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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...
A big enough pool that it looks exponential instead of sigmoidal. Once it's spread to >50% of the group, you can't exactly double the prevalence.
As I said, swapping partners annually from that pool is frequent enough for the dynamic to play out.
Maybe your source's sensibilities are a bit more delicate than mine, but I would not be shocked by someone having sex with their partner 52 times in one year, then with a different partner 52 times in the next year, and so on.
What did I ignore? I saw the rate for anal sex, I saw the rate for vaginal sex. Was I supposed to discuss blood transfusions and needles? Construct a model that is more detailed than "heterosexual" and "homosexual"? Increase the precision from "1%" to "1.11%"?
I mentioned his deceptive claim because it jumped out at me. I hadn't noticed the problems with his second sentence when I posted that.
I wouldn't be shocked either, but that's not a typical pattern for most straight people. I also think the willingness to cease sexual activity, once you're aware you're carrying the virus, also enters into the equation.
Sorry, I rephrased it to make it less accusatory.
From your first comment:
This comment thread is how something other than higher promiscuity could explain the difference between gay and straight people contracting HIV. The different transmission rates of different sex acts are enough on their own with no difference in promiscuity.
Thanks, that clarifies it. I was mostly focusing on the image, which is why I mentioned his bad comparison in a parenthetical aside instead of the main part of the comment.
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