Researchers aim to kick-start new AIDS prevention

Activists urged the outside world to keep up the pressure on political leaders in hard-hit countries such as South Africa, while other groups said that reducing violence and discrimination were also key to fighting the AIDS pandemic.

One big winner at this week's International AIDS Conference in Toronto was the field of microbicide research. Top speakers at the conference all stressed that microbicides and circumcision, as well as drugs, condoms and behavior change, were all key to stopping a pandemic that has killed 25 million people in 25 years.

Delivered as a cream, a gel or perhaps on a small vaginal ring, a microbicide would allow a woman to quietly protect herself against HIV, now transmitted mostly heterosexually.

"Not only are people saying it, but they are pronouncing it correctly," said Renee Ridzon, a programme officer at the Bill & Melinda Gates Foundation, which has given $124 million to support microbicide development.

But there is one big obstacle -- no one has invented one yet. Tests are under way on several formulations.

"As we are undertaking the current set of studies of microbicides, which are largely gels, we should think of ways to improve formulations," said Dr Salim Abdool Karim of the University of KwaZulu.

"Can we design a microbicide that could be taken once a week or once a month or once every three months?"

Delivery is also key, said Ridzon. "People are not going to use something that they don't like, that doesn't feel good," she said.

Similarly, men will not seek circumcision if they think it will hurt, said Carolyn Williams of the US National Institutes of Health.

SIMPLE, SAFE, PAINLESS
"We need a simple, fast, safe method, with low costs, that nurses can do," said Dr Bertran Auvert of the University of Versailles-Saint Quentin in France.

One South African study has shown that circumcised men were 60 percent less likely to become infected with HIV, and other studies are under way to try to confirm this.

But Auvert said if the studies show clearly that circumcision protects men, men will flock to have the procedure. "The demand will not be satisfied by the current health structure," he said. "We already see waiting lists in southern Africa."

Men will go to traditional practitioners instead, who may not use sterile methods. They could suffer potentially deadly infections. "It will be a nightmare," Auvert said at a news conference.

Many other groups also said the overall health care structure must be improved.

"It's not just a matter of supplying drugs," said Dr Daraus Bukenya of the British-based African Medical and Research Foundation.

"Issues such as poverty, geographical isolation, crumbling health systems, stigma and cultural practices, all play a part in the failure of many HIV/AIDS programmes."