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New HIV prevention methods providing rays of hope

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TORONTO — The excitement at the world's largest AIDS conference was over microbicides that could help women in poor countries protect themselves from HIV in several years.

Yet AIDS experts warned Tuesday that the world is woefully unprepared to ensure widespread access to such treatments.

Promising tests for new HIV prevention approaches are nearly complete, yet many financial and ethical obstacles could delay or even derail completion of critical trials.

More than 40 million people worldwide are living with the virus that can lead to AIDS; 25 million of them have already died since the first cases of HIV were reported 25 years ago.

Testing of microbicides that could protect impoverished women who have little say over their health and bodies in sub-Saharan Africa, for example, will be complete by the end of next year. A topical microbicide to block HIV transmission could be available by 2010.

Recent studies in Africa suggest men can cut the risk of getting HIV from an infected partner by some 60 percent if he is circumcised; men with HIV also appear about one-third less likely to spread the virus if they've been circumcised.

Other hopeful approaches include cervical diaphragms, AIDS drugs used as preventives, the suppression of herpes — which boosts HIV risk up to three times — and the relentless search for an HIV vaccine.

"Very soon, we could have new, highly effective ways to prevent many of the 4 million new HIV infections that occur every year," said Helene Gayle, co-chair of the Global HIV Prevention Working Group as well as the international AIDS conference. "But these tools will have little impact in the real world unless we take immediate steps to complete current trials, mount new ones, and reach people most in need."

The Working Group, with dozens of leading AIDS and public health experts from around the world, was launched by the Henry J. Kaiser Family Foundation and the Bill & Melinda Gates Foundation.

In a report released Tuesday, the group noted that fewer than 1 in 5 people at high risk for HIV infection today has access to effective prevention, a rate deemed too low to have a significant impact on the course of the epidemic.

"The development of effective new HIV prevention approaches could help millions avoid crippling illness and death," said David Serwadda, director of the Institute of Public Health in Kampala, Uganda, and co-chair of the Working Group. "But unless we prepare now to make new, lifesaving tools accessible in developing countries, this scientific triumph will turn into a moral failure."

The report made three recommendations to prepare for the roll-out of the new HIV prevention methods which have already proven effective in clinical trials: Major new donor funding; more trained health care providers; and better education campaigns to emphasize the importance of simple, cheap prevention such as condoms.

Gayle noted that a trial for the AIDS drug Viread (tenofovir), now being tested as a preventive pill, was cut short prematurely in Cameroon and Nigeria over concerns about whether the women in the study who got infected would receive treatment for AIDS.

"When we talk about the ethical considerations, there's a whole range of issues, but one that comes up most strongly is what's the ethical responsibility to treat," she said.

She said these ethical dilemmas that sideline clinical trials, compounded by lack of funding and the stigma still associated with AIDS were major obstacles to treatment.