[RGS1811]

While HIV vaccine research is an exciting field, it's worth pointing out that halting HIV transmission is, practically speaking, a solved problem with oral and injectable reverse transcriptase inhibitors. The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education. Waiting for an HIV vaccine is the domain equivalent of hoping fusion power will solve our energy needs. Other solutions exist already; we just have to use them.

[jonathanlydall]

You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.

If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.

So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.

Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.

[saghm]

> You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.

At the risk of derailing this conversation from the original topic, those two things are not remotely equivalent. There's no organized political movement trying to tell people that seat belts and speed limits are immoral, and you should only drive when you're willing to accept the responsibility that comes with the risks.

[jonathanlydall]

Where I am from, organised political movements are not a factor of teen pregnancy and were not the least bit in my mind when I made my statement.

And my two examples are completely arbitrary because my point applies to pretty much any problem which would be solved by people being “more careful”.

So, political/religious elements aside, teen pregnancy and road safety are the same in terms of “if people were just more disciplined, there would not be these problems” (i.e. if teens who have easy access to contraceptives planned ahead before giving into impulsiveness; if drivers were more attentive to their behaviour), which I then pointed out is naive because the reality is that people aren’t perfect, they aren’t always disciplined, we’re all only human.

Hence, we need other solutions to help with problems which don’t require ignoring that people are only human and lack perfect discipline.

I agree that some organised movements can be a problem in that they can make other problems worse.

[saghm]

My point is that teen pregnancy very much does have a solution that has empirically worked quite well at preventing it when it's actually practiced (i.e. high quality sex education and ample access to contraceptives), and pushing abstinence as a solution has demonstrably caused teen pregnancy rates in increase whenever it's used as a replacement for that; the only actual impetus for abstinence as a "solution" is ideological. I think teen pregnancy literally would be a solved problem (with instances being essentially a rounding error) in a society embracing what we actually have proven works well at preventing it; I've never seen any similarly successful mechanism at preventing injuries or deaths in automobile accidents be rejected by a society for ideological reasons.

Trying to handwave away the things we know work to prevent teen pregnancy as "just be careful" feels overly reductive, because it's way easier to do correctly than managing to drive without ever having an accident.

[jonathanlydall]

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...

[rixed]

  Perhaps road accidents, or at least fatalities, can be reduced more than you realize.

You are talking past each others. The exemple of Australia (or was it new Zealand?) shows that accidents can be lowered, as much as thé exemple of south Africa shows they can't.

I've always found this misunderstanding fascinating; it touches on the physical reality of sociological laws, the origin and purpose of morality, as well of course as supporting in part the modern political divides.

[xnyan]

> There's no organized political movement trying to tell people that seat belts and speed limits are immoral

I rode in a lot of cars when I lived in Eastern Ukraine, 9/10 times or more the seatbelts had been removed or tucked behind the seats and not intended to be used. I got some very funny/annoyed looks when I first arrived and dug around in seats looking for a belt.

There's no need for a political movement when you already have the thing (no seatbelts).

[rsynnott]

Seat belts, maybe not. Some of the campaigning against the new 30km/h urban speed limits here _is_ practically framing them as immoral, tho. People get weird about that stuff.

Campaigning against _contraception_ feels like pretty much a dead issue, at least here; you just don’t see it anymore.

[codesnik]

derailing further, it's no organized political movement, and they don't call it immoral but in Caucasus region some men avoid using seat belts as "unmanly", and that's a very social thing. Small plugs into a seatbelt socket to shut up the car audible warning are very common, including taxis.

[jonathanlydall]

Well, they do have a point on the “unmanly” aspect as there is a reason that men are statistically more likely to die before old age than women.

Also, I’ve found that when asked about the risk of something, most people believe that bad things only happen to other people (who also believed that, until it happened to them).

[kakacik]

Literally every cigarette smoker I've spoken to about this lives in that other-people fantasy

[rsynnott]

The ultimate expression of masculinity is being hurled at speed through a windscreen.

[tempfile]

Right, but we know that HIV/AIDS essentially is a solved problem in rich countries, that the mentioned interventions are readily available in rich countries, and the only reason HIV transmission is high in poor countries is because, well, they're poor. We (humanity as a whole) have plenty of money, we could fund these things, we simply choose not to.

I would caution against making an allusion to self control. It would be very cruel to act as if people who get a disease through no fault of their own could have avoided it, and most people who contract HIV could not. You may not have intended to make that allusion, but you did.

> So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.

This is obviously not what is meant by "practically solved problem". Everybody knows it is not actually solved.

[jcul]

I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide.

It's quite sad and difficult to read at times.

[everforward]

Tuberculosis is different, in a very dark, utilitarian way. 4% of new TB cases are multi-drug resistant (19% of recurrences).

Once it’s multi-drug resistant, if you’re poor then you get an incredibly depressing choice. Rich countries pay for expensive drug resistance testing.

Poor countries have to answer an impossible question. You either do nothing and see if they live, or you try to guess what drugs will work and give them those. However, if you’re wrong and the treatment doesn’t work then the risk that you’ve just made the strain immune to one or more of the drugs in that cocktail skyrockets.

They get asked to either do nothing, or do the best they can today knowing it will make tomorrow worse.

TB is also shockingly infectious, which is sad. You can at least take steps to dramatically reduce HIV risk, it’s much much harder to avoid TB.

[attila-lendvai]

> TB is also shockingly infectious

let's keep HN as a place where people usually do at least a cursory research before they state things with such confidence... or inject a few words of doubt to signal that you haven't done the homework.

if you feel the urge to fight this: i lived with someone infected with TB.

e.g. measles is shockingly infectious. TB is not.

[jquery]

A single, untreated person with TB will infect 1.5 to 4 people if public health interventions don’t happen. Measles sits at 12 to 18 people per infected person.

In case anyone was curious. Depending on what your priors were, 1.5 to 4 might be shocking.

[everforward]

Depends heavily on whether we're measuring in practical terms, or in "no medical intervention" terms.

If we're measuring in a vacuum without medicine, then absolutely, the measles is dramatically more infectious.

If we're measuring in the real world where medicine exists, the measles has a safe, cheap and effective vaccine. New case rates dropped 76% between 2000 and 2018 due to extensive vaccination campaigns, and new cases of the measles globally sits a hair below TB right now. The WHO has a plan to eradicate it (and rubella) just like polio.

Meanwhile TB is now the leading cause of infectious death in the world, and the WHO estimates 1 in 4 people globally have either active or latent TB. Despite having similar new case numbers, TB kills 13 people for every 1 person the measles does.

I would describe a disease that 1 in 4 people globally have and is the world's leading cause of death as "shockingly infectious". I doubt it is the most infectious, but I think shockingly infectious is apt.

> i lived with someone infected with TB.

If they were latent, no one would expect you to have contracted TB. Latent TB isn't infectious. If they had active TB, I would personally get tested for latent TB. Not showing symptoms isn't dispositive of contracting TB, it can lay dormant for a long time or forever. I'm not saying you would definitely have contracted it enough, but the odds are high enough and risks serious enough that I'd want it treated before it became active.

[shadowtree]

"the only reason HIV transmission is high in poor countries is because, well, they're poor."

This is factually untrue.

Being poor does not equal a HIV transmission rate. There is no 1:1 correlation.

A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom.

Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female.

The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk.

Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.

[dahinds]

I don't think the original assertion is "punching down" on poor people. While you're correct that poverty isn't the "only reason" for high HIV transmission, poverty certainly contributes to it, via lack of access to health care and lack of access to education. How is it less "punching down" to attribute it to social behavior and culture? Isn't needle sharing associated with poverty, or would you also call that "culture"?

[shadowtree]

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?

[pessimizer]

People enjoy drugs, people enjoy sex. If your solution to driving fatalities is not to drive, you have not solved anything.

Not having sex and not doing drugs isn't any sort of "right thing" other than because sex and drugs are dangerous. If sex and drugs were less dangerous (or made not dangerous at all) there would be no reason to tell people not to do them.

The wealthy use drugs and have sex all the time. They just have clean needles and nice doctors. You've completely bought into the moral explanation for poverty - which is that moral decay causes poverty, but poverty does not cause moral decay. But you think that this is a defense of the poor, rather than a defense of the exploitation and contempt for the poor by the rich.

The poor are not worse than the rich even if they do drugs, have sex, or swear on Sunday.

[lukeschlather]

> Don't shoot drugs in the first place

like insulin? should a diabetic skip the insulin? In poor countries I wouldn't be surprised if the majority of HIV infections are not as preventable as you're imagining.

You can moralize, but even if only 10% of HIV infections are unavoidable, you're not contributing to solving the actual problem. (And by unavoidable I mean, unavoidable without investing in more needles, better sanitation, or prophylactics that the people "responsible" cannot afford.)

[pibaker]

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.

[tempfile]

Being poor correlates with adverse health outcomes. If you insist (as you do) that those health outcomes are due entirely to culture and willpower, then you are forced to conclude that poor people have low willpower and are less moral. This is an unprovable assertion, based entirely on your own vibes, and is frankly a cruel thing to say. It basically asserts that these people deserve the things that happen to them, because they were avoidable and entirely due to their choices.

This is not a celebration of human agency. When people are treated badly, they behave badly. It is completely irrelevant that you were treated badly and happened not to behave badly. People are far too complex for you to say "well, we got treated the same, we should have behaved the same".

[sterlind]

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."

[jrflowers]

Lmao “South Korea never had a severe drug problem”

I’ve got bad news for you about methamphetamine in postwar east Asia

[garciasn]

Dry sex in SSA may be one of the contributing factors, but it’s never been truly proven out as a key contributor in any study I have read; they always address it but say more needs to be done to be certain.

Your comment makes it seem like a key factor when it’s not.

[shadowtree]

In the Global Burden of Disease analyses, sub-Saharan Africa (SSA) had the highest age-standardized STI incidence rate of any world region — around 19,973 per 100,000 person-years, which is roughly double the global average of about 9,536 cases per 100,000.

Forecasts to 2030 expect sub-Saharan Africa to continue having the highest incidence rates of both HIV and other STIs of any region.

How come a specific region of the globe has this issue? "Poverty"?

Many regions in India are poor. Afghanistan. Pakistan.

Love the science based debate here, btw, thank you all for the downvotes. Facts, not feelings.

[cwillu]

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.

[rsynnott]

I mean a big part of the issue in poor countries is lack of access to PrEP.

[xenospn]

I’ve never heard that before. That explains a lot.

[juliendorra]

Teen pregnancy (or unwanted pregnancy at all) has been extremely low in several countries, and the factors are not discipline but was of access, focus on health instead of morality, and public service campaign. If it is high in an otherwise rich country, it’s likely not a lack of discipline from teenagers but a lack of free and easy access to contraception and abortive means, social pressure and morality campaigns, lack of sex education (often by design sometimes by negligence after some period of activity)

[jasonfarnon]

" likely not a lack of discipline from teenagers"

You two might be using "discipline" pretty different. Your definition of discipline would encompass constant casual sex as long as contraceptives were used and any abortions were prompt, right?

[jquery]

They’re talking about evidence-based solutions to the issue, yes. Discipline is probably the wrong word. Expecting teenagers to be disciplined is a fool’s errand.

[kakacik]

'Discipline to avoid teen pregnancy', is it really hard to connect those few dots to what it actually means in behavior?

[jasonfarnon]

It's easy to connect the dots, which is that an obfuscation was being applied.

[reenorap]

FYI teen pregnancy in the US is the lowest it’s ever been in the history of the country.

[ElProlactin]

The overall US fertility rate is at/near all-time lows.

[jimbob45]

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.

[mrguyorama]

>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?

[sarchertech]

We haven’t even managed to wipe out polio, and that is a cheap, lifelong vaccine.

[BizarroLand]

If we gave every living human on the planet the polio vaccine as soon as they were able to receive it, it would still exist in the wild somewhere.

If new generations are not also given the vaccine, it will eventually return.

Probably the same with HIV, although I could see it being somewhat more difficult for that to make a resurgence. If we inoculated the entire human race against it, it could possibly eradicate HIV for several generations, if not permanently.

[sarchertech]

Humans are the only reservoir for polio, so that’s not true. We could theoretically wipe out polio just like smallpox because there are no animal reservoirs.

[BizarroLand]

Huh. TIL. That boggles the mind though. Makes me wonder where it came from, or if perhaps its source was somehow killed off or otherwise destroyed, or if perhaps there is a reservoir somewhere that we simply are not aware of?

[8note]

not only that, people are explicitly trying to bring back measles, and succeeding at it

[neonstatic]

> 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.

[maxerickson]

I thought the current panic was that young people (not necessarily teens) weren't having enough kids?

[epistasis]

Which is in fact panic that teens are not having enough children, because that's where we have seen big drops...

This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.

[MostlyStable]

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.

[mrguyorama]

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.

[Night_Thastus]

I agree, but I don't think #3 is possible. For a variety of reasons, both biological and societal, the older people get the less likely they are to have kids, and fewer of them.

[skissane]

Kiryas Joel, New York, has astronomically high fertility, but also extremely low rates of under-18 pregnancy - which proves the combination is possible.

[philipallstar]

No, it's from the cost of living being so high that people are delaying having kids.

[vasco]

Worldwide the main thing that correlates to having less kids is being more educated. High cost of living correlates with more kids, not less.

[siriusastrebe]

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

[cj]

Taking teen pregnancy as an example: we have the tools to avoid it. We have condoms, we have birth control, we have the morning after pill, we have abortion. We have all the tools -- are more tools really going to help? The fact that teen pregnancy is still an issue is not because we lack the tools to solve it.

HIV prevention is similar. We already have the tools. We have condoms. We have PrEP. Sure, a vaccine would be nice, but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?

Another tool isn't going to hurt, obviously. But it also isn't the #1 highest leverage place to be spending our time if the goal is to reduce HIV transmission. (It is, however, a great use of time to develop a vaccine if you're profit-motivated. HIV prevention is a massive business. 1 year of PrEP in the US costs $20-30k, although luckily ACA mandates $0 copay. I could imagine a $50k HIV vaccine being a blockbuster drug especially if ACA also mandates $0 copay - tons of money to be made! Ugh)

Edit: To be clear, I'm excited there's a promising vaccine. However, I am not getting my hopes up that a vaccine will magically cure all of the social/political issues getting in the way of a vaccine actually being widely distributed and administered.

[cguess]

> but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?

Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:

- People who misjudge the risk they're at, so don't go on the meds in the first place

- People who live in regions where getting to a doctor even every six months is a challenge

- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.

If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.

Then there's the financial savings of a series of three shots once vs a lifetime of them.

[tallanvor]

That's absolutely not correct. Truvada has had the same formulation since it was introduced in 2012. Descovy hasn't changed since it was approved in 2019.

You may be thinking of STD tests and bloodwork that is done every 3-6 months depending on your risk level to ensure that you're still HIV negative and that your kidneys are functioning normally, as kidney issues is a rare but serious side effect, especially for Truvada.

Now, what I believe is correct is that most people on PrEP would love to have a vaccine instead of needing a daily pill or even 2-6 injections per year as long as they remain sexually active.

[sterlind]

I think by "update" they mean "re-up," as in you need another depot injection every six months.

[HappMacDonald]

That's like asking "if someone is unwilling to practice abstinence, why would they be willing to wear a condom, or to flip a magic 'not fertile right at this moment' lightswitch?"

A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.

[ChrisMarshallNY]

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.

[egeozcan]

All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions.

If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).

Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.

[toomuchtodo]

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)

[kazinator]

I'm not following the points in the above thread.

- people need to make the right decisions to take oral or injectable reverse transcriptase inhibitors

- people need to make the right decisions to take HIV vaccines

We are comparing two tools, not tools versus discipline.

In some ways these reverse transcriptase inhibitors are like a vaccine, in that they can be taken by people who don't have HIV, for protection.

They are inconvenient, requiring regular injections every few months or timing protocols for the oral versions.

An effective vaccine that lasts years would be much more convenient.

Without a HIV vaccine, the toolkit has a gaping lack; another tool is needed!

[fluoridation]

No, nothing is being compared. The question being posed is, if there are already tools to prevent HIV transmission (condoms, drugs, etc.) and someone doesn't use them, why would they use a vaccine?

[throwway120385]

Because a vaccine is much easier for the doctor to administer and manage. My GP won't put condoms on me but they do have a list of shots I get basically once and then never again.

[kazinator]

Right; that's a better framing.

1. Some people don't use tools. (For instance, we have spellcheckers, but people don't use them or ignore them.)

2. So of what use is another tool? (Why develop a grammar checker?)

See the problem? For the people who do use tools, there are useful differences among them. Some users of spell checkers will welcome the grammar checker.

Some of those who would use drugs to prevent transmission will gladly switch to the vaccine, which is more convenient for them.

But there is also this: the inconvenient drugs that block transmission are mainly used by HIV positive people and people who are exposed to them. Someone not in that situation is not going to get on a train of injections every three months. (I've never even heard of these drugs until this submission and its discussion threads.) Whereas a HIV vaccine could be something more interesting to the general population. There will likely be some people who get the vaccine who ignored the transmission-blocking drugs.

Sometimes when you add a different tool to the arsenal, non-users of the tool arsenal come around.

E.g. lots of DIY tinkerers use USB oscilloscopes, who have never owned a big one. The invention and marketing of the USB scope turned them into users. The vendors of that could have axed the idea by saying, what's the use of this idea: we already have oscilloscopes? Those who don't have them already are not going to be interested in this.

There are right tools for the right job, but also the right tools for the right people in the right circumstances.

[tallanvor]

Unfortunately HIV is not a solved problem.

Condoms? They break. More frequently than you might think.

Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).

Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.

A vaccine is the only real option for dealing with HIV for good.

[Muromec]

The hardest problems to solve that actually matter are in humanities.

[soco]

All your arguments are sound, and I'm still missing your point. Pharma is interested in doing pharma, indeed. But who's interested in your solution, assuming you have one? A significant part of the current electorate (internationally, even) seems to abhor sex ed, condoms, abortions and all that. So tell me again please how you suggest we address teen pregnancy - in THIS world.

[cj]

The person I was responding to says "HIV is not a solved problem" and "we need a new tool to solve it, a vaccine!"

My argument is simply that new tools are great, but it's not what's going to solve the HIV problem. Distribution, cost, access, stigma, etc are the larger problems to deal with. (We need to solve all the reasons why people aren't using the existing tools)

[serf]

people don't forego condoms in high income nations due to lack of access, distribution, cost, or stigma.

they make the experience measurably worse for a maybe insurance.

I don't know what fixes that reality other than (maybe?) mass-traumatizing youths with stories and photos of STI/HIV victims, essentially scaring them into wearing a rubber at the risk of scaring them out of sex entirely.

... which is why a vaccine sure would be nice.

[cogman10]

It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).

The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.

I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.

[compass_copium]

This is completely inaccurate. There is PrEP that requires dosing two times a year. You can also get PEP if you engage in a risky activity without PrEP.

[SietrixDev]

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...

[sroussey]

The shots are expensive, but the pills are free in the USA. They do have adverse kidney issues over prolonged use (more for some people than others).

[cguess]

And clearly only the people in the USA matter.

[whimsicalism]

Are you serious? I would bank money on PEP being practically free in sub-saharan Africa.

[matharmin]

That PrEP is in some ways similar to a vaccine, and there is still a lot of value in getting a better vaccine (cheaper and/or lasting longer).

[lopis]

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.

[cyberax]

PrEP is effective even when taken after the event. The approved protocol is to take a loading dose (2x the normal dose) and then follow up with regular doses for 3 days.

[simonask]

Ad-hoc use of PrEP just requires that you take a double dose 1 hour prior to potential exposure, and follow up with another double dose 24 hours later, at least with the versions commonly prescribed to sexually active groups in my area.

I agree that a vaccine is another game-changer, but it’s extremely important that we don’t spread misinformation about the efficacy and convenience of PrEP. In developed societies, it has already all but eliminated new transmissions among groups that were previously most at risk.

[tallanvor]

At least 2 hours before, not 1, and preferably closer to 24 hours before.

[jcul]

Does this double dose completely prevent infection?

[matthewmacleod]

The evidence I’m aware of suggests that this method (on-demand or event-based PrEP) is broadly as effective as daily PrEP (though it’s not suitable for vaginal sex). I believe adherence rates are generally lower though, as people can find the instructions confusing, and it’s obviously easier to mis-dose than a daily regimen.

[cyberax]

It's called a "loading dose" and it's a common trick in medication dosing.

If your drug has an elimination half-life of 1 day, then it takes about 4 days to reach the steady-state concentration if you take normal doses. With the loading dose, you immediately reach it.

[nerdjon]

Cost and compliance are still 2 major factors that have not been solved.

We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.

Throw in doctors that are not being proactive about the conversation.

Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.

That is also before we get into the cost issues in many other countries just for those that do need it.

[bluGill]

PReP has some side effects. While they are rare, they are things you need to be aware of. If you are not doing risky sex it isn't for you.

Most people want to believe they are in a monogamous relationship and thus not having risky sex - even though they are the one cheating. Either PReP needs to be more common, are people need to stop their risky sex activities (that they are not even admitting to).

[nerdjon]

> If you are not doing risky sex it isn't for you.

That blanket statement I very much disagree with. Sure there are side effects but that is part of why you also get tested every 3 months for liver issues (not that it is the only side effect, but still).

Instead of it being a blanket statement it should be a conversation with your doctor about the pros and cons.

You can still get HIV even if not engaging in risky behavior. Same with people getting pregnant when they did not intend too.

I am thinking college kids that are still figuring out their sexuality and exploring new things. You're going to make mistakes so having a conversation about prep with your doctor is a really good idea.

[Telemakhos]

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.

[matthewmacleod]

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.

[camphy]

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Yeah, me. What a wild statement to make. It’s a big world out there, my friend.

[vasco]

You may have missed the word likely.

[mattjhall]

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Yes, it's the exact reason that it is widely available on the NHS. 20,000 people took it, adherence was high, HIV rates dropped significantly.

> Sure, it's a "really good idea," but a simpler and better idea is not to have random sex in the first place

Shaming people has been tried for centuries, maybe millennia and famously _does not work_. We have ample evidence that PrEP does.

[rsynnott]

> Is someone irresponsible enough to pursue causal, unprotected sex with random partners also likely to be responsible enough to visit a doctor proactively and comply with a prep regimen?

Er, I mean, a decent portion of gay men in the developed world, honestly. (I say this as a gay man in the developed world.)

[nerdjon]

> You are extremely unlikely to get HIV from anything other than risky sex.

Yes because it is such a fantastic idea to just ignore that there is still a risk regardless of what we call "risky" sex just because it doesn't fit in your puritanical views of sex.

If someone can get HIV the first time they have sex than your entire argument is moot.

Just have the conversation with your doctor and protect yourself and stop trying to push your views on others.

This is such a simple thing to say, talk to your doctor. Thats it. If doing so stops one person who is not engaging in anything that we would deem being risky from getting HIV, that is a win. There is nothing in your world that would stop someone who is having sex with someone that maybe they have been going on several dates, from getting HIV from that person if a mistake happens.

And yet, you seem to think that we are saying that you should be going to an orgy every other day.

Oh and let's not ignore that there are monogamous couples that one may have HIV and they need to also protect themselves.

[UltraSane]

Are you arguing that all sexually active people should take prep?

[bluGill]

I don't see how you are disagreeing. We are both saying that a lot more people are having risky sex than think they are.

[nerdjon]

I guess it depends on what we call risky, I mean if someone is actively trying to get pregnant are we considering that "risky"?

Someone could be taking the necessary precautions and a mistake happens, a condom breaks, whatever. Someone could have sex with one person in their life and they got it from that person. I would not consider that "risky" in any real sense of the word.

Any sex carries some amount of risk, and the key is being risk aware and not assuming that just because you are not engaging in what is generally deemed "risky" that you are safe. Instead you should be having that conversation with your doctor and determining what your risk tolerance is.

That is where I disagree, how many people are positive that never considered themselves engaging in risky behavior.

To me it is very dangerous, and leads to the situation we are in now, to just say only even consider prep if you are engaging in risky behavior.

[bluGill]

Someone trying to get pregnant is most likely to be low risk since odds are good they have a specific partner in mind and are having enough sex that they don't care to stray. Not always but in general

There are many pregnancies that result from one night stands and those are high risk, but only rarely was pregnancy a goal.

Also HIV spreads most often from anal sex. Someone trying to get pregnant is less likely to get HIV just because of how they are having sex and so lower risk. (Not zero though, don't rely on statistics with your life of your partner has HIV)

The topic here is HIV risk. Obviously getting pregnant requires unprotected sex, but the risk of HIV is about sex with someone who has it.

[simonask]

All sex is risky by this measure.

Condoms break. Partners lie. Shit happens.

It doesn’t take a lot for the risks to far outweigh any potential side effects. As far as I’m aware, every healthcare system in the developed world either recommends or enforces checkups after starting PrEP.

[abirch]

Compliance is the big thing.

Vaccines are the "an ounce of prevention is worth a pound of cure"

[gib444]

PrEP is freely available in the UK and there is almost no requirement in practice of engaging in risky sex. I don't know anyone turned down for not having risky enough sex

Which countries are you talking about out of curiosity?

[fhdkweig]

It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.

[tpolm]

HIV did not exist in human population before XX centiry. Crossings from SIV are extremely rare - vaccinations is about HIV, not SIV

[inemesitaffia]

>The reason they eat bushmeat is the because they are poor

This doesn't cover all the reasons

[niceguy1827]

This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?

[mohamedkoubaa]

"Grandma needs to stop taking her statins and just exercise" type shi

[greggsy]

Isn’t prep more like a prophylactic, as opposed to a a vaccine?

I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.

[RGS1811]

The analogy to malaria is pretty on point. Pre-Exposure Prophylaxis (PrEP) is, you nailed it, prophylactic. It's not as good as a vaccine would be, and it's not as cheap as a one-and-done shot, but we've gotten to the point where you can get one shot every six months (lenacapavir) and, it's 99%+ effective at preventing infection. And, much like with malaria, the prophylaxis works— there is currently no HIV vaccine that reliably prevents infection.

[fluoridation]

"Prophylactic" is a broad-enough word to encompass vaccines, as well, so I'm not sure what you're getting at. It just means something that defends against disease.

[greggsy]

Vaccines can be singled out as a specific type of prophylaxis.

The distinction is that a vaccine will train your immune system to actively destroy the foreign body, while a prophylactics might just prevent it from spreading or taking hold to begin with.

[fluoridation]

I have no idea what you're trying to say. An antiviral drug will destroy the pathogen just as much as the body would; that's how it prevents the disease from manifesting. What do you think would otherwise happen to HIV particles in your bloodstream? They just hang in there until the antiviral effects run out?

[greggsy]

The difference is that your body doesn’t make antiviral drugs. It does make antibodies after it has been trained to do so with a vaccine.

[evilfred]

prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver

[SoftTalker]

Which one do you suppose the pharmaceutical companies would prefer?

[wat10000]

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.

[ChadNauseam]

I’d guess the ones developing the vaccine would rather you take the vaccine

[evilfred]

who do you expect to create pharmaceuticals other than pharmaceutical companies? sheesh

[mtoner23]

I'm sure they will gladly sell us both

[tonnydourado]

Transportation was a solved problem with horses, doesn't mean the car isn't a good idea. Same for internal combustion and EVs.

A vaccine is an objectively better solution than PrEP, just because of the time scale, PrEP needs discipline on a daily or x-monthly basis. A vaccine could last for years. Although, realistically, it's more likely to end up requiring yearly updates like COVID, because HIV is also a mutating son of a bitch.

I 100% agree that waiting for a vaccine is stupid beyond measure. The world should do both: make PrEP widely available AND keep funding vaccine research.

[someguydave]

In the meanwhile everyone infected with HIV should be permanently quarantined like in Cuba

[XorNot]

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.

[skybrian]

There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard.

The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.

[wat10000]

> 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...

[ChrisRR]

There's still a huge difference between a one off injection and lifelong tablets.

[mathgeek]

From a convenience factor, sure, but both effectively turn a death sentence into a solved problem. I believe GP was pointing out that we should prioritize funding for the existing solution until the more convenient one is available.

[xutopia]

PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.

[smcg]

Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.

[gadders]

Is it not available in pharmacies?

[freeone3000]

Very dependent on locality. Mine requires a prescription for every refill, and I must continually meet certain risk criteria to qualify.

[est31]

For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.

Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.

[lizknope]

I was 16 when Magic Johnson announced he had AIDS. That was the first time it felt real to me. I remember a couple of friends crying because we all thought he would be dead in 1-2 years. And here he is and seems to be living a normal life.

[SoftTalker]

He doesn't have AIDS, he's HIV-positive.

[kstrauser]

I understand the difference between those statements, but confess that I'm not clear on the important distinction. Are there situations where untreated HIV doesn't progress to AIDS? Is the virus more transmissible in someone with AIDS than someone who's still at the HIV-positive stage?

Asking here because I don't know, and I think an answer might help others know, too.

(And to clarify, I genuinely don't know, and I'm asking from a supportive POV.)

[freeone3000]

We are unaware of any situations where HIV+ doesn’t turn into AIDS without treatment.

But being HIV+ is simply having a virus, not actively dying. HIV+ status also never clears - later tests that are “negative” mean your viral load is undetectable, at which point you can no longer transmit HIV to others. Undetectable = Untransmissable.

[SoftTalker]

FTA, it seems that a (very) small number of people develop effective antibodies againt HIV.

"These antibodies are very, very rare, but they can be found in blood samples from a small number of people living with HIV.

The vaccine causes the immune system to produce more of these "broadly neutralizing" antibodies.

[kstrauser]

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.

[compass_copium]

Again, inaccurate. You can get a PrEP shot twice a year now.

Access is a valid point. Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World.

[thinkcontext]

> Perhaps the money being used to fund a superfluous vaccine should be used to fund access to PrEP in the Third World

An astounding statement. Is it not possible that a vaccine giving decades of protection would give better health outcomes than doing PrEP every 6 months?

[Muromec]

Or maybe we should solve poverty which is a proxy to all kinds of solved problems that somehow still exist

[jitl]

A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.

[leptons]

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.

[rsynnott]

While that’s _kind_ of true, in practice compliance is going to be an issue. People are bad at taking medication, especially on an indefinite basis. As is, a lot of people use ‘event-based PrEP’ (dosing only before and a couple days after potential infection). There’s a lot of room for error. A working vaccine would definitely be preferable.

[ajsnigrutin]

It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.

Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.

[OkayPhysicist]

And they suck. Everyone who's ever worn one knows they suck. If they're too big they completely kill all sensation, if they're too small they cut off circulation, leading to, you guessed it, total loss of sensation. Topped off with the fact that they fail during higher friction activities (you know, exactly the kind that drastically increase HIV transmission risk), they're never going to be an adequate solution, because there will always be people who'll risk it, because what's the point in having sex if you're not going to feel it anyway?

[SoftTalker]

> Somehow we still need...

So, clearly condoms are not the complete answer. Any solution that does not acknowledge the reality of how people actually behave is going to be imperfect.

We live in a messy world.

[wat10000]

If only Isaac Asimov had worn a condom, he might still be with us today.

[ebruchez]

I got here to mention Asimov. For those unaware, it was revealed 10 years after his death that he had actually died of HIV, contracted from a blood transfusion during a heart operation. It's quite tragic.

[giantg2]

"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."

It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.

[simonask]

As we all hopefully learnt from COVID-19, slowing sufficiently is the same as stopping. It’s a numbers game. Slowing transmission below some threshold will eventually mean that there are no new transmissions.

[giantg2]

Then why aren't STDs, TB, etc, eliminted. Even heavily vaccinated diseases are still around and pop back up occasionally. The only one eliminted was smallpox.

[OkayPhysicist]

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.

[cucumber3732842]

Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).

[ElProlactin]

> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education.

I take it you've never been to rural parts of Africa, Southeast Asia, Latin America.

[raxxorraxor]

I disagree that this is a solution. Being dependent on life long medication isn't a trivial problem and transmission must still be seen as serious.

But of course it should be available to all that need it.

[j2j8]

In exchange for accelerated ageing for being on lifelong HIV drugs. That side effect could be because the reverse transcriptase in humans is telomerase.

[a-dub]

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.

[fortran77]

It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.

[alittlebee]

My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!

[kosh2]

Are people still getting infected? Yes? Then it is not a solved problem.

[alightsoul]

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.

[Varelion]

Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.

[RajT88]

Long history of not wanting to address the epidemic:

https://en.wikipedia.org/wiki/Ronald_Reagan_and_AIDS