You could say the same about teen pregnancy being a practically solved problem, except there is still the problem of teen pregnancy. Or even something more mundane as driving consistently safely all the time to solve the problem of accidents.

If everyone was disciplined all the time in regard to everything, many problems in the world would simply not exist. But we live in reality where for whatever reason, people don't know to do something, or they do know and they're just not disciplined, or they make a mistake due to extenuating circumstances. And I would expect that the vast majority of people would oppose any idea of somehow punitively "dealing with" people who get some things wrong.

So I would say that it's very evidently not a practically solved problem, because if it were we wouldn't be looking to solve it still.

Within this reality, a vaccine is a great additional tool at solving the problem of preventing the spread of HIV.

It's a solved problem if you are someone that knows you'll be exposed to HIV in the very near future and you have the money and wherewithal to purchase PrEP before that event (and you can plan the event 7 days out).

The power of a vaccine is you can give it to adults and kids before they are sexually active and protect them, potentially, for the rest of their lives.

I'd also be curious to know if the combination of ART + the vaccine might cure someone of HIV. Which is also a pretty big deal.

Cost and compliance are still 2 major factors that have not been solved.

We also have education and stigma. While within the LGBT community it is far more common to be open about status and taking prep and doxy (far from perfect though), it still feels like outside of that the conversations are not happening as much as they should.

Throw in doctors that are not being proactive about the conversation.

Right now it seems like having prep and doxy is largely considered only if you are engaged in "risky" behavior (not saying that in a judgmental way to be clear), instead of just being sexually active and protecting yourself. Money and investment alone won't fix that, that is a societal shift around how we talk about sex.

That is also before we get into the cost issues in many other countries just for those that do need it.

It is endemic in the simian population. It will keep crossing over into humans again and again. It has done it before several times. People who live near forests would have to be on Prep everyday of their lives. The reason they eat bushmeat is the because they are poor and will be too poor to afford daily medication. A once-and-done vaccine would at least stop new crossovers. Only then could we really get a handle on ending this disease world-wide.

Transportation was a solved problem with horses, doesn't mean the car isn't a good idea. Same for internal combustion and EVs.

A vaccine is an objectively better solution than PrEP, just because of the time scale, PrEP needs discipline on a daily or x-monthly basis. A vaccine could last for years. Although, realistically, it's more likely to end up requiring yearly updates like COVID, because HIV is also a mutating son of a bitch.

I 100% agree that waiting for a vaccine is stupid beyond measure. The world should do both: make PrEP widely available AND keep funding vaccine research.

This is the wrong take. You are basically arguing that if we have one solution, why bother having a second one?

Isn’t prep more like a prophylactic, as opposed to a a vaccine?

I’m more familiar with malaria, where the preventative medicines are currently more effective than the vaccines.

prep is great but i would really rather take a one-time vaccine than be expected to take an expensive pill forever that could mess up my liver

There are some dubious metaphors in use here. Public health is not about math problems to be “solved.” “A solution exists” is just a milestone. “We just have to use them” - yes, but leave out “just,” there is more to do and it’s hard.

The answer to “are more tools really going to help” is always going to be “it depends.” Promising interventions sometimes fail entirely. If they statistically improve outcomes, that’s a win. Only occasionally is a disease entirely eradicated.

A few people I know on PrEP have annoying uncomfortable side-effects. Vaccines are largely more tolerable, especially on a discomfort/time metric.

There's still a huge difference between a one off injection and lifelong tablets.

Are people still getting infected? Yes? Then it is not a solved problem.

PrEP is difficult on the body over time and though it can be used if you are high risk you are meant to avoid certain medications while using it and have to do follow ups with your doctor to check organ functions.

For rich people (meaning the ~3 billion people that have some sort of access to medical infrastructure), it is a solved problem, but there are quite many people without any access to it. Even for those "solved problem" people, taking a pill every day to be protected is inconvenient. They might not take it every day, etc.

Also, even if it were a solved problem, the methodologies developed here can probably help with other viruses too in the future. This has already happened with the antivirals originally developed for HIV.

Those on prep would welcome a vaccine, it would be a significant improvement. I agree that this is no reason to take the foot off the gas with prep availability, we need more ASAP.

"The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in wide-scale PrEP availability and public health education."

It wouldn't be stopped, only slowed. You would still have transmission from accidental or unknown exposure. You would also have a small portion of the population that didn't care, regardless of the education.

it's actually an interesting question: is there a point where the long acting prep injections have effective durations that look like vaccines and boosters. and yes, sadly, it appears that convenience and some of the psychological aspects of marketing play outsized roles in public health.

either way, worth doing. you never know when circumstances might change and another tool in the toolbox becomes essential.

In the global south a significant barrier is the lack of sex education, driven by local christian associations, which have significant power in local societies. They see it as "gender ideology" or as preventing births and thus being against the bible.

Who's waiting? The problem is the populations we need to distribute it to can least afford it.

The reason we want a vaccine is because there's a huge logistics difference between a twice yearly injection and the real magic of something more like an MMR shot where one dose is usually effective for life.

My hiv exposure was from an SA, I wasn’t on Prep. This will still save lives!

It's a solved problem for people in stable environments, who can follow instructions, take medication, etc.

This isn't just about HIV, it's about finding new ways to approach viruses. HIV wasn't the first and won't be the last virus we don't have a way to stop. This research adds to our knowledge about ways to attack some of the trickier viruses.

Everything is a "solved problem" if you're willing to ignore a variable (usually money or human life/toil).

It's a problem that was "solved" long before that by just wearing a condom and protecting yourself against other diseases too, and even pregnancy. Condoms are cheap, widely available and decades of condom-related education has been given out to many different generation of kids and adults worldwide.

Somehow we still need day after pills, abortions, antibiotics and other STD meds, and vaccines, now (hopefully) for HIV too.

Public health education means getting gay men to start wearing condoms or dental dams and apparently that's a bridge too far for them.

The total refusal for anyone at scale pretty much anywhere to use dental dams is particularly egregious:

https://www.theatlantic.com/health/archive/2019/04/dental-da...

https://slate.com/human-interest/2021/08/no-condoms-gay-sex-...

https://www.washington.edu/news/2024/02/27/qa-decline-in-con...

https://www.huffingtonpost.co.uk/entry/prep-condoms-gay-sexu...

At least a portion of the amount of people "in the closet" are closeted for fear of STDs, not particularly because of social stigma risk.

Project 2025 vehemently goes against of it. Why was I downvoted? I am right. The american government strides in lockstep with P25 and corruption.

Nobody else said it, so I will. Halting HIV transmission is a solved problem if people are willing to give up sex with untested strangers. The same is true of syphilis, monkeypox, and every other sexually transmitted disease. It says a lot about human nature that a small number of people would rather have society spend vast sums of money researching and developing prophylactics and vaccines instead of changing their own behavior, while the vast majority have enough self-control not to catch diseases through random sex.

> The ongoing loss of life and health due to HIV could be stopped if we cared enough to invest resources in...public health education.

It's definitely a problem of caring, but not one of education: there are not honestly many people out there who don't know that random sex leads to diseases, but there are some people who just don't care enough to prevent their spread. If they did care, they would have sex only with known, tested partners. Minimizing harms through additional investment of resources just leads people to continue to fail to care, at society's expense.