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One, I doubt that the cost of pre-exposure prophylaxis is greater than the cost of treatment for someone who has caught HIV.
Two, the more people become infected with HIV, the more opportunities it has to mutate, including mutations that would make it airborne or otherwise easily transmissible. If you ignore AIDS because "it's only killing gay people and drug users, and they don't matter", you run a not insubstantial risk of the first clause in that sentence no longer holding.
What would be effective policy to both maintain the current levels of HIV prevention and also reduce costs to taxpayers?
There's all kind of interesting lawfare going on these days. Could it be possible to follow the same kind of playbook that was used against Purdue Pharma?
Or perhaps dram shop laws?
Perhaps we should tax companies like Grindr (Tinder?) for facilitating HIV-transmission. Cities or other governments that publically glorify the homosexual and the drug-enthusiastic lifestyles (like Portland up until recently) should also be paying up on a federal level.
Once HIV infection is identified, we should be able to do some contact tracing, and make the most probable establishments that permitted the contamination (the last 3 bathhouses or bars visited by the infected within 3 days of probable infection) pay for the treatments.
If it appears that the infection occurred in a government-managed building or outdoors area, the government in question should be responsible for the treatments, unless they can prove that they have taken appropriate steps to mitigate possible infections.
In the spirit of the EEOC, HR departments, sexual harassment and discrimination trainings, I'm thinking of placards placed at regular intervals explicitly advising that anal masturbation and drug injections are formally prohibited in the area, the punishments associated with them, and the phone number to a confidential tip line to immediately address any possible incident.
Of course promotions, federal funds and contracts should be conditioned to how well these policies are applied.
We would need some new class of lawsuits similar to the ADA ones where any household or business harboring a rainbow or similar flag and symbols would be considered a supporter of the homosexual lifestyle and would have to contribute to a HIV-treatment fund, preferably through wage garnishment.
Figure out some way to produce anti-retrovirals more efficiently.
Buy out the patents and either void them or licence them for a peppercorn.
If someone develops a vaccine for HIV, or a cure for it, that would have a sizeable effect.
In general, things of the form 'everyone is still expected to contribute, either equally or in proportion to their means, to the costs of prevention; however, we will try to bring the total price tag downward.'
Your proposals, and others of the form 'total price stays the same, but we move the costs to my outgroup', are unlikely to be effective. 'I-got-mine-AMF-YOYO' attitudes have a rather nasty tendency to backfire.
It's not "I got mine". I'm more than happy to chip in for the healthcare of someone who got mauled in a freak alligator attack, but my enthusiasm drops suddenly when I find out they're an amateur alligator-wrestler.
Yes but to an extent everyone is an amateur alligator wrestler. Some people overeat, some people smoke, some people drink, some do extreme sports, or sports in general, some drive too fast, or pilot light planes and so on and so forth.
There are very few people who are utterly viceless when it comes to activities that increase the risk of illness or injury.
They're not amateur alligator wrestlers, they actually minimize their burden on society. They're more like the old men that used to go out "to hunt" in the dead of winter, knowing they will never come back.
Yes, but that doesn't mean anything. Saying "everyone is an extreme outlier, to an extent" is just saying "everyone is". "To an extent" nullifies the "extreme outlier" descriptor, which was the defining feature of the group I was pointing to.
Right, but everyone wants to minimise their own risk factors. Which is why the deal is we won't deny medical treatment to anyone. No-one can be trusted to objectively measure their own risks (I only overeat a bit!) against those of the people they dislike (they jump out of planes like lunatics!).
We are well aware that groups cannot be trusted to tell extreme outliers apart from non-outliers when social distaste is involved (as it pretty much always is) so our institutions have evolved to minimise that issue. Trying to go back to "this group doesn't deserve x because they do y" is opening the can of worms we just escaped from. We do it this way for a reason.
And smoking may kill people but it still puts a lot people in hospital for long painful treatment and decline. Smokers are not doing it so they die early in 30 years time after smoking 2 packs a day as some kind of honorable suicide. Plus the study that showed it was cheaper for smokers is contested. It was funded by Phillip Morris after all.
"This critique analyzes the methodology used in a study of the economic burden imposed on public finances in the Czech Republic by the consumption of cigarettes. The study was prepared by a consulting firm on behalf of the Phillip Morris Company. This critique, by using economic theory and a cost-benefit methodology, refutes the conclusion of the Phillip Morris study that smoking represents an economic benefit to Czech state finances. In fact, the correction of only one among numerous errors in assumptions and calculations in the Phillip Morris study leads to the opposite conclusion: Instead of savings of $150 million per year, smoking drains at least $373 million from the state budget annually, nearly.8% of the Czech gross domestic product. The net loss to the society is even greater if all pertinent costs and benefits are calculated properly. The critique demonstrates how to craft a rigorous economic response to common industry attempts to influence public opinion in which the industry employs specious or erroneous assumptions and data."
https://pubmed.ncbi.nlm.nih.gov/14982702/
Consensus building. No I am not aware of that, and would appreciate it if you would argue for that explicitly. Even if it was true, I don't need to rely on my ability to discern extreme outliers, because the gay community readily admits they are one, so unless you want to argue they have a distaste for themselves, your argent seems baseless.
I appreciate the correction, though I reserve the right to skepticism until I look into it further.
Either way you'll notice that, if this is true, it is precisely why tobacco is covered by heavy vice taxes.
Can I just point to history to show that we are very good as a species in judging our own behaviour objectively against others? The existence of the Russell conjugation proves it really, as it is describing a very common behaviour, for which the term would not need to be created if the action did not exist. I absolutely concede that there are some people who are rational enough not to do it. I think history shows the majority of humanity does though. Arguably that's part of the whole reason rationalism exists as an ethos/sub-culture.
As for smoking, "sin" taxes are indeed one way to square the circle, because they also disincentivize buying the product. But for gay people sex is the "product" and while we could raise taxes on rent boys, I don't think that really will be helpful volume wise. Adding a sin tax to Prep disincentivizes people buying it which makes the treatment happen less frequently. That's the opposite of what a sin tax is meant to achieve.
That's why you can't treat all "sins" the same. For some making the sin more expensive may help (where you have to buy a product or service) because it might make people indulge less frequently and you can put that money towards offsetting costs (see tobacco, alcohol, sugar et al). But in many other cases the sin is free. So making the preventives cheaper fills the same niche. Despite time periods that had heavy shame towards gay men, we have found no way to prevent them having pretty large amounts of sex with each other. Even in places where being gay can get you executed, it still happens, just more hidden. That's why you raise costs on smoking but make condoms free for example.
Sure, that is absolutely understandable. I think it's likely in some places with some combinations of taxes and healthcare/social care costs smoking may be cheaper. In others it might not be. The breakpoint is likely to change across time as well.
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