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Comment by ed25519FUUU | Hacker News Reader

> In 2018, for instance, there were approximately 36,400 newly infected patients living with HIV in the U.S.

This number seems insane to me in the USA. Why is a well known deadly disease, with well understood transmission vectors, still spreading so prominently here?

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Why is it spreading? Because ACCESS TO CARE is extremely unevenly distributed. It can be extremely difficult for people with limited resources to get proper care.

Not even proper care, it's extremely difficult just to get a lot of at-risk people tested (let alone tested regularly)

Canada, with universal healthcare has about the same number of new cases per capita.

So it’s not access to care.

I was about to reply: because no one ever recovers from HIV infection. Then I realised it isn't true. People being treated for HIV are not contagious, so they "recover" in the epidemiological sense the moment they start treatment. The only way that can happen is if a lot of people have HIV but don't know it.

> in the epidemiological sense the moment they start treatment

It usually takes weeks to months from treatment start until your copy number becomes non-contagious.

https://www.niaid.nih.gov/diseases-conditions/10-things-know...

Because people really, really like having risky and unsafe sex?

No, that's not the reason, given that PrEP exists. The actual reason is that Truvada, like other healthcare, can be hard to get in the American system.

Have we considered telling people to "just stay home" and to "not have sex"? Maybe that's the trick.

Right. Abstinence doesn't really work in the real world, only in the spherical-cow world where humans are perfectly obedient.

Isn't that a tacit argument against stay-at-home orders?

Yeah, I'm persuaded by the Julia Marcus school of thought that simply ordering people to stay home is important but not nearly enough. You have to provide ways for people to reduce their risk in case they decide not to listen to your orders.

I personally stay home as much as I can, but I have certain privileges many others don't.

No, that's the strategy for lower-caste straight people. Telling them that leads to socioeconomically capturing a large percentage of them by burdening them with children before they can hit early potential.

Telling people to not ever have sex is different from telling people to not meet in large groups during an acute and temporary pandemic. Especially when you only forbid sex for a subset of the population while the remainder of the population is allowed to have sex. The group ban on the other hand is mostly unrestricted and thus more fair.

The incidence rate of HIV infection is the same in the US as it is in France, Span, or Italy though higher than the Scandinavian countries. I couldn't easily find data for the current rate of new infections, but its not immediately obvious to me that access to health care is the major driving factor.

https://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_...

I don't know enough to comment on European countries, but I wouldn't be surprised if access was a big problem there as well. The American healthcare system is pretty bad, but it's not the only bad system in existence. There may be other linked factors like stigma at play as well.

Condoms also exist, and are trivial to buy, in the American system.

And I'm sure transmission rates would be even higher if condoms were harder to get.

Ronald Reagan had a hand to play in this, and the AIDS epidemic in america can be seen as the real birth of the neoconservative movement in united states' politics.

Regan refused to even acknowledge the disease until he couldn't get away. This put the US on a deficit addressing AIDS that continues to this day.

American Republicanism kills people.

Because people don't have healthcare. We've decided as a society that it's better for undesirable people (gay men, IV drug users) to die instead of paying a cent more than we absolutely must in taxes.

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