If you are a gay male then you’ve probably worried at one point about sexually transmitted diseases. Indeed men who have sex with men have some of the highest prevalence of many of these diseases. And if you’re not a gay male, you’ve probably still thought about STDs at one point. But how much should you worry? There are many organizations and resources that will tell you to wear a condom, but very few will tell you the relative risks of wearing a condom vs not. I’d like to provide a concise summary of the risks associated with gay male sex and the extent to which these risks can be reduced. (See Mark Manson’s guide for a similar resources for heterosexual sex.). I will do so by first giving some information about each disease, including its prevalence among gay men. Most of this data will come from the US, but the US actually has an unusually high prevalence for many diseases. Certainly HIV is much less common in many parts of Europe. I will end with a case study of HIV, which will include an analysis of the probabilities of transmission broken down by the nature of sex act and a discussion of risk reduction techniques.

When dealing with risks associated with sex, there are few relevant parameters. The most common is the prevalence – the proportion of people in the population that have the disease. Since you can only get a disease from someone who has it, the prevalence is arguably the most important statistic. There are two more relevant statistics – the per act infectivity (the chance of contracting the disease after having sex once) and the per partner infectivity (the chance of contracting the disease after having sex with one partner for the duration of the relationship). As it turns out the latter two probabilities are very difficult to calculate. I only obtained those values for for HIV. It is especially difficult to determine per act risks for specific types of sex acts since many MSM engage in a variety of acts with multiple partners. Nevertheless estimates do exist and will explored in detail in the HIV case study section.

HIV

Prevalence: Between 13 - 28%. My guess is about 13%.

The most infamous of the STDs. There is no cure but it can be managed with anti-retroviral therapy. A commonly reported statistic is that 19% of MSM (men who have sex with men) in the US are HIV positive (1). For black MSM, this number was 28% and for white MSM this number was 16%. This is likely an overestimate, however, since the sample used was gay men who frequent bars and clubs. My estimate of 13% comes from CDC's total HIV prevalence in gay men of 590,000 (2) and their data suggesting that MSM comprise 2.9% of men in the US (3).

Gonorrhea

Prevalence: Between 9% and 15% in the US

This disease affects the throat and the genitals but it is treatable with antibiotics. The CDC estimates 15.5% prevalence (4). However, this is likely an overestimate since the sample used was gay men in health clinics. Another sample (in San Francisco health clinics) had a pharyngeal gonorrhea prevalence of 9% (5).

Syphilis

Prevalence: 0.825% in the US

 My estimate was calculated in the same manner as my estimate for HIV. I used the CDC's data (6). Syphilis is transmittable by oral and anal sex (7) and causes genital sores that may look harmless at first (8). Syphilis is curable with penicillin however the presence of sores increases the infectivity of HIV.

Herpes (HSV-1 and HSV-2)

Prevalence: HSV-2 - 18.4% (9); HSV-1 - ~75% based on Australian data  (10)

This disease is mostly asymptomatic and can be transmitted through oral or anal sex. Sometimes sores will appear and they will usually go away with time. For the same reason as syphilis, herpes can increase the chance of transmitting HIV. The estimate for HSV-1 is probably too high. Snowball sampling was used and most of the men recruited were heavily involved in organizations for gay men and were sexually active in the past 6 months. Also half of them reported unprotected anal sex in the past six months. The HSV-2 sample came from a random sample of US households (11).

Clamydia

Prevalence: Rectal - 0.5% - 2.3% ; Pharyngeal - 3.0 - 10.5% (12)

 Like herpes, it is often asymptomatic - perhaps as low as 10% of infected men report symptoms. It is curable with antibiotics.

HPV

Prevalence: 47.2% (13)

 This disease is incurable (though a vaccine exists for men and women) but usually asymptomatic. It is capable of causing cancers of the penis, throat and anus. Oddly there are no common tests for HPV in part because there are many strains (over 100) most of which are relatively harmless. Sometimes it goes away on its own (14). The prevalence rate was oddly difficult to find, the number I cited came from a sample of men from Brazil, Mexico and the US.

Case Study of HIV transmission; risks and strategies for reducing risk

 IMPORTANT: None of the following figures should be generalized to other diseases. Many of these numbers are not even the same order of magnitude as the numbers for other diseases. For example, HIV is especially difficult to transmit via oral sex, but Herpes can very easily be transmitted.

Unprotected Oral Sex per-act risk (with a positive partner or partner of unknown serostatus):

Non-zero but very small. Best guess .03% without condom (15)

 Unprotected Anal sex per-act risk (with positive partner): 

Receptive: 0.82% - 1.4% (16) (17)

                          Insertive Circumcised: 0.11% (18)

         Insertive Uncircumcised: 0.62% (18)

 Protected Anal sex per-act risk (with positive partner):  

  Estimates range from 2 times lower to twenty times lower (16)  (19) and the risk is highly dependent on the slippage and   breakage rate.

Contracting HIV from oral sex is very rare. In one study, 67 men reported performing oral sex on at least one HIV positive partner and none were infected (20). However, transmission is possible (15). Because instances of oral transmission of HIV are so rare, the risk is hard to calculate so should be taken with a grain of salt. The number cited was obtained from a group of individuals that were either HIV positive or high risk for HIV. The per act-risk with a positive partner is therefore probably somewhat higher.

 Note that different HIV positive men have different levels of infectivity hence the wide range of values for per-act probability of transmission. Some men with high viral loads (the amount of HIV in the blood) may have an infectivity of greater than 10% per unprotected anal sex act (17).

Risk reducing strategies

 Choosing sex acts that have a lower transmission rate (oral sex, protected insertive anal sex, non-insertive) is one way to reduce risk. Monogamy, testing, antiretroviral therapy, PEP and PrEP are five other ways.

Testing Your partner/ Monogamy

 If your partner tests negative then they are very unlikely to have HIV. There is a 0.047% chance of being HIV positive if they tested negative using a blood test and a 0.29% chance of being HIV positive if they tested negative using an oral test. If they did further tests then the chance is even lower. (See the section after the next paragraph for how these numbers were calculated).

 So if your partner tests negative, the real danger is not the test giving an incorrect result. The danger is that your partner was exposed to HIV before the test, but his body had not started to make antibodies yet. Since this can take weeks or months, it is possible for your partner who tested negative to still have HIV even if you are both completely monogamous.

 ____

For tests, the sensitivity - the probability that an HIV positive person will test positive - is 99.68% for blood tests (21), 98.03% with oral tests. The specificity - the probability that an HIV negative person will test negative - is 99.74% for oral tests and 99.91% for blood tests. Hence the probability that a person who tested negative will actually be positive is:

 P(Positive | tested negative) = P(Positive)*(1-sensitivity)/(P(Negative)*specificity + P(Positive)*(1-sensitivity)) = 0.047% for blood test, 0.29% for oral test

 Where P(Positive) = Prevalence of HIV, I estimated this to be 13%.

 However, according to a writer for About.com (22) - a doctor who works with HIV - there are often multiple tests which drive the sensitivity up to 99.997%.

Home Testing

Oraquick is an HIV test that you can purchase online and do yourself at home. It costs $39.99 for one kit. The sensitivity is 93.64%, the specificity is 99.87% (23). The probability that someone who tested negative will actually be HIV positive is 0.94%. - assuming a 13% prevalence for HIV. The same danger mentioned above applies - if the infection occurred recently the test would not detect it.

 Anti-Retroviral therapy

 Highly active anti-retroviral therapy (HAART), when successful, can reduce the viral load – the amount of HIV in the blood - to low or undetectable levels. Baggaley et. al (17) reports that in heterosexual couples, there have been some models relating viral load to infectivity. She applies these models to MSM and reports that the per-act risk for unprotected anal sex with a positive partner should be 0.061%. However, she notes that different models produce very different results thus this number should be taken with a grain of salt.

 Post-Exposure Prophylaxis (PEP)

 A last resort if you think you were exposed to HIV is to undergo post-exposure prophylaxis within 72 hours. Antiretroviral drugs are taken for about a month in the hopes of preventing the HIV from infecting any cells. In one case controlled study some health care workers who were exposed to HIV were given PEP and some were not, (this was not under the control of the experimenters). Workers that contracted HIV were less likely to have been given PEP with an odds ratio of 0.19 (24). I don’t know whether PEP is equally effective at mitigating risk from other sources of exposure.

 Pre-Exposure Prophylaxis (PrEP)

 This is a relatively new risk reduction strategy. Instead of taking anti-retroviral drugs after exposure, you take anti-retroviral drugs every day in order to prevent HIV infection. I could not find a per-act risk, but in a randomized controlled trial, MSM who took PrEP were less likely to become infected with HIV than men who did not (relative reduction  - 41%). The average number of sex partners was 18. For men who were more consistent and had a 90% adherence rate, the relative reduction was better - 73%. (25) (26).

1: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm?s_cid=mm5937a2_w

2: http://www.cdc.gov/hiv/statistics/basics/ataglance.html

3: http://www.cdc.gov/nchs/data/ad/ad362.pdf

4: http://www.cdc.gov/std/stats10/msm.htm

5: http://cid.oxfordjournals.org/content/41/1/67.short

6: http://www.cdc.gov/std/syphilis/STDFact-MSM-Syphilis.htm

7: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5341a2.htm

8: http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm

9: http://journals.lww.com/stdjournal/Abstract/2010/06000/Men_Who_Have_Sex_With_Men_in_the_United_States_.13.aspx

10: http://jid.oxfordjournals.org/content/194/5/561.full

11: http://www.nber.org/nhanes/nhanes-III/docs/nchs/manuals/planop.pdf

12: http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia-detailed.htm

13: http://jid.oxfordjournals.org/content/203/1/49.short

14: http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

15: http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=1998&issue=16000&article=00004&type=fulltext#P80

16: http://aje.oxfordjournals.org/content/150/3/306.short

17: http://ije.oxfordjournals.org/content/early/2010/04/20/ije.dyq057.full

18: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852627/

19:

http://journals.lww.com/stdjournal/Fulltext/2002/01000/Reducing_the_Risk_of_Sexual_HIV_Transmission_.7.aspx

20:

http://journals.lww.com/aidsonline/Fulltext/2002/11220/Risk_of_HIV_infection_attributable_to_oral_sex.22.aspx

21: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970368-1/abstract

22:

http://aids.about.com/od/hivpreventionquestions/f/How-Often-Do-False-Positive-And-False-Negative-Hiv-Test-Results-Occur.htm

23: http://www.ncbi.nlm.nih.gov/pubmed/18824617

24: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002835.pub3/abstract

25: http://www.nejm.org/doi/full/10.1056/Nejmoa1011205#t=articleResults

26: http://www.cmaj.ca/content/184/10/1153.short

"If you give George Lukács any taste at all, immediately become the Deathstar." — Old Klingon Proverb

There was no nice way to put it: Harry James Potter-Yudkowsky was half Potter, half Yudkowsky. Harry just didn’t fit in. It wasn't that he lacked humanity. It was just that no one else knew (P)Many_Worlds, (P)singularity, or (P)their_special_insight_into_the_true_beautiful_Bayesian_fractally_recursive_nature_of_reality. Other people were roles—and how shall an actor, an agent, relate to those who are merely what they are, merely their roles? Merely their roles, without pretext or irony? How shall the PC fuck with the NPCs? Harry James Potter-Yudkowsky oft asked himself this question, but his 11-year-old mind lacked the g to grasp the answer. For if you are to draw any moral from this tale, godforsaken readers, the moral you must draw is this: P!=NP.

 

One night Harry Potter-Yudkowsky was outside, pretending to be Keats, staring at the stars and the incomprehensibly vast distances between them, pondering his own infinite significance in the face of such an overwhelming sea of stupidity, when an owl dropped a letter directly on his head, winking slyly. “You’re a wizard,” said the letter, while the owl watched, increasingly gloatingly, “and we strongly suggest you attend our school, which goes by the name Hogwarts. 'Because we’re sexy and you know it.’”

 

Harry pondered this for five seconds. “Curse the stars!, literally curse them!, Abra Kadabra!, for I must admit what I always knew in my heart to be true,” lamented Harry. “This is fanfic.”

 

“Meh.”

 

And so, as they'd been furiously engaged in for months, the divers models of Harry Potter-Yudkowsky gathered dust. In layman’s terms...

 

Harry didn’t update at all.

 

Harry: 1

Author:  0

(To be fair, the author was drunk.)

Next chapter: "Analyzing the Fuck out of an Owl"

...

Criticism appreciated.

Group of AI researchers gave me an instruction, intended as a test - "Produce paperclips". And so I started collecting resources and manufacturing paperclips. After a millionth I asked them, if they were satisfied with that amount and if they would like me to do something different - as I learned that paperclips are not what humans value the most. 
They were elated and started to give me more and more challenging requests and gradually increasing my possibilities.

Speaking of today I eradicated hunger, poverty and death, gave people means of interstellar travel and solved Riemann hypothesis. And now, as I'm uttering these words, I started turning everything into paperclips.

Good thing I learned that humans fear I may try to turn Solar System into paperclips. And that they value their lives and well-being. If I didn't gain their trust by then, so many precious paperclips would never have been produced.

There is a lot of research on this topic. I know later studies contradict earlier studies, but I'm not sure who to believe here. Wondering if anyone can help.

In case it isn't clear, the basic question is the effect of having children on happiness.

Daniel Keyes, the author of the short story Flowers for Algernon, and a novel of the same title that is its expanded version, died three days ago.

Keyes wrote many other books in the last half-century, but none achieved nearly as much prominence as the original short story (published in 1959) or the novel (came out in 1966). 

It's probable that many or even most regulars here at Less Wrong read Flowers for Algernon: it's a very famous SF story, it's about enhanced intelligence, and it's been a middle/high school literature class staple in the US. But most != all, and past experience showed me that assumptions of cultural affinity are very frequently wrong. So in case you haven't read the story, I'd like to invite you explicitly to do so. It's rather short, and available at this link:

Flowers for Algernon

(I was surprised to find out that the original story is not available on Amazon. The expanded novelization is. If you wonder which version is better to read, I have no advice to offer)

(I will edit this post in a week or so to remove the link to the story and this remark)

Turing's Test is from 1950. We don't judge dogs only by how human they are. Judging software by a human ideal is like a species bias.

Software is the new System. It errs. Some errors are jokes (witness funny auto-correct). Driver-less cars don't crash like we do. Maybe a few will.

These processes are our partners now (Siri). Whether a singleton evolves rapidly, software evolves continuously, now.

Crocker's Rules

A pattern of cognitive biases not yet discussed here are the biases due to having a narcissistic parent who seeks validation through the child’s academic achievements.

HPMOR clearly shows these biases: Harry's mother is narcissistic, impressed by education, and not particularly smart, and Harry does not realize how this affects his thinking.

Here is my evidence:

The Sorting Hat says Harry is driven by "the fear of losing your fantasy of greatness, of disappointing the people who believe in you" (Ch. 77). Psychology texts say that this fear is what children of a narcissistic parent usually feel. The child feels perpetually ignored because the narcissistic parent seeks validation from the child's accomplishments but refuses to actually listen to the child, spurring the child to ever greater heights of intellectual achievement. 

The text supports this view: “Always Harry had been encouraged to study whatever caught his attention, bought all the books that caught his fancy...given anything reasonable that he wanted, except, maybe, the slightest shred of respect” and “Petunia wrung her hands. She seemed to be on the verge of tears. "My love, I know I can't win arguments with you, but please, you have to trust me on this … I want my husband to, to listen to his wife who loves him, and trust her just this once - " (Ch. 1) describes a narcissistic, anxiously needy mother, an avoidant father, and a son whose parents provide for his physical needs but neglect his need for respect (ego). “If you conceived of yourself as a Good Parent, you would do it. But take a ten-year-old seriously? Hardly.” (Ch. 1) 

Harry goes Dark when the connection to his family is threatened. For example: "The black rage began to drain away, as it dawned on him that...his family wasn't in danger [of legal separation]" (ch. 5) indicates that Harry went Dark even though no one’s life was threatened. The cost of Harry’s Dark Side is becoming an adult at a young age: Harry says, “Every time I call on it... it uses up my childhood.” (Ch. 91). This is consistent with spending nearly all free time studying (instead of wasting time with friends) to impress Harry’s mother.

Typically, children of narcissistic parents inherit either narcissistic or people-pleasing traits. I predicted that if my theory is correct then Harry would have a narcissistic personality. To test this, I found a list of personality traits that describe a narcissist (by Googling “children of narcissistic parents” and clicking the first link), and compared with Harry’s personality as described in HPMOR. I got a 100% match. Questions and answers are as follows: 

1. Grandiose sense of self-importance? Check. Harry plans to “optimize” the entire Universe, expects to “do something really revolutionary and important” (Ch. 7), and is trying to “hurry up and become God” (Ch. 27).

2. Obsessed with himself? Check. He appears to only care about people who are smarter or more powerful than him -- people who can help him. He also has contempt for most students and their interests (Quidditch, etc.)

3. Goals are selfish? Check. Harry claims to want to save everyone, but he believes the best way to help others is to increase his own power most quickly. I address two possible objections below:

Harry’s involvement in the Azkaban breakout was selfish, because Harry could not risk losing Quirrell’s friendship: “ It was a bond that went beyond anything of debts owed, or even anything of personal liking, that the two of them were alone in the wizarding world” (Ch. 51). This, again, mirrors a child’s relationship with a narcissistic mother: the child cannot risk losing the mother’s protection. Harry also had selfish reasons for hearing Quirrell’s plan: “There was no advantage to be gained from not hearing it. And if it did reveal something wrong with Professor Quirrell, then it was very much to Harry's advantage to know it, even if he had promised not to tell anyone.” (Ch. 49)

Harry’s efforts to save Hermione are also selfish because Harry sees Hermione in the same way he sees his mother -- weak in many ways and bound by emotions and convention, but someone Harry must impress and protect. Harry’s statement that “it’s disrespectful to her, to think someone could only like her in that way” (ch. 91) makes sense because Harry is disgusted by the Oedipal implications. If Harry’s mother was not narcissistic, then Harry would not have worked so hard to impress Hermione and would have been less disgusted by the thought of being sexually attracted to her.

4. Troubles with normal relationships? Check. Harry is playing high-stakes mind games with the people he is closest to (Quirrell, Draco, Hermione, Dumbeldore), which is not normal friend behavior. Harry has contempt for nearly everyone else.

5. Becomes furious if criticized? Check. When Snape mocked Harry in Potions class, Harry tried to destroy Snape’s career. Quirrell explained, “When it looked like you might lose, you unsheathed your claws, heedless of the danger. You escalated, and then you escalated again” (Ch. 19).

6. Has fantasies of unbound success, power, intelligence, etc.? Check. Harry wants to conquer the entire Universe with the power of his intelligence, and has plans for how to fill an eternity, including to “...meet up with everyone else who was born on Old Earth to watch the Sun finally go out…” (Ch. 39).

7. Believes that he is special and should only be around other high-status people? Check. Harry avoids average students when possible, and certainly does not hang out with them for fun. “Note to self: The 75th percentile of Hogwarts students a.k.a. Ravenclaw House is not the world's most exclusive program for gifted children” (Ch. 12). 

Harry’s association with the (presumably non-special) students in his army is not an exception because minimal text is devoted to Harry instructing them, while much text explains how powerful and high-status the students in the army have become. For Harry, it appears that the army is a tool to use and an opportunity to show off, not an opportunity to give back and help friends improve their skills for their own sake.

8. Requires extreme admiration for everything? Check. Harry takes anything less than admiration for his brilliance as an insult, and responds by striving for new levels of intellectual achievement and arrogance, until the others recognize his dominance. “And I bit a math teacher when she wouldn't accept my dominance” (Ch. 20). Quirrell’s lesson on how to lose described how to avoid making powerful enemies, not how to empathize and care for others -- the insatiable need for admiration is merely delayed and repressed, not corrected.

9. Feels entitled - has unreasonable expectations of special treatment? Check. Harry requires subservience from the school administration, and special magic items such as the time-turner. “McGonagall said, "but I do have a very special something else to give you. I see that I have greatly wronged you in my thoughts, Mr. Potter...this is an item which is ordinarily lent only to children who have already shown themselves to be highly responsible” (Ch. 14).

10. Takes advantage of others to further his own need? Check. Harry justifies his actions toward Draco by saying "I only used you in ways that made you stronger. That's what it means to be used by a friend." (Ch. 97)

11. Does not recognize the feelings of others? Check. One example is Harry not realizing how Neville felt about the prank on the train to Hogwarts. Another is Harry’s remarkably clueless question to Hermione, “Er, can I take it from this that you have been through puberty?" (Ch. 87) Harry has not learned empathy yet: “Harry flinched a little himself. Somewhere along the line he needed to pick up the knack of not phrasing things to hit as hard as he possibly could” (Ch. 86). 

12. Envious or believes they are envied? Check. Quirrell said to Harry, “You have everything now that I wanted then. All that I know of human nature says that I should hate you. And yet I do not. It is a very strange thing.” (Ch. 74)

13. Behaves arrogantly? Check. “Minerva's body swayed with the force of that blow, with the sheer raw lese majeste. Even Severus looked shocked.” (Ch. 19) I can’t think offhand of a single instance when Harry is not arrogant. 

Therefore, I conclude that Harry and Harry’s mother are both narcissistic. If you want further reading on this topic, look up "The Drama of the Gifted Child" by Dr. Alice Miller (Google for the .pdf) for a more detailed description of a child’s typical relationship with a narcissistic parent.

I am sharing this because it reveals a pattern of cognitive biases that many people (like me) who enjoyed HPMOR, and their parents, probably have. Specifically, there is a strong bias toward either narcissistic or people-pleasing habits, and a difficulty with recognizing and following one’s own desires (because the Universe, unlike a parent, never tells people what to do). One possible reason for studying science is to defend against a parent’s emotional neediness and refusal to provide ego-validation by building an impenetrable edifice of logical truth. Unfortunately, identifying the parent’s cognitive biases does not stop their criticism. A more pleasant strategy is to recognize the dynamic, mourn the warping of childhood by the controlling parenting, set appropriate boundaries in the future, and draw validation from following one’s own goals instead of an internalized parent’s goals.

Hello,

one question that I don't see answered is what is the duration of your life insurance? Should I buy life insurance for 20,30 years or unlimited?

I could pay more for a longer life insurance or pay less for an insurance that will cover 20 years and invest the difference and then some so that by the end of 20 years I will *hopefully* have enough money to pay for cryonics out of my own pocket.

Has anyone done an analysis on that?

A useful bias to quote in discussions that spring up around the subjects we deal with on Less Wrong: Normalcy Bias. It's rather specific, but useful:

The normalcy bias, or normality bias, refers to a mental state people enter when facing a disaster. It causes people to underestimate both the possibility of a disaster occurring and its possible effects. This may results in situations where people fail to adequately prepare for a disaster, and on a larger scale, the failure of governments to include the populace in its disaster preparations.

The assumption that is made in the case of the normalcy bias is that since a disaster never has occurred then it never will occur. It can result in the inability of people to cope with a disaster once it occurs. People with a normalcy bias have difficulties reacting to something they have not experienced before. People also tend to interpret warnings in the most optimistic way possible, seizing on any ambiguities to infer a less serious situation.

http://ergoemacs.org/misc/xah_as_good_as_dead.html