[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.