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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 9:57 am 
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solipsistnation wrote:
annak wrote:
Finally, I really don't like the assumption that has crept into the vaccination argument that people have a duty to create some sort of herd immunity on behalf of other people. I think it sets a bad precedent in general to say that I'm obligated to put something in my body in order to protect someone else's health.


Oh?

So, if you happened to be carrying HIV, would you not bother to tell people and not bother to practice safe sex because, well, it's not YOUR obligation to protect somebody else's health?


i don't think that's quite a fair comparison. there is a difference between actively engaging in physical contact and lying about your status. non-vaxers don't lie about their status and aren't actively doing something to infect people.

anyway, i think unfortunately it is a trade off you have to live with in a free society. we can't force people to do things for the greater good. you can think their decision to not vaccinate is stupid and advocate against it, but annak's point holds.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 10:14 am 
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solipsistnation wrote:
annak wrote:
Finally, I really don't like the assumption that has crept into the vaccination argument that people have a duty to create some sort of herd immunity on behalf of other people. I think it sets a bad precedent in general to say that I'm obligated to put something in my body in order to protect someone else's health.


Oh?

So, if you happened to be carrying HIV, would you not bother to tell people and not bother to practice safe sex because, well, it's not YOUR obligation to protect somebody else's health?

All of us, every day, do things that we might not necessarily want to do (or refrain from doing things we'd like to do) in order to protect other people. That's part of living in a society.



While personally I consider myself at very low risk of contracting HIV and thus have a hard time saying what I'd do in that hypothetical situation, I do think it's the responsibility of individuals to protect themselves. An HIV+ person who is being treated for that is going to be at lower risk of passing the virus on than someone who has no idea he or she is carrying it. Since there's still a lot of stigma (depending on the culture/social environment) to being HIV+, I'm not sure that disclosure should be expected if people don't know each other well, and I definitely don't think it should be legally mandated for consensual sex partners. (This isn't really a good idea from a public health policy standpoint in my mind, since ultimately what mandatory disclosure would reward is people not getting tested in the first place.)


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 10:58 am 
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I just want to preemptively remind everyone to keep your comments civil here please.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 11:28 am 
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We get all of the vaccines for our children. We do split them up by a few weeks and get 2 or 3 at a time, because I know I don't like getting 4 or 5 shots at once, so I presumed my kids wouldn't either. Things like pertussis and measles are actually coming back around my area. It's a bit scary.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 11:59 am 
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I used to be mildy pro-vax, but I have become more and more strongly pro-vax since having my daughter and reading up on this stuff. Yes, the side effects of vaccines can be scary, but I think the diseases are far scarier. Lydia didn't get a Hep B vax at birth (that just seemed pointless), but all other vaccines have been on schedule and will continue to be.

Honestly, I get a bit angry thinking about this too much because unvaccinated kids are basically relying on fully vaccinated families like mine to keep them healthy. I do understand that anti-vax parents are doing what they think is best, but it still bothers me. This is why I NEVER talk about vaccination with other parents whom I do not know well.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 12:04 pm 
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We vaccinate on the normal schedule... no one in my family has ever had an adverse reaction to any vaccine, we're not allergic to any vaccine ingredients, they have had to be in daycare and go to (or will go to) public school, and overall I believe the benefits outweigh the risks. And despite the fact that it bugs me that flu shots contain egg, there's no way we won't be doing flu shots this year - the baby will be here right at the beginning of flu season.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 12:10 pm 
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The measles has been making a comeback thanks to people avoiding vaccination.
http://www.boingboing.net/2011/05/25/th ... ppens.html

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 12:12 pm 
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Another recommendation for Seth Mnookin's The Panic Virus. You won't look at this debate the same way.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 12:14 pm 
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What is a holistic or naturopathic vaccine?

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 12:57 pm 
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annak wrote:
I'm about as pro-vaccine generally as a person gets, but there are a few things about the debate in general (not necessarily here) that always bug me.

One, the assumption that everyone who makes a nonstandard choice is doing so because of faulty information like that autism study. I'm concerned about autism but that's totally separate from any concerns I have about vaccines, and I think it's really patronizing to assume that people who choose not to vaccinate their children haven't researched this and made their own decisions on it.


Agreed. We have chosen to follow the Dr. Sears alternative vax schedule for our son. He will be fully vaccinated, just with fewer vaccines given at one time. We aren't doing this because of the Autism study, Jenny McCarty, etc. Our son was born premature and almost died from a rare lung disease at birth. After a one month stay in NICU on all kinds of medication that taxed his liver and immune system, we want to give the guy a little break from the meds. Our pediatrician is more than fine with this, and a few NICU nurses even suggested it to us.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 1:01 pm 
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I ended up going with the normal recommended vax schedule for my son. We did ask them to break up one month when he was supposed to get 4 into two visits, so it was a bit slower, but that's about it.

In the first few months he'd get tired after a shot (which was actually great because he usually doesn't sleep well!) but that's about it. He's all done now until a year old.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 1:07 pm 
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we do an alternative schedule, the kids get most of them just at a different pace. I am a bit scared since we have a strong history of autoimmune diseases in this family. I had a bad thing happen when my son was a baby, he was vaccinated without my permission, the nurse basically told me to stfu and there is no record of that vaccination-it was for the flu and he was too young for it. So I strongly distrusted any doctors so he didn't get anything until he was 2. He just had his first round and that was it. He's on the autism spectrum and was showing signs before the age of 2-so I don't do the alternative schedule because of autism, which everyone thinks.
We can get exemptions here for medical and religious reasons. Also, we've run into the fact that my son was almost refused treatment because he was not fully vaccinated. He was near a coma and doctors were flipping out that he didn't have the mmr shot yet. He was hospitalized later that year for something that couldn't have been prevented by a vaccine, yet I was questioned again on his status and threatened if he tested positive for the flu. They wouldn't release him until he was fully caught up. So a boy who was just in the PICU near death because of diabetes was shot up with around a dozen vaccines a few days later, which didn't make things easier for his health because vaccinations sometimes cause high blood sugars. So overall, I'm a bit leery with doctors but have to find some kind of balance.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 1:09 pm 
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FootFace wrote:
What is a holistic or naturopathic vaccine?

That was my question...

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 1:19 pm 
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vegimator wrote:
The measles has been making a comeback thanks to people avoiding vaccination.
http://www.boingboing.net/2011/05/25/th ... ppens.html


After reading the boingboing excerpt and the slightly more informative plos.org post (but not yet the original CDC report), I still don't see a lot of evidence that this is a result of people deliberately choosing not to vaccinate or that this is compelling evidence to force it. 11% of the cases involve [fully] vaccinated people, 20% (either of the remaining 89% or, as the later sentences seem to imply, of the total; it doesn't make the numbers very much different) are too young to have had any vaccine regardless of parental opinion, and another 20% are too young to have been through the full vaccination schedule. So about half of these cases are definitely NOT people who've deliberately avoided vaccination, and among the other half it's not clear what the reasons are or the age breakdown. (The plos.org post goes on to mention Somali immigrants in Minnesota, but I don't see evidence that the measles cases involve these immigrants, or that they are anti-vaccine rather than some other practical or cultural issue. Immigrant communities can have varying / really low vaccination rates, and I think a better response is for healthcare providers to find out why and address those reasons.)

I thought the figure that 98% of hospitalized cases are of unvaccinated people was a good indicator that even when it doesn't work ideally, vaccination helps; the symptoms will be less severe if you do come down with a disease despite previous vaccination. (This makes me wonder why private insurance companies don't balk more at nonvaccinating parents, given that $150k figure, but maybe they do?)

So in my mind, the question to answer is: have we really reached a tipping point in vaccination rates due to parental choice (rather than other factors like access to healthcare or immune problems preventing vaccination or higher concentrations of small children in daycare facilities or anything else) that changes the risks for other people? I tried to google around for information that would answer this and am not meeting with a whole lot of success, but I did think this is interesting (and points to a completely different social problem): http://www.aafp.org/online/en/home/publ ... rates.html


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 1:39 pm 
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annak wrote:
Finally, I really don't like the assumption that has crept into the vaccination argument that people have a duty to create some sort of herd immunity on behalf of other people. I think it sets a bad precedent in general to say that I'm obligated to put something in my body in order to protect someone else's health.

To the extent that moral arguments create precedent of any kind, that precedent is well established in the limited case of parental responsibility--we already hold (most of us) that parents do have an obligation to put at least some things in their children's bodies. Like, say, putting sufficiently nutritious food in their foodholes.

I've rarely seen the debate turn to compulsory vaccination in the US, and certainly not to compulsory vaccination of adults.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 5:21 pm 
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annak wrote:
Then, there seems to be this dichotomy set up between people who don't follow the CDC recommended schedule and people who "selectively vaccinate," popularly regarded as causing some sort of major epidemiological catastrophe. The thing is, everyone is vaccinating selectively to some extent. The US recommendations aren't the same as Europe's or other country's, and we're all making choices based on what we think the likelihood of benefit vs. the likelihood of harm are, it's just that some people are taking someone else's recommendations and some people are deviating from that. How many people in the US are vaccinating their kids against yellow fever? If they haven't, does that mean they don't care if their child gets yellow fever? No, it just means that it's generally accepted that the benefit of getting the vaccine is considered low compared to the costs.



I just wanted to comment on this, because this is something that my crazy international life has allowed me to think about. I agree that it is interesting to compare your countries requirements to those with similar environments. That said, there are some pretty straightforward reasons why these requirements vary. For example, you wouldn't push HiB vaccines with the same urgency in a place where under 0.5% of the population is a carrier, like in the States, and where as much as 20% of the population is a carrier, like in SE Asia (WHO data) - even if you happened to compare countries with similar economic development.

Also, countries even with simila r environments may have different policies but that both work towards creating a coherent public health policy. I believe that in Western Europe, at least when I was a kid, the assumption was that enough kids contracted chicken pox to create herd immunity and protect the adults from shingles. In the US, the herd immunity would be achieved by vaccinating. That doesn't mean that it's perfectly fine not to vaccinate when you're in the US or that the risk/benefits would be the same than if you didn't vax in Europe.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 5:50 pm 
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annak wrote:
solipsistnation wrote:
annak wrote:
Finally, I really don't like the assumption that has crept into the vaccination argument that people have a duty to create some sort of herd immunity on behalf of other people. I think it sets a bad precedent in general to say that I'm obligated to put something in my body in order to protect someone else's health.


Oh?

So, if you happened to be carrying HIV, would you not bother to tell people and not bother to practice safe sex because, well, it's not YOUR obligation to protect somebody else's health?

All of us, every day, do things that we might not necessarily want to do (or refrain from doing things we'd like to do) in order to protect other people. That's part of living in a society.



While personally I consider myself at very low risk of contracting HIV and thus have a hard time saying what I'd do in that hypothetical situation, I do think it's the responsibility of individuals to protect themselves. An HIV+ person who is being treated for that is going to be at lower risk of passing the virus on than someone who has no idea he or she is carrying it. Since there's still a lot of stigma (depending on the culture/social environment) to being HIV+, I'm not sure that disclosure should be expected if people don't know each other well, and I definitely don't think it should be legally mandated for consensual sex partners. (This isn't really a good idea from a public health policy standpoint in my mind, since ultimately what mandatory disclosure would reward is people not getting tested in the first place.)

I'm confused. Are you really suggesting that if you are HIV+ that you don't have a moral obligation to tell any and all people you are going to have sex with that you are HIV+?

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:01 pm 
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Vantine wrote:
I'm confused. Are you really suggesting that if you are HIV+ that you don't have a moral obligation to tell any and all people you are going to have sex with that you are HIV+?


Well, given that the most dangerous people who are HIV+ don't know they are... I don't see how they have a moral obligation to disclose something they don't know, no.

I think that more importantly there's a dangerous assumption here that the riskiest sex partner is the one who knows he or she is HIV+ and is receiving treatment, and I don't agree with that at all.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:07 pm 
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Vantine wrote:
annak wrote:
While personally I consider myself at very low risk of contracting HIV and thus have a hard time saying what I'd do in that hypothetical situation, I do think it's the responsibility of individuals to protect themselves. An HIV+ person who is being treated for that is going to be at lower risk of passing the virus on than someone who has no idea he or she is carrying it. Since there's still a lot of stigma (depending on the culture/social environment) to being HIV+, I'm not sure that disclosure should be expected if people don't know each other well, and I definitely don't think it should be legally mandated for consensual sex partners. (This isn't really a good idea from a public health policy standpoint in my mind, since ultimately what mandatory disclosure would reward is people not getting tested in the first place.)

I'm confused. Are you really suggesting that if you are HIV+ that you don't have a moral obligation to tell any and all people you are going to have sex with that you are HIV+?

And further to that, how can the sex possibly be consensual if you don't know what risks you're taking?

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:08 pm 
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aelle wrote:
annak wrote:
Then, there seems to be this dichotomy set up between people who don't follow the CDC recommended schedule and people who "selectively vaccinate," popularly regarded as causing some sort of major epidemiological catastrophe. The thing is, everyone is vaccinating selectively to some extent. The US recommendations aren't the same as Europe's or other country's, and we're all making choices based on what we think the likelihood of benefit vs. the likelihood of harm are, it's just that some people are taking someone else's recommendations and some people are deviating from that. How many people in the US are vaccinating their kids against yellow fever? If they haven't, does that mean they don't care if their child gets yellow fever? No, it just means that it's generally accepted that the benefit of getting the vaccine is considered low compared to the costs.



I just wanted to comment on this, because this is something that my crazy international life has allowed me to think about. I agree that it is interesting to compare your countries requirements to those with similar environments. That said, there are some pretty straightforward reasons why these requirements vary. For example, you wouldn't push HiB vaccines with the same urgency in a place where under 0.5% of the population is a carrier, like in the States, and where as much as 20% of the population is a carrier, like in SE Asia (WHO data) - even if you happened to compare countries with similar economic development.

Also, countries even with simila r environments may have different policies but that both work towards creating a coherent public health policy. I believe that in Western Europe, at least when I was a kid, the assumption was that enough kids contracted chicken pox to create herd immunity and protect the adults from shingles. In the US, the herd immunity would be achieved by vaccinating. That doesn't mean that it's perfectly fine not to vaccinate when you're in the US or that the risk/benefits would be the same than if you didn't vax in Europe.



Oh absolutely, this depends on local risk, but that's precisely what I was trying to get to: people assess risk and benefits and make decisions based on that, whether those people are the CDC or individual parents....but when some of the outbreaks are coming from international travellers (in the link somebody posted about measles, at least two outbreaks were attributed to travel - I think one to Sweden (Switzerland?), one to India), maybe vaccination recommendations should be more globally-minded. I looked up the schedule for the Netherlands, and the vaccines themselves were the same, but the schedule is a little more compressed. So basically if we move there I'll likely catch crepe from pediatricians if I decide to stick with the American schedule, but then if I switch to the Dutch one I'll catch crepe once I move back to the US a few months later. There may be medical reasons for the specific minor differences in the scheduling, but I think it might just be cultural. When I moved back and forth with my cat, he just got double-vaccinated for some things.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:09 pm 
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I believe Vantine was asking whether someone WHO KNOWS HE OR SHE IS HIV+ has an obligation to disclose their HIV status. I also believe you had to have known that's what she meant.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:24 pm 
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FootFace wrote:
I believe Vantine was asking whether someone WHO KNOWS HE OR SHE IS HIV+ has an obligation to disclose their HIV status. I also believe you had to have known that's what she meant.



Well, I wouldn't consider it moral in my case but that's because I'm in a decade and a half long monogamous relationship with someone who is regularly tested by his workplace and would have his career ended by a positive diagnosis, so that does seem like a shiitake thing to do. But unless the last couple of blood draws I've had from the midwives were somehow with dirty infected needles, I'm guessing it's not an issue.

I think when people are having casual sex, well, they need to assume that the risks they're posing to themselves and each other CANNOT be known. I don't think someone has a moral obligation to disclose medical history to a stranger, and I don't think said stranger should assume that all medical history is being disclosed or withheld. And I think that assuming that somehow a person who knows he or she is HIV+ is a riskier sex partner than someone who has no clue is dangerous and, frankly, how newly infected people end up with HIV. Someone receiving treatment early is going to have an undetectable viral load these days - the chances of transmission are really low. And HIV isn't the only STD out there either.


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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:39 pm 
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annak wrote:
FootFace wrote:
I believe Vantine was asking whether someone WHO KNOWS HE OR SHE IS HIV+ has an obligation to disclose their HIV status. I also believe you had to have known that's what she meant.



Well, I wouldn't consider it moral in my case but that's because I'm in a decade and a half long monogamous relationship with someone who is regularly tested by his workplace and would have his career ended by a positive diagnosis, so that does seem like a shiitake thing to do. But unless the last couple of blood draws I've had from the midwives were somehow with dirty infected needles, I'm guessing it's not an issue.

I think when people are having casual sex, well, they need to assume that the risks they're posing to themselves and each other CANNOT be known. I don't think someone has a moral obligation to disclose medical history to a stranger, and I don't think said stranger should assume that all medical history is being disclosed or withheld. And I think that assuming that somehow a person who knows he or she is HIV+ is a riskier sex partner than someone who has no clue is dangerous and, frankly, how newly infected people end up with HIV. Someone receiving treatment early is going to have an undetectable viral load these days - the chances of transmission are really low. And HIV isn't the only STD out there either.

I don't think I can disagree strenuously enough with this. I absolutely do think that if you know your status you have a moral obligation to share that with anyone who you are putting at risk. And I think that if you don't know your status you equally have a moral obligation to share that fact (e.g. the last time I was tested I was negative but I haven't been tested since _____ and have slept with x people since then).

I think it is well understood by most that when having sex with someone you are putting yourself at risk of coming in contact with a number of things. And I think that it is a reasonable expectation that if you ask a potential sex partner about their sexual health and history that they will be honest with you.

I also feel like you are creating a false dichotomy between sex partners knowing they are HIV+ and not knowing but being positive. Those are not the only two choices.

Finally, I feel like there is a distinction to be made between casual sex--that is, sex outside of a romantic relationship, whether monogamous or not--and near-anonymous sex--that is, with someone you don't know or have just met.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 6:54 pm 
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j-dub wrote:
Finally, I feel like there is a distinction to be made between casual sex--that is, sex outside of a romantic relationship, whether monogamous or not--and near-anonymous sex--that is, with someone you don't know or have just met.


Okay, so let's go back to my original Analogy By Exaggeration.

Let's compare somebody who goes around having unprotected casual sex with all kinds of random people with a person who isn't vaccinated.

That roaming humper could be carrying all kinds of diseases. They at this point have no idea. (The analogy here is somebody who has been exposed to, say, mumps or whatever but is as of yet asymptomatic.)

They continue to roam around, humpin' away. (The analogy here is coughing, shaking hands with, and generally being in contact with people, which will spread many diseases.)

Yes, it IS those people's responsibility to make sure they are protected-- condoms, say. (A vaccinated person.)

However, sometimes condoms break, or are faulty, or you aren't quite careful enough. (Sometimes vaccines don't work.)

In this case, you'd hope that the person with whom you've just had a condom accident has been careful in the past. Unfortunately, they haven't. Now you've been exposed to whatever they're carrying.

Would you want to know that they've been unsafe in the past? Would you want to know that they could be carrying STDs? Wouldn't you want to know that BEFORE you bed down with them?

If it's not okay for somebody to practice all kinds of unsafe sex without being open about this with potential partners, why is it okay for unvaccinated people to roam around without having to warn people that they could be unvaccinated? It's dangerous for the unvaccinated person and it's potentially dangerous for people around them.

Do you think this is stretching the analogy? There's always the argument that havin' sex is consensual. Well, sure. Right. So if you're having sex with people without at least asking if they've been unsafe, that's your own fault, right?

What about being around people who haven't been vaccinated? You aren't given the choice of avoiding contact with unvaccinated people because there isn't any sort of custom that encourages asking people if they're vaccinated before being around them. You could be surrounded by unvaccinated people-- potentially carrying any number of diseases-- anywhere. In the store. On the sidewalk. At work. At school. In restaurants. You are not given the choice of avoiding contact.

THAT is why it bothers me so much.

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 Post subject: Re: Can we talk about vaccinations here?
PostPosted: Wed May 25, 2011 7:15 pm 
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Posts: 9621
Location: Seattle
Someone who knows he is HIV+ is 100% likely to have HIV.

Someone who doesn't know whether he is HIV+ is somewhere between 0 and 100% likely to have HIV.

I think that makes a difference.

If I am HIV+ and know it, and I have sex with someone who never bothers to ask about my HIV status or insist on my using a condom, is it moral for me to say, "Sucks to be her. She should have asked. Now let's get to sexin'"? Maybe in Ayn Rand's world that's moral. In mine that's repugnant.

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