Where I am from, organised political movements are not a factor of teen pregnancy and were not the least bit in my mind when I made my statement.

And my two examples are completely arbitrary because my point applies to pretty much any problem which would be solved by people being “more careful”.

So, political/religious elements aside, teen pregnancy and road safety are the same in terms of “if people were just more disciplined, there would not be these problems” (i.e. if teens who have easy access to contraceptives planned ahead before giving into impulsiveness; if drivers were more attentive to their behaviour), which I then pointed out is naive because the reality is that people aren’t perfect, they aren’t always disciplined, we’re all only human.

Hence, we need other solutions to help with problems which don’t require ignoring that people are only human and lack perfect discipline.

I agree that some organised movements can be a problem in that they can make other problems worse.

I recently read "Everything is Tuberculosis". It describes a similar issue with the rich / poor country divide.

It's quite sad and difficult to read at times.

"the only reason HIV transmission is high in poor countries is because, well, they're poor."

This is factually untrue.

Being poor does not equal a HIV transmission rate. There is no 1:1 correlation.

A single protected (condom) sexual act between a male and female averages somewhere around 0.1-0.5% chance of pregnancy, and during the fertile window it could still be around 1% or more even with a condom.

Chance of HIV from one act of unprotected vaginal sex with an HIV-positive partner: ~0.08% male-to-female.

The high HIV transmission rates are NOT correlated with wealth, but social behavior. Unprotected anal sex with many partners? High risk. Now, Africa - the practice of dry sex contributes a ton to HIV transmission. Cultural belief that a dry vagina increases pleasure, hence woman use sand, chalk or bleach to dry out their vaginas, massively increasing HIV risk. Needle sharing of drug users? High HIV risk.

Not a class issue, no reason to punch down on poor people. Poor people have agency and many do not infect themselves with HIV in the first place.

We haven’t even managed to wipe out polio, and that is a cheap, lifelong vaccine.

>if PrEP had come out in the 80s when public hysteria was at an all-time high

You mean the time the US admin was intentionally neglecting the epidemic because "it's a gay disease"? Why do you think Reagan would have done anything to ensure such a medication was easily available?

> but if someone is unwilling to go on PrEP, why would they suddenly be willing to get a vaccine?

Because PrEP at even its best and most modern version requires an update every six months for life. If you're well-off and in SF or NYC or London that might be easy, but there's so many externalities such as:

- People who misjudge the risk they're at, so don't go on the meds in the first place

- People who live in regions where getting to a doctor even every six months is a challenge

- The six-month injection is extraordinarily expensive and a life-time treatment, for a disease you don't even have yet.

If instead it becomes a once-in-a-lifetime series of shot, like many other vaccines are already, we can start considering a path to extinguishing the disease, not just teaching people to live with it.

Then there's the financial savings of a series of three shots once vs a lifetime of them.

That's like asking "if someone is unwilling to practice abstinence, why would they be willing to wear a condom, or to flip a magic 'not fertile right at this moment' lightswitch?"

A vaccine is something you do once and PrEP is something you have to continue to do over time and get overcharged out the ass for the entire time and worry about if it will remain available in the future.

It's still killing people like crazy (and spreading) in undeveloped nations. The new drugs are un-cheap.

Also, I believe that we just DOGEd our only vehicle for distributing these to underdeveloped nations.

All the tools we have against teen pregnancy need teens making right decisions, or taking corrective actions.

If there were a pill that'd block pregnancy for X years, given at the age of Y, then parents could enforce it and teen pregnancy would be solved (also it'd be very cruel but I'm just trying to make a point so bear with me).

Going back to our topic: People could also forget PrEP, be drunk and forget to wear a condom and so on. If this vaccine (or vaccine series) creates a somewhat permanent protection, it'd make a huge difference.

Unfortunately HIV is not a solved problem.

Condoms? They break. More frequently than you might think.

Truvada and Descovy are great and make a big difference, but they require either high adherence to taking pills daily or being able to plan ahead for 2-1-1 (for same-sex relations - it's effectiveness for heterosexual intercourse hasn't been determined).

Apretude and Lenacapavir obviously require getting to a doctor or someone who can give you the injection either every other month or twice a year, is expensive, and can be very painful for some days afterward. And, of course, they're expensive.

A vaccine is the only real option for dealing with HIV for good.

The hardest problems to solve that actually matter are in humanities.

All your arguments are sound, and I'm still missing your point. Pharma is interested in doing pharma, indeed. But who's interested in your solution, assuming you have one? A significant part of the current electorate (internationally, even) seems to abhor sex ed, condoms, abortions and all that. So tell me again please how you suggest we address teen pregnancy - in THIS world.

Which is in fact panic that teens are not having enough children, because that's where we have seen big drops...

This whole "panic" seemed weird from the start, but once it becomes clear that it's from the lack of teen pregnancies it takes on an even creepier Epstein-like oddness.