
Gates Foundation to Invest Up to $140M in HIV Prevention Device - dsr12
http://www.wsj.com/articles/gates-foundation-to-invest-up-to-140-million-in-hiv-prevention-device-1483023602
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mrfusion
Where in the body does the device go? How is it inserted?

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johansch
And how the heck do they make this cost-effective while still being safe? In
Sub-Saharan Africa?

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chimeracoder
> And how the heck do they make this cost-effective while still being safe? In
> Sub-Saharan Africa?

PrEP (as in the daily pill) is actually incredibly cost-effective. We already
have distribution networks for HIV medications, because we need to treat
people who are HIV+ with ARVs. So expanding those to be used by people who are
HIV- is really straightforward.

The advantage of this proposed approach (the implantabable pumps), of course,
is that it'd be more akin to an IUD, which is preferable in situations where
people have reliable, but infrequent, access to medical care. That's a
situation that applies a lot of rural and poor areas in developing countries.

We've already been looking into making PrEP available as a vaccine that would
be effective for six months at a time, so I don't think this is particularly
shocking of a proposal. (Which is not to say that it wouldn't be amazing if it
works out - it would!)

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johansch
(Re-phrasing.)

Right, but how exactly are they making a surgery/implant kind of thing safe
and cost-effective in this area?

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chimeracoder
> Right, but how exactly are they making a surgery/implant kind of thing safe
> and cost-effective in this area?

Same way a vaccine becomes cost-effective, I'd imagine.

The article is paywalled, but from what I can tell, they're using Truvada, so
the research is specifically for the method of delivery, not developing the
drug itself, which cuts the overhead costs dramatically. Stents[0] aren't
expensive _per se_ ; the expensive part is installing them. But if that only
needs to be done every six months, and if it can be done by an RN or NP, then
the cost of delivery starts to fall quickly as well.

The main question I have is why they're heading down a fairly different road
(subdermal implant) as opposed to a vaccine, since as far as I know, Gilead is
already developing the latter. There must be more to this story than what I
can find on the WSJ stub and the Quartz article.

[0] This isn't actually a stent, but it looks like it'll be something similar

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uvince
A device for this exists already. Is he going to invest all that money in
Durex or Trojan?

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chimeracoder
> A device for this exists already. Is he going to invest all that money in
> Durex or Trojan?

First of all, sex is not the only way to contract HIV.

Second - and most people don't know this - condoms are _not_ FDA approved for
anal sex. They're not even tested for anal sex, and the testing requirements
for condoms are specifically limited to vaginal sex[0].

But even if we look at vaginal sex, condoms are rather ineffective compared to
other prevention methods, even when you look at success rates under perfect
use. And perfect use is not what's relevant - what you need to look at are
success rates under actual use). In this regard, condoms fail _horribly_ as an
HIV prevention tactic.

Decades of unscientific education or education based on faulty science have
caused people to subjectively underestimate their risk of contracting HIV when
using condoms, and to subjectively overestimate their risk when using other
prevention methods.

For example, how would you rank these behaviors in terms of risk levels?

* Having sex, with a condom, with more than one partner of unknown HIV status * Having sex, without a condom and without PrEP, with a single, HIV+ partner with an undetectable viral load * Having sex, without a condom while taking PrEP, with multiple partners of unknown HIV status

Surprisingly, the first is the _riskiest_ , and the second and third are
comparable levels of risk. (The second is actually believed to be slightly
less risky than the third, but the difference is not even statistically
significant, let alone practically significant).

The common counterargument to this is that condoms prevent more than just HIV
- except even _then_ , people dramatically overestimate the protection that
condoms provide. HIV is pretty much the only (common) sexually transmitted
disease that can be transmitted through vaginal or anal intercourse but not
through oral sex or other forms of physical and sexual contact. Since most
people only use condoms for intercourse, the added protection they provide for
other STDs under these scenarios is a lot less than people imagine.

In fact, STD transmission rates are actually _lower_ among people who use PrEP
for HIV prevention. The common explanation for this is that people on PrEP
have to get routine checkups (every 90 days, usually), and this provides a
convenient time to do other STD testing as well. For most people, the problem
is that they simply don't do routine STD testing at all, which means they can
have asymptomatic STDs (chlamydia, gonorrhea, syphilis, etc.) for much longer,
which makes them harder to treat, and pass them on to more people in the
interim.

[0] [http://www.imstilljosh.com/fda-condoms-not-approved-anal-
sex...](http://www.imstilljosh.com/fda-condoms-not-approved-anal-sex/)

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user5994461
> For example, how would you rank these behaviors in terms of risk levels?

Under 1% for all examples given.

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corn13read
Penis guillotine

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dtzuzu
What's the point in posting an article where you can only read the first
paragraph? It seems like click/subscription bait to me.

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grzm
You should be able to use the "web" link under the submission title and, if
necessary, an incognito window, to read the article.

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ImTalking
Obviously, this is great news and well-done by the Gates family. But I always
wonder if we shouldn't be putting this kind-of money into what I consider
society's most pressing problem which is our social intelligence, or in a
single word, tolerance.

We can have all the technical/medical/etc intelligence but if our social
intelligence lags behind then it creates the problems we have today such as
over-population, racism, nationalism, etc. And, seemingly, this gap is
increasing; we are now on the cusp of AI, machine-learning, robotics,
automation, etc, yet we can't tolerant another person's skin-colour, or their
lifestyle, or their life choices, or even their gender. Socially, we are apes
with nuclear weapons.

I guess one might say that these innovations help mankind as a whole since
they (should) increase quality-of-life. But these innovations only help if
they help the entire base of the population pyramid. And as we know, greed and
the pursuit of money/power/etc can and usually do create a world of haves/have
nots which, again, are symptoms of a selfish, individualistic society. We only
have to look at Martin Shkreli as evidence here.

So all these innovations pour out of labs, corporations, universities as the
earth temperatures and ocean waters rise-up. We just don't have the political
or economic will to understand that our intolerance, and the increasing gap
between our social and technical intelligence is the biggest issue of our
time.

