
Hope for 'end of Aids' is disappearing, experts warn - rshx
https://www.theguardian.com/global-development/2016/jul/31/aids-could-spiral-out-control-africa-again-experts-warn
======
cryoshon
the ugly truth that everyone knows but suppresses: ending HIV is completely
impossible without massively increasing the level of human development
(social, economic, industrial, medical) in the problem areas.

go ahead and throw money at the scientists; they need it and can put it to
good use. go ahead and throw money at testing people for HIV. go ahead and
throw money at treating people for HIV. these things are necessary but not
sufficient for HIV to be conquered.

like all infectious diseases, HIV devastates the fringes, the poor, and the
ignorant. without building roads, hospitals, drug factories, hygiene education
programs, disease education programs, universities, etc-- without building a
new, more advanced society-- the problem populations will forever be problems.
without modernizing backward cultures, they cannot be saved from HIV. this, of
course, is extremely patriarchal, and expensive to implement. but HIV won't be
stopped otherwise.

a first-world level application of public-health force is necessary to control
HIV on their home turf, nevermind end it. why would anyone think that ending
HIV would require anything other than 100% organized mobilization and a long
term commitment?

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elgabogringo
Hmm... I'm surprised by this. At least in the US AIDS is under much more
control, is it not? My fiancee treats AIDS/HIV and has never mentioned
"resistance" except when referring to antibiotics. This seems more like a
funding issue, though I could be wrong.

All told, this is sad. Aids is the most easily preventable disease. Most of
her patients know exactly when they got it.

~~~
chimeracoder
A few things are at play here.

First, there are a number of different forms of HIV. HIV-1 is what's most
prevalent in the US; HIV-2 is mostly restricted to sub-Saharan Africa, but a
lot of HIV cases in Africa are HIV-1. (These can be broken down further - for
example, there are about seven groupings of HIV-1 - but HIV-1 vs. HIV-2 is the
most important distinction). Treatment for HIV-1 and HIV-2 can vary, and a
_lot_ less research has been done into the types of HIV that are common in
Africa and India.

Secondly, yes, _AIDS_ (as opposed to HIV) is "mostly under control" in the US.
There are still cases of AIDS in the US, but they tend to be in populations
that are undertreated medically. For people who identify HIV early on, while
their CD4s are still manageable, if they stick to a treatment regimen, they're
far more likely to die from something else. In fact, people in the US who are
HIV+ and under active treatment now live slightly _longer_ lives than their
HIV- counterparts.

> Aids is the most easily preventable disease.

AIDS is somewhat preventable (for people who already have HIV), but it
requires an active and ongoing treatment regimen, as well as periodic medical
care from a clinician. The funding for both of these is an issue, particularly
in developing nations.

HIV itself is somewhat preventable, though, which is why pre-exposure
prophylaxis (PrEP) has been met with such excitement from HIV prevention
efforts[0]. Not only is it over 99.9% effective[1], but it piggybacks off of
_the exact same drugs_ that are already used for treatment of HIV. It's much
more effective to utilize the same distribution network for both treatment
_and_ prevention than it is to try to have separate efforts that exist side-
by-side, but do very different work.

[0] The AHF is the lone exception, but they've turned into the anti-vaxxers of
HIV/AIDS prevention[2]. I don't consider them to be an HIV prevention group
anymore; they've done far more work recently to _worsen_ the HIV/AIDS epidemic
than they have to stop it.

[1] There has only been _one_ infection recorded from a patient who was
actively taking PrEP, and he was on an off-label treatment (PrEP is not
approved for prophylactic purposes in his country), so it's unclear how
typical his medication schedule was.

[2] See in particular #2 and #3:
[http://www.hivplusmag.com/opinion/2015/06/24/op-
ed-10-worst-...](http://www.hivplusmag.com/opinion/2015/06/24/op-ed-10-worst-
offenses-aids-healthcare-foundations-michael-weinstein)

~~~
mortehu
> people in the US who are HIV+ and under active treatment now live slightly
> longer lives than their HIV- counterparts

This sounded implausible, so I looked for a source. This page says "the
average life expectancy of a 20-year-old person in the U.S. or Canada who
began [anti-HIV therapy] shortly after he or she became HIV positive should be
around 70", which is less than the life expectancy at birth of U.S. men:

[http://www.catie.ca/en/treatmentupdate/treatmentupdate-200/a...](http://www.catie.ca/en/treatmentupdate/treatmentupdate-200/anti-
hiv-agents/longer-life-expectancy-hiv-positive-people-north)

They do mention a plausible way for HIV-positive individuals to live longer,
though: "compared to HIV-negative people, many HIV-positive people in Canada
and similar countries are under a relatively high degree of medical
scrutiny—they undergo visits to the clinic for interviews and laboratory tests
several times each year. This degree of heightened medical surveillance is
likely to detect any complications early on, before they can become serious"

~~~
Aelinsaar
It's probably hard to underestimate just how significant that it though. How
many medically founded causes of death can be traced to something that, if
caught very early, would have been treatable? If every single little "blip"
was a concern worth investigating, you'd undergo a lot of testing, but you'd
rarely slip through the cracks.

Expensive and painful though.

~~~
pkaye
I think chronic kidney disease is one of them and I'm dealing with it. If they
did urine test screening of the whole population every few years they could
catch it in the early stages and try to keep it stable for much longer. Most
of the medicines to do this are affordable generic medicines like ACE
inhibitors and prednisone however once the kidney damage gets to a point where
it is physically noticeable it is too late to treat or manage and costly
dialysis and transplants are the only solution.

~~~
Aelinsaar
To be honest, that's more the norm for organ systems than not. The tests are
mostly giant red flags, not subtle warning signs. Hopefully this is an area
ripe for disruption with machine learning systems.

------
justifier
can anyone speak to the efficacy of protein folding to cure AIDS?

i feel a number of pvnp conversations say, 'if found to be p=np then cures for
a number of disease will be possible through a greater understanding of
protein folding'

------
speeder
The article blames aids spread on "machismo" and discrimination against gays.

But at least on my country, aids spread is much slower among more patriarchal
segments of the population, but spread quite fast, even among the rich, in
groups that are more liberal, with the fastest spread I saw personally among
gays and feminists.

So I wonder, what is the logic that the article used.

I know nothing abou Africa, so maybe I missed something important regarding
that, but still, the article generalized the "thirld world" too, thus why I
commented about what I see where I live.

~~~
zepto
Do you have any citations to support this?

~~~
Amezarak
I can't imagine there's any statistics about the rate of HIV infections among
feminists, but if we limit the discussion to men who have sex with men, he is
correct.

[https://www.aids.gov/hiv-aids-basics/hiv-
aids-101/statistics...](https://www.aids.gov/hiv-aids-basics/hiv-
aids-101/statistics/index.html)

In 2014 in the US, men who have sex with men constitute more than two-thirds
of new HIV diagnoses despite being 1-10% of the population.

In the 21 worst-off US cities, 1 out of every 5 gay men (!) have HIV:
[http://www.webmd.com/hiv-aids/news/20100923/1-in-5-gay-bi-
me...](http://www.webmd.com/hiv-aids/news/20100923/1-in-5-gay-bi-men-have-hiv-
nearly-half-dont-know)

None of that, of course, means discrimination is not involved. Frankly, I
don't think enough attention is being paid to the problem, if we have these
grand plans of ending AIDS by 2030 while 20% of a subpopulation has the
disease.

~~~
matthewmacleod
He's not correct, because that's totally orthogonal to the point being made.

The issue is that when there is active discrimination against men who have sex
with men, those men are more likely to contract HIV – for a whole bevy of
obvious reasons.

Looking at this from the perspective of HIV spreading fastest in "groups that
are more liberal" is obviously missing the whole point.

It is correct that men who have sex with men are far, far more likely to be
diagnosed with HIV in developed countries – this is kind of disconnected from
the issues being discussed in developing countries, where infection of young
girls in particular is far more of a problem.

~~~
DominikR
How could discrimination against gays be the cause for the spread of HIV? Did
some country sign a law that forbids the sale of condoms to gays?

Gays are at higher risk for contracting this disease because they have more
sexual partners. The same is true for any person (doesn't matter if
heterosexual or homosexual) that has more than average sexual partners.

You know it's called a sexually transmitted disease for a reason, so anyone
that has lots and lots of sexual partners has a higher risk.

~~~
fucking_tragedy
> How could discrimination against gays be the cause for the spread of HIV?

People are less likely to seek testing, diagnosis or treatment if they will or
think they will be at the receiving end of discrimination. Avoiding
discrimination that could put your job, living situation or life at stake
could also prevent treating a disease that does the same.

> You know it's called a sexually transmitted disease for a reason, so anyone
> that has lots and lots of sexual partners has a higher risk.

You're right, but there's a reason that certain subpopulations have a higher
risk and occurrence rate and it has little to do with number of partners.

~~~
Amezarak
Men who have sex with men do report having more sexual partners than
heterosexual men [1]; the number of sexual partners is _a_ factor in the rate
of HIV infection among gay men.

I think it would be reasonable to speculate the other major contributing
factors are (as posted elsewhere) the hugely increased likelihood to transmit
HIV during anal sex vice other kinds of sex and discrimination.

[1]
[http://www.ncbi.nlm.nih.gov/pubmed/21884382](http://www.ncbi.nlm.nih.gov/pubmed/21884382)

------
DominikR
Doesn't surprise me at all that sexually transmitted diseases spread much
slower among Conservatives as they tend to also much more sexually
conservative.

Actually here in the West the group that was affected the most in the
beginning were gays, this is a fact. After that it spread to drug abusers and
prostitutes.

You can't even repeat historical facts anymore in liberal comment sections
without getting down voted into oblivion because apparently so many are
triggered by facts.

Next time you should consider being PC - AIDS was caused by the patriarchy.

Edit: My comment was meant to be a response to this one:
[https://news.ycombinator.com/reply?id=12197329&goto=item%3Fi...](https://news.ycombinator.com/reply?id=12197329&goto=item%3Fid%3D12197099%2312197329)

~~~
nostromo
Nobody denies that gay men have a higher occurrence of HIV. The problem is
when you turn it into a value judgement about being gay, rather than seeing it
as an opportunity to exercise empathy and understand why the problem exists
and how it can be improved.

The same sort of controversy existed when birth control was invented. Large
sections of society argued that now nothing could control women, who were free
to be "sluts" without fear of pregnancy.

Now we recognize that was a ridiculous argument. Of course women should be
able to have sex without worrying about pregnancy! And, similarly, gay men
should be able to have sex without worrying about a life-threatening illness.

~~~
DominikR
There is no value judgement about gays in my comment! You are making this up
in your head.

I call things as they are to my best of knowledge and in this particular case
I know it is a fact. So when I read that "machismo" is the underlying problem
with HIV then I call it nonsense because it simply isn't true.

------
jkot
Genetic research is progressing fast, I believe 2030 target to eliminate AIDS
is possible. We have good understanding howto defeat virus. It will
increasingly become ethical problem.

~~~
fdsaaf
The public freaks out when they learn that someone might have spliced a salt
resistance gene into a tomato, and you think the public will accept the kind
of advanced genetic manipulation you'd need to kill HIV dead?

~~~
psychometry
Probably, since most people are generally ignorant of how drugs are developed.
We've been making synthetic insulin with recombinant DNA since the 70s and no
one bats an eye.

~~~
Qantourisc
You mean the <your local medicinal vetting institute> checked (at least I
hope) products, that (at least I hope) only contain the filtered product and
normally none of the DNA / unknown side effects ?

------
SandraJones213
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which my medical doctor gave to me. i went to the hospital to do a checkup,
the result came out and i tested HIV NEGATIVE. I'm sharing this with you,
because i believe there's someone out here who also desire to have this cure.
feel free and contact Dr Abai, delay in treatment leads to death. visit Dr
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