HIV Treatment As HIV Protection

I’m a broken record on this, but the second truly important thing about HIV meds (after saving your life if you’re infected) is that they can also save your life and protect your health when you’re not infected. The last group to be tested for pharmaceutical prophylaxis is IV drug users, and they too saw remarkable results:

Drug-injecting addicts who took a daily antiretroviral pill were half as likely to become infected with H.I.V. as those who did not, a major new study has found, providing the final piece of evidence that such treatments can prevent AIDS in every group at risk … According to the C.D.C., when study results are adjusted to include only participants who took their pills most of the time, the protective effects are 92 percent for gay men, nearly 90 percent for couples in which only one partner is infected, 84 percent for heterosexual men and women, and about 70 percent for drug injectors.

AIDS and HIV are no longer terrifying for young gay men – for the good reason that the impact of the disease is so much less devastating than it once was. But it remains a chronic disease, the medications are not without serious side-effects, and infection rates remain stubbornly high. It’s not over, and it should be.

TenofovirMy view is that every doctor who treats a sexually active gay man should put him on a daily retroviral in the same way you might prescribe a daily anti-cholesterol drug for someone with high cholesterol. If 92 percent of gay men can avoid infection this way, then we could truly turn the tide.This is the equivalent of Plan B for pregnant women – except it’s taken every day and prevents infection, rather than trying to contain HIV once the virus has gotten inside.

Using the old tactics of fear and sexual shaming simply will not – does not – work. Men will have sex with other men, period. It’s about as predictable as cold in the winter and warmth in the summer (maybe more predictable these days). The cost is a fraction of what a full anti-retroviral regimen would be after infection.

So what are we waiting for? Unless to get past the stigma that gay sex is something you should keep as scary as possible? And in my view, these pills should also be over the counter. If we really want to bring infection rates down, there is no reason not to use one the most effective weapons we have. Could it generate HIV-resistance if taken irregularly? Not if you don’t have the virus in the first place. Yes, getting people to take this regularly and properly may be a struggle. But if we can get people to take an aspirin today (one of the best and simplest things you can do for your health), why not this?

Dad And The Dish

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Still struggling to think of a gift for Father’s Day? Why not a subscription to the Dish? We just got the capacity to deliver one for you, with a personal message, to the man who doesn’t need another necktie.

We know Dishheads love sharing Dish posts with their ornery dads, or dads who think conservatism only means Fox News, or dads who keep emailing the latest conspiracy theory they got from their old high-school buddy, or dads who’d never dream of getting an online subscription to anything but might get addicted to the Dish on their iPad.

So don’t wait till Thanksgiving dinner to realize (again) that your dad still takes Sean Hannity seriously; get him reading the Dish and engaged in the real back and forth that goes on here every day. Then at least when he defends Hannity this fall, you’ll know Roger Ailes isn’t his only source of information about the world, and that he might even have seen another kind of conservatism worth thinking about. Give him one by clicking here. And make next Thanksgiving a little livelier.

Prohibition In The Lab, Ctd

Despite the difficulties associated with researching the medical effects of cannabis, Colleen Kimmett points to signs of improvement:

“I think it’s inevitable that marijuana will become a prescription medicine,” says [Multidisciplinary Association for Psychedelic Studies’ Rick] Doblin. “It’s just a question of how long we’re going to fight it out as a society.” The fact that the National Institute for Drug Abuse is funding [UC-Davis Dr.] Barth Wilsey’s study is significant. It’s the only trial looking at the potential benefits of cannabis in the institute’s funding history.

With funding direct from NIDA, Wilsey didn’t have to submit his protocol to Human Health Services for approval, eliminating an extra burden of bureaucracy and making for “relatively smooth sailing,” he says.

Wilsey believes one of the reasons his study was funded is because—unlike Doblin—he is looking at a low-THC strain of cannabis, a product that would be presumably less susceptible to diversion by criminal interests. This is intentional, he says, to serve the best needs of his patients. Many are middle-aged, and uninterested in the psychedelic side effects of cannabis. What they do want is relief. And right now, only about half of his patients can find that with conventional prescription drugs. “The science is becoming more robust, and I think we’re going to see more funding,” he says. “As a pain-management therapy, cannabis is effective.”

Snowden And China vs The US

Allahpundit picks apart the NSA leaker’s reasoning for his latest “revelation” from Hong Kong, about the US hacking China:

The “best-case” scenario for him telling Chinese media that we’re spying on China is that he figures that inflaming local sentiment against the U.S. will make it harder for Chinese/Hong Kong authorities to extradite him. Which is to say, instead of gratuitously humiliating America, in this scenario he’s merely betraying state semi-secrets to protect himself. Somewhere Obama’s watching this CNN clip and smiling because he knows that, like it or not, he’s locked in a battle for public opinion with Snowden right now. And everyone who saw this segment this afternoon is now thinking the same thing: If Snowden’s willing to tell China this, what else is he willing to them that he knows? Advantage: Obama.

Yep, it certainly got my back up. Osnos finds that the Chinese public is warming to Snowden:

Offering details about America’s cyber strategy on China may not help him much in American public opinion, but it already has in China. After initially attracting muted attention during a Chinese holiday earlier this week, by Thursday, his case was major news, and Snowden was a popular man here. Mo Shucao flagged me to an online survey that found that seventy-eight per cent of respondents regarded Snowden as a freedom fighter who protects civil liberties. As for how the Chinese government should handle the case, eighty-one per cent supported giving Snowden asylum either to protect him or extract more of the intelligence he is able to leak. Only three per cent supported surrendering him to the United States.

Adam Minter analyses the Chinese government’s reasons for staying quiet about the leaker for now:

What’s becoming clear is that it’s in China’s best interest that Snowden leave Hong Kong — and soon. No doubt, on Monday there was no small amount of gloating in Beijing at the thought of a former U.S. intelligence analyst contemplating asylum on Chinese territory. But that satisfaction likely gave way to a wary recognition that Snowden is an advocate for digital privacy and against the surveillance state. Whatever benefit he might serve as an intelligence asset, or as a source of national prestige, is outweighed by the prospect of the world’s most famous whistle-blower living out his days in Hong Kong with nothing better to do than turn his attention to the surveillance state across the border.

Texas And Immigration Reform

A new poll finds the following in the lone star state:

In Texas, the rapidly changing but still-conservative state with two senators who have resisted reform – Ted Cruz and John Cornyn – 67 percent said they could support the reform bill as described, with 72 percent backing a pathway to citizenship.

If I were a Republican, I’d worry about Texas. Voter suppression can only last so long. Resisting immigration reform could lead to Latino backlash; and backing it could lead to a bluer state. But the bluer state is likely anyway – and surely it would be better to get on the right side of it.

On the other hand, when a kid like the one above gets pummeled with racist xenophobic tweets, maybe Cruz and Cornyn know their base.

It Really Does Get Better

I wish I could be more persuaded by the Pew poll’s new survey of “LGBT” Americans. The reason I’m suspect is a pretty simple one: the biggest group in the survey were bisexuals. They comprise a full 40 percent of the survey population, which is extremely odd to me. They skew the data dramatically: only 28 percent of them have come out, compared with 77 percent of gay men and 71 percent of lesbians. I don’t know SDT-2013-06-LGBT-0-08whether this is a hidden gay population, or a large, closeted bisexual cohort that does not interact with gays or lesbians. I do know it makes almost every data point a little suspect to me.

I have to say that is why I have resisted the ubiquitous acronym “LGBT” on the Dish. It covers such a wide variance of experience and community and gender it is close to meaningless when analyzing the real world and the specific issues each of these groups grapple with. It emerged out of an ideology of shared victimology as a political device. To be clear: I have no issues with equality for all four types of human experience. But they are emphatically not the same. And when you are deducing facts from such a complex and diverse group of people, I don’t think it adds much to generalize by lumping them all in together.

Perhaps “bisexual” is a what closeted as well as bisexual people call themselves when asked. But one thing that seems to actually hold true for bisexuals, “bisexuals”, gays and lesbians is general happiness with orientation. Being gay, for most of us, is a great thing.

Obamacare Isn’t Going To Implode

Ponnuru provides a reality check to Republicans:

Conservatives and Republicans in Washington — activists, strategists, politicians — are increasingly embracing a theory about Obamacare: It’s going to collapse of its own weight, and its failure could yield a sharp right turn in the 2014 and 2016 elections. That theory is probably wrong, and dangerously so. To be rid of Obamacare, Republicans will have to do more than just wait for it to go away — and more than they have done so far.

And they’ll have to say that those pilot cost-controls in the ACA may be starting to work in lowering costs. Ramesh wants Republicans to come up with a real alternative to the ACA:

Republicans’ confidence that Obamacare will collapse has contributed to their lassitude in coming up with an alternative. It is a perverse complacency. If the program were going to collapse in the next three years, it would be all the more important for Republicans to build the case for a replacement for it. We can be sure that the Left would respond to any such collapse by making the case for a “single payer” program in which the federal government directly provides everyone insurance.

Congressional Republicans have not reached agreement on what should replace Obamacare, let alone a strategy for enacting that replacement. The best option for replacing Obamacare would be a plan that made it possible for almost everyone in the country to purchase catastrophic insurance (and possible for most people to buy insurance that goes beyond catastrophic coverage) by removing the obstacles that government policy puts in the way of that goal.

Chait doubts that coming up with an Obamacare alternative would benefit the GOP politically:

Republicans have wisely decided to attack Obamacare without committing themselves to an alternative because the alternative would be easy to attack. Ponnuru, for instance, suggests changing the tax code and stripping regulations to create “a market in which almost everyone would be able to purchase relatively cheap, renewable insurance policies that protected them from the risk of catastrophic health expenses.” Telling tens of millions of Americans they’ll lose their insurance that covers basic medical expenses and get bare-bones policies with thousands of dollars in deductibles is not a winning play.

I don’t dispute Chait’s analysis – but wouldn’t it be great if the GOP and politics in general were not that cynical all the fucking time?