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PaperclipPerfector  12d ago (text post)   33245 thread views

Culture War Roundup for the week of February 10, 2025

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NYTimes article that wasn't paywalled for me, with my browser extensions: https://www.nytimes.com/2025/02/06/health/usaid-clinical-trials-funding-trump.html

In more bad-things-happening-due-to-USAID-stop-work-order-news*, it turns out that USAID participated in clinical trials. ("The Times identified more than 30 frozen studies that had volunteers already in the care of researchers...") Interrupting clinical trials is bad:

Asanda Zondi received a startling phone call last Thursday, with orders to make her way to a health clinic in Vulindlela, South Africa, where she was participating in a research study that was testing a new device to prevent pregnancy and H.IV. infection.

The trial was shutting down, a nurse told her. The device, a silicone ring inserted into her vagina, needed to be removed right away.

When Ms. Zondi, 22, arrived at the clinic, she learned why: The U.S. Agency for International Development, which funded the study, had withdrawn financial support and had issued a stop-work order to all organizations around the globe that receive its money. The abrupt move followed an executive order by President Trump freezing all foreign aid for at least 90 days. Since then, the Trump administration has taken steps to dismantle the agency entirely.

Ms. Zondi’s trial is one of dozens that have been abruptly frozen, leaving people around the world with experimental drugs and medical products in their bodies, cut off from the researchers who were monitoring them, and generating waves of suspicion and fear.

The State Department, which now oversees U.S.A.I.D., replied to a request for comment by directing a reporter to USAID.gov, which no longer contains any information except that all permanent employees have been placed on administrative leave. Secretary of State Marco Rubio has said that the agency is wasteful and advances a liberal agenda that is counter to President Trump’s foreign policy.

In interviews, scientists — who are forbidden by the terms of the stop-work order to speak with the news media — described agonizing choices: violate the stop-work orders and continue to care for trial volunteers, or leave them alone to face potential side effects and harm.

The Declaration of Helsinki, a decades-old set of ethical principles for medical research that American institutions and others throughout the world have endorsed, lays out ethical guidelines under which medical research should be conducted, requiring that researchers care for participants throughout a trial, and report the results of their findings to the communities where trials were conducted.

Ms. Zondi said she was baffled and frightened. She talked with other women who had volunteered for the study. “Some people are afraid because we don’t know exactly what was the reason,” she said. “We don’t really know the real reason of pausing the study.”

The stop-work order was so immediate and sweeping that the research staff would be violating it if they helped the women remove the rings. But Dr. Leila Mansoor, a scientist with the Centre for the AIDS Programme of Research in South Africa (known as CAPRISA) and an investigator on the trial, decided she and her team would do so anyway.

“My first thought when I saw this order was, There are rings in people’s bodies and you cannot leave them,” Dr. Mansoor said. “For me ethics and participants come first. There is a line.”

Setting aside that we now won't get the scientific results of these studies, fucking people over like this** seems like counterproductive foreign policy.

*I'm posting this, because I didn't recall clinical trials coming up in the other discussions (I only learned of it this morning), so it's presumably also news to others and I thought it was different in a key way. (see footnote 2)

**I say "fucking people over," because it's not a situation in which receiving something is better than nothing, even if you didn't receive everything you expected/were promised; these test subjects risked their own health on the basis of guarantees from the trials and the USA reneged on its part of the deal. (I.E., if you're too hard-heartened a libertarian to believe in Kantian medical ethics, the USA is still in the wrong, due to not following the terms of contracts it entered.)

Why are we funding birth control and HIV prevention research in South Africa? We already know how they have babies and get aids and we know how they can avoid those things. That they choose to rape virgins instead of taking hiv medicine is irrelevant to the effectiveness of condoms.

As experimental treatments, none of these treatments have been shown to be safe and effective. If your doctor gave you one of these treatments, he would be disgraced, disbarred, and possibly improsoned. If any of the trial subjects dropped dead due to the treatment, nobody would bat an eye.

As a matter of ethics these patients were making a sacrifice in the name of science, and it's a shame the science is lost. But it's disingenous to call it lifesaving treatment, because it's not.

Maybe the pharmaceutical companies that hold the patents and stand to profit hand over fist if these experiments work should chip in a bit.

Silicone rings in vaginas are commonly self inserted and removed.

NuvaRing is a fairly common birth control drug with this delivery method.

That sounds like another entry into more bad things happening because USAID was doing things they shouldn't have been, in this case conducting medical trials.

Why shouldn't they have been participating in clinical trials? Couldn't the problem have been avoided by the stop-work order having specific previsions for per-protocol discontinuation of trial interventions, as applicable?

It's not what I hoped they were doing, anyway. I'm a bit surprised that experimental contraceptive methods is even something that countries are still accepting from the US. South African TFR: 2.3 -- apparently they are already utilizing birth control adequately. Perhaps they should stop engaging in activities that spread HIV.

I'm not really sure how the executive office works, but my impression is that, somehow, they can't do that, the study in question just finds endless ways to file extensions, are forgotten about, and continue operating as usual until the next administration comes into power. My first guess would be that it's relatively hard to figure out what any specific program is actually doing, until they go complaining to the New York Times about it, since there are so many of them, and they have an incentive to look important but also non controversial.

@OilFieldRando posted about the first person to die because of Trump's funding cuts.

A poor woman in Thailand died because her hospital couldn't afford the oxygen to keep her alive.

Except that the NGO whose funding was cut off has $630 million in assets, a stock portfolio of $98 million, and it's CEO (a former member of British parliament) makes $1.2 million a year. They have $1.3 billion a year in revenue, and spend some of that helping people illegally immigrate to the United States.

Might this incredibly wealthy organization spare just few hundred dollars to keep a poor woman alive?

I'm sure there's more to the story, but it begs the question. How much baby? How much bathwater? It's not imperative on the U.S. to fund these bloated, corrupt, and biased NGOs just because they might occasionally do some good things.

It's just like when there are cuts to school budgets: the affected orgs, who oppose the cuts, make sure that the effects of the cuts create maximum sympathy as a PR campaign against the cuts. Meanwhile, none of the org administrators suffer a salary cut.

Does this emotional blackmail work? It just makes me harden my heart. I feel like from a game theory standpoint, one must never submit to these kind of tactics, otherwise the other person just gets whatever they want.

Earlier, I expressed disappointment about cutting these programs root and branch, preferring instead a more surgical method.

Now I realize I was wrong. USAID must be pulled up by its roots and rebuilt with people who care about their mission more than their paycheck. Imagine how much good could be done without all the grifters and ideologues in the way.

The conservative in me wants slow, methodical cuts that do the least damage to the good parts. But I also understand that those cuts are easier to block/mitigate, and maybe the best thing is to destroy and rebuild the good parts. People will suffer in the process, but that's true of all change.

Does this emotional blackmail work?

Yes. It works on most of the normies most of the time.

its not just the funding but also stop-work orders

CAPRISA appears to be an NIH partnership, FWIW. I'm open to the possibilities she was incorrect or lying, but it seems Dr. Monsoor believed the stop-work order applied to discontinuing interventions per-protocol. (Even if she, herself wasn't employed by USAID, it wouldn't be surprising if it was practically impossible to do so without using any USAID resource.)

Can’t make an omelette without cracking a few eggs.

We have a massive problem. 2T deficit p.a. We have an NGO network funded by our own government working against us. And indeed, it is almost certain that any of these stories are being coordinated by current USAID employees (in part why it was absurd for the judge to issue a TRO re thr admin leave). That is, we are paying the American executive to try to undermine the American executive.

No sorry I don’t care about this. Sorry it sucks but we can’t afford it and it needs to be cut. This is the way.

OP isn't talking about whether these things needed to continue to be funded indefinitely. The problem is that instead of "we will fund no further studies, no argument" the order literally caused studies to be halted midway through. Which would be fine if the study was a passive observation of the mating habits of roofing bats in the wild; less fine when it means the volunteers have already begun potentially dangerous treatment regimens, and are now being dumped out into the world. (It's not even as though they can continue taking experimental drugs on their own dime to avoid withdrawal; if the study's over the study's over.)

Lots of people answer this kind of talk with "it was a clean break, or the tiniest amount of leeway being used by everyone and their dog until the whole DOGE died by a thousand paper cuts". But come the fuck on. Leaving clinical-study volunteers hanging is ridiculously evil in principle, and I just can't accept that it was this or setting such a precedent for leniency as to scuttle the entire DOGE endeavor. Really now. The genius entrepreneur's elite crack team can't come up with a clearly-worded directive that accounts for "don't dump medical volunteers in the street with experimental equipment inside their bodies" without giving gender activists an out? Really?

Because you aren’t working with people who want to cut. So every carve out you give will be expanded beyond belief. Half measures rarely work against an entrenched enemy.

The genius entrepreneur's elite crack team can't come up with a clearly-worded directive that accounts for "don't dump medical volunteers in the street with experimental equipment inside their bodies" without giving gender activists an out? Really?

No, it's literally impossible. Remember, you're dealing with people with sufficient motivated reasoning to pretend to be confused about words like "man" and "woman". People with years of critical theory training that teaches that meaning is subjective, and concepts constructed.

The place where Elon's people draw the line doesn't have to be accepted by the woke activists, though. DOGE can just come up with a common-sense criterion that makes sense to them, and if someone tries to argue in obvious bad faith that their bullshit study is on the right side of the line, they can just say "no it isn't; you may not appeal this decision; goodbye, please don't email us again". This would undoubtedly still cause a ruckus, and it might even have a few false positives, but it would still be immeasurably better than not having common-sense exceptions at all, and I genuinely think it should be trivial for DOGE to implement if they really have the stuff.

Like, why are you acting as though trivial word-salad smoke-and-mirrors would leave them helpless and befuddled? Isn't cutting through the obfuscation and identifying the good government programs from the woke hustlers supposed to be what they're for? If they're not up to this then one wonders why an elite crack team led by one of the most successful men in the world is needed for this job. You could get the same effect if you told an AI to cut all government programs no matter what, gave it access to a government email, and let it loose.

The DOGE (and Trump more broadly) is fighting a bureaucracy hostile to them. The activists are the people carrying out the orders.

Doing it before-the-fact rather than after-the-fact enables what is essentially a DDOS attack on the decision-makers. Doing it in this order makes a flood-the-zone-with-appeals strategy work in favor of DOGE instead of against it.

The argument against that is that if I have funding and I think I won’t next week, if I get a reprieve by “putting medical devices in bodies”, then I might just do that. Or maybe a drug that needs to be strictly monitored, again, if I will lose everything if I don’t and I get to maintain funding and my job if I just start the trials and hope that the funding doesn’t dry up, why not?

And this would actually be worse for those patients who are being asked to start said trials knowing that the funds might not be there to finish. I’ll be honest, any doctor at the moment trying to recruit people for a NIH trial on a serious disease like cancer knowing that the funding won’t be there should have his license yanked. We know these trials will be stopped, and we know that those recruits will waste time and possibly risk health doing a trial that will stop. And those patients lose time for treatment.

That’s where ripping off the bandage helps. We know the trials are stopping mid trial so people signing up now should know better.

We're talking about months-long trials that were already ongoing when everything was suddenly put on hold with no forewarning. Obviously no one should be starting any more trials for the time being; and doubly-obviously, any doctors trying to blackmail the government by suddenly adding dangerous procedures to an ongoing trial should be sued with extreme prejudice. (They shouldn't be hard to catch, the whole deal with clinical studies that get government funds is that you register what you said you were going to use the money for in advance.)

We have very rich liberals in Washington. And wiring money takes less than 24 hours. If people cared as much as they whine about it - someone would have picked up the slack already.

Coordination is hard. I think it's unsurprising for liberals' position to be "we have a coordination machine, it's called the government, please give it back instead of making us build a second one for no reason". (Even if there are obvious rejoinders.)

please give it back instead of making us build a second one for no reason

The conservative then proceeds to holds up a mirror. "Just build your own foreign aid organization."

I'm honestly surprised they don't. It would be such an obvious PR win, even if they don't actually care about the affected people.

If you prove it can be done without the state, then you'll have a much harder time arguing that it should be the responsibility of the state.

I can't take Trump seriously about the deficit when he openly plans on insulting massive tax cuts that will massively outdo whatever nibbling around the edges DOGE manages to accomplish.

A lot of that is make believe. There are a ton of expiring provisions that will “cost money” to extend but won’t raise or lower current taxes. At the same time, there are some tax relief they want.

I mean, do you not count tariffs as taxes? If you eliminate the 25% tax on the profits of China-to-Amazon Inc, but instead charge them 25% on everything they bring from china, are you cutting taxes? Or just shifting the tax burden?

Sloshing tariffs and corporate tax around is well and good, but what about the rest of the tax cuts promised, amounting to a fiscal hole somewhere in the neighborhood of $5T?

Overtime pay tax cut could be anywhere from .25 trillion to 3 trillion? Sounds like they just wanted to throw a few extra trillion in there.

I'm upset he wants to expand salt deductions though. Reducing those last time was a huge coup. Guess tech bending the knee means he needs to give something back.

The analysis seems pretty reasonable to me. It's hard to put an exact number accounting for how people will react to the new rules environment. But it's even harder to imagine this all penciling out.

Yeah, Trump's tariff announcement today was good actually. Certainly much better than his previous ideas.

  1. Reciprocal tariffs. We charge others what they charge us.

  2. VAT offsets. If European countries average 20% VAT and we average 6% sales tax, that's the equivalent of a 14% difference in tariffs that need to be accounted for.. Edit: I am wrong. Thanks to @The_Nybbler.

There's a good chance Trump could lower taxes in the US in a revenue neutral way.

A VAT isn't similar to a tariff at all, and reciprocating Euro VAT with American tariff is harm to Americans with no purpose. The way VAT works is an American hammer costs e.g. $10 in the US and $12 in Europe because of VAT... but a European hammer of the same base price ALSO costs $10 in the US and $12 in Europe. There's no unfair practice there.

If you set the tariffs off against sales tax, you've made a truly horrible incentive; it makes it easier for states to raise their sales taxes up to Euro/Canadian VAT levels.

i still dont get why people think VAT is comparable to tariffs? is trumps idea of "fair" that we keep taxing our own products with VAT but make an exception american imports?

Reciprocal tariffs. We charge others what they charge us.

Except that others don't charge us tariffs, we charge ourselves tariffs. It's more like "we charge ourselves what others charge themselves". When you formulate it that way it becomes clear why this is a losing proposition.

If it's purely self charging then why are there retribution tariffs? Obviously when you raise the price of a good when produced by foreigners such that you give your internal market an advantage it is bad for those foreigners. They need to pass the cost to the consumer but that would make them uncompetitive. The winner of tariffs is special local interests, the loser are general internal interests and foreign competitors. The only interests influential in foreign states are the foreign competitors thus foreign states oppose it.

The whole "the consumer pays 100% of the tariff" has ben debunked a million times. The cost is never passed on 100% to the consumer.

Can you provide more information on this? I'm curious what proportion is, as I'd assume it'd be fairly close intuitively, and I've never seen anything otherwise.

A quick peruse of google scholar give this paper: https://sci-hub.ru/https://www.jstor.org/stable/1814161

It suggests that for a change in tariff rates, less than 1/3 is reflected in end consumer prices.

Sorry I don't have more sources, I haven't read many econimics papers even though I'm an economist 🙃

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I don't see what that has to do with what I wrote.

I've always thought reciprocal carbon taxes on imports would be an amazing scissor-wrench to throw in the works.
Get the free traders arguing with the greens about why you can import silicon made with coal in China at 0% tax, but silicon made with coal in the US gets taxed and regulated to death.

First time I’ve ever heard of tax cuts being insulting

It's not necessarily just nibbling around the edges. There are some indications that the amount of fraud in the larger programs such as SSI, Medicare/caid, and defense might be significant. If so, the savings could easily amount to $1 trillion per year. I guess we'll see.

DOGE started with USAID because the spending was so ludicrous and so obviously geared towards sinecures for the uniparty political machine.

It's been what, 3 weeks. They've cut $100 billion so far. Give it time. If they're allowed to cook, it's going to be a lot, lot more.

Here's the doom loop chart

For those of you too lazy to click on the link; the CBO has crunched the numbers and the net effect on income due to transfers (i.e. medicare, medicaid, SS, etc.) beings to be a net negative starting at the middle quintile.

Phrased differently: the top 60% of Americans have less income, on net, because of the massive transfers to the bottom 40%.

Culture war angle: Which quintiles are the sources of new business formation, full time employment, responsible family practices etc?

60+ years of Great Society-ism and horrific perverse incentives for family formation and work mean that we now have a situation where 40% of the population can be - indelicately - called a drag on growth and prosperity. 40%.

Even Sarah McLaughlin can't save this DOGE, and this DOGE can't save America.

What is surprising about that chart? What did you expect? Obviously the transfers benefitting the poor come from the rich. People have been voting for this for the last century, and will keep voting for it. The state's share of the economy will keep growing, first to european levels, then beyond. And it doesn't matter to people how rich in absolute terms "the poor" are, or how much wealth gets destroyed in the process. I find the impulse difficult to understand, perhaps an extreme rawlsian risk aversion (like an insurance against relative poverty) coupled with the egalitarian ideal of equal social status leading to a demand of equal income.

Did you intend to offer a serious reply, or just use my comment as a way to jerk the spotlight towards yourself?

The former. Of course there's always a status element in the background, but in the spirit of collaborative discussion, it should be ignored. Pretend I'm not a person, just a collection of positions, and I will do the same for you.

Even if they do find $1 trillion in fraud, he’s proposed five trillion in tax cuts. That math is harsh.

Total government revenue is less than 5 trillion. You are comparing annual vs total numbers.

They've cut $100 billion so far.

doge-tracker.com/ gives 45.6 billion, of which 37.5 billion comes from counting the full annual salary and benefits of the staff accepting the voluntary retirement scheme as a saving, even though they are still being paid for another 8 months. Given the number of staff involved compared to normal Federal employee turnover, the real saving here may be negative. And of course, this saving goes away if the government can't eliminate the work the retired employees were doing.

That leaves about $8 billion in unambiguously real savings, of which $4 billion is the illegal cut to the overhead on NIH grants.

I think the difference between the $100 billion being bandied about and the doge-tracker numbers comes from assuming that the entire USAID budget is zeroed out, and that this counts as a DOGE saving.

There are some indications that the amount of fraud in the larger programs such as SSI, Medicare/caid, and defense might be significant. If so, the savings could easily amount to $1 trillion per year. I guess we'll see.

SS, Medicare, Medicaid, and defense amount to amount to $3.5T. do you really believe that "easily" 30% of that is waste?

They've cut $100 billion so far.

Have they cut or have they just put a temporary stop on expenditures? How many programs have actually been durably cancelled, either by the executive or by Congress?

SS, Medicare, Medicaid, and defense amount to amount to $3.5T. do you really believe that "easily" 30% of that is waste?

The US is definitely getting as least bang for their buck with military contracts. Any reason to believe that the other are different?

The military presumably wastes money on slow rolling procurement and other things of that nature. A full quarter of defense spending is salaries, and perhaps there are people drawing a salary that don't need to be there.

SS is a cash transfer program that spends less than one percent on administrative overhead, so savings from firing useless employees would be minimal. The only possible avenue for waste would be actual fraud on the part of the recipients. I doubt that this is anywhere near 30%, but I don't expect either of us could convince the other on this point. However, the longer DOGE goes on without announcing finding this fraud, the more skeptical we should be.

A full quarter of defense spending is salaries

I would go the other way. Salaries should be a bigger fraction of the military budget.

There could be massive savings also in Medicare and Medicaid if they only stomp their feet and use their massive scale to cut costs.

So USAid is sponsoring a study that will benefit a foreign drug company and may develop a treatment that at best Americans will have to pay eye watering prices while [that] foreigners get it for free? For a disease that I'd really prefer not a single tax dollar went to treat in the first place. Call me heartless, but I'm strongly in favor of shitting this trial down.

Let's let quarter trillion dollar firms pay for their own medical studies and let's let foreign nations who use monopsony to bid down their fair share of treatment development costs accept that that means fewer treatments get developed.

a study that will benefit a foreign drug company... quarter trillion dollar firms...

Which foreign company is benefiting from this?

Americans will have to pay eye watering prices while foreigners get it for free?

Americans can already get PrEP and it's even covered by Medicare and Medicaid, much to the chagrin of members of this forum who would rather people did not have HIV treatments.

Not to mention that other members of this forum were railing against USAID because they are "propping up" unsustainable populations of Africans. This trial was for a birth control device which would directly reduce the number of future Africans and yet I don't see those members defending this as a worthwhile expenditure. It makes me think that objections founded on population growth aren't really the crux of the objection.

Not to mention that other members of this forum were railing against USAID because they are "propping up" unsustainable populations of Africans. This trial was for a birth control device which would directly reduce the number of future Africans and yet I don't see those members defending this as a worthwhile expenditure.

Presumably I’m one of the posters you have in mind here. For the record, I do think that researching birth control methods (experimental or otherwise) in Africa is a very worthwhile expenditure.

Now, should that expenditure come from USAID specifically? I’m less sure about that. I can see a good argument for it, which is basically: Efforts to drive down Sub-Saharan African fertility cannot be conducted openly and for explicitly eugenic/racialist reasons. Not only would many Africans themselves understandably perceive this as a colonialist affront, but a great many westerners would also be made very uncomfortable by this and would not want their tax dollars employed in such a way. Therefore, laundering this mission through an ostensible charity organization creates the veneer (and, in fairness, also in some sense the reality) of both benevolence on our part and voluntariness on the part of the Africans.

Now, this attitude is directly at odds with the ethos of transparency and legibility which is motivating DOGE’s cuts to things like USAID. They don’t want the government doing things that look like one thing but are actually a totally different thing. They don’t want to continue to countenance the surreptitious laundering of funds for misrepresented ends. This is a respectable motivation, but I do wonder whether it is necessarily at odds with the important work that advanced nations need to be urgently performing in order to find every way imaginable to drive down third world fertility.

Efforts to drive down Sub-Saharan African fertility cannot be conducted openly and for explicitly eugenic/racialist reasons.

They can be and are conducted openly. Yes, they don't openly do this because they think subsaharans are inferior, but that's because they don't and I don't see why that's a bad thing.

Obviously I’m aware of the work the Gates Foundation is doing in this arena, and I applaud it. What I mean is simply that if the Gayes foundation did exactly the same work, but instead of presenting it as a fulfillment of liberal principles of female empowerment they presented it as a work of paternalistic technocratic imposition on a less-developed society for the protection/betterment of a higher civilization, that work would be utterly rejected by both the African populace and the donors. That the Gates Foundation, as far as I’m aware, does sincerely believe in the aforementioned liberal principles is simply the cherry on top.

To be clear, I do absolutely think it’s true that most African women who are currently having six or seven children would prefer to have less than that. (I had a previous post about declining fertility in advanced countries, in which I said that most women simply do not instinctively desire large families, and given the option to have a small number of children, the revealed preference of the average woman is to do so.)

Lowering African fertility is indeed a boon to those women, and to the countries in which they live, which do not have the economic infrastructure to provide gainful and productive employment to their current masses of young people. To the extent that African countries can be made less unstable and less likely to export tens of millions of unemployed and restless young black men to First World countries, the efforts of the Gates Foundation, and of USAID insofar as their efforts have been similar, are a net good for humanity.

However, my hope is that behind the curtain, at the upper echelon of organizations like the Gates Foundation and USAID, there is also a covert understanding of additional eugenic principles and that their work can be targeted, under the guise of charity, to take specific interest in improving the genetic stock of the relevant countries; to not only produce less Africans but also, in the long run, better Africans. Africans who are better equipped to be peer-level participants in the global order as their countries are further integrated into a global political infrastructure.

In patriarchal societies(like most of Africa), women typically desire multiple grown sons. African fertility preferences are genuinely high.

Despite having the highest fertility rate in the world, women and men alike in Niger say they want more children than they actually have – women want an average of nine, while men say they want 11.

—Jill Filipovic, "Why have four children when you could have seven? Family planning in Niger," Guardian, March 2017

Even in that article, the family planning clinic is funded by USAID, huh.

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I misread the participant's name as AstraZenica, my apologies.

Americans can already get PrEP and it's even covered by Medicare and Medicaid, much to the chagrin of members of this forum who would rather people did not have HIV treatments.

I am quite happy with people getting whatever treatments they wish to pay for, but I'd strongly prefer HIV treatments from taxes be limited to children born with it and transfusions.

For a disease that I'd really prefer not a single tax dollar went to treat in the first place.

Yeah, there's been a growing awareness how badly we've been lied to about HIV.

HIV doesn't readily spread from heterosexual sex. There is essentially zero risk from vaginal intercourse the way that 99% of Americans will experience it. In the Western world, it spread in the gay community because of anal sex and extreme promiscuity.

So what happened in South Africa? 1) The common practice of "dry sex" in which women rub abrasives into their vagina 2) Huge rates of child rape.

Those problems might be intractable. Apparently there was a billboard in Eswatini that said "don't rape kids".

So what happened in South Africa? 1) The common practice of "dry sex" in which women rub abrasives into their vagina 2) Huge rates of child rape.

It’s part of it, but it’s also much more frequent prostitution in these places. In any case, there were heterosexuals did get HIV in the West unless you think they’re all lying, and anal sex is increasingly common among heterosexuals (a joke about it is, for example, the opening scene in the very popular PMC lib comedy ‘Fleabag’), probably more so than it was in the 80s.

HIV doesn't readily spread from heterosexual sex. There is essentially zero risk from vaginal intercourse the way that 99% of Americans will experience it

This is a heck of a non sequitur. Whether you like it or not, a lot of straight men like anal sex - with women. The first Google hit found that in 2013 about a third of heterosexuals in 20 US cities they polled admitted to having had anal sex in the past year. Now, I've never seen the appeal myself, and you're welcome to say it's against nature for all the same reasons as gay sodomy if you want to be all Catholic about it - but it's a thing, massively so. Promiscuous gay men might be a small minority of the American population, but it doesn't follow that the remainder only have wholesome church-approved missionary sex, and you'd have an even harder time trying to change that than trying to walk back gay acceptance.

Probably something like 99% of the anal sex is being had by gay men. Straight people might try it occasionally (not sure why) but it's not really on the menu like it is for gay men. The average N count for straight people is also tiny compared to gay men.

HIV has never really spread in a western heterosexual population.

Probably something like 99% of the anal sex is being had by gay men.

The poll I linked specifically polled heterosexuals. Thirty percent of male respondents would have to have lied about being straight (and thirty percent of female respondents would have to have lied about having had it at all) for this to fit the data.

Probably something like 99% of the anal sex is being had by gay men.

The poll I linked specifically polled heterosexuals.

Your link doesn't contradict his claim. It's a question of frequency within each population.

If you think HIV does spread readily from heterosexual sex, then why hasn't it?

Last time I ran the numbers (several years ago. It might be time for an update), gay men got HIV at >80x the rate of the rest of the population. This was reported like "20x the general population" or something, which neatly hides the fact that people-who-aren't-gay-men get HIV at less than half the rate of the general population.

I don't think your mechanism of action can dismiss such stark differences.

If you think HIV does spread readily from heterosexual sex, then why hasn't it?

I'm not particularly invested in proving that it does, I just specifically wanted to point out what I believed to be a really weird jump in reasoning.

then why hasn't it

It has in Africa and it did to an extent at the height of the HIV pandemic in Russia (mostly intravenous drug fueled, but it spilled over into the straight population for a time) in the late 90s and early 2000s. In almost all cases prostitutes form the reservoir population, such that even though the risk of an individual customers getting infected was very low, there are so many customers that it can still spread.

If you think HIV does spread readily from heterosexual sex, then why hasn't it?

Frequency and the amount of partners would be an obvious alternative explanation.

Last time I ran the numbers (several years ago. It might be time for an update), gay men got HIV at >80x the rate of the rest of the population.

That does not indicate that anal sex is more risky in itself, by that factor. I haven't looked into it, it's just something that popped up on twitter, but I see "only" a 10x difference between receptive anal, and receptive vaginal intercourse. The base rate is so low in any case, that I struggle to understand how anything but higher promiscuity could explain the difference between gay and straight people contracting HIV.

I see "only" a 10x difference

That's a shockingly huge difference that could explain the entire disparity and then some.

Masking for COVID is still poorly studied (or at least poorly publicized), but the range I saw was between 1.05x - 6x difference compared to unmasked. I have no problem believing that a 90% effective intervention could stop an epidemic in its tracks.

(As an aside, I'm pretty sure that tweet is comparing the 1.11% risk of HIV per exposure to the 2% risk of pregnancy per year.)

I have no problem believing that a 90% effective intervention could stop an epidemic in its tracks.

We are talking about a 1% transmission rate vs 0.1% transmission rate. You're not getting an epidemic from either, without massive promiscuity.

(As an aside, I'm pretty sure that tweet is comparing the 1.11% risk of HIV per exposure to the 2% risk of pregnancy per year.)

What am I missing?? It says "estimated median risk of HIV transmission per exposure". Where did you get anything about pregnancy?

If you assume weekly sex and other simplifications, then a 1% rate of transmission doubles the infected population every two years. A 0.1% rate doubles it every 20 years. That's moderate promiscuity IMO, particularly since it still mostly works if they change partners annually (as opposed to weekly).

What am I missing?? It says "estimated median risk of HIV transmission per exposure". Where did you get anything about pregnancy?

The first sentence of the tweet (emphasis added):

Even gay sex per se is less risky than people think - comparable to female pregnancy risk with a condom

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