neo-neocon Mon, 18 Sep 2017 20:33:39 +0000 en-US hourly 1 I’m still going to do a bit of Emmy fashion Mon, 18 Sep 2017 20:33:39 +0000 Why? Because I enjoy it.

First up—somewhere, a raven and a flamingo are missing their feathers:

I just don’t understand the need to publicly bare so very much of one’s breasts, but it’s rampant:

What’s up with the matching Ace bandage around the elbow?:

More breast-baring. An ugly dress on a woman who, dressed differently, could easily look a whole lot better:

I sort of like this one, in a weird way. It looks like a Star Trek costume, and the colors are very unusual, but it has a certain classic elegance. Then again, maybe I’ve just looked at too many of these dresses:

Oh, Jessica, no! Say it isn’t so! Looks like a Disney villainess:

I could go on—and on and on. I’ll stop now, but I really really like this one, although perhaps it’s the skirt action:

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Mark Lilla gives advice to fellow-progressives on how to get elected Mon, 18 Sep 2017 19:54:22 +0000 Mark Lilla wrote a book called The Once and Future Liberal: After Identity Politics that caused a bit of a stir among his fellow-liberals because it said that in order to win elections the Democrats should abandon identity politics.

As an example of some of the reaction from critics, we have this Politico piece:

Today, Democrats simply cannot win evangelical voters for whom LGBT rights is an absolute deal-breaker. Of course, individuals bear multiple identities. It’s therefore incumbent upon liberals to try to convince such voters to privilege their identity as workers, environmentalists, teachers, parents, health care professionals or what have you, above their religious identity. In effect, history suggests that Democrats shouldn’t discard interest-group politics. They should get better at it.

And they should do so with steely-eyed recognition that one of the oldest and most powerful variations of interest group politics—white nationalism—is both resurgent and mainstream once again…

But it’s not the topic of identity politics that I’m going to write about today, and it’s not why I brought up Lilla. Something else he said caught my eye when I was reading this essay by Richard Fernandez. Fernandez refers to an interview with Lilla that appeared in The New Yorker recently (mostly behind a paywall, so I’m using quotes from it that Fernandez offered). In that interview, Lilla—who is a political scientist and professor at Columbia—had this to say:

…when we go out on the stump, it makes no sense to call out to various groups, as Hillary Clinton did, and inevitably leave people out. …

I want to get this across: we cannot do anything for these groups we care about if we do not hold power. It is just talk. Therefore, our rhetoric in campaigning must be focussed on winning, so then we can help these people. An election is not about self-expression. It’s not a time to display everything we believe about everything. It’s a contest. And once you hold power, then you can do the things you want to do.

Even if it’s not what the people who voted for you wanted you to do or expected you to do. In other words: lie, misrepresent yourself, do whatever you need to do to get elected, and then change the world—for the better and for their own good, of course.

Well, at least he’s being honest about it.

One thing I noticed during the Obama campaign and then presidency was how blatant this deception had become. This wasn’t just a garden-variety case of a candidate lying or shading the truth, making promises he couldn’t keep and painting a rosy picture to appeal to the largest possible number of voters. This was more, and I wrote about it several times in several posts (beginning way back during the 2008 campaign). But the summary version can be found in this sentence:

Obama is the first president who didn’t merely disappoint and fail to follow through on certain issues, but who fundamentally lied about who he was in the most basic sense, and about what he had planned…

On a very specific issue, that of gay marriage, I traced his outright lies here. But there’s plenty more where that came from.

When I was a kid, politicians on the left were more up-front about their intentions. Although there were lots of leftists in ordinary life who kept their leftism under wraps, generally speaking if a politician was running for office and he was a leftist you pretty much knew exactly how far to the left he was. Some of the more extreme leftists ran for office as members of the Socialist Party, for example. And more mainstream leftists such as Eugene McCarthy and George McGovern ran their campaigns making it quite clear where they stood and what they planned to do if they were elected.

Obama broke with that tradition—and I’m not not talking about the question of where he was born or whether he was a closet Muslim or any of those fringe issues (and by the way, I think he was born in Hawaii and that he is not a Muslim or even much of a believer of any kind). The break with tradition that I’m talking about was the fact that Obama was purposely unclear or even deceptive about what some of his more basic political positions and where he thought the country should be going and would be going during his presidency. “Hope and change”—it’s awfully vague, isn’t it?

Obama was able to successfully accomplish this because his political track record wasn’t especially long, although anyone who actually studied that record ought to have noticed that he was further to the left than he presented himself as being during his campaign. But his relative lack of political record helped to hide the extent of his leftism, and he was helped along in that endeavor by the cooperation of the MSM. That sort of approach would be likely to work best for the politically inexperienced; relative political neophytes can get away with it more easily, but if a person has a long long political trail it would be quite difficult.

That brings us to Donald Trump (doesn’t just about everything these days?), an even more extreme political neophyte than Obama was because Trump had never even held office before being elected president. Did Trump do the same thing? Did he fundamentally misrepresent himself politically?

I’m not sure, but I think the answer is “no, for the most part.” That’s because—unlike Obama—Trump isn’t an ideologue of left or right. He supports bits and pieces of both sides. His overriding presentation during the campaign was that he would put America first, and I think that has continued. On specifics, he often promised one thing one day and changed it the next, but I haven’t seen any vast ideological reversals—yet. In fact, I’ve been surprised at how much he’s adhered to the basics of his plan for the most part. I expected far less of a match between his campaign statements and his presidential acts than we’ve gotten from him so far.

[NOTE: Of course, people who believe that Trump is really a Russian agent or a closet Nazi also believe that he has indeed misrepresented who he is in a fundamental way. I don’t happen to agree with them.]

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On insulting half your audience: I never watch the Emmys, but if I did I would have stopped by now Mon, 18 Sep 2017 18:41:29 +0000 Apparently the folks who participate in the Emmys have come to feel that their mission is to put down Trump and his supporters, which is approximately half of the country.

I wouldn’t think that this would be good for ratings—or much of anything else except the swelling of the Emmy participants’ own egos, which were probably sufficiently large to begin with.

Long long ago, back when I was a freshly hatched blogger (January 2005), I wrote a post about this sort of thing—not in connection with the Emmys, but the phenomenon in general. I reproduce it here.

It happens nearly every time. I’ll be reading a short story, let’s say, enjoying myself, lost in the experience—when suddenly, there it is: the gratuitous and mean-spirited and out-of-context slap at Bush, or at those who support him. It’s not as though the story is even tangentially about politics, either; it can be about anything at all, it doesn’t really matter.

The Bush-dissing will be thrown in when you least expect it, just to let the reader know—well, to let the reader know what, exactly? To let the reader know that the author is hip, kindly, intelligent, moral—oh, just about everything a person ought to be. And that the reader must of course be a member of the club, too—not one of those Others, the warmongers, the selfish and stupid and demonized people who happen to have voted for Bush.

Back when I was one of the gang, too, back when I was in with the in crowd (“if it’s square, we ain’t there”), did I notice when authors dragged in their political credentials from left field? Or perhaps it wasn’t quite as commonplace back then for them to do so?

At any rate, now it seems positively obligatory. I’m reading along, sunk deep within the story, bonding with the characters—and then, suddenly, it’s as though the author has reached a hand out of the pages of the magazine (OK, I’ll confess, sometimes it’s the New Yorker—yes, I still read it for the fiction, just as some people claim they read Playboy for the interviews) and slapped me across the face.

Authors, do you really want to do this? Because, with a single sentence, you’ve managed to alienate and offend (not to mention insult) up to half your audience.

I don’t think this even occurs to you. I think you just assume that anyone perceptive and intelligent and downright nuanced enough to be reading your fabulous work couldn’t possibly—no, say it isn’t so, Joe!!—support that disgusting, repulsive, lying POS Bush. Or maybe you just don’t care. Maybe you don’t want people like that for your audience.

It’s not just authors. It’s plays, concerts, performances of all kinds, even those given by friends of mine, people I know and otherwise respect, people with good hearts. It’s poetry readings most particularly. It’s gotten so bad that I go to all cultural events girding my loins and waiting for the blow to fall, waiting for my intelligence and judgment and ethics to be insulted. And this from people who consider themselves culturally and morally superior, although this sense of superiority doesn’t seem to reside in their needing to prove themselves to be well-informed or logical or knowledgeable about the issues—just in letting the world know that they’re on the right side of them (which would be the left side, naturalment).

Maybe Trump-bashing shouldn’t affect me the same way, because I’m not exactly what you’d call a Trump-supporter. But it does affect me the same way; turns me off utterly and entirely. And in the many years since I wrote that post, the phenomenon of liberal entertainers and artists gratuitously bashing the political opposition when performing or in their fiction or at awards ceremonies has only gotten more ubiquitous. I feel a surge of anger and annoyance whenever people do it, and they do it a lot.

Something akin to that anger and annoyance was described by John Updike in an essay he wrote in the late 80s about the Vietnam protests of the 60s and his own reaction among the literati back then:

The protest, from my perspective, was in large part a snobbish dismissal of Johnson by the Eastern establishment; Cambridge professors and Manhattan lawyers and their guitar-strumming children thought they could run the country and the world better than this lugubrious bohunk from Texas. These privileged members of a privileged nation believed that their pleasant position could be maintained without anything visibly ugly happening in the world. They were full of aesthetic disdain for their own defenders, the business-suited hirelings drearily pondering geopolitics and its bloody necessities down in Washington. The protesters were spitting on the cops who were trying to keep their property—the USA and its many amenities—intact…

It was hard to explain my indignation, even to myself. The peace movement’s predecessor and progenitor, the civil-rights movement, had posed no emotional problem…

…Those who deplored the war fit what protesting they could into their suburban schedules and otherwise dismissed it with a gesture of automatic distaste; the technocrats of our acquaintance, the electronic engineers and stockbrokers and economics professors, tended to see the involvement as an administrative blunder, to which they could attach no passion. But I—I whose stock in trade as an American author included an intuition into the mass consciousness and an identification with our national fortunes—felt obliged to defend Johnson and Rusk and Rostow, and then Nixon and Kissinger, as they maneuvered, with many a solemn bluff and thunderous air raid, our quagmirish involvement and long extrication. My face would become hot, my voice high and tense and wildly stuttery; I could feel my heart race in a kind of panic whenever the subject came up, and my excitement threatened to suffocate me…

…Were we really secure enough—high and mighty and smug enough—to become a pacifist nation? “You don’t get something for nothing,” my father, a schoolteacher, would frequently say…I would rather live under Diem (or Ky, or Thieu) than under Ho Chi Minh and his enforcers, and assumed that most South Vietnamese would. Those who would not, let them move North. But the foot traffic, one could not help noticing in these Communist/non-Communist partitions, was South, or West, away from Communism. Why was that? And so on.

I wanted to keep quiet, but could not. Something about it all made me very sore. I spoke up, blushing and hating my disruption of a post-liberal socioeconomic-cultural harmony I was pleased to be a part of…

…My thoughts ran as follows. Peace depends upon the threat of violence. The threat cannot always be idle…It was all very well for civilized little countries like Sweden and Canada to tut-tut in the shade of our nuclear umbrella and welcome our deserters and draft evaders, but the United States had nobody to hide behind. Credibility must be maintained. Power is a dirty business, but who ever said it wasn’t?…The Vietnam war—or any war—is “wrong,” but in the sense that existence itself is wrong. To be alive is to be a killer; and though the Jains try to hide this by wearing gauze masks to avoid inhaling insects, and the antiabortionists by picketing hospitals, and peace activists by lying down in front of ammunition trains, there is really no hiding what every meal we eat juicily demonstrates. Peace is not something we are entitled to but an illusory respite we earn. On both the personal and national level, islands of truce created by balances of terror and potential violence are the best we can hope for. Pacifism is a luxury a generous country can allow a small minority of its members, but the pacifism invoked in the anti-Vietnam protest was hypocritical and spurious. Under the banner of a peace movement, rather, war was being waged by a privileged few upon the administration and the American majority that had elected it…

My earliest sociological thought about myself had been that I was fortunate to be a boy and an American. Now the world was being told that American males—especially white, Protestant males who had done well under “the system”—were the root of evil.

It’s a very long essay, beautifully written as Updike’s work always is whether you like it or not. It’s sobering that he could write a line such as “Now the world was being told that American males—especially white, Protestant males who had done well under ‘the system’—were the root of evil” in describing the 60s of about 50 years ago. But yes, I remember the 60s, and I was there.

[NOTE: That last sentence is a reference to this.]

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Why we increasingly shop online these days Sat, 16 Sep 2017 16:49:11 +0000 The other day I decided I wanted one of those kitchen mats that are cushy to stand on. Actually, I wanted two. I use one little rug in front of the sink for when I’m washing dishes, and one in front of my computer because I work standing up due to the effects of my long-ago back and arm injuries. The rugs I have now have seen much, much better days.

So I went to Bed Bath & Beyond to peruse their selections. They’ve got a ton of kitchen stuff; why not a little rug?

But nada. However, one of the women who worked there told me that until recently she’d worked at Home Goods and they had plenty of them. Go there, she said.

So a few days later I made the journey. I couldn’t find anything there, either. But I asked a young man who worked there and he said yes, they had some with the other area rugs, and that they were mostly to be found on the bottom shelf of the section, interspersed with all the other little area rugs.

So I went back to look. The display was chaotic and appeared as though no one had ordered it in a long long time. There were a lot of little rugs, and I had to look through most of them before I found my prize: one of those foamlike “comfort” rugs. In chartreuse. A sort of fake basket-weave chartreuse.

No wonder it was still there. Hideous.

And it immediately occurred to me that this is why brick-and-mortar stores aren’t doing so well these days compared to the internet. And it’s a vicious cycle, because as the stores do worse, they cut back on hiring staff, and therefore they are maintained a lot worse and the staff hardly cares one way or the other.

At least, that was the attitude of the guy who spoke to me. He conveyed the idea that he could barely be bothered to answer my question and point the way, much less go to the rugs and help me find one. And there was no other customer in the store at the time.

Contrast that to what you can find here. I ordinarily like brick-and-mortar stores because I like to see what I’m buying, but in this case I’ll be ordering something online.

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Intelligence, heredity, and environment Sat, 16 Sep 2017 16:30:01 +0000 In school I always did very very well on IQ tests. But I also always felt they did not, and could not, measure some completely innate and unchanging thing called “intelligence.” Here is some research support for that perception.

I’m referring to a curious phenomenon known as the Flynn effect. In the huge amount of verbiage on the subject of intelligence (as measured by IQ scores) and heredity vs. environment and race and class, the Flynn effect is well-known in the field of research but far less well-known in non-technical articles for the general population on the subject of IQ. Here’s a brief definition:

In his study of IQ tests scores for different populations over the past sixty years, James R. Flynn discovered that IQ scores increased from one generation to the next for all of the countries for which data existed (Flynn, 1994). This interesting phenomena has been called “the Flynn Effect.” Many of the questions about why this effect occurs have not yet been answered by researchers.

As with many fields of scientific inquiry, there’s no small amount of politics involved in such research, both with those who perform it and those who use it to make various points. In addition, we have all the intrinsic problems and difficulties of psychological research with human subjects.

But given those caveats, nevertheless the Flynn effect seems to be both real and widespread:

In general, countries have seen generational increases between 5 and 25 points. The largest gains appear to occur on tests that measure fluid intelligence (Gf) rather than crystallized intelligence (Gc)….

…[Tests for fluid intelligence] try to emphasize problem solving and minimize a reliance on specific skills or familiarity with words and symbols. These tests on average have shown an increase of about 15 points or one standard deviation per generation…Deary (2001) notes that it is these types of tests (i.e., “culturally reduced”) on which we would not expect to see score increases if the cause of the increases was due to educational factors.

…IQ gains for [tests of crystallized intelligence) have been more moderate, with an average of about 9 points per generation…

Flynn believes that the increase is actually an increase in abstract problem solving rather than intelligence. Flynn…favors environmental explanations for the increase in test scores.

You don’t have to agree about the strength of environmental factors. But those who don’t agree still need to explain the results known as the Flynn effect. Some of the environmental factors studied and cited to explain the effect are years of formal education, which apparently correlates somewhat with the rise in scores, as well as nutrition, which has some correlation as well.

I doubt that any one factor explains it. But I think it’s likely that something is changing that’s environmental and leads to the higher scores, which indicates that IQ tests don’t just measure some wholly innate factor called intelligence, but instead measure something called intelligence that is linked (as are so many things) to some combination of heredity and environment.

The real question is how much of the variation in intelligence found among countries and among groups within a country can be attributed to heredity and how much to environment. I’ve read a great deal on the subject—much much too much to go into in any blog post (it’s a very complex subject)—and my conclusion is that the jury is out on it but that environment is definitely an important factor.

Who cares? Obviously, a lot of people do. But to me, individuals are individuals and everyone must be evaluated on the strength of his/her own personality and achievements. Some members of all ethnic groups are brilliant. Some members of all ethnic groups are dumb. Even if most of the variation among groups were to turn out to be hereditary—and I happen to think that is not the case—how would it change anything? It still wouldn’t tell us one single thing about any individual and his or her potential to achieve. And it oughtn’t to ever affect the human rights of anyone, or the concept of equality of opportunity.

But there’s plenty more information on the Flynn effect and attempts to tease out what may be going on regarding environment. For example, see under the heading “environmental factors” in this analysis of the Flynn effect. See also this, this, this, this, and this.

And that’s just the tip of the iceberg.

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I see that Fox News… Sat, 16 Sep 2017 16:02:34 +0000 has noticed the red-pill political changer phenomenon I wrote about a couple of weeks ago.

Interesting. Seems to be a trend that’s getting some notice.

[Hat tip: Ace.]

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Car question Fri, 15 Sep 2017 18:56:34 +0000 A question for all you car folks out there—

I’m thinking of buying a used car with active safety features, although I rather I like my car—2010 Ford Fusion. Some makes and models of car introduced these features a couple of years ago (I think around 2015) as options. On some models they were even made standard on more recent cars.

I’ve never bought a new car in my life. The used cars I’ve bought have been relatively low mileage—in the 30 thousand-or-less category—and that’s what I’m planning to do now. The prices are so much better that to me it makes more sense to do that than to buy a new car for a whole lot of $$$ and have it depreciate so much immediately.

My question for you is whether you’ve driven a car with some of these active safety features, and if so what you think of the car and the features.

Isn’t this more fun than talking about Trump?

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Burning their MAGA hats: right, left, and DREAMERS Fri, 15 Sep 2017 18:26:22 +0000 It’s been reported that a great many Trump supporters, angered by his supposed DACA deal, have taken to burning their “Make America Great Again” hats.

No doubt the MSM are happy as clams over this.

I have noticed several types of Trump reportage from the press. The first type is designed to hurt Trump with both the right and the left, and it’s of the “Trump is stupid” or “Trump is crazy” or “the Trump administration is a chaotic mess” variety. The second type reports on something Trump has done or is about to do that favors the right and is designed to drive the left crazy. The third type does the opposite—reports on something the right (and particularly Trump supporters) has wanted and that Trump supposedly is preparing to jettison.

Some of these stories turn out to be true. But some are false. Whichever variety they are, the stories are relentless—-many piled on many more, day after day after day. It’s not easy to sort out the false from the true. But I would caution everyone to not react prematurely to stories that are mere rumors, such as the DACA-deal one.

Of course, if Trump supporters want to send Trump a message about DACA, that’s fine with me. But I don’t know why they’d trust the press on this.

There’s another aspect of the Trump/DACA story that puzzles me. My own recollection is that during Trump’s campaign he promised many things, including many things about DREAMERS (the people affected by DACA). Sometimes he was sympathetic to them and sometimes not so sympathetic. But I don’t recall him ever saying he was going to deport them. Nor have I seen any recent article that goes back and finds a quote from him to that effect. And yet a lot of people keep alluding to the fact that he went back on a promise of that sort.

I say, show me the promise. Maybe it was there and I just missed it. But I haven’t been able to find it so far.

What I have found are old articles in which the MSM said that Trump would be likely to deport DREAMERS. But his own words don’t seem to indicate that. For example, his most major campaign speech on the subject of immigration, given in Sept of 2016 in Phoenix and widely billed as a statement of the more Draconian measures he’d been advocating, didn’t say it. Here are some excerpts from that speech:

We will treat everyone living or residing in our country with dignity. We will be fair, just and compassionate to all. But our greatest compassion must be for American citizens.

President Obama and Hillary Clinton have engaged in gross dereliction of duty by surrendering the safety of the American people to open borders. President Obama and Hillary Clinton support Sanctuary Cities, they support catch-and-release on the border, they support visa overstays, they support the release of dangerous criminals from detention – and they support unconstitutional executive amnesty…

On day one, we will begin working on an impenetrable physical wall on the southern border…

Under my Administration, anyone who illegally crosses the border will be detained until they are removed out of our country…

Trump then talks for quite some time about various ways he plans to crack down on criminal illegal aliens, and touches on the issue of ending sanctuary cities. He then addresses DACA and DREAMERS (although he doesn’t use those terms):

We will immediately terminate President Obama’s two illegal executive amnesties, in which he defied federal law and the constitution to give amnesty to approximately 5 million illegal immigrants…

In a Trump Administration, all immigration laws will be enforced. As with any law enforcement activity, we will set priorities. But, unlike this Administration, no one will be immune or exempt from enforcement – and ICE and Border Patrol officers will be allowed to do their jobs. Anyone who has entered the United States illegally is subject to deportation – that is what it means to have laws and to have a country.

Our enforcement priorities will include removing criminals, gang members, security threats, visa overstays, public charges – that is, those relying on public welfare or straining the safety net, along with millions of recent illegal arrivals and overstays who’ve come here under the current Administration.

Now, maybe somewhere else Trump said something different from that. But as I read that—and remember, this was a speech widely regarded as a statement of his most forceful and complete anti-immigrant policy—he is saying that he will cancel Obama’s DACA order because it was unconstitutional, and everyone else will be treated case by case, with criminals and gang members the top priorities for deportation.

There’s more in the speech, but none of it is especially relevant to DACA. Nor does he mention what Congress might be doing about DREAMERS.

Recently Trump did exactly what he said he would do—rescind Obama’s DACA order because it was unconstitutional. Saying that every illegal immigrant is now subject to deportation does not even come close to saying every illegal immigrant will be deported or should be deported, and his priorities for deportation (criminals) have long been very very clear. In addition, Trump’s saying he will terminate Obama’s unconstitutional DACA order (and doing it) is not the same as saying that he will never ask Congress to help some of the DREAMERS, or that he would block Congress if they were to do so.

In fact, on other occasions Trump has expressed a fair amount of sympathy for DREAMERS. During the campaign, I certainly got the distinct impression that Trump would be at least somewhat conciliatory towards DREAMERS if he ever became president, although a lot of people on both sides acted as though they believed he would be very harsh towards them.

I find myself once again in the odd (to me) position of defending Trump, or sort of defending him. I don’t have any interest in either defending or attacking him, though; my interest is in trying to get at the truth. It’s not easy and I certainly don’t always achieve it, but that’s my goal. And the truth as I see it is that Trump never was planning (and never said he was planning) to be as hard on the DREAMERS as his supporters on the right thought and hoped he was (or as the MSM said he was). And Trump never was planning to be as hard on the DREAMERS as his enemies on the left feared he was.

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HIV prognosis and spread—plus ça change, plus c’est la même chose Thu, 14 Sep 2017 20:22:28 +0000 It’s been my impression that advances in antiviral drugs in recent years have transformed the treatment of HIV/AIDS, once a death sentence. But I wondered how accurate that perception of mine was.

I got curious and looked it up, and it turns out it’s even better than I’d thought:

HIV/AIDS has become a chronic rather than an acutely fatal disease in many areas of the world. Prognosis varies between people, and both the CD4 count and viral load are useful for predicted outcomes. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. After the diagnosis of AIDS, if treatment is not available, survival ranges between 6 and 19 months. HAART and appropriate prevention of opportunistic infections reduces the death rate by 80%, and raises the life expectancy for a newly diagnosed young adult to 20–50 years. This is between two thirds and nearly that of the general population. If treatment is started late in the infection, prognosis is not as good: for example, if treatment is begun following the diagnosis of AIDS, life expectancy is ~10–40 years. Half of infants born with HIV die before two years of age without treatment

Before all this happened, about 30 million people had died worldwide since AIDS burst on the scene. I remember when the disease raced though the dance world and killed many of its leading lights. Horrible.

So we don’t hear anywhere near as much about HIV or AIDS as we used to. And this all makes me wonder whether rates of infection have gone up or down or stayed the same, now that treatments are available.

The answer is “all of the above.” The situation is complex; you can find a lot of statistics here and some more here. A few of the most salient facts: diagnoses have gone down in most populations but stayed relatively stable in the gay population (accounting for about 2/3 of new diagnoses), particularly the black and Hispanic gay population. Among white gay and bisexual men, incidence has decreased, but among Hispanic gay and bisexual men it has risen, while rates have been relatively stable among gay black men.

If you look at the chart here, you can see that HIV is concentrated in certain areas of the country. Half the cases are in the South, for example.

A map (from 2016)—with lifetime incidence rates—can be found here:

You can see from the map that the incidence of HIV infection in Washington DC is a whopping 1 in 13. That’s extraordinary. States such as Louisiana, Georgia, Florida, New York, and Maryland are all around the 50-70 mark, with Texas at 81.

This is shocking and disturbing. Why are rates still so high despite antiviral drugs that can not only help the patient but can markedly reduce the chance of transmission of the virus from that patient to others? Some clues to what’s going on can be found here

…[L]ooking across the spectrum from HIV diagnosis to viral suppression reveals missed opportunities for addressing the epidemic. According to the Centers for Disease Control and Prevention (CDC), while many people with HIV are diagnosed (87%), far fewer are retained in medical care (56.5% of those diagnosed) and fewer still are virally suppressed (55% of those diagnosed). Viral suppression is greater among those who are in medical care.

Because HIV can be transmitted long before it is symptomatic, that figure for the infected-but-undiagnosed (13%) is part of the transmission pattern. People think they are safe when they are not, and practicing preventive measures is often jettisoned where sex is concerned (in the heterosexual arena, that same phenomenon leads to high rates of unwanted pregnancy despite the high availability of many varieties of effective birth control). I would guess that the falling death rates for AIDS might have a part in this feeling of false safety, as well.

And why are so many people who are diagnosed not being treated with antiviral medication, almost half? There are some clues here (although the study was done in Australia, the psychology might be similar). A lot of people feel that the drugs make them more aware that they have HIV, and as long as they’re not feeling bad physically (yet) they don’t want that reminder. That seems problematic to me if they are sexually active with an uninfected person, because antiviral drugs could markedly reduce the chances of their transmitting the disease.

Here’s a Canadian study:

Nearly 20 years after ART became available, therapy is much simpler (often once a day and there are entire regimens available in one pill), safer and more effective. However, there are still HIV-positive people who do not wish to start therapy, though there are many benefits to starting early. At the level of the individual, early use of ART can reduce the amount of HIV in the body. This reduction in HIV helps relieve ongoing damage to the immune system, brain, heart, lungs, kidneys and other vital organs and systems. At the level of thousands of people in a city or region (what researchers call “population level”), taking ART every day exactly as directed and getting regular checkups for sexually transmitted infections helps to greatly reduce the future risk for spreading HIV. This is an important benefit for the community.

Researchers in the European Union and Australia conducted a survey of HIV-positive patients and their doctors about perceived barriers to starting ART. Analysis of the survey results suggest that in the current era barriers to initiating therapy still exist but are different from those of the late 1990s. A primary barrier among HIV-positive people today is that they may not feel sufficiently unwell and they lack serious symptoms that would hasten their entry to treatment. Major reasons by doctors for delaying the initiation of ART include that they perceived some of their patients to be suffering from a degree of depression, that there was active substance use and that patients did not understand the need to adhere to HIV medicines.

It seems as though this is a very difficult population to treat. Particularly the young people (the following data is for the US, not Canada):

Significantly fewer young people with HIV accessed services to maintain viral suppression. The researchers found only 13 percent of HIV patients aged 18 to 24 had achieved viral suppression, though that percent doubled for people aged 35 too 44. Nearly 40 percent of HIV-positive people over age 65 were able to effectively manage their disease with drugs and other health care services.

And then there’s money. I don’t know how often that’s the barrier to taking the drugs, and I haven’t found any statistics on it, but even in Canada payment for the antiviral drug treatment can be a problem. I was surprised to hear that; previously I had been unaware that medication wasn’t necessarily covered there. Some Canadians have private insurance that helps, and each province has a special program to subsidize AIDS drug payments. There is a lot of variation there:

Generally, the publicly funded provincial and territorial drug programs offer coverage for people on social assistance (“welfare”) and for seniors over the age of 65. Some provinces issue cards to show to your pharmacist that prove you are entitled to this type of coverage.

Some provinces and territories offer assistance to cover costs for other citizens who have high drug costs but little or no private insurance. This is often referred to as a catastrophic drug program. The availability of such programs varies among provinces and territories…

In the US, there’s also a wide variety of programs to help people with drug payment (see this). No doubt money is a problem for some, but I have no idea how many. My guess, though, is that a lot of people might qualify for those programs that pay for drugs but are not about to pursue the treatment for a variety of reasons, including denial and/or drug addiction and/or fear.

As I got deeper and deeper into writing this piece, I felt a growing sense of sorrow. Although you can’t compel treatment, nor can you compel people to change their sexual behavior, the consequences for this behavior include a lot of suffering as well as the continuation and spread of a dreadful disease. I also realized as I wrote this post that some of the comments here were probably going to be of the “then let them rot” variety. I don’t feel that way. Not only are innocent lives affected negatively, but the social costs are great.

I don’t have a remedy, but I have compassion. You may not think that’s worth a whole lot, however.

The good news is that AIDS isn’t killing people at anywhere near the old levels, and that it never became a widespread conflagration as was often predicted. Even in Africa, where it has taken its deadliest toll, things have calmed down a bit.

[NOTE: This post had already grown so long that I decided not to get into the Truvada controversy. Maybe another post sometime.]

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Trump, DACA, the wall, and the press Thu, 14 Sep 2017 18:37:31 +0000 In the Trump era it’s gotten even more difficult to write about the news, for the simple reason that for the most part I distrust all prognostications and rumors, both of which have come to take up a larger and larger part of reporting ever since Trump was inaugurated.

Take these headlines at today’s page at memeorandum as an example. Here are the titles of the lead stories, in order:

Fox & Friends: Maybe Trump Wall Was ‘Symbolic’

Trump Caves on DACA, Wants ‘Quick’ Amnesty for 800K Illegal Aliens

Trump: “The wall will come later”

Trump’s diehard supporters are fuming after an apparent about-face on ‘dreamers’

Trump 2.0: They’re Sending Their Best!

Trump: If There’s Not a Wall, We’re Doing Nothing

White House: ‘There will be no amnesty’ under Trump

Trump, top Democrats agree to work on deal to save ‘dreamers’ from deportation

Now granted, much of the confusion (a wall or no wall? DACA deal or no DACA deal?) is due to Trump’s contradictory messages on the subject. But that’s par for the course. You know what I’d like to see—although I have no illusions that I will see it? Newspapers that report on what actually has happened once it has happened, rather than predicting what they think is happening or what is supposedly happening behind closed doors.

For example, how about a piece that says “Trump has been issuing contradictory and confusing statements on DACA, and we don’t really know what’s happening or what’s going to happen.” Yeah, I know; it wouldn’t make much of a story, would it?

To read every one of those articles and to try to sort out what really might be happening would take all day and then some. I’m not going to do it. But from what I’ve read, my impression is that some sort of compromise is being worked out that will preserve the DACA rights of some people while getting some sort of concession on the wall or the border.

Works for me—perhaps.

Till then, the best summary and the best guess I can find so far is by Paul Mirengoff at Powerline:

Late last night, in an update to a post about DACA, I noted that President Trump reportedly had just made a deal with Chuck Schumer and Nancy Pelosi regarding DACA-style legislation. The alleged deal would protect the roughly 690,000 people covered by the current DACA program (but not, I take it, other “dreamers”) and would include a package of border security measures, excluding the wall, that’s “acceptable to both sides.”…

The White House, though, is denying that it struck such a deal. Sort of.

Press Secretary Sarah Sanders tweeted:

“While DACA and border security were both discussed, excluding the wall was certainly not agreed to.”

Trump tweeted:

“No deal was made last night on DACA. Massive border security would have to be agreed to in exchange for consent. Would be subject to vote.”

Trump’s tweet has a non-denial denial quality to it. Obviously, the details of any deal would have to be worked out and the final deal would be subject to a vote. But this doesn’t mean Trump didn’t reach the framework for an agreement.

Note too that this statement doesn’t mention the wall — only “massive border security,” whatever that means.

Then today, Trump reiterated the importance of the wall itself:

“Very important is the wall. We have to be sure the wall isn’t obstructed because without the wall I wouldn’t do anything… It doesn’t have to be here but they can’t obstruct the wall if its in a budget or anything else.”…

“We’ll only do it if we get extreme security, not only surveillance but everything that goes with surveillance. If there’s not a wall, we’re doing nothing.”

Got that?

I will repeat something I’ve said many times before, something that should be obvious to anyone who’s been following Trump from the start of his candidacy two (count ’em, two!) long years ago: he goes back and forth on things. He sends out mixed signals, or at the very least ambiguous, hard-to-read signals.

His admirers say it’s because he’s cagey. His detractors say it’s because he’s an idiot and/or a liar. I say he’s no idiot, and he’s sometimes very cagey, sometimes flat-out lying, and sometimes changes his mind. On DACA he’s been very waffley from the start. On the wall not so waffley, although he always talked about that great big beautiful door, too.

We’ll see.

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