We'll Know By the Next International AIDS Conference Whether We Can Deliver AIDS Care Globally

The "time to deliver" theme of the XVI International AIDS Conference in Toronto "suggested both ongoing urgency and frustration at the pace of the response" to the HIV/AIDS pandemic, writes Robert Steinbrook, a correspondent for NEJM, in an NEJM opinion piece. Although highly active antiretroviral therapy, which became available a decade ago, has "streamlined" HIV/AIDS treatment, "the average cost of first-line regimens remains hig[h], and second-line regimens may cost $1,500 or more per year," Steinbrook writes. He adds that HIV/AIDS treatment provision in many countries is "compromised by profound shortages of skilled health workers and dysfunctional and inefficient health systems." According to Steinbrook, HIV/AIDS "prevention and treatment are inextricably linked; it is not possible to deliver one without the other." Several new HIV prevention methods -- including some that are "controversial," such as male circumcision and pre-exposure prophylaxis -- are being evaluated, Steinbrook writes. "By August 2008, when the XVII International AIDS Conference is held in Mexico City, it will be clear whether the world is continuing to lose ground to the AIDS pandemic or finally getting ahead of it," Steinbrook concludes (Steinbrook, NEJM, 9/14).

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