There's still a lot of uncertainty but here's the big picture: we are still distributing ARVs (the medications you need to take if you're HIV+ to stay alive and avoid spreading it.) There have been massive disruptions to provision of those ARVs and to the provision of tests.

You need tests to know if an ARV is working and to potentially switch to a second or third line medication if the first line is failing. There's one high profile release from Mozambique which suggests about 40% fewer people got their medications during the disruptions, but -

I'm kind of confused by its numbers - the primary comparison is February 2024 to February 2025 over which there's a big drop. Did that all happen in Feb? There's another drop from Feb to May reported but a smaller one. I don't want to cite it until I have more confidence in the#s

https://www.medpagetoday.com/s... if you want to read it - I haven't been able to find a paper, which is another reason I don't want to rely on it heavily.

We halted all programs to provide preventative medication to every category of people receiving it (which includes gay men, sex workers, women whose husbands are HIV+, etc) except pregnant and breastfeeding women. Approx 750k people in this category.

When I last wrote about this I estimated that perhaps a quarter of those people could contract HIV as a result. @gatturu wrote a thoughtful response persuading me that (per-year) it should be lower. One study in Kenya found 8% per year higher risk of contracting HIV w/out PreP.

(That's for a married couple where the husband has HIV and the wife does not.) So the PreP cuts have likely already caused many infectious, but if I had to guess I'd guess the bulk of deaths is from the ARV interruptions. The problem is that estimating deaths there is even

HIV takes a long time to kill you (unless you're a young child or otherwise in poor health, then it can kill quite quickly). But people who aren't on ARVs in Africa have markedly higher mortality even before they reach the advanced stages of HIV.

I'm not even going to try to hazard a number. As for how to help, my immediate donations were to the Rapid Response Fund through Founders Fund, but the rest of my donations for the year will be to GiveWell. They are more focused on other dropped parts of the aid portfolio.

They already did malaria and tuberculosis work previously, so it's more straightforward to try to pick up what was dropped there. They said in a blog post they may try expanding into areas like HIV that were previously well funded 😔

It's a lot of work to figure out how all of this trades off against what were previously the best opportunities in global giving but I trust @givewell to do it more than anyone else.

anyway DMs are open if you have any further questions!

@KelseyTuoc Out of curiosity, have you read this article on the PEPFAR program: https://www.csis.org/analysis/...

@newmachines Yes. I appreciate that it at least tries to tackle what next steps should look like, but it seems to me like it's in way too much of a hurry to jettison the program. Its real funding falls every year. It does more every year.

@KelseyTuoc Unrelated, but it’s getting around that you’re something of a freak!

It's a bit painful for me to share this, but I respect @KelseyTuoc (and @evavivalt) a lot, and I think they're basically right: the most rigorous recent studies on basic income and cash transfers (in rich countries) have yielded pretty disappointing results.

Never thought I'd become a 'take your relationship problems to ChatGPT' person but when the 8yo and I have an argument it actually works really well to mutually agree on an account of events for Claude and then ask for its opinion

Broke mutuals over this. You WILL appreciate Rothko, you WILL have an IQ above room temperature or you WILL be exiled from the lightcone. Fucking ask ChatGPT what’s so cool about this painting if you’re too stupid to form the thoughts and ask the questions yourself.

are you girls from china? cause you three gorgeous, damn