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.
And yet, as you yourself pointed out, (at least in western countries) its prevalence among heterosexuals is much less than its prevalence among homosexuals.
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.
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.)
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.
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.
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.
So why hasn’t HIV-1 group M subtype C spread out of Southern Africa?
So why hasn’t HIV-1 group M subtype C spread out of Southern Africa?
That question assumes a false premise. HIV-1 group M subtype C hasspread out of Southern Africa.
Perhaps what you were trying to ask was why subtype C hasn’t spread as aggressively as you personally expect beyond Southern Africa, though the information I gave two comments ago suffices to answer that question. Still, I will build on that information to spell this out.
The transmissibility of an HIV subtype is not the only factor determining how, and how far, that subtype spreads; behavioural differences between populations also matter. Southern African populations more often engage in non-circumcision and multiple concurrent partnerships than people elsewhere, and that combination of behaviours is the most likely reason why subtype C hasn’t run riot among heterosexuals outside of Southern Africa (and Ethiopia & India).
If I leave things there, I suspect, I can look forward to a follow-up attempt at a dubious gotcha question along the lines of “So why bring up the transmissibility differences in the first place?”. Because the fact remains that relative transmissibility is probably a factor in explaining why subtypes B & C have different spatial distributions. I had thought it clear that I was invoking relative transmissibility as merely a probable secondary factor, since I mentioned it parenthetically and wrote it “likely played a role”, not that it was a sufficient, primary explanation in its own right.
Southern African populations more often engage in non-circumcision and multiple concurrent partnerships than people elsewhere, and that combination of behaviours is the most likely reason why subtype C hasn’t run riot among heterosexuals outside of Southern Africa (and Ethiopia & India).
What about western groups that have many sexual partners, e.g., the swinger and polyamory communities?
What about western groups that have many sexual partners, e.g., the swinger and polyamory communities?
Your question blurs the distinction between promiscuity and multiple concurrent partnerships — I assume that was an accident.
Which precise question are you asking? Are you asking why Western groups with MCPs and low circumcision rates don’t have (much) subtype C? If so, I’d like some specific evidence that they don’t — it’s a good idea to establish a phenomenon occurs beforetrying to explain it, and I’m having trouble finding systematic evidence on the HIV subtypes found among Western polyamorous people & swingers. If your question is about something subtly different (e.g. if you’re asking about HIV in general among those groups, not subtype C in particular), please clarify.
Your question blurs the distinction between promiscuity and multiple concurrent partnerships
Which are?
If your question is about something subtly different (e.g. if you’re asking about HIV in general among those groups, not subtype C in particular), please clarify.
Your theory predicts that promiscuous heterosexual westerners should be getting HIV at rates similar to Southern Africa. Near as I can tell this is not the case.
Which is that one can have many sexual partners over some time period (promiscuity) without having multiple sexual partners simultaneously (concurrency), and one can have multiple sexual partners over some time period (concurrency) without having many (promiscuity).
Suppose Person A abstains from sex through the even months of each year, but in every other month (i.e. January, March, and so on) they have sex with one (& only one) new person. (So for example in January 2006 they have sex with a first person; in February 2006 they have no sex; in March 2006 they have sex with a second person; in April 2006, no sex; in May 2006, sex with a third person, and so on.) In the course of 50 sexually active years, then, they have 300 different sexual partners.
Suppose person B has weekly sex with 2 other people for 5 years, then weekly sex with 2 completely different people for the next 5 years, then weekly sex with 2 more completely different people for the 5 years after that, and so on. In the course of 50 sexually active years, they have only 20 different sexual partners.
Person B is liable to be a more efficacious transmitter of HIV than person A, despite person A being far more promiscuous.
Your theory predicts that promiscuous heterosexual westerners should be getting HIV at rates similar to Southern Africa. Near as I can tell this is not the case.
One, you are still conflating promiscuity and MCPs.
Two, do uncircumcized (if male) Western heterosexuals with MCPs get HIV at rates substantially below Southern Africa? Taking the 2011 statistics on Southern Africans living with HIV from Wikipedia’s table, summing them, and dividing by the total population of those countries, I get 8.7%. This is high by general Western standards, but it’s not obvious to me that HIV prevalence is lower among the unusual subset of Western heterosexuals we’re talking about.
I’ve tried looking for hard numbers on HIV prevalence among swingers and the polyamorous and not found much. (A 2010 article in Sexually Transmitted Infections reports on a convenience sample of swingers, 4%-10% of whom had various STIs, though the paper didn’t report on HIV specifically. Another article, in Sexologies, reports results from interviews with Montreal swingers, but HIV prevalence doesn’t seem to have been assessed. These are the kinds of paper I’m finding.) Do you have hard numbers on how many swingers and polyamorous people in the West have HIV?
Three, my(!) theory explains why Southern Africa is distinct from similarly broad aggregates of humanity like heterosexuals in the rest of Africa, or heterosexuals in Europe (since those were the levels of aggregation under discussion earlier). You’re now trying to apply the theory to a finer-grained population, specifically uncircumcized (if male) Western heterosexuals with MCPs, and when you zero in on an unrepresentative subpopulation like that, the relevant causes of differences in HIV rates will likely change, however applicable the theory is to the wider population. So your alleged falsification is not as clear-cut as you imply.
Do you have hard numbers on how many swingers and polyamorous people in the West have HIV?
Do you have any hard numbers about how many partners typical Southern Africans have? As for polyamorous, there are a lot of them on LW. None have reported having to deal with AIDS in the community.
Do you have any hard numbers about how many partners typical Southern Africans have?
For the nth time, I’m not talking about the number of partners as such, but the number of concurrent partners. And yes, I do have hard numbers on those, some of which you’d have seen had you flicked through the SA J. HIV Med. article I’ve already linked and quoted. See figures 2 & 3 if you’re having trouble finding them; figure 2′s blurrier than I’d like but you can find numbers from the same data set plotted more clearly in this Lancet article, which is reference 23 in that SA J. HIV Med. article.
As for polyamorous, there are a lot of them on LW. None have reported having to deal with AIDS in the community.
Unless there’s reason to think polyamorous LWers are broadly representative of polyamorous people in the West generally, this doesn’t mean much. And I see no reason to think there is any reason, because you haven’t given any, and LWers in general are hilariously unrepresentative of the West in general. As a concrete example (albeit one based on self-reported data), our mean IQ is allegedly 138. (And yes, the mean remains unrepresentatively high among polyamorous respondents. Looking at the data myself, the mean IQ is 144 for survey takers claiming to have multiple current partners.)
Also, even if we assume polyamorous LWers are representative of all polyamorous Westerners, there’s another matter of numbers. While many people on our survey said they prefer polyamorous relationships (Yvain’s summary says 234), there are far fewer LWers who report actually having multiple partners and being heterosexual and living in the West and actually posting on LW. Taking Yvain’s public-use data for the 2013 survey, I count 86 people who said they had multiple partners, 43 of whom report being heterosexual, of whom 39 are left when I subtract out those in Brazil, Greece & Slovenia. How these people used LW seems to be a missing variable in the public data, but Yvain’s summary says 49% of survey replies were from lurkers. If the same rate applies to our sub-sub-sub-sample, that’d leave only 20 relevant LWers, at which point it’d be much less surprising that the relevant group hadn’t reported any AIDS concerns.
Stepping back and looking at this conversation as a whole, I’m going to walk away from it, because it just isn’t productive. You’re not showing any sign of changing your beliefs in the face of contrary evidence & argument, you’re leaving me to take up almost all of the argumentative burden, and by all appearances you’re either unable or unwilling to reason about this properly.
When I pointed out you made a fallacious inference, you didn’t acknowledge that — not even to dispute it, oddly.
You repeatedly conflate two ideas which, although presumably correlated, are nonetheless distinct, and you’re not respecting that distinction even though it matters greatly to the theory you wish to refute.
You show no sign of having even glanced at the sources I’ve referenced. Nor do you seem to be reading my replies carefully.
You don’t refer to specific sources for your own claims. I still have no idea where you “herd” “~15 years ago” that subtype C was going to “break into the western heterosexual population real soon now”.
When I explicitly ask whether you have specific HIV prevalence numbers, you dodge the question by demanding numbers you could’ve found by reading my sources yourself.
At least one of your questions, as stated, assumed a false premise. When I pointed that out, you didn’t acknowledge it (again, not even to disagree).
You mostly argue by posing would-be killer objections to the orthodox model, one at a time and without substantiation, and when one objection gets knocked flat you don’t acknowledge that but just move on to your next. I match that pattern of arguing to conspiracy theorists and others engaging in motivated cognition to defend a bizarre hypothesis; at no time is a semi-coherent alternative theory laid out by the arguer, just a procession of loosely linked anomalies presented as Devastating Critiques which turn out, on closer examination, to be irrelevancies, non-anomalies, or just really piss-weak evidence against the orthodox theory.
Speaking of bizarre hypotheses, the idea that a virus can be transmitted by anal sex but not at all by penis-in-vagina sex is quite an odd one, and you act as if utterly unaware of this. You argue like the idea’s almost self-evidently true and everybody else is being inexplicably thick in disregarding it, even though it’s an a priori unlikely hypothesis. (And even though you can’t have applied much effort to understand why the relevant experts disregard it, because you raise objections they’ve tackled years ago in Googleable papers.)
The most parsimonious explanation of these facts is that, at least on this topic, you can’t or won’t think straight. Whichever is the case, you’re wasting my time, so I’m done here.
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.
Really? This seems more like a misallocation of resources to me.
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.
http://www.sciencedirect.com/science/article/pii/S1473309909700210
And yet, as you yourself pointed out, (at least in western countries) its prevalence among heterosexuals is much less than its prevalence among homosexuals.
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.
That still doesn’t explain how HIV spread as much as it did in Southern Africa given how hard it is to transmit heterosexually.
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.)
Europe has an even lower circumcision rate.
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.
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:
It is the conjunction of low male circumcision rates and multiple concurrent partnerships which explains HIV’s strong showing in Southern Africa.
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.
So why hasn’t HIV-1 group M subtype C spread out of Southern Africa?
That question assumes a false premise. HIV-1 group M subtype C has spread out of Southern Africa.
Perhaps what you were trying to ask was why subtype C hasn’t spread as aggressively as you personally expect beyond Southern Africa, though the information I gave two comments ago suffices to answer that question. Still, I will build on that information to spell this out.
The transmissibility of an HIV subtype is not the only factor determining how, and how far, that subtype spreads; behavioural differences between populations also matter. Southern African populations more often engage in non-circumcision and multiple concurrent partnerships than people elsewhere, and that combination of behaviours is the most likely reason why subtype C hasn’t run riot among heterosexuals outside of Southern Africa (and Ethiopia & India).
If I leave things there, I suspect, I can look forward to a follow-up attempt at a dubious gotcha question along the lines of “So why bring up the transmissibility differences in the first place?”. Because the fact remains that relative transmissibility is probably a factor in explaining why subtypes B & C have different spatial distributions. I had thought it clear that I was invoking relative transmissibility as merely a probable secondary factor, since I mentioned it parenthetically and wrote it “likely played a role”, not that it was a sufficient, primary explanation in its own right.
What about western groups that have many sexual partners, e.g., the swinger and polyamory communities?
Your question blurs the distinction between promiscuity and multiple concurrent partnerships — I assume that was an accident.
Which precise question are you asking? Are you asking why Western groups with MCPs and low circumcision rates don’t have (much) subtype C? If so, I’d like some specific evidence that they don’t — it’s a good idea to establish a phenomenon occurs before trying to explain it, and I’m having trouble finding systematic evidence on the HIV subtypes found among Western polyamorous people & swingers. If your question is about something subtly different (e.g. if you’re asking about HIV in general among those groups, not subtype C in particular), please clarify.
Which are?
Your theory predicts that promiscuous heterosexual westerners should be getting HIV at rates similar to Southern Africa. Near as I can tell this is not the case.
Which is that one can have many sexual partners over some time period (promiscuity) without having multiple sexual partners simultaneously (concurrency), and one can have multiple sexual partners over some time period (concurrency) without having many (promiscuity).
Suppose Person A abstains from sex through the even months of each year, but in every other month (i.e. January, March, and so on) they have sex with one (& only one) new person. (So for example in January 2006 they have sex with a first person; in February 2006 they have no sex; in March 2006 they have sex with a second person; in April 2006, no sex; in May 2006, sex with a third person, and so on.) In the course of 50 sexually active years, then, they have 300 different sexual partners.
Suppose person B has weekly sex with 2 other people for 5 years, then weekly sex with 2 completely different people for the next 5 years, then weekly sex with 2 more completely different people for the 5 years after that, and so on. In the course of 50 sexually active years, they have only 20 different sexual partners.
Person B is liable to be a more efficacious transmitter of HIV than person A, despite person A being far more promiscuous.
One, you are still conflating promiscuity and MCPs.
Two, do uncircumcized (if male) Western heterosexuals with MCPs get HIV at rates substantially below Southern Africa? Taking the 2011 statistics on Southern Africans living with HIV from Wikipedia’s table, summing them, and dividing by the total population of those countries, I get 8.7%. This is high by general Western standards, but it’s not obvious to me that HIV prevalence is lower among the unusual subset of Western heterosexuals we’re talking about.
I’ve tried looking for hard numbers on HIV prevalence among swingers and the polyamorous and not found much. (A 2010 article in Sexually Transmitted Infections reports on a convenience sample of swingers, 4%-10% of whom had various STIs, though the paper didn’t report on HIV specifically. Another article, in Sexologies, reports results from interviews with Montreal swingers, but HIV prevalence doesn’t seem to have been assessed. These are the kinds of paper I’m finding.) Do you have hard numbers on how many swingers and polyamorous people in the West have HIV?
Three, my(!) theory explains why Southern Africa is distinct from similarly broad aggregates of humanity like heterosexuals in the rest of Africa, or heterosexuals in Europe (since those were the levels of aggregation under discussion earlier). You’re now trying to apply the theory to a finer-grained population, specifically uncircumcized (if male) Western heterosexuals with MCPs, and when you zero in on an unrepresentative subpopulation like that, the relevant causes of differences in HIV rates will likely change, however applicable the theory is to the wider population. So your alleged falsification is not as clear-cut as you imply.
Do you have any hard numbers about how many partners typical Southern Africans have? As for polyamorous, there are a lot of them on LW. None have reported having to deal with AIDS in the community.
For the nth time, I’m not talking about the number of partners as such, but the number of concurrent partners. And yes, I do have hard numbers on those, some of which you’d have seen had you flicked through the SA J. HIV Med. article I’ve already linked and quoted. See figures 2 & 3 if you’re having trouble finding them; figure 2′s blurrier than I’d like but you can find numbers from the same data set plotted more clearly in this Lancet article, which is reference 23 in that SA J. HIV Med. article.
Unless there’s reason to think polyamorous LWers are broadly representative of polyamorous people in the West generally, this doesn’t mean much. And I see no reason to think there is any reason, because you haven’t given any, and LWers in general are hilariously unrepresentative of the West in general. As a concrete example (albeit one based on self-reported data), our mean IQ is allegedly 138. (And yes, the mean remains unrepresentatively high among polyamorous respondents. Looking at the data myself, the mean IQ is 144 for survey takers claiming to have multiple current partners.)
Also, even if we assume polyamorous LWers are representative of all polyamorous Westerners, there’s another matter of numbers. While many people on our survey said they prefer polyamorous relationships (Yvain’s summary says 234), there are far fewer LWers who report actually having multiple partners and being heterosexual and living in the West and actually posting on LW. Taking Yvain’s public-use data for the 2013 survey, I count 86 people who said they had multiple partners, 43 of whom report being heterosexual, of whom 39 are left when I subtract out those in Brazil, Greece & Slovenia. How these people used LW seems to be a missing variable in the public data, but Yvain’s summary says 49% of survey replies were from lurkers. If the same rate applies to our sub-sub-sub-sample, that’d leave only 20 relevant LWers, at which point it’d be much less surprising that the relevant group hadn’t reported any AIDS concerns.
Stepping back and looking at this conversation as a whole, I’m going to walk away from it, because it just isn’t productive. You’re not showing any sign of changing your beliefs in the face of contrary evidence & argument, you’re leaving me to take up almost all of the argumentative burden, and by all appearances you’re either unable or unwilling to reason about this properly.
When I pointed out you made a fallacious inference, you didn’t acknowledge that — not even to dispute it, oddly.
You repeatedly conflate two ideas which, although presumably correlated, are nonetheless distinct, and you’re not respecting that distinction even though it matters greatly to the theory you wish to refute.
You show no sign of having even glanced at the sources I’ve referenced. Nor do you seem to be reading my replies carefully.
You don’t refer to specific sources for your own claims. I still have no idea where you “herd” “~15 years ago” that subtype C was going to “break into the western heterosexual population real soon now”.
When I explicitly ask whether you have specific HIV prevalence numbers, you dodge the question by demanding numbers you could’ve found by reading my sources yourself.
At least one of your questions, as stated, assumed a false premise. When I pointed that out, you didn’t acknowledge it (again, not even to disagree).
You mostly argue by posing would-be killer objections to the orthodox model, one at a time and without substantiation, and when one objection gets knocked flat you don’t acknowledge that but just move on to your next. I match that pattern of arguing to conspiracy theorists and others engaging in motivated cognition to defend a bizarre hypothesis; at no time is a semi-coherent alternative theory laid out by the arguer, just a procession of loosely linked anomalies presented as Devastating Critiques which turn out, on closer examination, to be irrelevancies, non-anomalies, or just really piss-weak evidence against the orthodox theory.
Speaking of bizarre hypotheses, the idea that a virus can be transmitted by anal sex but not at all by penis-in-vagina sex is quite an odd one, and you act as if utterly unaware of this. You argue like the idea’s almost self-evidently true and everybody else is being inexplicably thick in disregarding it, even though it’s an a priori unlikely hypothesis. (And even though you can’t have applied much effort to understand why the relevant experts disregard it, because you raise objections they’ve tackled years ago in Googleable papers.)
The most parsimonious explanation of these facts is that, at least on this topic, you can’t or won’t think straight. Whichever is the case, you’re wasting my time, so I’m done here.
I’d guess that condom usage is way more widespread among LWers than among the general population of southern Africa.