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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.Which foreign company is benefiting from this?
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.
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.
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.
—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.
I mean, who else will spend money on it? Niger doesn’t have the money. Russia and China don’t care. Japanese and EU foreign aid is strictly quid pro quo.
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I misread the participant's name as AstraZenica, my apologies.
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.
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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".
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.
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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.
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.
Your link doesn't contradict his claim. It's a question of frequency within each population.
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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.
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.
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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.
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Frequency and the amount of partners would be an obvious alternative explanation.
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.
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.)
We are talking about a 1% transmission rate vs 0.1% transmission rate. You're not getting an epidemic from either, without massive promiscuity.
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).
The first sentence of the tweet (emphasis added):
Assuming weekly sex with people from a pool of how many partners? We're not talking about a sneeze in a crowded subway train letting you infect a rando's from your community.
Ah ok... well, I'd focus on the attached image, seeing that is has specific figures for all types of intercourse and cites a source...
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