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Experts Plan Strategies to Prevent HIV

Governments must be held accountable for their choices, said Dr. Jim Yong Kim, an AIDS expert at Brigham and Women's Hospital and Harvard University. Kim advocates "prevention scores," which would rate governments on how appropriately their AIDS dollars were being spent.

Potential solutions include microbicides, pre-exposure use of antiretrovirals and circumcision.

Microbicides under study or development include a vaginal gel that could help women protect themselves against HIV in countries where men are notoriously reluctant to use condoms, and substances that enhance natural vaginal defense mechanisms by maintaining an acidic pH, killing pathogens by stripping them of their outer covering or preventing replication of the virus after it has entered the cell.

Preliminary trials in South Africa last year showed circumcised men were 60 percent less likely than uncircumcised men to become infected from female partners. New data from trials in Uganda and Kenya are due in mid-December from the National Institutes of Health in the United States, the trials' sponsor.

Still, experts say there is no silver bullet. Success ultimately hinges on implementation.

"It will be so disappointing if we have a new tool but we can't deliver it," said Kim, adding that bottlenecks in health care need to be addressed now if the outbreak is to be curbed.

While WHO's ambitious "3 by 5" strategy, an attempt to put 3 million people on antiretrovirals by 2005, failed to reach its target, the urgency inspired by the campaign did galvanize the global community. Much of that drive has dissipated since the campaign ended. A recent report from the International Treatment Preparedness Coalition says efforts are stagnating, meaning the world will miss the UNAIDS 2010 target of treating 9.8 million people by more than half.

Kim said public health experts have an unfortunate tendency to spend too much time in meetings before taking action.

"While officials work on a process of getting consensus and no one is held accountable," he said, "poor people die."

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© 2006 The Associated Press