Beyond Condoms: HIV Prevention

In the past decade, since the advent of HIV combination therapy, we have made enormous strides in the treatment of HIV. Drug regimens have been simplified and pill burdens greatly reduced. Effective treatments for drug side effects have brought us closer to the goal of making HIV a "chronic manageable" disease. People with the virus today can expect to live longer and healthier lives than at any time since the epidemic began.

But treatment alone isn't the answer. For one thing, the drugs used to treat HIV are wildly expensive, most notably in developed nations. In the United States, for all our wealth, the cost of providing treatment outstrips government outlays, forcing people onto waiting lists for these lifesaving drugs. Around the world, most people living with HIV go without access to effective treatment, notwithstanding well-publicized international efforts to vastly expand access.

There are other problems with a lifetime of antiretroviral therapy: Even though the situation has much improved, there are still many people who cannot tolerate the side effects of some or all of the available medications. Drug resistance and cross-resistance are a growing concern. And no one knows what unanticipated effects of prolonged use of these powerful drugs may yet turn up.

The fact is that we cannot treat our way out of this epidemic. Prevention is key. This issue of the Update deals with various issues surrounding prevention. On the medical side are articles about the search for a vaccine and effective microbicides, and the use of pre- and post-exposure prophylaxis. First-person stories examine some of the thornier issues of risk behavior, including those who seek sex without condoms.

We must not let the treatment advances of the last ten years make us complacent about HIV. Prevention, ultimately, remains the answer to eradicating this epidemic, and to ending all of the associated costs, especially the devastating human costs.