Comment by hn_throwaway_99 | Hacker News Reader

Comment by hn_throwaway_99 | Hacker News Reader

hn_throwaway_99

As a gay man well into middle age, whenever I get somewhat depressed about the state of human affairs, I think about the incredible improvements in AIDS treatment and prevention and I feel a little better.

It's hard for people who didn't live through it to really understand what a terrifying time the 80s and 90s were. First off, the general message of sexual education was pretty much "If you have sex, it's probably going to kill you." There's some hyperbole there, but not much. There was really no such thing as "sex-positive messaging", and even many years later it took me time to realize how much I had internalized "sex is a bad, dangerous thing". More importantly, though, is that an HIV diagnosis really was seen as a death sentence. If you're in your 20s, imagine a situation where tons of your friends had died, and there was an ever-present fear that you might be next. I honestly believe everyone who lived through that time in that situation has some level of PTSD.

So yes, there is still a lot to do as this article points out, but it is really amazing to see how far we've come. Even a lot of the issues pointed out in the article had less to do with technology and (honestly to my surprise) economic access than with shitty cultural practices (e.g. overall misogyny and men refusing to get tested). It's important to not lose vigilance, but I think it's also important to indulge in a moment of gratitude every now and then to all the warriors (both in the medical and research fields, and the many patients who lost their lives) who have accomplished so much for all of humanity.

I have spent my adult life in a community that experiences higher-than-average HIV/HepC exposure, and well remember the "Great Die-Off" of the early-to-mid 1990s.

To anyone that missed out, dying of AIDs is horrible. The West has the luxury of expensive drugs to treat it, but much of the developing world doesn't have that, and they are still dying like flies, with very little of the transmission happening through homosexual contact.

Africa has a big problem with that, and misogyny also plays into it, as the article mentions.

The thing that disgusted me the most, was the "Good riddance" attitude of many folks. I see echoes of that, in the Fentanylopocalypse, going on, now. As soon as Muffy and Biff start popping their clogs, though, it becomes a "national tragedy."

> but much of the developing world doesn't have that, and they are still dying like flies,

Fortunately life expectancies are steadily rising even in the African countries hardest hit by HIV. Eswatini for instance has over 25% of the population HIV positive, but the life expectancy is now up to around 60 years (it was around 40 two decades ago), only 5 years behind Pakistan.

The good riddance attitude is so, so disturbing to me. And it’s fucked that we still have that attitude today.

> The West has the luxury of expensive drugs to treat it, but much of the developing world doesn't have that, and they are still dying like flies

That's not really true, as the article points out. PEPFAR has really done amazing work lowering the HIV mortality rate in developing countries. And a reminder of who may keep this program from being reauthorized: https://www.washingtonpost.com/health/2023/07/29/pepfar-aids...

Glad to hear that.

Most of Africa is still a pretty terrible place to be gay, though.

How does it relate to misogyny if you don't mind me asking?

The article mentions that women are afraid to take prophylactic treatments, because their husbands/boyfriends will take umbrage. It's not uncommon for men to have multiple sexual partners, and transmission is often accomplished that way.

There's also a fairly pervasive problem with sexual violence. Women tend to bear a lot of the pain.

There's something so morally depraved about punishing someone for insisting on protecting themselves. It really is unspeakably and irredeemably evil in my view to insist someone disregard their boundaries so thoroughly that they leave themself open to a lethal devastating virus just to satisfy someone else's ego in tandem with their nihilistic desire for short-term gratification.

I am afraid to ask but what is similar between AIDS and Fentanylopocalypse? Surely no one choses to get HIV. Surely drug usage is a choice once made. What is the link between the two I am missing here?

The mindset is that people that got AIDS got it from (gay) sex that they chose to have.

If anything, people hate addicts, even more than gays, so there's a significant portion of the population that celebrates overdose deaths; just like they danced with glee over gays dying of AIDS.

But these days, people are lacing pot with fentanyl, so when Thurston Howell XIV smokes a joint at a Harvard frat party, he might well be dead, by the time he hits the floor.

I feel like that “good riddance” attitude is a left over from an earlier time in human history. When the struggle for resources was life or death, and the survival of your community sometimes meant going to war with another community and killing other human beings, it was probably extremely useful to be able to mentally put those other other humans into a “not people” category. Now we’re living in a different world where survival doesn’t work like that anymore, but we still have the machinery in our heads that wants to classify The Other Group as less than human.

Thanks for sharing this. One of my major motivations when I was in high school- around the time that AIDS was starting to grow rapidly, was to go into drug discovery to find medicines that could cure HIV infection/reduce the impact of AIDS on patients.

At the time (about 5-6 years later) we were working on reverse transcriptase inhibitors, which I think eventually turned out to work pretty well as an early treatment. But boy, was the process slow... decades of basic and applied biology... to get where we are today.

It's so painful to watch COVID vax deniers today because it's hard enough to stay motivated over long periods of time... but when people just sort of crap all over the important scientific and medical work to get to where we are, it reminds me of some of the aggressive groups, such as Act Up SF (which actively fought against the establishment, including Fauci, who was a critical ally to HIV-infected patients at the time): https://www.nytimes.com/2022/12/31/opinion/anthony-fauci-hiv...

I often mention the whole Gen X trauma thing.

Part of it is literally seeing the ladder being pulled up just as we reached for it. Not just for jobs or college tuition, but also sexually -- the previous generation had a pretty good time and the worst that was on offer was herpes. Puberty starts rumbling around and we're wondering what the future looks like and suddenly "GRID." And we were flailing around, is it viral? (There was, most people do not know, a period wherein it was thought that this was some kind of weird immune reaction to getting semen, any semen, into the bloodstream, which seemed unlikely to me even as a tween) How transmissible is it? Okay so maybe kissing doesn't do anything. And by the time that we figured out that it isn't exactly Ebola in terms of transmissibility, some damage was done.

So, Sex = Death, rain is acid, the bees are coming, the nukes will eradicate us all. Gen X has been waiting for the other shoe to drop for decades and AIDS was just one facet of it.

herpes is the worst thing? What about chlamydia, gonorrhea?

Herpes is permanent. While there are some stubborn antibiotic-resistant versions of the other two, they weren't that bad back then. So, yes, herpes is the worst thing.

Except, there is limited evidence that Herpes causes infertility in women while the other two definitely cause female infertility. I'd say the other two are worse since they often go undetected in women until the damage is already done.

Those are both treatable and not permanent.

They are treatable if a person knows they have it, but they often go undetected in women. Women often have no outward symptoms and by the time they are diagnosed, the damage is done and they are infertile. This is permanent damage that is devastating news to couples trying to get pregnant.

Which is precisely why people should get regularly tested for STDs.

Except, we all know that doesn't happen, mostly because of the state of healthcare in the USA. My brother got colon cancer, so I tried to get a colonoscopy (I'm over 50), they refused unless I saw a primary care doctor first, well the first available appointment was 6 months out. After that I got a colonoscopy appointment, another 6 months out. Ridiculous reality.

I think there are plenty of problems with US healthcare, but I don't think this is one of them. Standard of care in the US is to get screened for STDs at least annually for sexually active people, and more frequently depending on your risk factors. Being on PrEP involves mandatory testing for STDs every 3 months. There are also tons of free clinics where people can get checked for STDs.

Yeah I always remind my wife about that but she says she doesn’t like needles and it’s not necessary.

Oh well.

Testing only once in 3 months is insane to me

One Medical makes it easy to get tested for STDs; it's not a colonoscopy, which is a specialist procedure. Looking at my app, the next available appointment with my PCP is two days away, at which point she'll put in a lab order. I go down the hall, they draw blood, and I give them a urine sample, and a few days later I get a pdf of results in the app.

Not just for my own peace of mind, but potential partners have asked to see it in the past. Different cultures I guess. ¯\_(ツ)_/¯

Both of those are on the same order as "a bad cold" in terms of health - they are straightforward to treat and are not at all a big deal.

That's not true. Both can cause infertility in women. One of my friends is an ob/gyn and they say that one of the saddest parts of their jobs is telling a couple that the wife is infertile because of an STI she contracted (almost always Chlamydia or Gonorrhea) at some time in the past. Both of these STIs can go undetected in females for years. They just don't have any outward symptoms. By the time they find out, it is too late.

Gonorrhea has become drug resistant due to the overuse of anibiotics (both for people and animals).

Prior to fairly recently, it was easily cured if detected.

https://www.who.int/news-room/fact-sheets/detail/multi-drug-...

It's the detection that is the problem. Ideally people will get checked regularly, but with the state of healthcare in the USA, we know that does not happen.

Well, in the sense that as a retrovirus that integrates into your genome and then erupts unexpectedly decades later.... yes.

I'm Gen X and I don't agree with this at all.

There's this idea that every generation bitches about the generation that comes after it, but I submit to you that every generation apparently also has people in it that see themselves as a special victim, as if the generations that came before it didn't also have their own challenges.

I point out that the eighties got so bad that George Michael, known mostly for writing happy celebratory songs, very nearly released a 'whole world is going to end' song in 1990's "Praying for Time"

It's hard to love / there's so much to hate / hanging on to hope / when there is no hope to speak of / And the wounded skies above / say it's much too late / So maybe we should all be praying for time.

They released that on the radio, it went to #1 on the Billboard charts, and stayed on the charts for 10 weeks. All while the First Gulf War was starting. Which he wouldn't have known when he was writing it.

One of the (younger) queer creators I follow posted about how they'll occasionally stumble upon pictures of the famous "NO OBITS" newspaper headline[1], and feel a surge of hope for our species.

https://www.ebar.com/story.php?ch=news&sc=news&id=280418

I suspect you've blotted out some of the worst of the early years, when lots of people didn't understand that it could only transmit through bodily fluids. People were afraid of the idea of being in the same room with someone with HIV. We had education campaigns about this. PSAs. Character arcs in prime time TV shows. Maybe that period was short in California, but it was spread out over years in the midwest.

I'm not convinced that the trauma of Covid for some adults wasn't re-experiencing the trauma of the AIDS epidemic. Here's another scary disease and we don't know how it's communicated and it's killing people and ruining their lives. Will it still be killing people in ten years? Ebola and a few others threatened to do the same, but they never actually arrived.

Aids is definitely the strongest sexually transmitted virus out there. But don't you think that there will always be sexually transmitted diseases associated with promiscuity? Not to say that aids is only transmitted through promiscuity, but superspreading is highly relevant.

It is my understanding that gay people have more sex partners than than straight people, so it's likely that these diseases will disproportionately affect gay men.

I think that limiting amount of partners is a vital part to combating sexually transmitted diseases, and that some people will have sex until they encounter the physical limitation of STDs. Not sure "sex-positive" messaging is quite helpful in this sense.

It's not the 90s anymore. In the developed world HIV primarily and disproportionately effects IV drug users, not gay men.

In the developing world, it has nothing to do with promiscuity but lack of education and access to preventative measures like condoms and PrEP.

This is not true. In 2018 in the US, 66% of new HIV diagnoses were in the transmission category of male-to-male sexual contact:

https://www.cdc.gov/hiv/library/reports/hiv-surveillance/vol...

No. New HIV diagnoses in the US are 67% male-to-male sexual contact, 22% heterosexual contact, and 7% injection drug use. (BTW, I have no agenda here except accurate statistics.)

From https://www.cdc.gov/hiv/basics/statistics.html

According to [0] in 2020, MSM accounted for 71% of new HIV diagnoses, while people who inject drugs (PWID) accounted for 7% of new HIV infections. AFAIK similar stats are also for western and central Europe. These are population-level stats, not relative risks, but If we disregard PWID and scale to population size, MSM are still one to two orders of magnitude more at risk than non-MSM, non-PWID population, so they are clearly disproportionately affected.

[0] https://www.hiv.gov/hiv-basics/overview/data-and-trends/stat...

The difference with AIDS is that AIDS at the time condemned you to a slow, horrible, visible decline, in which your death was celebrated via a radio talk show host that at the time had an entire regular segment to name and mock the people who died.

Like, this doesn't apply to people who get cervical cancer from HPV or other similarly tragic outcomes of acquiring an STD. The cruelty on the scale is way above anything.

Don't forget Reagan's press secretary mocking the so-called "gay plague"

https://www.vox.com/2015/12/1/9828348/ronald-reagan-hiv-aids

There was also Reagan's surgeon general, C. Everett Koop, who seems to have taken HIV/AIDS seriously and opposed stigmatization:

https://www.hiv.gov/blog/in-memoriam-c-everett-koop/

As painful a read as that was, I think it's really important to understand what the social norms were at that time. Thousands of people had died and the reaction, not just from the press secretary but from the press pool at large, was to laugh and joke. Really the only widely socially acceptable response to even the mere thought of gay male sexuality was complete and utter disgust. If you were a man, to not express disgust at this thought opened the door to "you might be a fairy too", which is why you see so many of these displays of "the banality of evil".

Audio from those press conferences is available at https://www.youtube.com/watch?v=yAzDn7tE1lU

That's revolting. Which radio show was this?

Rush Limbaugh.

Rush Limbaugh? Or any of the right-wing radio hosts who mocked belittled and laughed at liberal/minority suffering, I'm sure.

The point I try to get across is to separate "promiscuity is inherently bad" from "sex can have serious negative consequences that you should appropriately plan for depending on your risk tolerance."

Another way to think of it: it's also highly likely that if you go to a crowded event that there are tons of diseases you can expose yourself to. Pre-COVID, people used to talk about getting "SXSW flu", e.g. with so many crowded events at SXSW it was nearly impossible to avoid getting sick. Importantly, at some times (obviously when there was a high prevalence of COVID), I think this risk is too great and crowds should be avoided. At other times, though, I think it's utterly reasonable to think that the risk of a cold or flu is worth it to go to a bunch of fun concerts. Nobody ever talks about "You know, there will always be a ton of dangerous diseases associated with concert-going, so you should always avoid them."

So when it comes to sex, I find it totally reasonable to adjust your behavior based on the risk at the time. Currently, e.g. for a gay man on PrEP, lets look at potential risks:

1. HIV risk is extremely low for those who adhere to PrEP.

2. Most bacterial infections can be cured straightforwardly with antibiotics.

3. The biggest risks are then (a) lifetime viral diseases, primarily Herpes, and (b) at this point, multi-drug resistant gonorrhea.

Thus, I think it's important to be aware of #3 and to take precautions, again relevant to your risk level, accordingly. What I don't think makes sense is to say "But you never know what could spring up!" That's true, but if you look at the recent monkeypox outbreak, I think a lot of people had the right approach: when the outbreak was publicized, many people (a) stopped or reduced their number of sexual partners and then (b) got vaccinated as quickly as possible.

The primary point I'm making is to disentangle the real risks associated with sex (and to treat them dispassionately) from the the moralizing around "you're a dirty whore if you have sex a lot."

Regarding concert going, I've certainly met people so risk averse that they don't join a concert mass outdoors, and a lot more that don't do so indoors. This is especially more common before important events like a trip.

That said, the respiratory route is very distinct from the oral, genital and anal route.

On a spectrum of frequency of contact, respiratory is the most frequent, then comes oral/digestive, then genital, and finally anal.

The more frequent and vital a route is, the more natural and artificial resources we can allocate to combat infections.

So infections spread by talking to each other, being vital, gets a vaccine developed in less than a year, and gets diverse natural antibodies.

On the other hand, a disease that spreads among adults who seek pleasure, will be allocated less resources, more so if it spreads preferentially through non reproductive sex.

Aids on the respiratory system would be fucking deadly, but my guess is that it would never spread there because there's more protection mechanisms, respiratory is like a process running unprivileged on an open port 80. Genital is port 22 and anal-genital is rdp or teamviewer with admin privileges on a server.

> but my guess is that it would never spread there because there's more protection mechanisms, respiratory is like a process running unprivileged on an open port 80. Genital is port 22 and anal-genital is rdp or teamviewer with admin privileges on a server.

Dude, considering we're not even done yet with a worldwide pandemic caused by a deadly respiratory virus, I'd probably stop with the bad analogies.

Covid is not remarkably deadly. How long will people insist it is? Don’t they teach history in the US?

In 2022, Covid was the fourth leading cause of death in the US.

1.https://www.cdc.gov/mmwr/volumes/72/wr/mm7218a3.htm

Lethal respiratory diseases do exist, but they spread too fast to be as impactful. That's another factor to consider.

Promiscuity does not propagate sexually transmitted diseases. You are working off of a false stereotype which has limited the capacity of your rational thought, and as a result, you imagine a world which does not exist, and propose solutions which will not work. This is a common problem with HN people. They come up with this one idea that kind-of makes sense, and then stop thinking, and shape their whole thought process around this false premise.

Did you take a second to google this idea you had to see if it made sense? No; because if you had, you'd have found that HIV is spread by blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, breast milk. People who inject hormones, silicone, steroids, and drugs, can get or transmit HIV by sharing needles, syringes, or other injection equipment. It can be spread through pregnancy or stepping on an infected needle at the beach. It's often spread by not using protection during sex. And straight and gay people both get it.

Gay people do not have more sex partners than straight people. Promiscuous people do have more partners than non-promiscuous people. Gay, straight, bi, queer, etc, can all be promiscuous, just like they can all also be monogamous or even asexual. You may not like that de-simplification, but it exposes the flaw in this notion that gay people are sluts and sluts get STDs. It just doesn't work that way. Safe sex, even if you fuck a lot of people, makes you much less likely to get an STD than if you only occasionally had sex and never use protection. In countries with limited access to safe sex, all people across all demographics contract it. It's not just poor Africans and gay men, despite that being the unfortunately common misconception.

> Promiscuity does not propagate sexually transmitted diseases.

Of course not, they are propagated by poneis and unicorns. Nothing to do with having sex with multiple partners.

> Gay people do not have more sex partners than straight people.

You are deluded. Not only gay people have higher median number of sexual partners, but our sexual network is tighter, since fewer people are gay compared to straight. That's a perfect environment for sexual diseases to spread, which was the case with AIDS and more recently MPox.

>Gay people do not have more sex partners than straight people.

On average, gay men will have more sexual partners than straight men. There's no reason to deny this.

https://www.psypost.org/2020/07/lgb-people-and-extraverts-te...

>transmit HIV by sharing needles

The vast majority of new infections are through gay men having sex. IV drug use only accounts for 7% of new infections

https://www.hiv.gov/hiv-basics/overview/data-and-trends/stat...

>but it exposes the flaw in this notion that gay people are sluts and sluts get STDs.

Your insecurities don't change the facts. Gay men have more sex and more sex leads to more STDs.

In particular though, anal sex has a higher chance of passing on specific STDs. Gay women have a statistically lower (but not zero) chance of passing on STDs.

https://stanfordhealthcare.org/medical-conditions/sexual-and...

"The vast majority of new infections are through gay men having sex. IV drug use only accounts for 7% of new infections"

In the US.

The vast majority of infections (90%) in Africa are from heterosexual sex:

https://pubmed.ncbi.nlm.nih.gov/12665438/#:~:text=Abstract,a....

The primary driver of the enormous epidemic ongoing in Russia is by far IV drug users (and heterosexual sex):

https://www.politico.eu/article/everything-you-wanted-to-kno...

"Although needle-sharing among drug addicts was one of the main reasons the disease spread so quickly, most HIV transmissions in Russia — 57 percent — are now a result of heterosexual sex. Drug use is responsible for 40 percent, while gay sex accounts for around 3 percent, according to Russia’s Federal Research Center for AIDS Prevention and Control in Moscow."

The majority of people living with HIV worldwide are straight women (52%):

https://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and....

I agree with you that the claim from some people to make like sex and number of sexual partners has nothing to do with STDs is ridiculous. It annoys me a great deal.

Gay men are disproportionately at risk and affected due to number of partners and type of sex. But most people with AIDS are straight.

Anyway your LGB link is funny because it claims (I think out of confusion) that lesbians have more partners as well. But lesbians also have the lowest std rates of any group. Making them obviously the best and most morally superior of the orientations.

STDs are spread through sexual activity, and the more partners you have will increase the transmission rate. Gay men are well documented to have on average more sexual partners than other sexualities. Both of these are… obvious and well documented, depending on your experience or understanding of the literature (take your pick).

Obviously HIV can be spread by other vectors, that doesn’t make what I’ve said above not true. This is one of the most illogical comments I’ve seen in awhile, purely wishful thinking. Promiscuity is fine, but don’t be naive.

I'm willing to bet you're a white male, because on average, most HN users are. Given that, would it be okay if I said most white people are imperialistic, colonizing abusers who oppress women and minorities? Because on average they have been exactly that.

Once you're on the receiving end of these "averaged" generalizations, you realize that it's not a great idea to think that way or to try to rationalize using them. It's like the people that say things like "on average, black people commit more crime" and then use that oversimplification to justify racial bias.

(and yeah, i'm probably gonna be flagged for pointing out the logical fallacies that get propagated to justify systemic racism, misogyny, homophobia and slut-shaming, but i'm not gonna censor myself to avoid pointing out fallacious tropes in common discourse)

I'm not sure this is the GREAT COMEBACK you'd hoped for.

I'm sorry if you're not comfortable with dealing with averages. It's not that I don't understand that the average doesn't define all or most members of a group.

As someone living promiscuously, I'd say it's a correlation.

Some factors that lead people to a promiscuous livestyle also lead them to high risk behaviours, probably because they see promiscuous sexual behaviour also as risky and, in turn, desirable.

I met many that would frown upon condoms, but I also met many that would see them as no big deal.

I for one would count myself as risk averse, and got to that lifestyle through other motivations, and in turn, always ensured to stay safe.

>I think that limiting amount of partners is a vital part to combating sexually transmitted diseases

It's much more important to have safe sex. Condoms and PrEP work.

Every thread on HN about HIV/AIDS seems to attract at least one person who feels obliged to say something about how promiscuous gay people are. I don't think these comments often come from a good place. (For example, you have previously made a rather insensitive joke about 'pozzing' on this site.)

I was super impressed when I went to see my PCP for my annual physical and when I mentioned I'm non monogamous (which apparently triggers a diagnostic code for "high risk sexual behavior") she said, "We can put you on PrEP if you want, just to be sure. Cheap insurance." Cheap insurance indeed.

It's really amazing how much that attitude has changed in a decade or so. I asked my PCP at the time (and this was the last time I saw this doctor, FWIW) about PrEP when it was relatively new, and basically got a "I don't want to encourage dangerous behavior" lecture.

> Every thread on HN about HIV/AIDS seems to attract at least one person who feels obliged to say something about how promiscuous gay people are. I don't think these comments often come from a good place.

Just the one? If only.

Every time there is a story on HN that is even tangentially related to either HIV or LGBTQ+ sexual health, it inevitably devolves into a morass of misinformation and thinly-veiled homophobia. There are different degrees of it - some is presented in a more "civil" veneer, which helps it stay upvoted, but at its core, it's all coming from the same place.

Public health professionals who specialize in HIV and LGBTQ+ sexual health are actually pretty unanimous in their position on this topic, but somehow that never sways these folks (which should be a pretty good sign that they're not arguing in good faith).

I was understating, for sure. Civility (or the veneer thereof) is HN’s major exploit vector.

The parent comment is poorly veiled moralizing and faux humility.

The reality is that they are generally more promiscuous and generally under worse circumstances.

This is a statement of fact, please stop mistaking it as a moral judgement that we need to fight against. You cannot help mitigate or solve a problem without accepting reality.

Unfortunately you're buying into a lot of propaganda that persists to this day.

Straight sex workers exist. Given straight people outnumber gay people by (let's say) 10:1, there is almost certainly a higher absolute number of straight promiscuous potential superspreaders than there are gay ones.

Even in the middle of the bell curve, nearly 50% of American babies are born to unmarried parents, so it's not like strict monogamy is the norm among straight people [0]

The reason that HIV transmitted so well in gay male populations is because receptive anal sex has a 20x higher likelihood of transmission than receptive vaginal sex and a 40x higher likelihood of transmission vs. insertive sex.[1]

Within the gay community, you have plenty of men who engage in that relatively high risk act of receptive anal sex, who then go on to be the insertive party in another interaction.

Within straight populations, the potential spreaders are just much less likely to contract HIV in the first place.

Sorry to be so specific about something sexual, but I have always found it odd that this very practical information has not been put into the mainstream. I guess it's the imperfect middleground - people who want to shame gay men don't care about the data and people who support gay men don't want to stigmatize receptive anal sex. But unfortunately, I bet it's led to a lot of needlessly risky behaviors.

[0]https://www.cdc.gov/nchs/pressroom/sosmap/unmarried/unmarrie... [1] https://stanfordhealthcare.org/medical-conditions/sexual-and....

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