ShardPhoenix comments on Quantified Risks of Gay Male Sex - Less Wrong

33 Post author: pianoforte611 18 August 2014 11:55PM

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Comment author: ShardPhoenix 20 August 2014 04:37:17AM *  9 points [-]

I was young in the 80's, but my impression is that HIV/AIDS was considered a pretty gay-specific thing at first. Later there was more media pushing the idea that it can affect anyone - for example, one of my schools had a straight woman with HIV visit to tell us about it. While this was presumably well-meaning and may have even had good effects in terms of encouraging safety, it did lead me to a quite skewed perspective of the relative risks (I was still aware that it was more prevalent in gays, but not by how much).

Comment author: pianoforte611 21 August 2014 12:22:23AM 7 points [-]

"HIV can affect anyone" is far better than "HIV is a gay thing" along several criteria.*

One: factual - it can indeed affect anyone. And the difference in prevalence varies form country to country. In parts of Southern Africa the prevalence is about the same as the general population.

Two: Instrumental. If those involved in public health used HIV as leverage to get everyone to wear condoms more often, then I applaud them. Many lives were saved, and many infections prevented.

Three: Political. I'd be very curious to know what proportion of people reporting that HIV affect gay men more are doing so out of genuine concern rather than as code for "Those gays are dirty and disgusting and deserve to die/be ridiculed".

  • "Some groups are at higher risk for HIV than others, and the transmission rates depend on the nature of the sex act" is the most correct, but it is unwieldy for a public health effort.
Comment author: Azathoth123 22 August 2014 08:39:13AM -1 points [-]

it can indeed affect anyone. And the difference in prevalence varies form country to country. In parts of Southern Africa the prevalence is about the same as the general population.

Supposedly. Except, for some reason it doesn't appear to be heterosexually transmitted in western countries. The two most plausible explanations I've seen for this phenomenon are that either "AIDS" is massively over-diagnosed in in Southern Africa or that it is primarily transmitted by uncleaned syringes. Either way the "HIV can affect everyone" lie is leading a major misallocation of resources in Southern Africa that is likely leading to many deaths.

Instrumental. If those involved in public health used HIV as leverage to get everyone to wear condoms more often, then I applaud them. Many lives were saved, and many infections prevented.

Really? This seems more like a misallocation of resources to me.

Political. I'd be very curious to know what proportion of people reporting that HIV affect gay men more are doing so out of genuine concern rather than as code for "Those gays are dirty and disgusting and deserve to die/be ridiculed".

How about looking that the effect of telling the truth versus lying about the subject rather than the supposed motives of people for doing so.

Comment author: pianoforte611 22 August 2014 12:23:47PM 5 points [-]

it doesn't appear to be heterosexually transmitted in western countries

http://www.sciencedirect.com/science/article/pii/S1473309909700210

Comment author: Azathoth123 23 August 2014 03:19:13AM 1 point [-]

And yet, as you yourself pointed out, (at least in western countries) its prevalence among heterosexuals is much less than its prevalence among homosexuals.

Comment author: satt 24 August 2014 06:16:05AM 5 points [-]

Which is a consequence of HIV being harder to transmit through heterosexual sex. Which does not automatically imply HIV is impossible to transmit through heterosexual sex.

Comment author: Azathoth123 24 August 2014 06:19:43AM 2 points [-]

That still doesn't explain how HIV spread as much as it did in Southern Africa given how hard it is to transmit heterosexually.

Comment author: satt 24 August 2014 06:35:33AM 3 points [-]

Epidemiologists currently reckon that's mainly down to Southern Africans having multiple concurrent partnerships and low male circumcision rates. (Other factors have likely played a role as well, like South Africa's recent bout of officially-sanctioned HIV/AIDS denialism, and the potentially higher transmissivity of the HIV-1 subtype prevailing in Southern Africa.)

Comment author: Azathoth123 25 August 2014 02:13:02AM 2 points [-]

Southern Africans having multiple concurrent partnerships and low male circumcision rates.

Europe has an even lower circumcision rate.

the potentially higher transmissivity of the HIV-1 subtype prevailing in Southern Africa.

When I first herd this theory ~15 years ago it was accompanied by a prediction that the HIV-1 subtype would break into the western heterosexual population real soon now. Since that has failed to happen, I'm dubious about this theory.

Comment author: satt 25 August 2014 01:04:44PM 3 points [-]

Southern Africans having multiple concurrent partnerships and low male circumcision rates.

Europe has an even lower circumcision rate.

Pay attention to the word "and" in what you quoted, it is actually quite important. The Southern African Journal of HIV Medicine article I linked explicitly addressed Europe's lower circumcision rate:

The now conclusive body of epidemiological and biological evidence confirming the strong association between lack of male circumcision and HIV10-15 is increasingly understood to explain much of the roughly fivefold difference in HIV rates between southern and western Africa7,16 [...] However, this key driver does not explain why HIV has spread so much more extensively in southern Africa than in India or in Europe, where circumcision is similarly uncommon. Although sexual cultures do vary from region to region,20 these differences have not been studied in sufficient depth and their significance is not so obvious. [...]

Of increasing interest to epidemiologists is the observation that in Africa men and women often have more than one – typically two or perhaps three – concurrent partnerships that can overlap for months or years. [...] This pattern of concurrent partnerships differs markedly from that of the pattern of serial monogamy more common in the West – i.e. the tendency to have one relatively long-term (a few months or longer) partner after another – or the more ‘one-off’ casual and commercial sexual encounters that occur everywhere.

It is the conjunction of low male circumcision rates and multiple concurrent partnerships which explains HIV's strong showing in Southern Africa.

the potentially higher transmissivity of the HIV-1 subtype prevailing in Southern Africa.

When I first herd this theory ~15 years ago it was accompanied by a prediction that the HIV-1 subtype would break into the western heterosexual population real soon now. Since that has failed to happen, I'm dubious about this theory.

I don't give that point any more weight than the last time you raised it (which I can't link because the relevant post got deleted). Now, as then, you haven't cited any specific person or authority who's supposed to have made this prediction, and I still don't see why the failure of that prediction would be strong evidence against the hypothesis that HIV-1 group M subtype C likely has a higher transmissivity than HIV-1 group M subtype B. Non-zero evidence? Yes. Decisive evidence? No.

Comment author: coffeespoons 20 August 2014 04:10:16PM *  1 point [-]

I'm female, but I had no idea until after I'd had sex with bisexual men that the HIV risk was much higher than from sleeping with straight men. I used condoms anyway, but I was pretty shocked to learn about it. I still date bi men*, but I'm much stricter about making sure they've had STI tests than I used to be.

*My main social group are the UK bi/poly community, so two out of three of the men I've dated in the last few years have been bi.

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