Would this be recommended for anybody sexually active? Or just for people in higher risk like someone with a partner that has HIV or if you're homosexual?
These aren't really the questions to be asked when they just started with a first trial.
If it's 99% effective and has close to zero sideeffects that's very different from 60% effective and significant sideeffects. In both cases there are probably some people you'd recommend it to, but in the first case you may just recommend it to everyone, in the second case probably not.
Given that it requires sexual contact to contract, I bet we could vaccinate a small portion of high risk people and effectively eradicate the disease entirely, without ever needing to vaccinate everyone.
> vaccinate a small portion of high risk people and effectively eradicate the disease
You could remove it as an endemic disease in the US and Europe. In places like South Africa where a third of the population is infected, nothing less that a blanket vaccination campaign would work.
(And of course it is not easy to find out who the high risk people are when both HIV and sexual promiscuity are stigmatised, so you might need to vaccinate everyone anyway to avoid costly errors...)
You mean HIV? Yeah, you can get it from fluid-to-blood contact, accidentally getting yourself with a needle, or someone trying to use a contaminated needle as a bio-weapon. Microscopic cuts under your fingernails are important, so you should wear gloves for sure.
I think it will be rolled out to those most at risk at first, including those who are already infected.
This may actually reduce the HIV infection rate to a large degree. Or people don't take the effing vaccine despite the benefits. Then yes, probably anybody sexually active should get it.
Agree - if we can get rid of HIV we should. I looked at the exclusion criteria in the trial and it didn't mention use of a prophylactic. Widely available prophylactics have been a huge success with preventing HIV, I wonder how that will impact the trial.
No, the point is that you could probably extinguish HIV with a very low vaccination rate - if the vaccination rate in the at-risk population is high enough.
"Anybody taking the vaccine" (not "everybody") will actually not eradicate the virus, but rather protect those who take the vaccine. Much like now with Covid.
The prophylactics should not affect clinical trials a lot. Obviously the organizers need to track who also takes prophylactics. It would be unethical to only enroll participants (especially those at higher risk) who don't take prophylactics because they could get the placebo and then they have zero protection.
Everything else is just a question of the statistical signal detection. Those Studies are planned and designed to provide such a signal, with all we know about HIV prevalence (which is already quite low, in most industrial countries, speaking statistically and for the overall population) and the effectiveness of prophylactic treatment.
Also what I'm hearing the prophylactic treatment is not much fun either... I rather see the danger of participants getting the placebo, drop the prophylactics and think they are protected...
It's tricky, because between condoms, PREP and PEP (pre- and post-exposure drugs) and treatments now being good enough that life expectancy with HIV is nearly the same as without, it'd take very low risks of side effects before giving it to everyone would cause more harm than not giving it.
So the safety profile will be hugely important in determining how widely to use it.
No vaccine is 100% effective. No medicine seems to be 100% effective either. This is a known issue, and it always has been. Good thing we don't need it to be to eradicate an illness.
It won't be necessary for most folks to take both, though, that's just not how things work.
I think marketingwise the vaccine will have a very, very hard time against PrEP, unless it can be proven that it's just as effective. And what about booster shots? It would be highly unethical to give someone an experimental vaccine INSTEAD of just PrEP. But if we don't do that, we can never find out how good the vaccine works. A dilemma.
> I think marketingwise the vaccine will have a very, very hard time against PrEP
Probably not. PrEP has some nasty side effects. Those who take it need to get their organ function checked every few months (I think just kidneys?).
Of course this vaccine is just entering trials. We have no idea how effective it is, or what the side effects might be. As such we can only guess and hope that it is better than PrEP - though that is a somewhat low bar.
To be clear, Truvada (or Descovy) for vast majority of people will have essentially no side effects. There is a small increase in chance of kidney disease, mainly for those with other risk factors, the risk profile is similar to over the counter ibuprofen.
"HIV-positive individuals who use Truvada to control their infection are more likely to experience kidney damage and bone density loss than those who take it to prevent HIV infection, as so-called pre-exposure prophylaxis (PrEP)[2]. But “no significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years,” according to the U.S. Department of Health and Human Services. Numerous studies have shown that the risk of HIV-negative Truvada users developing kidney disease is not statistically significantly different from those taking placebo[3]."
Unpopular opinion but Africa also desperately needs to fix the root cause of its HIV spread. Maybe this vaccine would give some relief and give them a chance to start over, but if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut.
Yikes. This is actually a field that I do research in, and this analysis just really, really doesn't hold water. Of course there are sociological contributors to the spread of HIV on the African continent. But the idea that there's a "culture of rape" is pretty far off base, if only because Africa is an incredibly diverse continent so there's not a shared culture of pretty much anything. For a much more accurate look at the development of the AIDS pandemic in Africa, I recommend Jacques Pépin, The Origin of AIDS.
Yeah, I probably could have phrased my original comment better. I didn't mean to imply the areas in Africa with HIV issues have a culture of rape. I said "if there is a rampant culture of rape/unprotected sex with many partners the same region will just get ravaged by the next STD and stick them back in the same rut." (emphasis added).
My point being, if we have a magic pill that cures them of a given STD, but there are underlying cultural problems that contribute to elevated STD transmission (such as unprotected sex or rape), etc., then the magic pill is only a bandaid that doesn't address the underlying elevated STD transmission problem.
As a sibling comment stated, maybe the problem is that these Africans believe homeopathic cures like special tea leaves will protect them from HIV when in reality they are just all having unprotected sex, so it's both a cultural and educational issue.
Double yikes to "these Africans." Pretty sure misplaced belief in homeopathy is not a distinctively African phenomenon.
But to the point: the major driver of the early explosion of HIV on the continent was almost certainly large-scale vaccination and medical treatment campaigns by colonial governments, which injected staggering numbers of people in rural areas without adequate disinfection of needles.
In the present, the sociological drivers of HIV spread do include rates of nonconsensual sex (particularly between teen girls and older men). More important factors, however, are historical and contemporary patterns of urban/rural migration and long-distance transit networks. The distinctive forms of cyclical migration created by the shape of the mining industry in apartheid South Africa are the largest reason that the pandemic is so much worse in that region than anywhere else on the continent.
Research is pretty clear that Africans understand that condoms work to prevent HIV transmission - there have now been decades of public education campaigns on the subject. That doesn't mean they are always used, of course, but it's not a knowledge problem.
>But to the point: the major driver of the early explosion of HIV on the continent was almost certainly large-scale vaccination and medical treatment campaigns by colonial governments, which injected staggering numbers of people in rural areas without adequate disinfection of needles.
Colonial governments were mostly out of Africa after the 1960s.
>In the present, the sociological drivers of HIV spread do include rates of nonconsensual sex (particularly between teen girls and older men). More important factors, however, are historical and contemporary patterns of urban/rural migration and long-distance transit networks. The distinctive forms of cyclical migration created by the shape of the mining industry in apartheid South Africa are the largest reason that the pandemic is so much worse in that region than anywhere else on the continent.
That's being very disingenuous. What makes periodic migration by miners in South Africa different from large-scale worker migrations elsewhere in the world? Mexican farm workers to the US, half of China, or for that matter Canadian, Russian, and Australian miners, or oil-rig workers everywhere. It's not so much the migration patterns, but what the migrants do (or don't do) when "back home".
> Colonial governments were mostly out of Africa after the 1960s.
HIV was probably spreading in the Belgian Congo in the 1920s. It likely spread to the US in the 60s. It takes a decade for HIV to turn into AIDS, which is why we think of the pandemic as starting in the 80s.
The median time is a little longer than that, but the range goes down to less than a year. We think about it as starting in the 1980s because that's when the diverse manifestations were recognized as a common syndrome, not because that's when symptoms first appeared in the US (in fact, there is a case retroactively identified as a death from full-blown AIDS in the US in 1969.)
I don't think it's particularly helpful to "yikes" everything, because I'm not intending to offend, be racist, etc.
I admit I am not an expert. I formed an opinion after scanning the official wiki on the topic (https://en.wikipedia.org/wiki/HIV/AIDS_in_Africa) which says things like: "High-risk behavioral patterns are largely responsible for the significantly greater spread of HIV/AIDS in Sub-Saharan Africa than in other parts of the world. Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity." and don't mention anything about migration patterns being the more important factors.
So if this is actually your field of study, it would be helpful if the wikipedia article were updated with the latest research.
It's okay, everyone expresses an ignorant opinion at some point. We aren't born knowing everything and we have to keep learning as the world changes. What's important is that we recognize that we can put a foot in our mouth and offend people without knowing it. But, it's important to accept and digest feedback. The feedback can be bad or good but it should at least be considered, and hearing "yikes" is pretty mild all things considered.
That said, I really think you should reflect on how much research you did (read a wikipedia page) before stating that Africa's high HIV rates compared to the rest of the world are due to "a culture of rape/unprotected sex" or quack-medicine. (Also, I don't see "rape" anywhere on the wiki article you linked.)
> That said, I really think you should reflect on how much research you did (read a wikipedia page) before stating that Africa's high HIV rates compared to the rest of the world are due to "a culture of rape/unprotected sex" or quack-medicine.
I never stated those things authoritatively. I threw them out as potential example factors because those were things I saw during my brief wikipedia foray.
> (Also, I don't see "rape" anywhere on the wiki article you linked.)
Yeah because it wasn't on that page but a related page:
> But to the point: the major driver of the early explosion of HIV on the continent was almost certainly large-scale vaccination and medical treatment campaigns by colonial governments, which injected staggering numbers of people in rural areas without adequate disinfection of needles.
Do you have a citation for that? I’ve never seen it authoritatively claimed and “almost certainly” seems strong for something which isn’t at the standards for inclusion on the Wikipedia page.
Is there not an issue of “dry sex”, where men prefer unlubricated partners which without protection can contribute to a greater likelihood of transmission?
I think a bigger issue that would need to be addressed is the distrust of Western medicine, the beliefs that they know how to prevent HIV, that HIV was caused by the West in order to kill them, and the belief that they already know the cure of HIV.
There are parallels between the disinformation in the anti-vax Covid community, and the disinformation in regards HIV in Africa.
Additionally, unless you can convince the majority in Africa to take the vaccine, partial vaccine deployment would put a evolutionary pressure on the virus to evade the vaccine and re-infect the world with a resistant strain.
HIV transmission is related to sexual activity not sexual orientation. Being in an open relationship, cheating on your partner, performing unprotected sex, are all examples of behaviors that put people at "higher risk". Being attracted to your own gender does not.
HIV transmission is 18 times more likely with receptive anal sex than with receptive vaginal sex and 69% of the HIV positive people in the USA are active gay men.
So yes, being a homosexual man is a huge risk factor and probably more significant than being in an open relationship, cheating on your partner or performing unprotected sex unless you live in Sub-Saharan Africa.
The risk factor in the US is "man who has sex with men", not "gay man". Factors can combine: e.g. "gay virgin" is a lower risk factor than "straight + multiple partners".
HIV transmission is partially related to attributes that are correlated with sexual orientation, the most prominent of which is the fact that the chance of transmission is much higher for anal sex than it is for vaginal sex.
From personal experience, anal sex is definitely not limited to sex between men. I'm going to guess that there are entire websites dedicated to that, and there are definitely sections of porn websites dedicated to it. Additionally, sex between men encompasses much more than anal sex.
Which all goes back to teh point: HIV transmission isn't related to sexual orientation, even if some sex acts are traditionally attributed to one specific sort of orientation.
I feel like you aren’t queer because this isn’t what we think about it.
I’m bi, and hiv is a big deal in the gay community. I know people who have it, we have clinics around dedicated to treating people with it. Straight people can do anal, straight people can get it otherwise, but this is hitting gay/bi men way harder. It’s okay to acknowledge that
The argument you are addressing is a strawman. Nobody claimed that anal sex is limited only to sex between men. Anal sex is, however, far more common in frequency among homosexual men than between heterosexual couples, and significantly increases the risk of HIV transmission compared to vaginal sex, therefore it is a risk factor that is strongly correlated with sexual orientation.
That's a bit misleading. Attraction doesn't change the risk but certain types of activities (anal sex) are significantly more prone to bleeding which drastically increases spread rate.
As a male who is bisexual, this isn’t true. Transmitting hiv via unprotected vaginal sex is actually pretty rare, something like 1/1000 or under. And gay/bi men also tend to be more promiscuous. But of course a straight male and woman could do anal sex and that would be the same risk rate that gay men have, which is higher.
I guess people who have a lot of partners and unprotected sex such as people who do porn or sex workers as well as people with partners that are positive.
I will tell you at right now even if it has a recommendation for all people many will not in first world. HIV still is "gay disease" to most thinking and many will not want to admit risk of getting it. This is largest problem to solve if you are wanting to remove HIV from population. I think maybe best focus are bi sexuals, they are representing "cross over point" from gay population into straights where it maybe can spread more in future.
Indeed. There are people wanting there to be a gay disease, and may actually oppose research to preserve what they see as a natural form of personal judgment.
There are multiple ways actually. This is not a tit for tat kind of thing.
No one I know, who are gay or otherwise just not a normie in these things, would want, or have expressed HIV something needing to be preserved, continuing to exist and do the great harm in this world that it does.
Maybe you do. That just has not been my experience.
One would also think of confusion in people as a shared risk regardless of where any of us may be. Despite best efforts, everyone has a risk unless they are inactive.
That depends. Do senior CDC or NIH staff stand to collect patent royalties on its administration? The former (and probably informally mandatory). If not, then the latter. Given Stéphane Bancel's and others' recent trading, then I wouldn't bank on this one being a winner.
As with any preventative medicine it boils down to risk/benefit and (unfortunately) economics. FDA approval process should expose most of the risk/benefit equation and the manufacturer will set the price. When all of that is said and done you will have a lot more information with which to consider your question.
