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.
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.
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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
> 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.
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.
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.
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.
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.
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).
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.
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.
"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.
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"?
"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.)
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.
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."
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.
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.
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.
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.
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.
>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?
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.
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.
Kiryas Joel, New York, has astronomically high fertility, but also extremely low rates of under-18 pregnancy - which proves the combination is possible.
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.
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.
> 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.
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.
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.
Considering his family history and his weird eugenic tirades, perhaps that was the intended effect to complete his fantasy cosplaying as a Roman general.
> 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?
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?
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.
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)
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?
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.
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.
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.
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)
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.
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.
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"
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.
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.
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.
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.
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.
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).
> 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.
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.
> 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.
> 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.
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.
> 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.
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.
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.
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.
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.
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?
The LGBT community should also think about abandoning some risky practices which allow infections, and promote antibiotic resistance in the case of doxycicline "prep".
But I guess that sex without condoms is worth it, right?
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.
> 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.
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.
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.
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.
"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.
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.
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.
> 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.
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.
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.
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.
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.
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.)
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.
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.
* 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.
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.
> 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?
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.
"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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
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.
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.
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.
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.
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.
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 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.
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
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.
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.
> 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.
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?
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.
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.
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.
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."
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)
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.
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.
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.
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.
HIV isn't the only virus that generates decoys to trick antibody development, so having techniques that bypass that decoy strategy is very useful.
What else does this?
I think all viruses do to some extent. We refer to them as DIPs https://en.wikipedia.org/wiki/Defective_interfering_particle
List includes RSV, flu, sc2 and of course hiv
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.
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...
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.
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.
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.
I cannot answer those questions as much as I wish I could. My dads papers around the stuff they are working on is here if it’s of any use https://www.sciencedirect.com/author/7005329466/gunnar-kvalh...
Well, they kind of all work that way, it's just that most of the curriculum occurs naturally through interactions with wild pathogens
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.
As someone whose had rheumatic fever, your immune system can definitely prime itself for the wrong target.
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.
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.
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.
Are you saying that the result of millions of years of evolution is more impressive than decades of medical research?
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.
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.
> 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.
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.
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.
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.
[1]: https://www.citizen.co.za/northcliff-melville-times/222787/2...
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.
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).
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.
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.
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.
"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.
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"?
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?
> 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.)
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.
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."
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.
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.
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.
I’ve never heard that before. That explains a lot.
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.
We haven’t even managed to wipe out polio, and that is a cheap, lifelong vaccine.
not only that, people are explicitly trying to bring back measles, and succeeding at it
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.
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.
>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?
> 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.
I thought the current panic was that young people (not necessarily teens) weren't having enough kids?
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.
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.
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.
Kiryas Joel, New York, has astronomically high fertility, but also extremely low rates of under-18 pregnancy - which proves the combination is possible.
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.
No, it's from the cost of living being so high that people are delaying having kids.
Worldwide the main thing that correlates to having less kids is being more educated. High cost of living correlates with more kids, not less.
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
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.
> 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.
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.
I think by "update" they mean "re-up," as in you need another depot injection every six months.
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.
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.
We did, Musk has sentenced hundreds of thousands, if not millions, to death by dismantling USAID.
Considering his family history and his weird eugenic tirades, perhaps that was the intended effect to complete his fantasy cosplaying as a Roman general.
He’s a lovely individual really, just a boon to humanity all around.
> 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?
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?
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.
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).
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)
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!
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?
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.
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.
The hardest problems to solve that actually matter are in humanities.
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.
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)
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.
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.
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"
Source: https://www.doctorswithoutborders.org/latest/campaigns/acces...
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).
And clearly only the people in the USA matter.
Are you serious? I would bank money on PEP being practically free in sub-saharan Africa.
*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.
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.
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.
My understanding is PrEP is also free, but I'm less certain about that post-cuts.
It is not, at all anymore.
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).
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.
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.
At least 2 hours before, not 1, and preferably closer to 24 hours before.
Does this double dose completely prevent infection?
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.
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.
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).
> 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.
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.
> 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.
> 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.
You may have missed the word likely.
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?
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.
> 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.
Are you arguing that all sexually active people should take prep?
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.
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.
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.
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.
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.
Compliance is the big thing.
Vaccines are the "an ounce of prevention is worth a pound of cure"
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?
The LGBT community should also think about abandoning some risky practices which allow infections, and promote antibiotic resistance in the case of doxycicline "prep".
But I guess that sex without condoms is worth it, right?
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.
> 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.
And still others may be allergic to LaTeX.
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.
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.
This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?
"Grandma needs to stop taking her statins and just exercise" type shi
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.
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.
"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.
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
Which one do you suppose the pharmaceutical companies would prefer?
I’d guess the ones developing the vaccine would rather you take the vaccine
who do you expect to create pharmaceuticals other than pharmaceutical companies? sheesh
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.
I'm sure they will gladly sell us both
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.
> 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.
https://www.tumblr.com/squareallworthy/163790039847/everyone...
There's still a huge difference between a one off injection and lifelong tablets.
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.
A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.
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.
Are people still getting infected? Yes? Then it is not a solved problem.
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.
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.
He doesn't have AIDS, he's HIV-positive.
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.)
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.
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.
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.
* 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.
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.
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.
> 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?
Or maybe we should solve poverty which is a proxy to all kinds of solved problems that somehow still exist
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.
Is it not available in pharmacies?
Very dependent on locality. Mine requires a prescription for every refill, and I must continually meet certain risk criteria to qualify.
"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.
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.
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.
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.
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.
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.
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.
My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!
It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.
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.
Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).
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.
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?
> 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.
If only Isaac Asimov had worn a condom, he might still be with us today.
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:
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.
Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.
Long history of not wanting to address the epidemic:
https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS
Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.
> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.
It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.
> ... 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.
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.
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.
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.
Antibiotic resistant syphilis and ghonerrea don't sound like a fun time
More or less fun than dying of AIDS?
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
This subthread is specifically about better HIV treatments leading to an increase in other STIs. Did you forget about what you were replying to?
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.
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.
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.
I agree but asking your partners to get tested is not abstinence
So in other words… it’s not a solved problem. What point are you trying to make?
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.
The actual paper - never trust press releases from authors' institutions: https://www.nature.com/articles/s41586-026-10837-5
Peer review files: https://media.springernature.com/original/springer-static/es...
Independent article covering it: https://cen.acs.org/pharmaceuticals/vaccines/hiv-vaccine-can...
Phase I trials happening now. Godspeed to them. It’s where most HIV vaccines die
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.
Tested on rhesus macaques. Worked well for 44% of them.
It's a positive step, but still a fair way off for humans.
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.
It will have the opposite effect, if people who get the vaccine start behaving as though they are 100% protected (which, many people will).
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
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.
> It will
It might. You don't know that.
The epistemic modality of my statement was implied. I obviously don't know the future.
> 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.
> 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.
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?
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?
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.
Long-acting antiretroviral injection ≠ vaccine
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.
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.
Congratulations, I hope the vaccine shows the same highly positive results in humans as it did in the other primates.
Jury is out until the overall health effect is shown to be positive
Hard "in-mice" vibes.
Duck yeah
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."
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."
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)
* 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 wish people doesn't let their guard down because of this
The people who would "let their guard down" did long before this news. (Or Prep, for that matter.)
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.
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.
Which treatments specifically are you referring to?
Been there more times than I can count
Wait, really? Gonna have to look into this