sex that they don't care to stray. Not always but in general
There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal.
Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV)
The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.
simonask 1 days ago [-]
All sex is risky by this measure.
Condoms break. Partners lie. Shit happens.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
abirch 1 days ago [-]
Compliance is the big thing.
Vaccines are the "an ounce of prevention is worth a pound of cure"
Saline9515 1 days ago [-]
[flagged]
derektank 19 hours ago [-]
The “LGBT community” broadly does not engage in risky sex practices. Lesbians don’t have regular, no strings attached sex and are at lower risk of contracting HIV than straight women. The common denominator is horny men, specifically horny men that have access to a variety of different sex partners.
matthewmacleod 1 days ago [-]
Any solution to a public health problem that involves moralising about how groups should change their behaviour is not only doomed, it’s actively counterproductive.
And doxycycline is a PEP treatment, not a PrEP treatment; respectfully you should probably take a step back from conversations where you obviously aren’t informed about the basics.
Saline9515 17 hours ago [-]
The solution to the STD epidemic was moralizing teenagers to tell them to put on condoms. I was told personally several times in sex ed, biology classes and on-the fly by teachers and adults that condoms were not an option for casual sex. It worked.
Regarding PEP/PreP, Doxy has been researched and shown effective as PreP as well:
I have met doctors that recommended it to gay men, which is why I mentioned it.
neonstatic 1 days ago [-]
> But I guess that sex without condoms is worth it, right?
Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
tigerlily 1 days ago [-]
And still others may be allergic to LaTeX.
17 hours ago [-]
gib444 1 days ago [-]
PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex
Which countries are you talking about out of curiosity?
fhdkweig 1 days ago [-]
It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.
tpolm 1 days ago [-]
HIV did not exist in human population before XX centiry. Crossings from SIV are extremely rare - vaccinations is about HIV, not SIV
inemesitaffia 19 hours ago [-]
>The reason they eat bushmeat is the because they are poor
This doesn't cover all the reasons
niceguy1827 1 days ago [-]
This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?
mohamedkoubaa 1 days ago [-]
"Grandma needs to stop taking her statins and just exercise" type shi
greggsy 1 days ago [-]
Isn’t prep more like a prophylactic, as opposed to a a vaccine?
I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
RGS1811 1 days ago [-]
The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.
fluoridation 1 days ago [-]
"Prophylactic" is a broad-enough word to encompass vaccines, as well, so I'm not sure what you're getting at. It just means something that defends against disease.
greggsy 14 hours ago [-]
Vaccines can be singled out as a specific type of prophylaxis.
The distinction is that a vaccine will train your immune system to actively destroy the foreign body, while a prophylactics might just prevent it from spreading or taking hold to begin with.
fluoridation 13 hours ago [-]
I have no idea what you're trying to say. An antiviral drug will destroy the pathogen just as much as the body would; that's how it prevents the disease from manifesting. What do you think would otherwise happen to HIV particles in your bloodstream? They just hang in there until the antiviral effects run out?
evilfred 1 days ago [-]
prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver
SoftTalker 1 days ago [-]
Which one do you suppose the pharmaceutical companies would prefer?
ChadNauseam 1 days ago [-]
I’d guess the ones developing the vaccine would rather you take the vaccine
evilfred 1 days ago [-]
who do you expect to create pharmaceuticals other than pharmaceutical companies? sheesh
wat10000 1 days ago [-]
The company making the expensive pill you take forever would prefer the pill. Competitors who don't make those pills would love to develop a vaccine and put that first company out of business.
mtoner23 1 days ago [-]
I'm sure they will gladly sell us both
tonnydourado 1 days ago [-]
Transportation was a solved problem with horses, doesn't mean the car isn't a good idea. Same for internal combustion and EVs.
A vaccine is an objectively better solution than PrEP, just because of the time scale, PrEP needs discipline on a daily or x-monthly basis. A vaccine could last for years. Although, realistically, it's more likely to end up requiring yearly updates like COVID, because HIV is also a mutating son of a bitch.
I 100% agree that waiting for a vaccine is stupid beyond measure. The world should do both: make PrEP widely available AND keep funding vaccine research.
someguydave 11 hours ago [-]
In the meanwhile everyone infected with HIV should be permanently quarantined like in Cuba
skybrian 1 days ago [-]
There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard.
The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.
wat10000 1 days ago [-]
> If your solution to some problem relies on “If everyone would just...” then you do not have a solution. Everyone is not going to just. At not time in the history of the universe has everyone just, and they’re not going to start now.
There's still a huge difference between a one off injection and lifelong tablets.
mathgeek 1 days ago [-]
From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.
xutopia 1 days ago [-]
PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.
smcg 1 days ago [-]
Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.
gadders 1 days ago [-]
Is it not available in pharmacies?
freeone3000 1 days ago [-]
Very dependent on locality. Mine requires a prescription for every refill, and I must continually meet certain risk criteria to qualify.
jitl 1 days ago [-]
A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.
rsynnott 13 hours ago [-]
While that’s _kind_ of true, in practice compliance is going to be an issue. People are bad at taking medication, especially on an indefinite basis. As is, a lot of people use ‘event-based PrEP’ (dosing only before and a couple days after potential infection). There’s a lot of room for error. A working vaccine would definitely be preferable.
est31 1 days ago [-]
For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
lizknope 1 days ago [-]
I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.
SoftTalker 1 days ago [-]
He doesn't have AIDS, he's HIV-positive.
kstrauser 1 days ago [-]
I understand the difference between those statements, but confess that I'm not clear on the important distinction. Are there situations where untreated HIV doesn't progress to AIDS? Is the virus more transmissible in someone with AIDS than someone who's still at the HIV-positive stage?
Asking here because I don't know, and I think an answer might help others know, too.
(And to clarify, I genuinely don't know, and I'm asking from a supportive POV.)
freeone3000 1 days ago [-]
We are unaware of any situations where HIV+ doesn’t turn into AIDS without treatment.
But being HIV+ is simply having a virus, not actively dying. HIV+ status also never clears - later tests that are “negative” mean your viral load is undetectable, at which point you can no longer transmit HIV to others. Undetectable = Untransmissable.
SoftTalker 1 days ago [-]
FTA, it seems that a (very) small number of people develop effective antibodies againt HIV.
"These antibodies are very, very rare, but they can be found in blood samples from a small number of people living with HIV.
The vaccine causes the immune system to produce more of these "broadly neutralizing" antibodies.
kstrauser 1 days ago [-]
That all makes sense. A couple things I’m still not clear on:
* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Thanks for your earlier answer. I know this specific infection has lots of difficult history. It’s hard to formulate my questions without sounding suspiciously close to a sea lion or something, but I sincerely want to know. And yes, I could google it but then it wouldn’t be an interesting conversation, or one others could read and learn from.
freeone3000 1 days ago [-]
* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?
Yes. HIV+ patients require antiretroviral treatment for the remainder of their lives. Most are able to manage with a pill regimen. This is not to say it is cheap or side effect free, but most HIV+ people are able to live normal lives with outpatient support.
(To link it back, PrEP is the same drug used to treat; ex, emtricitabine + tenofovir. Dosage, schedule differs. Other antiretrovirals may be chosen.)
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Public health does talk about Inflenza (and other viral positive) individuals. Public messaging is usually with the term “carrier” - but in jargon, this implies that the individual will likely mot develop the disease themself, and will remain asymptomatic, which is untrue for HIV. NCoV-19, recently in the public eye more than any other virus, has a lot of literature around positive tests vs disease.
kstrauser 1 days ago [-]
1. What a freaking miracle. Growing up in the 80's, the notion was terrifying. I was straight and it was something my friends and I discussed. I can't imagine how awful it must've been for gay communities. Again, what a miracle.
2. OK, fair point.
Thanks for the info! I know HIV isn't exactly "no big deal" today, but seeing it go from "you're certain to die" to "it's annoying to have to take medicine forever" is still a wonder of modern science.
rsynnott 12 hours ago [-]
> What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Generally if you have the influenza virus, you’ll also have the disease that that virus causes. This is true of most viruses. I’m not sure any other virus does the “undetectable and untransmissible, but still _there_” thing; generally, if you get viral load to undetectable for most viruses, it will go away entirely. HIV is unusually good at dealing with the human immune system.
est31 11 hours ago [-]
HIV virus inserts itself into the DNA of long lived cells in your organism, and it stays around as long as those cells stay around, which is (unless u have blood cancer and your doctors decide to kill those cells) your entire life.
That constant low level stream of HIV viruses in your body can cause the virus to return at any moment you stop the therapy. So you have to take daily pills for the rest of your life to stop that stream from exponential growth and killing all of your immune system.
The last part is what is referred to as AIDS: your immune system is so weak that even the simplest pathogens can kill you, which they usually do once you reach AIDS stage.
There are a couple of viruses that can lay dormant in you and cause problems later on. Many of them insert themselves into the DNA of long living cells.
Without therapy, HIV will progress to AIDS in a couple of years in basically 99.9% of patients. Some very rare cases are known where HIV patients survive without getting AIDS and therapy, via broadly neutralizing antibodies. But again, less than a tenth of a percent. Everyone else would die without a therapy.
Being HIV positive isn't a death sentence, if you take your meds (and started taking them early after HIV infection) you can live for as long as someone who isn't HIV positive. In fact studies show that the effect of regularly going to a doctor and getting your blood checked actually improves your life chances. HIV positive people can do 99% of the things normal people can, although they are not allowed to donate blood (for good reason).
Having AIDS though is a major impairment and you are on your way to death at that stage (1-3 years to live). So it makes sense to distinguish the two.
compass_copium 1 days ago [-]
Again, inaccurate. You can get a PrEP shot twice a year now.
Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.
thinkcontext 1 days ago [-]
> Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World
An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?
Muromec 1 days ago [-]
Or maybe we should solve poverty which is a proxy to all kinds of solved problems that somehow still exist
ElProlactin 18 hours ago [-]
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education.
I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.
raxxorraxor 17 hours ago [-]
I disagree that this is a solution. Being dependent on life long medication isn't a trivial problem and transmission must still be seen as serious.
But of course it should be available to all that need it.
giantg2 1 days ago [-]
"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
simonask 1 days ago [-]
As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.
giantg2 1 days ago [-]
Then why aren't STDs, TB, etc, eliminted. Even heavily vaccinated diseases are still around and pop back up occasionally. The only one eliminted was smallpox.
OkayPhysicist 1 days ago [-]
Most STDs we don't have vaccines for, and the ones that have survived to the modern day are the ones that can be good at hiding. Syphilis, for example, has the nasty habit of seemingly going away by itself, only to pop up again years later. Chlamydia and Gonorrhea can be asymptomatic.
The only reason we haven't eradicated TB is because we've failed massively in getting the vaccine to people in the poorer parts of the world. We could eliminate it just like we did smallpox, the only barrier is actually doing the damn thing. It is made more difficult by the fact that it has a rather long latent infection time, but again, could be solved by vaccinating everyone.
j2j8 20 hours ago [-]
In exchange for accelerated ageing for being on lifelong HIV drugs. That side effect could be because the reverse transcriptase in humans is telomerase.
a-dub 1 days ago [-]
it's actually an interesting question: is there a point where the long acting prep injections have effective durations that look like vaccines and boosters. and yes, sadly, it appears that convenience and some of the psychological aspects of marketing play outsized roles in public health.
either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.
XorNot 1 days ago [-]
Who's waiting? The problem is the populations we need to distribute it to can least afford it.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
1 days ago [-]
kosh2 1 days ago [-]
Are people still getting infected? Yes? Then it is not a solved problem.
alittlebee 1 days ago [-]
My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!
alightsoul 1 days ago [-]
In the global south a significant barrier is the lack of sex education, driven by local christian associations, which have significant power in local societies. They see it as "gender ideology" or as preventing births and thus being against the bible.
leptons 1 days ago [-]
This isn't just about HIV, it's about finding new ways to approach viruses. HIV wasn't the first and won't be the last virus we don't have a way to stop. This research adds to our knowledge about ways to attack some of the trickier viruses.
cucumber3732842 1 days ago [-]
Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).
fortran77 1 days ago [-]
It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.
ajsnigrutin 1 days ago [-]
It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
OkayPhysicist 1 days ago [-]
And they suck. Everyone who's ever worn one knows they suck. If they're too big they completely kill all sensation, if they're too small they cut off circulation, leading to, you guessed it, total loss of sensation. Topped off with the fact that they fail during higher friction activities (you know, exactly the kind that drastically increase HIV transmission risk), they're never going to be an adequate solution, because there will always be people who'll risk it, because what's the point in having sex if you're not going to feel it anyway?
SoftTalker 1 days ago [-]
> Somehow we still need...
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
We live in a messy world.
wat10000 1 days ago [-]
If only Isaac Asimov had worn a condom, he might still be with us today.
ebruchez 22 hours ago [-]
I got here to mention Asimov. For those unaware, it was revealed 10 years after his death that he had actually died of HIV, contracted from a blood transfusion during a heart operation. It's quite tragic.
Der_Einzige 1 days ago [-]
Public health education means getting gay men to start wearing condoms or dental dams and apparently that's a bridge too far for them.
The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:
> ... a solved problem if people are willing to give up sex with untested strangers
It's wired into our DNA to do this, and while we can be socialised out of it, you'll never get anywhere close to the near 100% you'd need.
InsideOutSanta 1 days ago [-]
It's not a small number, and like you point out, this is human nature, so asking people to stop is pointless. If people always acted rationally and with empathy for others, everything would be much easier. There would have been no Covid pandemic, no global warming, no drunk driving, and so on.
Yet here we are, needing laws, cops, vaccines, and so on. Asking people to only have absolutely safe sex due to its external effects is about as useful as asking them to stop eating meat due to its external effects.
felixg3 1 days ago [-]
Besides that, PrEP has enabled the return of non-HIV STIs in major cities like Berlin where a lot of the community has returned to raw-dogging since the AIDS-Scare has become a historical artifact.
dyauspitr 1 days ago [-]
Is that a huge problem? Doesn’t almost everything else have a prophylactic and is curable? Hep-C might be the only other one I believe and I’m unaware if it’s treatable or not.
gib444 1 days ago [-]
Antibiotic resistant syphilis and ghonerrea don't sound like a fun time
wat10000 1 days ago [-]
More or less fun than dying of AIDS?
gib444 1 days ago [-]
Don't move the conversation goalposts (and we don't do "gotchas" here, as you well know)
And AIDS is not considered a death sentence btw. It's not the 1980s
wat10000 1 days ago [-]
This subthread is specifically about better HIV treatments leading to an increase in other STIs. Did you forget about what you were replying to?
gib444 7 hours ago [-]
When I reply to a comment, it's a reply to that comment. Which I don't think you even read
wat10000 7 hours ago [-]
So we’re supposed to ignore all the context leading up to it? What did I supposedly not read, then? Some other comment that’s no longer relevant here?
6 hours ago [-]
simonask 1 days ago [-]
Abstinence has been shown to be an extremely, hilariously, stupidly ineffective strategy in all questions of human sexual health.
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
It doesn’t work. Change your mind.
nextaccountic 1 days ago [-]
I agree but asking your partners to get tested is not abstinence
simonask 16 hours ago [-]
The post I replied to criticized people’s choice to have “random sex”, i.e. they suggest a behavioral change.
Getting tested is great practice, but you can’t rely on partners being diligent or consistent with that for your own safety.
tempaccountabcd 1 days ago [-]
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dyauspitr 1 days ago [-]
Literally no one asks for proof of an STD test before sleeping with them. You might ask someone if they have STDs and use a condom but that’s how 99.99% of how people sleep with other strangers.
basisword 1 days ago [-]
Most things are a solved problem if we give up the things that make life worth living. Obesity is a solved problem if you just eat for health. Road traffic deaths are a solved problem if you never leave your house. Suicides are a solved problem if you just don't kill yourself.
tempaccountabcd 1 days ago [-]
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matthewmacleod 1 days ago [-]
So in other words… it’s not a solved problem. What point are you trying to make?
Der_Einzige 1 days ago [-]
This is the brainlet version of the correct take, which is "anal sex without condoms is objectively bad from a public health perspective".
If compliance with safe sex techniques were anywhere close to where it should be, this wouldn't be a problem.
Phase I trials happening now. Godspeed to them. It’s where most HIV vaccines die
cromka 1 days ago [-]
I invested in Moderna around the time they had their vaccine enter Phase I trials, hoping for a pay off.
Paid off it did not.
nerdjon 1 days ago [-]
I have to admit that given how many times we have been here, I struggle with being excited about any news about a HIV vaccine until we see results from humans. Just way too many times of hope.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
xutopia 1 days ago [-]
The reason why this is a big deal is because they figured out a way to engineer the type of cells that are hard to create that can readily fight off the virus. In some people they create them already. Here they were able to get the body to create them.
I agree it is far off from something in humans but it's a giant leap. The way I see it is like sending Laika in space before we send humans. It's significant and promising of a future where humans might have a vaccine.
noname120 1 days ago [-]
Long-acting antiretroviral injection ≠ vaccine
AndrewDucker 1 days ago [-]
Tested on rhesus macaques. Worked well for 44% of them.
It's a positive step, but still a fair way off for humans.
mohamedkoubaa 1 days ago [-]
It doesn't need to be 100% effective in humans, it just needs to slow transmission enough such that the rate of incidence declines in the direction of eradication.
wavemode 1 days ago [-]
It will have the opposite effect, if people who get the vaccine start behaving as though they are 100% protected (which, many people will).
Jalad 1 days ago [-]
This is called moral hazard, and people love to worry about it. Usually though (the relevant example here is PrEP, or birth control) it's fine and enables people to live their lives with fewer risks to their, and others, wellbeing
wavemode 1 days ago [-]
No, I'm not talking about moral hazard at all. I'm just talking about the poor effectiveness. If it were highly effective, like PreP and birth control are, there would be no issue in my mind.
cromka 1 days ago [-]
> It will
It might. You don't know that.
wavemode 1 days ago [-]
The epistemic modality of my statement was implied. I obviously don't know the future.
JumpCrisscross 1 days ago [-]
> I obviously don't know the future
Nor the past. Seatbelt requirements did result in riskier driving. It also, on the net, saved lives. Same for every other vaccine, or e.g. birth control in respect of teenage and unwanted pregnancies.
Also, PreP exists and works.
wavemode 1 days ago [-]
> Seatbelt requirements did result in riskier driving. It also, on the net, saved lives.
Okay? This seems unrelated. A better analogy would be if they had invented airbags and then people stopped wearing seatbelts. (like taking a 44% effective vaccine and then stop using PreP)
> Same for every other vaccine, or e.g. birth control in respect of teenage and unwanted pregnancies.
Also unrelated. Birth control is highly effective, and in fact is statistically more effective than condoms (since condoms can slip and/or break). My issue is the poor effectiveness of this vaccine.
JumpCrisscross 9 hours ago [-]
> This seems unrelated
It's the exact effect you're describing. Seatbelts aren't 100% efffective. When they were mandated, a common criticism was that this would increase risky driving. It did, a bit. But not enough to negate the significant safety effects of wearing a seatbelt.
> My issue is the poor effectiveness of this vaccine
One, it's still preclinical. We don't know its effectiveness in humans. But two, your argument is still historically invalid. Vaccines have been effective at the community level without being totally effective individually. And again, your concerns would apply more to PreP than the vaccine.
Your hypothesis wasn't a bad instinct. But you could have followed up on it or, when confronted with evidence against it, chosen not to double down.
wavemode 8 hours ago [-]
I can't tell if you're arguing in bad faith or if you just don't actually understand anything I've been saying.
> Your hypothesis wasn't a bad instinct. But you could have followed up on it or, when confronted with evidence against it, chosen not to double down.
...huh? What solitary point of evidence has even been presented? First it was pointed out to me that I'm not a psychic, which is true but is not evidence of anything. Then it was pointed out to me that seatbelts save lives and contraception prevents pregnancy, which are also true statementsnbut are also not evidence of anything, given that both are highly effective at what they do.
If you want to present evidence of something, why don't you start by presenting evidence of this:
> Vaccines have been effective at the community level without being totally effective individually.
Let's start with, what historical vaccine had 44% effectiveness? Then, let's move on to, what historical vaccine had 44% effectiveness and was released to the public despite there already existing a 99% effective prophylactic drug for the same disease? And what was the outcome there?
If you still don't get the point I'm making, then nothing will change this and we should just end the exchange.
paseante 1 days ago [-]
[flagged]
alightsoul 1 days ago [-]
I am sure in some countries this vaccine will be made mandatory for all teenagers because the assumption is they will have unprotected sex, even if you're a loner.
CGMthrowaway 1 days ago [-]
Why did people downvote this? Virginia, Rhode Island, DC and Puerto Rico public schools all mandate the HPV vaccine for kids, regardless of sexual activity. Many people think it's a good idea and this may be a good idea also.
jonplackett 1 days ago [-]
Can anyone explain why the body doesn’t just naturally make lots of These broadly neutralising antibodies?
It seems like they’d be so useful - so there must be a good reason there aren’t lots of them normally?
bottle_roket 1 days ago [-]
Because humans were designed by evolution, a process driven by random mutations and natural selection that can become stuck at local maxima rather than producing the best possible design.
grokcodec 1 days ago [-]
Jury is out until the overall health effect is shown to be positive
okzgn 1 days ago [-]
Congratulations, I hope the vaccine shows the same highly positive results in humans as it did in the other primates.
short_sells_poo 1 days ago [-]
OK this sounds fantastic, but is it going to be another case of an expert dropping in on this thread and going "Ah, 100s of these come out every month. It's promising but nowhere near human trials yet."
ebiester 1 days ago [-]
We don't need an expert even - pre-clinical is a far ways off even if successful.
This is in the "interesting advancement" stage, not "promising treatment."
haimanotgetu 1 days ago [-]
I wish people doesn't let their guard down because of this
ebiester 1 days ago [-]
The people who would "let their guard down" did long before this news. (Or Prep, for that matter.)
goreyee 1 days ago [-]
Hard "in-mice" vibes.
hacker_88 1 days ago [-]
Duck yeah
ck2 1 days ago [-]
The timeline of HIV/AIDS discovery to treatment to "cure" is fascinating to me
I distinctly remember Reagan cabinet members openly joking about all the people dying from it in WhiteHouse press briefing (basically Trump before Trump prototypes)
Now if they could just do this for me-cfs/long-covid and related auto-immune diseases (there are over eighty) without the 50 year timeline please
nephihaha 1 days ago [-]
I knew someone who claimed they had encountered AIDS as a doctor in late 1960s London. I don't know the truth of this, of course, and the person concerned has passed away. I do know that some illnesses present similarly, but it's not impossible. I am sure these diseases are around for a while before people identify them properly.
ck2 11 hours ago [-]
in early 2020 people would show up in the covid forums and warn about what would become long-covid that they had experienced for TWENTY YEARS since 2003 from SARS-1
I suspect sometime in the 2030s we are going to go through all this again as there won't be any investment into making a cure, there's not enough profit
wastewater analysis in major cities shows covid is alive and well, just not in the news anymore because not enough dropping dead from it, but lifelong chronic fatigue and pain is still on the table for many
nephihaha 2 hours ago [-]
It's not a good survival strategy for a virus to kill its hosts. Its main priority is to reproduce, and if the host is alive, it can be transmitted. There are signs that Covid has moved towards that. Scarlet fever certainly has.
I think with AIDS, it has a long incubation period, That means it has long enough to infect other people.
kylehotchkiss 1 days ago [-]
This follows a widely renounced successful treatment drug too right?
The hype train is strong. In reality antibodies can do absolutely nothing against retroviruses integrating into the genome. What they basically do is keep a host of perpetually paying customers. That does not solve the underlying problem.
oduduwaherbal 15 hours ago [-]
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heyitsmedotjayb 1 days ago [-]
[flagged]
bmurphy1976 1 days ago [-]
Well that's definitely a take. I'm not going to be the first in line to defend government, but more often than not I'm seeing friends and family getting chased out of the hospital BEFORE they should be.
delis-thumbs-7e 1 days ago [-]
You don’t recover from HIV at home. We tried that in the 80’s because we had to.
heyitsmedotjayb 1 days ago [-]
Have they tried having personal responsibility for their own health?
mannanj 1 days ago [-]
There's non-vaccine treatments and holistic therapies that work great for HIV too. Though if you talk about this you get labeled woo or an enemy to science. If people could make more money off those alternatives though I think it would be more acceptable to discuss.
seattle_spring 1 days ago [-]
Which treatments specifically are you referring to?
mannanj 9 hours ago [-]
I'm actually not referring to any treatments at all. There's no evidence to suggest that anything I said exists, or works, and it causes vaccine hesitancy so I think that I may be killing people and taking lives by even talking about it.
This is a real likeness of a reply I received during COVID when I shared my vaccinated parents used treatments like Ivermectin to manage COVID.
I can tell you, maybe look into frequency therapies & managing what frequencies are around you, look at inflammation reduction activities, and try cleansing like diets. I remember hearing also, with no evidence to support this conclusion of course, as I am not making any claim to remedy or cure any disease nor am I an FDA licensed practitioner, that classes of probiotics and bacteria and connected substances work great too. Edit: there's no evidence to suggest that 10 years of personal obsession and experience reversing my own diabetes (said to be incurable) and working with cutting edge scientists, doctors and researchers makes me qualified to make any sort of claim about this. I am not really certain what qualifies as evidence though, maybe you can help me understand who decides that.
So each turn, B-cells are presented with the latest version of the virus, they generate various antibodies to the various parts, and are graded at the end by how well the generated antibodies bind to the virus. The problem is that you have 1 million cells which bind strongly to the fake decoy targets and 1 cell which will bind not as strong to the real effective target. So this 1 cell never gets "promoted".
What this "germline targeting" multi-shot vaccine tries to do is to introduce a series of targets that stimulate that 1 in a million cell which will attack the right part of the HIV virus, so it gets "promoted", so if the real virus appears, the body will still go for the decoy targets, but will also generate a lot of these really effective 1 in a million cells, which got "promoted" previously by the vaccine.
To be more precise, you need to "guide" a lets call it B1 cell that all of us have in our repertoire to mutate into B2 then B3 than B4, because this B4 version will be capable of creating the right antibodies for HIV, the issue being that the intermediary states, B2, B3 are not naturally promoted so you very rarely get to the B4 state without this intervention.
The acquired immune system: a vantage from beneath
https://pubmed.ncbi.nlm.nih.gov/15539148/
Basically saying our immune systems ensure that microbes get ever more devious
However there’s ways that we counter that, like mucus that basically slowly feeds and tames your bacteria. Doesn’t work on viruses though
Origin of immunoglobulins and T cell receptors: A candidate gene for invasion by the RAG transposon
https://pubmed.ncbi.nlm.nih.gov/40614193/
List includes RSV, flu, sc2 and of course hiv
I would like to thank all the scientists who have dedicated all their hard work and ingenuity to eliminating the impact of cancer. Also, fuck cancer.
This is why it's hard to make a 'super vaccine' for flu, becuase it takes many rounds of shots to retrain some people's immune systems once they've latched on to the wrong recipe for antibodies.
this is called “original antigenic sin”
https://en.wikipedia.org/wiki/Original_antigenic_sin
we can also get better at predicting what each year's mutations are going to be, though that takes funding
but the idea that more vaccination is always better is technically not true, especially for a virus that is extremely good at mutating/shuffling its genome like the flu does.
but the reasons given by anti-vaxxers are generally BS.
Also the COVID shot is damn painful for some reason
An analogy of this is having the wrong math instruction in middle school could make your math classes harder at the university level.
It's an incredible system, and a product of probably a billion years of evolution since the first multicellular organisms had to protect themselves from infection.
If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.
So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.
At the risk of derailing this conversation from the original topic, those two things are not remotely equivalent. There's no organized political movement trying to tell people that seat belts and speed limits are immoral, and you should only drive when you're willing to accept the responsibility that comes with the risks.
And my two examples are completely arbitrary because my point applies to pretty much any problem which would be solved by people being “more careful”.
So, political/religious elements aside, teen pregnancy and road safety are the same in terms of “if people were just more disciplined, there would not be these problems” (i.e. if teens who have easy access to contraceptives planned ahead before giving into impulsiveness; if drivers were more attentive to their behaviour), which I then pointed out is naive because the reality is that people aren’t perfect, they aren’t always disciplined, we’re all only human.
Hence, we need other solutions to help with problems which don’t require ignoring that people are only human and lack perfect discipline.
I agree that some organised movements can be a problem in that they can make other problems worse.
Trying to handwave away the things we know work to prevent teen pregnancy as "just be careful" feels overly reductive, because it's way easier to do correctly than managing to drive without ever having an accident.
In South Africa we have 12,000+ road fatalities a year, by comparison Australia (renowned for strong law enforcement) with about half of our population size has 1,200 or something. (And they apparently happen to have about 4,500 teen pregnancies a year.)
Australia’s (or maybe it was New Zealand’s which I visited on the same trip) road safety campaign is called “Towards Zero”, while South Africa’s is called “Arrive Alive”.
A big part of the difference in fatalities is that Australia has much better general law enforcement (such that a lot of foreigners complain about it), while over here it’s dismal with Arrive Alive’s strategy seemingly being to always do the same thing as last year’s holiday season except with “trying harder”, while largely ignoring day-to-day traffic offences.
Due to the high chance of being caught for transgressions, Australians tend to way more often stick to the rules of the road, while over here there is horrendous amount of (to put it politely) shenanigans happening almost all the time.
And the impact of this difference in discipline shows in the above stats.
Years ago now, but my now wife spent 10 days in intensive care after a minibus taxi driving on the wrong side of the road head on collided into the car she was a passenger in. My wife was fortunately in a car with good safety features and had a medical aid plan allowing her to receive some of the best care possible in the country, but I’m doubtful that the mini bus taxi passengers (who tend to be in the poor class of the population) sent to public hospitals received care anywhere near as good, I think I heard after this article [1] was published that two people died.
Perhaps road accidents, or at least fatalities, can be reduced more than you realize.
[1]: https://www.citizen.co.za/northcliff-melville-times/222787/2...
I've always found this misunderstanding fascinating; it touches on the physical reality of sociological laws, the origin and purpose of morality, as well of course as supporting in part the modern political divides.
I rode in a lot of cars when I lived in Eastern Ukraine, 9/10 times or more the seatbelts had been removed or tucked behind the seats and not intended to be used. I got some very funny/annoyed looks when I first arrived and dug around in seats looking for a belt.
There's no need for a political movement when you already have the thing (no seatbelts).
Campaigning against _contraception_ feels like pretty much a dead issue, at least here; you just don’t see it anymore.
Also, I’ve found that when asked about the risk of something, most people believe that bad things only happen to other people (who also believed that, until it happened to them).
You two might be using "discipline" pretty different. Your definition of discipline would encompass constant casual sex as long as contraceptives were used and any abortions were prompt, right?
I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.
> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.
This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.
It's quite sad and difficult to read at times.
Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.
Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.
They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.
TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.
let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework.
if you feel the urge to fight this: i lived with someone infected with TB.
e.g. measles is shockingly infectious. TB is not.
If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious.
If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio.
Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does.
I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt.
> i lived with someone infected with TB.
If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.
In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.
measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).
This is factually untrue.
Being poor does not equal a HIV transmission rate. There is no 1:1 correlation.
A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom.
Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female.
The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk.
Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.
I did not use drugs.
"I share needles because I can't afford my own" is an INSANE take. Don't shoot drugs in the first place! Poor people are normal humans, they have willpower, agency. It is a rich people myth that poor people are cattle, devoid of any chance of doing the right thing.
It is culture, behavior, social norms. Being poor does not force you to abandon the nuclear family, does not force you to engage in criminal acts. (there is reverse causality though)
In the early 1960s South Korea had a per capita income lower than those of Haiti, Ethiopia, and Yemen, and about 40% below India's. Did all South Koreans become heroin addicts with HIV?
like insulin? should a diabetic skip the insulin? In poor countries I wouldn't be surprised if the majority of HIV infections are not as preventable as you're imagining.
You can moralize, but even if only 10% of HIV infections are unavoidable, you're not contributing to solving the actual problem. (And by unavoidable I mean, unavoidable without investing in more needles, better sanitation, or prophylactics that the people "responsible" cannot afford.)
you don't have to care about the drug users at all. even if you treat them as pests rather than humans, we frequently vaccinate pests for public health measures. pathogens will spill over to populations you do care about, they'll create a drain on the healthcare system, they'll harbor other opportunistic infections. it's not sanitary.
this is completely leaving aside that some drug addicts can and do turn their life around, and that HIV is a horrible illness nobody should have to deal with, even if it's "their fault."
Not having sex and not doing drugs isn't any sort of "right thing" other than because sex and drugs are dangerous. If sex and drugs were less dangerous (or made not dangerous at all) there would be no reason to tell people not to do them.
The wealthy use drugs and have sex all the time. They just have clean needles and nice doctors. You've completely bought into the moral explanation for poverty - which is that moral decay causes poverty, but poverty does not cause moral decay. But you think that this is a defense of the poor, rather than a defense of the exploitation and contempt for the poor by the rich.
The poor are not worse than the rich even if they do drugs, have sex, or swear on Sunday.
This is not a celebration of human agency. When people are treated badly, they behave badly. It is completely irrelevant that you were treated badly and happened not to behave badly. People are far too complex for you to say "well, we got treated the same, we should have behaved the same".
I’ve got bad news for you about methamphetamine in postwar east Asia
Your comment makes it seem like a key factor when it’s not.
Forecasts to 2030 expect sub-Saharan Africa to continue having the highest incidence rates of both HIV and other STIs of any region.
How come a specific region of the globe has this issue? "Poverty"?
Many regions in India are poor. Afghanistan. Pakistan.
Love the science based debate here, btw, thank you all for the downvotes. Facts, not feelings.
I fully believe that HIV wouldn’t exist if PrEP had come out in the 80s when public hysteria was at an all-time high and the will to eradicate it was present.
If new generations are not also given the vaccine, it will eventually return.
Probably the same with HIV, although I could see it being somewhat more difficult for that to make a resurgence. If we inoculated the entire human race against it, it could possibly eradicate HIV for several generations, if not permanently.
You mean the time the US admin was intentionally neglecting the epidemic because "it's a gay disease"? Why do you think Reagan would have done anything to ensure such a medication was easily available?
Of course, and for good reason. The ones who know for a fact they are right, might in fact be wrong or malicious.
This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.
1. The drop is fertility is bad for society
2. The drop in teen pregnancy is good, despite it's contributions to 1
3. We should try to fix 1. without undoing 2.
That's not something typical outside of that one particular group, nor can you copy-paste that anywhere else.
I think in fact it's the opposite. Because of how universal below-replacement rates are in EVERY developed nation, it shows just how independent it is from factors of culture, economics, environment, etc. It takes a seriously unusual situation like the one in Kiryas Joel for below-replacement to not be the norm.
They want married teen pregnancy. By their own admission.
Of course, Israel also has a nearly identical rate of secondary and tertiary educational attainment to other OECD countries so I’m not sure that makes the argument against education.
The one thing you can do to stop teenage pregnancies is for example to educate young girls, give them menstruation support and allow them to go to school. This effect dominates vs "oh I can't put my kid in private school" that we say is the reason for no kids.
HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?
Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)
Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.
Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:
- People who misjudge the risk they're at, so don't go on the meds in the first place
- People who live in regions where getting to a doctor even every six months is a challenge
- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.
If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.
Then there's the financial savings of a series of three shots once vs a lifetime of them.
You may be thinking of STD tests and bloodwork that is done every 3-6 months depending on your risk level to ensure that you're still HIV negative and that your kidneys are functioning normally, as kidney issues is a rare but serious side effect, especially for Truvada.
Now, what I believe is correct is that most people on PrEP would love to have a vaccine instead of needing a daily pill or even 2-6 injections per year as long as they remain sexually active.
A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.
Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.
Why haven't other countries stepped up to address this pressing need? I'm sure every other western nation could easily chip in collectively to cover the roughly $34B budget USAID had. Or do they just not care about these millions of people apparently sentenced to death?
The problem is money doesn't build supply lines overnight. Nor does it hire experts both locally and globally and get them there. Much of the data collected on patients by USAID can't just be handed over to another government for a myriad of privacy issues. Patients then have to know that their old clinic no longer exists and they have to go to a new one (is it in the same village anymore?). In the meantime viral counts go up, people get sick, infect their partners or newborn children. You can't just "pick it up later" without causing real harm.
> or do they not care
Do we not? Why can't we care, why is it now someone else's problem because Musk is still mad Mandela was let off of Robin Island?
If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).
Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.
If you're sure you don't want kids, or more kids, a bisalp, or bilateral salpingectomy (permanent birth control, removal of both fallopian tubes), is covered by Medicaid or ACA compliant private insurance in the US at 100% with no patient cost sharing as part of the Affordable Care Act federal statute. Doesn't apply to teens imho, but provides protection for 20-39 prime reproductive age cohort for those seeking it. It also decreases the risk of ovarian cancer by 42–77% (https://doi.org/10.5468/ogs.2018.61.5.542).
HIV PrEP in the short term is solved with a twice a year injectable (lenacapavir) until improved options become available (rapid deployment and robust availability of a vaccine given to as many at risk people as possible, as soon as possible). It can be provided for as little as $40/person (HN Search: lenacapavir - https://hn.algolia.com/?q=lenacapavir).
US Government Overhauls Teen Pregnancy Program to Focus on Marriage and Starting Families - https://www.nytimes.com/2026/07/22/us/politics/teen-pregnanc... | https://archive.today/ - July 22nd, 2026
Teen birth rates hit another historical low in 2025, CDC says - https://www.npr.org/2026/04/09/nx-s1-5777587/teen-birth-rate... - April 9th, 2026
Private Money Saves Colorado IUD Program As Fight Continues For Public Funding - https://kffhealthnews.org/health-industry/private-money-save... - August 27th, 2015
(with all of that context shared, all vaccines and medical protocols that improve quality of life, as well as defend and empower the human, are welcome and needed, as quickly as reasonable)
- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors
- people need to make the right decisions to take HIV vaccines
We are comparing two tools, not tools versus discipline.
In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.
They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.
An effective vaccine that lasts years would be much more convenient.
Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!
1. Some people don't use tools. (For instance, we have spellcheckers, but people don't use them or ignore them.)
2. So of what use is another tool? (Why develop a grammar checker?)
See the problem? For the people who do use tools, there are useful differences among them. Some users of spell checkers will welcome the grammar checker.
Some of those who would use drugs to prevent transmission will gladly switch to the vaccine, which is more convenient for them.
But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
Sometimes when you add a different tool to the arsenal, non-users of the tool arsenal come around.
E.g. lots of DIY tinkerers use USB oscilloscopes, who have never owned a big one. The invention and marketing of the USB scope turned them into users. The vendors of that could have axed the idea by saying, what's the use of this idea: we already have oscilloscopes? Those who don't have them already are not going to be interested in this.
There are right tools for the right job, but also the right tools for the right people in the right circumstances.
This isn't quite the right analogy, because a vaccine doesn't do something different from PrEP, it just does it in a different way. At the individual level it might make a compelling case (but more of that in a bit), but for the systemic purpose of eradicating the disease, not so much; not until it's given out during childhood like other vaccines.
>But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.
The fact of the matter is, HIV is a shitty virus, by which I mean it's an inefficacious one. It has a bad spreading mechanism and it has effects that are too severe and too obvious. The reason people ignore those drugs (besides them being expensive) is that HIV is so rare, and there are overall better methods to avoid catching it. So most people will likely never have sex with a carrier, and of those who would, most will already be using condoms. Among this latter group, I don't know that a vaccine is that compelling. HIV is not the only infection you can contract from unprotected sex. If you have a stranger in front of you with whom without a vaccine you would have used a condom, would you have unprotected sex with them after having been inoculated? While it might make sense to get the vaccine anyway as a second layer of defense, in all likelihood it won't have any effect on your personal safety.
Condoms? They break. More frequently than you might think.
Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).
Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.
A vaccine is the only real option for dealing with HIV for good.
My argument is simply that new tools are great, but it's not what's going to solve the HIV problem. Distribution, cost, access, stigma, etc are the larger problems to deal with. (We need to solve all the reasons why people aren't using the existing tools)
they make the experience measurably worse for a maybe insurance.
I don't know what fixes that reality other than (maybe?) mass-traumatizing youths with stories and photos of STI/HIV victims, essentially scaring them into wearing a rubber at the risk of scaring them out of sex entirely.
... which is why a vaccine sure would be nice.
The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.
I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Gilead sells LEN at very high prices (over $28,000 per person per year in the US), severely restricts its supply to certain countries, and refuses to sell it directly to Doctors Without Borders/Médecins Sans Frontières"
Source: https://www.doctorswithoutborders.org/latest/campaigns/acces...
It... was, until Musk dismantled USAID and Congress defunded PEPFAR.
So many comments by people who have never stepped foot out the Global North making wild assumptions.
PEP remains largely free in SSA post-USAID/PEPFAR cuts.
1. Know you were exposed (many many many people don't know they're HIV+)
2. Have the means to go to a clinic within 72 hours
3. Have the social capacity to go to the clinic safely (in many parts of Sub Saharan Africa doing so would insult your partner)
PEP is an emergency drug, not a prevention at all.
> I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.
"Cure" in the sense they could become indefinitely under detectable levels. It's worth noting that to really cure a person of HIV you'd need to remove all mutated cells.
I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.
If your drug has an elimination half-life of 1 day, then it takes about 4 days to reach the steady-state concentration if you take normal doses. With the loading dose, you immediately reach it.
We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.
Throw in doctors that are not being proactive about the conversation.
Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.
That is also before we get into the cost issues in many other countries just for those that do need it.
Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).
That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).
Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.
You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.
I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.
Some of that table is already mitigated: we test blood for HIV, so transmission by blood transfusion is unlikely. Transmission by pregnancy is less likely simply because few women have HIV: 80% of new cases in the US are male, 20% female.
The real question is whether "having a conversation about prep with your doctor" is going to lead to someone caring enough to pursue a prophylactic course of medication when that same person doesn't care enough about his own health or others' to avoid risky sexual encounters. Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen? Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place. A "really good idea" depends on a level of self-control that some people obviously lack.
Yeah, me. What a wild statement to make. It’s a big world out there, my friend.
The word likely doesn’t make this argument any less dumb
Yes, it's the exact reason that it is widely available on the NHS. 20,000 people took it, adherence was high, HIV rates dropped significantly.
> Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place
Shaming people has been tried for centuries, maybe millennia and famously _does not work_. We have ample evidence that PrEP does.
Er, I mean, a decent portion of gay men in the developed world, honestly. (I say this as a gay man in the developed world.)
Anecdotally, very much so - at least among the gay/MSM community.
The thing is, people generally quite like having sex. That comes with some level of risk, which can be mitigated in various different ways - and PrEP is one of those tools.
All humans engage in some level of risky behaviour; evidence suggests that moralising about “responsible behaviour” or “self control” is rarely effective at mitigating that risk.
Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.
If someone can get HIV the first time they have sex than your entire argument is moot.
Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.
This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.
And yet, you seem to think that we are saying that you should be going to an orgy every other day.
Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.
Maybe it isn't worth it for you in the end after that conversation, but we should also not assume that the only way you get HIV is through "risky" behavior. That is irresponsible.
At least you would know it's an option and you can make the decision yourself, I know a lot of straight people that do not know prep exists because it just isn't talked about. Or maybe they have heard about it but they don't really understand what it is. That is a problem.
Through cost plus a month's supply is $14 (which means without insurance): https://www.costplusdrugs.com/medications/emtricitabine-teno...
Yes there is the additional costs of the tests on top of that, but people should already be doing regular STD testing if they are sexually active.
Regardless, nothing about that changes that you should still be having this conversation with your doctor if you are sexually active. I do not understand how this is an argument, a conversation about prep or doxy should be in the same conversation about condoms and your general sexual health.
The worst that is going to happen from that conversation is that you don't take it, but at the very least you are educated on its existence and that decision is made between you and your doctor based on your risk factors.
Edit:
In fact, the CDC backs up this opinion: https://www.cdc.gov/hivnexus/hcp/prep/index.html
> Inform all sexually active adult and adolescent patients about PrEP.
> Prescribe PrEP to anyone who asks for it, including sexually active people who do not report HIV risk factors.
Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.
Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.
That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.
To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.
There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal.
Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV)
The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.
Condoms break. Partners lie. Shit happens.
It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.
Vaccines are the "an ounce of prevention is worth a pound of cure"
And doxycycline is a PEP treatment, not a PrEP treatment; respectfully you should probably take a step back from conversations where you obviously aren’t informed about the basics.
Regarding PEP/PreP, Doxy has been researched and shown effective as PreP as well:
https://www.sciencedirect.com/science/article/pii/S120197122...
I have met doctors that recommended it to gay men, which is why I mentioned it.
Not speaking about LGBT related matters; Sex without condom is just like everything else - it depends on the person. For some people there is little to no difference. For others, wearing the condom removes all sensation, reducing the act to physical exercise. So is sex without condoms worth it? For some people, yes, it is.
Which countries are you talking about out of curiosity?
This doesn't cover all the reasons
I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.
The distinction is that a vaccine will train your immune system to actively destroy the foreign body, while a prophylactics might just prevent it from spreading or taking hold to begin with.
A vaccine is an objectively better solution than PrEP, just because of the time scale, PrEP needs discipline on a daily or x-monthly basis. A vaccine could last for years. Although, realistically, it's more likely to end up requiring yearly updates like COVID, because HIV is also a mutating son of a bitch.
I 100% agree that waiting for a vaccine is stupid beyond measure. The world should do both: make PrEP widely available AND keep funding vaccine research.
The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.
https://www.tumblr.com/squareallworthy/163790039847/everyone...
Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.
Asking here because I don't know, and I think an answer might help others know, too.
(And to clarify, I genuinely don't know, and I'm asking from a supportive POV.)
But being HIV+ is simply having a virus, not actively dying. HIV+ status also never clears - later tests that are “negative” mean your viral load is undetectable, at which point you can no longer transmit HIV to others. Undetectable = Untransmissable.
"These antibodies are very, very rare, but they can be found in blood samples from a small number of people living with HIV.
The vaccine causes the immune system to produce more of these "broadly neutralizing" antibodies.
* If someone has a negative test after treatment, but that’s not counted as “cured”, does that imply it could (or maybe will) come back if treatment is stopped?
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Thanks for your earlier answer. I know this specific infection has lots of difficult history. It’s hard to formulate my questions without sounding suspiciously close to a sea lion or something, but I sincerely want to know. And yes, I could google it but then it wouldn’t be an interesting conversation, or one others could read and learn from.
Yes. HIV+ patients require antiretroviral treatment for the remainder of their lives. Most are able to manage with a pill regimen. This is not to say it is cheap or side effect free, but most HIV+ people are able to live normal lives with outpatient support.
(To link it back, PrEP is the same drug used to treat; ex, emtricitabine + tenofovir. Dosage, schedule differs. Other antiretrovirals may be chosen.)
* What’s the importance of the distinction between HIV+ vs AIDS, from a public health or human perspective? We don’t talk about influenza+ vs “has the flu”, at least as far as I know. Does HIV+ carry less stigma than AIDS?
Public health does talk about Inflenza (and other viral positive) individuals. Public messaging is usually with the term “carrier” - but in jargon, this implies that the individual will likely mot develop the disease themself, and will remain asymptomatic, which is untrue for HIV. NCoV-19, recently in the public eye more than any other virus, has a lot of literature around positive tests vs disease.
2. OK, fair point.
Thanks for the info! I know HIV isn't exactly "no big deal" today, but seeing it go from "you're certain to die" to "it's annoying to have to take medicine forever" is still a wonder of modern science.
Generally if you have the influenza virus, you’ll also have the disease that that virus causes. This is true of most viruses. I’m not sure any other virus does the “undetectable and untransmissible, but still _there_” thing; generally, if you get viral load to undetectable for most viruses, it will go away entirely. HIV is unusually good at dealing with the human immune system.
That constant low level stream of HIV viruses in your body can cause the virus to return at any moment you stop the therapy. So you have to take daily pills for the rest of your life to stop that stream from exponential growth and killing all of your immune system.
The last part is what is referred to as AIDS: your immune system is so weak that even the simplest pathogens can kill you, which they usually do once you reach AIDS stage.
There are a couple of viruses that can lay dormant in you and cause problems later on. Many of them insert themselves into the DNA of long living cells.
Without therapy, HIV will progress to AIDS in a couple of years in basically 99.9% of patients. Some very rare cases are known where HIV patients survive without getting AIDS and therapy, via broadly neutralizing antibodies. But again, less than a tenth of a percent. Everyone else would die without a therapy.
Being HIV positive isn't a death sentence, if you take your meds (and started taking them early after HIV infection) you can live for as long as someone who isn't HIV positive. In fact studies show that the effect of regularly going to a doctor and getting your blood checked actually improves your life chances. HIV positive people can do 99% of the things normal people can, although they are not allowed to donate blood (for good reason).
Having AIDS though is a major impairment and you are on your way to death at that stage (1-3 years to live). So it makes sense to distinguish the two.
Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.
An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?
I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.
But of course it should be available to all that need it.
It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.
The only reason we haven't eradicated TB is because we've failed massively in getting the vaccine to people in the poorer parts of the world. We could eliminate it just like we did smallpox, the only barrier is actually doing the damn thing. It is made more difficult by the fact that it has a rather long latent infection time, but again, could be solved by vaccinating everyone.
either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.
The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.
Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.
So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.
We live in a messy world.
The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:
https://www.theatlantic.com/health/archive/2019/04/dental-da...
https://slate.com/human-interest/2021/08/no-condoms-gay-sex-...
https://www.washington.edu/news/2024/02/27/qa-decline-in-con...
https://www.huffingtonpost.co.uk/entry/prep-condoms-gay-sexu...
At least a portion of the amount of people "in the closet" are closeted for fear of STDs, not particularly because of social stigma risk.
https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS
It's wired into our DNA to do this, and while we can be socialised out of it, you'll never get anywhere close to the near 100% you'd need.
Yet here we are, needing laws, cops, vaccines, and so on. Asking people to only have absolutely safe sex due to its external effects is about as useful as asking them to stop eating meat due to its external effects.
And AIDS is not considered a death sentence btw. It's not the 1980s
The HIV/AIDS epidemic would not have been nearly as serious as it was if people like you and the Catholic Church hadn’t advocated for it over all other measures.
It doesn’t work. Change your mind.
Getting tested is great practice, but you can’t rely on partners being diligent or consistent with that for your own safety.
If compliance with safe sex techniques were anywhere close to where it should be, this wouldn't be a problem.
Peer review files: https://media.springernature.com/original/springer-static/es...
Independent article covering it: https://cen.acs.org/pharmaceuticals/vaccines/hiv-vaccine-can...
Paid off it did not.
That being said, I don't understand enough to parse this very buzzword heavy release. Is this fundamentally different than the every 6 month vaccine we have now and is a more traditional vaccine or is it just continuing on that trend?
I agree it is far off from something in humans but it's a giant leap. The way I see it is like sending Laika in space before we send humans. It's significant and promising of a future where humans might have a vaccine.
It's a positive step, but still a fair way off for humans.
It might. You don't know that.
Nor the past. Seatbelt requirements did result in riskier driving. It also, on the net, saved lives. Same for every other vaccine, or e.g. birth control in respect of teenage and unwanted pregnancies.
Also, PreP exists and works.
Okay? This seems unrelated. A better analogy would be if they had invented airbags and then people stopped wearing seatbelts. (like taking a 44% effective vaccine and then stop using PreP)
> Same for every other vaccine, or e.g. birth control in respect of teenage and unwanted pregnancies.
Also unrelated. Birth control is highly effective, and in fact is statistically more effective than condoms (since condoms can slip and/or break). My issue is the poor effectiveness of this vaccine.
It's the exact effect you're describing. Seatbelts aren't 100% efffective. When they were mandated, a common criticism was that this would increase risky driving. It did, a bit. But not enough to negate the significant safety effects of wearing a seatbelt.
> My issue is the poor effectiveness of this vaccine
One, it's still preclinical. We don't know its effectiveness in humans. But two, your argument is still historically invalid. Vaccines have been effective at the community level without being totally effective individually. And again, your concerns would apply more to PreP than the vaccine.
Your hypothesis wasn't a bad instinct. But you could have followed up on it or, when confronted with evidence against it, chosen not to double down.
> Your hypothesis wasn't a bad instinct. But you could have followed up on it or, when confronted with evidence against it, chosen not to double down.
...huh? What solitary point of evidence has even been presented? First it was pointed out to me that I'm not a psychic, which is true but is not evidence of anything. Then it was pointed out to me that seatbelts save lives and contraception prevents pregnancy, which are also true statementsnbut are also not evidence of anything, given that both are highly effective at what they do.
If you want to present evidence of something, why don't you start by presenting evidence of this:
> Vaccines have been effective at the community level without being totally effective individually.
Let's start with, what historical vaccine had 44% effectiveness? Then, let's move on to, what historical vaccine had 44% effectiveness and was released to the public despite there already existing a 99% effective prophylactic drug for the same disease? And what was the outcome there?
If you still don't get the point I'm making, then nothing will change this and we should just end the exchange.
It seems like they’d be so useful - so there must be a good reason there aren’t lots of them normally?
This is in the "interesting advancement" stage, not "promising treatment."
I distinctly remember Reagan cabinet members openly joking about all the people dying from it in WhiteHouse press briefing (basically Trump before Trump prototypes)
* https://en.wikipedia.org/wiki/Timeline_of_HIV/AIDS
Now if they could just do this for me-cfs/long-covid and related auto-immune diseases (there are over eighty) without the 50 year timeline please
I suspect sometime in the 2030s we are going to go through all this again as there won't be any investment into making a cure, there's not enough profit
wastewater analysis in major cities shows covid is alive and well, just not in the news anymore because not enough dropping dead from it, but lifelong chronic fatigue and pain is still on the table for many
I think with AIDS, it has a long incubation period, That means it has long enough to infect other people.
Go team!
This is a real likeness of a reply I received during COVID when I shared my vaccinated parents used treatments like Ivermectin to manage COVID.
I can tell you, maybe look into frequency therapies & managing what frequencies are around you, look at inflammation reduction activities, and try cleansing like diets. I remember hearing also, with no evidence to support this conclusion of course, as I am not making any claim to remedy or cure any disease nor am I an FDA licensed practitioner, that classes of probiotics and bacteria and connected substances work great too. Edit: there's no evidence to suggest that 10 years of personal obsession and experience reversing my own diabetes (said to be incurable) and working with cutting edge scientists, doctors and researchers makes me qualified to make any sort of claim about this. I am not really certain what qualifies as evidence though, maybe you can help me understand who decides that.