It will be the quality of these options that determines the direction the AIDS epidemic takes in its next 25 years. It's becoming clear that as effective as AIDS treatments are, any gains they provide will only be erased if new infections are not prevented. This year, for the first time, prevention options that extended beyond education and behavioral modification approaches finally took center stage, literally, when Bill and Melinda Gates and former President Bill Clinton all highlighted new prevention techniques in the opening days of the conference. These include the development of microbicides, oral drugs to prevent HIV infection, and even male circumcision. There still isn't enough evidence yet that proves any of these strategies can actually halt the spread of the disease, but they are promising enough to earn new infusions of research dollars and scientists' time. This of course doesn't mean that the traditional prevention approaches — Abstain, Be Faithful and Use condoms, — shouldn't still be a cornerstone of any responsible HIV-AIDS program. It just means that experience has shown that ABC isn't always possible.
It won't be easy bringing any of the proposed prevention techniques into widespread use — microbicides may run into cultural barriers and won't be useful at all unless women use them and their partners accept them, while preventive drugs may exponentially increase the risk that drug resistant HIV strains will blossom. But it's important that new prevention options become part of future plans to control HIV-AIDS. As this conference has expanded over the years and become as much about the spectacle as about the science, many AIDS researchers have stopped attending. Yes, the scope of the meeting and the now predictable demonstrations from activists can be daunting, but it's only by bringing together the doctors in the field with the activists on the floor that the biggest challenges in the epidemic can be overcome. It was the activists pushing for much-needed treatments that accelerated development and approval of the antiretroviral drugs, and it's this kind of combined effort that will be needed to prevent HIV-AIDS from worsening in Africa, and from sprialling out of control in countries like China and India. "It's one week every two years to express solidarity for the AIDS movement, "says Dr. Martin Markowitz, of New York City's Aaron Diamond AIDS Research Center who makes it a point to attend. "I think by not coming, you cheat yourself and you cheat the movement." And when it comes to fighting HIV, that's something we just can't afford to do right now.