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Comment by hughes | Hacker News Reader

I think in addition to the stigma, there will always be a matter of trust. If someone claims to be undetectable, at what point do you believe them? Right away, no questions asked? What level of trust is required to be sure they ever were, or still are, undetectable? Has the source of their medicine changed? How secure is their access to it? Any financial stresses or other factors that would affect their medicine's availability?

It's a lot to ask of someone - on both sides. How do you think someone could approach this in a way that preserves your humanity and your privacy?

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A very similar kind of trust is required in general for any sexual contact: if someone claims to have been tested, at what point do you believe them? Has that changed? How reliable is their access to testing? Could they have contracted something recently, and it is simply incubating with no symptoms?

It's not exactly the same, but it's not entirely different.

The demand for Levonorgestrel (aka Plan B, or morning-after pill), abortion, not to mention other STDs, can be seen as indicating that that trust is not always warranted.

These aren't indicators of lack of trust, merely that things happen.

Even with testing, not all STD's show up on tests - this is why folks get tested regularly. Many folks won't know they have an STD (think HPV). Condoms break, get forgotten, and so on. People do stuff when they are drunk.

Rape happens (rape isn't a lack of trust but rather something else entirely).

   These aren't indicators 
   of lack of trust

I disagree. There are multiple levels of trust:

- Your partner that they don't lie about taking contraception, that they have taken it as required.

- The medical sciences and medical regulatory authorities that the contraception works as expected.

- Pharmacist that they don't sell counterfeit medicine

and many others. Society is largely based on trust.

But trust doesn't mean you won't have demand for plan B. It doesn't mean you won't have STD's. Society is, indeed, based on trust but yet, none of these products means you don't have trust.

Humans happen and make mistakes. Condoms break. Therefore, plan B.

One doesn't have to be promiscuous or untrustworthy to have an STD. All that means is that you've had sex with someone. Someone might not even know they have an STD either. Even if folks have more than one partner, it doesn't actually mean they are sleeping around or that they are being dishonest, nor does it mean they'll get an STD.

In addition, if you are trusting that your partner has taken something as required, you probably are in a sexual relationship with someone you are familiar with. Otherwise, the prudent thing would be to use a condom and hope it does not break.

Contraception working as expected leaves a lot of room for error. Again, condoms break. Medications interfere with hormonal birth control and most folks don't take it like laboratory settings, which increases risk of pregnancy. This is all still "working as expected".

What you say is true, but I'm not sure it's in contradiction with my point.

If The System tells me that contraceptions are X% effective, and I believe them, and it's true, the problem remains of the failure rate. That's unrelated to trust.

That's maybe mostly a semantic quibble about the precise meaning of trust. I don't think it's considered absurd to say "I trust that my plane won't crash" when flying. Maybe it's more usual to say "I hope that my plane won't crash". It appears to be the case that we "hope" if we don't see the social dimension of the phenomenon we are referring to, while "trust" is also communicates a stronger social dimension.

Note also that in interactions with humans, we generally don't have a precise probabilities.

Condoms break, despite whatever trust I have in them. That's when it's time for Plan B.

I'm not sure what contraception has to do with trust.

Clearly A's statement

   I'm using contraception method X

could be true or false. If you are not verifying the truth of this statement, and have heterosexual intercourse with A, you are trusting A. How do you verify such a statement in practise?

Especially since we live in a fucked up world where there are people who spread HIV on purpose as some sort of sick goal. I wouldn't trust someone I don't have a lot of history with about something like this.

I don’t think they would tell you they were HIV positive if their goal was to infect you.

In a Bayesian framework, a person telling you they are HIV+ would seem to serve to establish some trust. Why admit to to that, but then lie about viral load?

On a more practical level, I would probably go on PreP if I regularly had hookups with men. I’m actually somewhat envious of the gay scene in that regard. The option just doesn’t meaningfully exist at the mostly-hetero sex parties I’ve been at.

> Why admit to to that, but then lie about viral load?

I mean I'd worry that they were being honest, but mistaken. I'd have to do a lot of research on the efficacy and frequency of testing beforehand (e.g. it's possible that it might be calibrated to be frequent enough to provide proper care for the patient, but not to guarantee to protect partners).

Your worries are misplaced. Three drugs are what keep them undetectable. And once you are there for a period of time (3 months to be safe) you stay that way forever as long as you take your medication as prescribed. Once they are at that point they will be getting blood tests every 6 months.

So really you need to be trusting that they are responsible enough to take their drugs every day. These days that is pretty easy, most people take 1 pill in the morning and that's it.

What option doesn't exist? You can take PreP regardless of what kind of sex party you go to.

I was hinting at the answer: it’s not a known concept, so your (potential) partners will tend not to trust it. Plus I would prefer both to be on it.

But this isn't necessarily a bad thing. PreP needs to be taken religiously to be effective, or it can lead to increased exposure by people who take it irregularly. So it's mostly only offered to high-risk populations that would have an incentive to take it properly, and afaik, straight white cishet people aren't such a population.

The fact that people don't trust it means nobody's casually taking it or taking for granted that other people are taking it. So it increases awareness of the potential for contracting HIV and underlines the need for protection. At the same time, you can independently choose to take it and provide yourself more protection. So I think it all balances out.

Why can’t you go on prep?

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