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by Aardwolf 606 days ago
> and results published Wednesday show it worked nearly as well in men.

So not as well? Is there a biological reason for this?

Also, is it typical to do such studies on single genders rather than on a mix of humans?

5 comments

When you're trying to limit the variables on a study, yes. HIV reception between men and women has many differences so it can be better to limit your study and get twice as much data
The receptive partner in sexual activity is at much higher risk of infection than the penetrating partner.
Soooo we should've seen the opposite outcome given that fact?
A few reasons:

- Women and girls make up the majority of HIV cases, especially in the developing world

- If you're estimating the effect in both men and women, you're reducing your power to detect an effect in either group. If you have a limited budget, it's going to be hard to recruit, etc., you may well be better off powering your study for the group you think is going to be the most impactful, then going back. We saw this with the HPV vaccine - getting it going in the highest impact groups, and then going back later

- Preventing HIV in women also prevents maternal to child transmission

- "Men with HIV" are actually two different groups - men who have sex exclusively with women, and men who have sex with men. You then also need to power your study for both sub-groups.

That's inaccurate. The vast majority of all cases are in men. For instance in America only 22% of HIV+ people are women. Our World In Data has a map that shows this visually:

https://ourworldindata.org/hiv-aids

The only place this isn't true is sub-Saharan Africa. As there's no biological explanation for that discrepancy it's been hypothesized that it's because in Africa a lot of reported HIV cases are fraudulent, due to the large amount of AIDS/women specific foreign aid money and weak auditing standards.

It's not inaccurate. More than half of the people currently living with HIV worldwide are women:

https://www.unaids.org/en/resources/infographics/girls-and-w....

https://www.hiv.gov/hiv-basics/overview/data-and-trends/glob...

The phrasing "majority of all cases, especially in the developing world" implies that it's true everywhere. Even putting that aside, it's only the bizarre situation in Africa makes the statement technically true. If we interpret it in the way it was meant to be interpreted then the statement isn't really true because everywhere that has reliable data shows the opposite: men get it the most.
I don't think the 'especially' has that implication when you consider the context of the article that we're commenting on. It's true that women and girls make up the majority of people living with HIV worldwide, and this is especially true of the developing world. On the other hand, your statement that "the vast majority of all cases are in men" is simply false. Depending on the interpretation of 'vast', it's arguably not even true in much of the West. For example, in the UK, about a third of people living with HIV are women; in the US it's about a quarter.

There's nothing 'bizarre' about the situation in Africa. People's sexual behaviour is different in different societies, and this can obviously influence how STIs are distributed among different groups in the population.

There is a societal reason; condom use and polygamy. Condom use is less common and polygamy more amongst straight people in sub saharan Africa.

There was also very prominent AIDS denialism up to the 2000s so there was a bunch of lost time leading to an explosion in infections; the most notable example being South African president Thabo Mbeki.

Receptive PIV sex has 2% transmission rate, PIA is 20%. Cis men don't have a vagina, so...
To further elaborate, the anal mucous membrane is thinner than that of the vagina, so it’s easier for HIV to transmit that way.
There's also a chance that the countries they were able to / encouraged to test in are quite hostile to LGBTQ+ people
This is mentioned in the article.
Your numbers are way, way off [1].

Receptive vaginal sex: 0.08% (1 transmission per 1,250 exposures)

Insertive vaginal sex: 0.04% (1 transmission per 2,500 exposures)

Receptive anal sex: 1.4% (1 transmission per 71 exposures.)

Insertive anal sex: 0.11% (1 transmission per 909 exposures)

[1] https://stanfordhealthcare.org/medical-conditions/sexual-and...

Ah, I didn't read carefully - https://stanfordhealthcare.org/medical-conditions/sexual-and.... is my source, this was for acute infections. Regardless, it's still more than an order of magnitude of difference. Sadly too late to edit.
could you undo the abbreviations please?
Penis in vagina. It's a specification. It's like "birthing parent", to be clear what hardware is being used.

Given that HIV infection rates are very variable (over an order of magnitude, sometimes two) by subpopulation, clarifications detailing what hardware is doing what are very necessary.

We already have words for that: anal/vaginal sex.
Yeah you’re right, I’m not sure why I wrote it that way.
HIV has heavily…gendered outcomes. Others have mentioned infection rates, there’s also sheer exposure rates to consider.

https://www.cdc.gov/hiv-data/nhss/estimated-hiv-incidence-an...

This varies between countries. In South Africa, the country with the largest HIV positive population, women have double the HIV incidence of men. https://sph.brown.edu/news/2024-11-07/south-africa-hiv-obste...
That’s interesting that the gendering is reversed in Africa. Why do you think that is? The linked article didn’t try to explain it.

The OP article covered Mexico which remains closer to the US in outcomes being heavily male-gendered.

https://www.unaids.org/en/regionscountries/countries/mexico

https://www.statista.com/statistics/941203/distribution-indi...

my understanding is that

* condom use is much lower in sub-Saharan Africa

* polygamy, specifically a man with multiple wives, is also more common in sub-Saharan Africa