[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.

[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.

[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).

[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.

[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?

[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.

[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.

[attila-lendvai]

don't forget that untreated TB runs for years, sometimes for many years.

measles heals in weeks (and 99.9% non-malnutrished survives without lasting damage; see France prior to 1983).

[attila-lendvai]

also note the exponential function here... and an exponent of 2 and 12 are very different animals.

[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?

[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.

[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.

[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."

[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".

[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.

[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.

[sarchertech]

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

[8note]

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

[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.

[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?

[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.

[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.

[Night_Thastus]

That is an exceptional outlier. It's almost entirely (>90%) made up of one religious group that has strict cultural rules about early marriage and having many children.

That's not something typical outside of that one particular group, nor can you copy-paste that anywhere else.

I think in fact it's the opposite. Because of how universal below-replacement rates are in EVERY developed nation, it shows just how independent it is from factors of culture, economics, environment, etc. It takes a seriously unusual situation like the one in Kiryas Joel for below-replacement to not be the norm.

[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.

[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

[derektank]

I suppose it depends by what you mean by “high birth rates” but Israel has a high cost of living, Tel Aviv is comparable to most American superstar cities when you account for resident’s lower incomes, but the country has a birth rate well above replacement, at roughly 3 births per woman.

Of course, Israel also has a nearly identical rate of secondary and tertiary educational attainment to other OECD countries so I’m not sure that makes the argument against education.

[vasco]

High cost of living can happen for two reasons, either everything is expensive, or you make no money. And guess what, people with no money have way more kids than people with a lot of money in middle class lives in developed countries, who then say lack of money is why they don't have kids.

The one thing you can do to stop teenage pregnancies is for example to educate young girls, give them menstruation support and allow them to go to school. This effect dominates vs "oh I can't put my kid in private school" that we say is the reason for no kids.

[cj]

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.

[fluoridation]

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

This isn't quite the right analogy, because a vaccine doesn't do something different from PrEP, it just does it in a different way. At the individual level it might make a compelling case (but more of that in a bit), but for the systemic purpose of eradicating the disease, not so much; not until it's given out during childhood like other vaccines.

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

The fact of the matter is, HIV is a shitty virus, by which I mean it's an inefficacious one. It has a bad spreading mechanism and it has effects that are too severe and too obvious. The reason people ignore those drugs (besides them being expensive) is that HIV is so rare, and there are overall better methods to avoid catching it. So most people will likely never have sex with a carrier, and of those who would, most will already be using condoms. Among this latter group, I don't know that a vaccine is that compelling. HIV is not the only infection you can contract from unprotected sex. If you have a stranger in front of you with whom without a vaccine you would have used a condom, would you have unprotected sex with them after having been inoculated? While it might make sense to get the vaccine anyway as a second layer of defense, in all likelihood it won't have any effect on your personal safety.

[tallanvor]

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.