Hacker News Reader

"HIV is largely a preventable disease."

Except when the government is responsible for spreading the disease. 50% of all new infections come from intravenous drug use, and an even larger percentage are secondary to drug users. If you're gay then it's not illegal to use condoms, but if you're a heroin user then you can literally get put in jail for trying to use clean needles.

What's more, many black communities in the US have higher HIV rates than sub-Saharan Africa. Why? Because so many black males are in prison that it completely changes the sexual dynamics for everyone left on the outside. And further, many of those in prison contract the virus and then end up spreading it throughout the larger community once they get released.

--------------- but if you're a heroin user then you can literally get put in jail for trying to use clean needles. ---------------

Many pharmacies have programs for drug users to buy clean needles, no-questions-asked for exactly this reason.

I am not negating what you said, I'm am sure there are elements of the program (or accessibility) that make it a less-than-perfect solution, but it does exist.

>Many pharmacies have programs for drug users to buy clean needles, no-questions-asked for exactly this reason.

unfortunately, not being a drug user i couldn't benefit from it. Once i needed to buy a syringe, and when i'd ask for it (it was here in Bay Area), they would make big eyes and refuse. Surprised, i tried a couple other places - the same. Until, at another place, they sold it to me and made sure that it packed so when i'm walking to the car, it wouldn't be visible.

Where I live in Canada we have clinics where people can get clean needles / properly dispose of used ones.

Vancouver (where I live right now) has several needle exchanges, as well as, safe injection sites.

I was reading yesterday that coastal health is releasing a free crack pipe + cleaner kit.

Granted we are likely a bit more progressive then the rest of the country.

Yeah, Gabor Mate is doing some awesome things with OnSite. There's actually a really good interview with him here:

http://www.wpr.org/book/100307a.cfm

>if you're a heroin user then you can literally get put in jail for trying to use clean needles.

// You know what's not illegal. Stopping injecting yourself with dirty needles.

Australia (and particularly NSW) has a long running and very successful needle exchange program. The anti exchange (largely conservative christian) lobby has been basically silenced by its undoubted effectiveness.

I don't think even the crazies here (Australia) bother lobbying against needle programs anymore.

Injecting rooms are a different story though...

It's not good public health to deny information to everyone because some people will misuse said information.

While the linked rag's piece is sensationalized, the Nature Medicine article on this device is more useful. http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2408....

I am not at all opposed to providing information! I merely want the test to come with very easy to understand instructions so that people know what results really mean.

> I merely want the test to come with very easy to understand instructions so that people know what results really mean.

Do you see any evidence that it will not?

Do you see any evidence that it will? I don't need evidence either way to state that I prefer for it to be distributed with such information. If it is, then that's great.

All I see is that this isn't in large-scale production yet (though chips do exist and have been verified to work), and likely won't be marketed to the general public. Preferring it to be distributed with information is great - I entirely agree with that - I'm just trying to point out that your reasons for expecting it not to include that ("this particular kit is advertised too much like a silver bullet to assure me that the manufacturers are anywhere near that responsible") make no bloody sense. This isn't advertising, this is a report on a study that was published in Nature (so why should we care what some reporter characterizes it as?), and there are no manufacturers yet.

I admit to having a knee-jerk reaction. The "no more condoms for me!" comments I saw on the original Engadget article evoked some very unpleasant memories. Having seen the effects of HIV on a first-hand basis, I sometimes fail to respond to such things with purely rational objectivity. I ask your pardon for that.

It actually is a public health issue. Officials often make decisions on what treatments are available to what groups based on their effects on public health. For instance, vaccination or lack there of of certain demographics, when to begin mammograms, etc.

These tests absolutely fall under the FDAs jurisdiction; after all, pregnancy tests do! If research was done that found that people would ignorantly use these tests in lieu of condoms, that would worsen the HIV epidemic considerably, and the FDA would likely not approve them for off the counter usage.

I'm libertarian minded, so my feelings about this are more complicated from that. But you brought up public health, and from a public health standpoint there absolutely is an interest in denying people access to technology that would worsen an epidemic!

When you frame the argument like that, there's no disagreeing. Keep in mind I wasn't advocating for technology that would worsen an epidemic, but I don't see that as a strawman; I see your point as orthogonal rather than in reply. I'm not saying that I would advocate for throwaway tests in public bathrooms with no support system around them. I'm looking at the device, not the silly article written about an article written about a Nature Medicine article.

>> While I'm sure that everyone on HN understands the seroconversion window period...

I don't. Care to explain?

Usually, an HIV test doesn't test for presence of the virus itself; it tests for the antibodies your immune system develops in response to infection. The "window period" is the span of time between contracting the virus and the presence of detectable antibodies, which can be up to 6 months in some cases (though it's usually shorter). During this period, a person will test negative for HIV even though he or she is infected with the virus (and, worse, is contagious).

Newer tests have been developed that test for presence of the virus's RNA, shortening the window period to about 21 days (if I recall correctly), but they are more expensive and much, much less widespread.

thanks for the explanation. it worries me that anyone thinks this is common knowledge amongst a more-or-less programmer community. It worries me even more that perhaps it is, and I'm just ignorant.

Any time I see a comment like yours, the correct response to your question is almost always, "It's a system problem." If we aren't effectively disseminating knowledge about an important public health risk, we're not putting ourselves in a winning position.

This was taught in my school system, but not in such depth. They focused on prevention, rather than recognition, and we had to rely on old faithful Wikipedia to tell us the rest.

An additional piece of information- you're approximately 4,000% more likely to transmit HIV during this early stage infection because of this high viral load. Some research estimates as much as 50% of all new infections come from people in this early infectious window.

Whoa. I knew about the window, but NOT that it was much more contagious during the early window. Thank you!

Here is an excellent video that explain in detail this that in the early stages it is much more contagious http://www.ted.com/talks/elizabeth_pisani_sex_drugs_and_hiv_... and others IMPORTANT commonly unknow details that change totally how to fight to the virus.

I only learned about it the first time I got tested. If this is the case among most people, a self-test like this could be dangerous in that a lot of people who've never been tested would be likely to start using it. If I'm abnormal, though, I'm curious where most people know it from.

Thanks for playing this role on HN. I've responding to people on engadget to this effect; it really worries me that there are so many comments like "no more condoms for me!"

The irony is that such a technology could easily worse the epidemic in the U.S. because of such ignorance.

All this said, I think it's role is a not to be a "check if someone is clean for sexytime" test (incidentally, probably not a good tagline).

Instead, it's a cheap, easy and effective way to test people (especially pregnant women) so they can begin a medical regime, rather than not having any realistic means to test and risk further spread and health damage.

Your comment sounds like someone saying at the advent of the pill that it was not about enabling promiscuity but about allowing wives to manage their family planning better.

"Researchers at Columbia University claim the mChip has a 100 percent detection rate, although there's a four to six percent chance of getting a false positive"

That sounds like a negative result DOES mean you don't have it, but a positive result DOESNT mean you do.

Edit: I guess this is just misleading and you actually can get false negatives.

A negative result DOES mean there are not detectable levels of antibodies. However, while obviously highly linked this is NOT the same as saying you don't have it.

They're correct to say it has a 100% detection rate (assuming it does, but we have no reason to suspect otherwise), but I think this is quite misleading - it's detecting HIV-specific antibodies, not the virus itself.

Wow. Yeah, that's pretty misleading. Hope they have a big warning label to go with it.

Better false positives than false negatives. Generally, after testing positive for HIV, there are follow-up tests done to verify the result (usually with a different test from the first) and to check for t-cell count (to determine how damaged the immune system is).

Does anyone here know anything about what goes into creating a test with a 0% false negative rate? That sounds impressive (even with the noted caveats that it's detecting the antibodies and not the virus).

Making a test with 0% false negative rate is a piece of cake:

if (test_taken == true) { test_result = true; }

No negatives means no false negatives. ;)

But seriously, this is the classic trade-off between high sensitivity (no false negatives) and high specificity (essentially no false positives). Usually, the lower you set your threshold for detection the more likely you are to tell some people they have the disease when they actually don't. Where you set that bar depends on what you're trying to accomplish and forces you consider the harms associated with telling people they have disease when they don't or missing disease in someone who does.

Couldn't agree more (hence my post) - although nutrition may play a role in the antibody response. Malnourished individuals (especially those with low protein diets) tend to show slower antibody responses, so may have a longer seronconversion window period