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Small-Scale Question Sunday for December 10, 2023

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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But I think it's reasonable to call that a "cofactor", if you miraculously managed to keep a person with AIDS in a perfectly sterile environment and scrubbed their microbiome, I'd expect them to live a lot longer (not that deleting a microbiome is a good idea in the least).

There's an increased rate of certain wasting cancers that start to occur after certain thresholds of HIV infection hit, but that wasn't recognized until the late 80s, but the theory I'm motioning around was a little different.

The (later disproved) hypothesis was not that HIV alone couldn't directly kill you short of other external factors, but that it would not progress to immune deficiency in a large portion (usually 50-95%) of those who carried the virus: either their immune systems would fight it off, or it would only have some marginal impact that would never progress to recognizable symptoms. Usually the claim was that full-blown AIDs was limited to those who abused certain hard drugs or had diseases like hepatitis, though more rarely they'd point to a genetic or full-body health version.

This wasn't as crazy at is seems at first glance -- some healthier people, and those with lower initial viral exposures, often did have much longer incubation periods, at a time where all of the virologist modelling expected an incubation time in the area of months or a year. And some of the craziness that did come about wasn't just limited to the self-motivated gays, as even before HIV was isolated or AIDS formalized, the NIH spent as much time seriously entertaining theories about poppers or sperm causing the immune deficiencies due to their chemical makeup, rather than a viral contagion. Shilts has a section where one of the early gay activists does a statistical analysis for the known cases among the (wildly) sexual active men, their expected number of sexual partners, and claimed times of original infections a year earlier, and then comes up with some astronomically low odds ratio (billions-to-one?) for the then-current number of cases.

But then it turned out the disease couldn't be transmitted casually, and almost all of the healthy people in that analysis ended up just being in the incubation stage, probably had reduced T-cells even at the time, and eventually developed symptomatic AIDS, and a large portion (around two-thirds?) died before protease inhibitors were on the market.

Of course, I am not necessarily opposed to mandatory testing, for human beings who have any reason to interact with anyone else, which is just about all of them. I've browsed enough /r/Grindr to know that while some of the more fastidious ones can make a song and dance about using condoms, getting tested and PREP, if the bussy is tight enough they'll usually relent.

That's part of it, but there were also expectations that the tests could and would be used as a proxy -- both to blacklist HIV-positive men from places and activities where they would not be at unusual risk of transmitting the virus, and to Notice men who got tested repeatedly (even if they tested negative) as gay and having gay sex at a time where this was often illegal.

But putting myself in the shoes of the FDA/CDC in the 70s? I can't see myself doing better really.

Dunno. It's easier, looking back that far, to see what of our vision is hindsight, but there's also a lot more fog between the mistakes of that era and today. Shilts focuses a lot on the homophobia -- and while he exaggerates the sense that the CDC didn't care about gay men dying, he isn't totally unfounded -- but there was a lot of fatheaded provincialism and simple status quo bias, too.