The 15th international AIDS conference has come and gone, but what will we have hoped to achieve when the world meets again in Toronto in two years time?

Unlike the international AIDS conference in Vancouver 1996 when Highly Active Antiretroviral Therapy (HAART) broke new scientific ground and Durban 2000 when equal access to medicines made centre-stage, Bangkok 2004 presented no revolutionary science, no dramatic breakthroughs.

But it did get back to basics and the need for an holistic approach.

There is no single strategy to address HIV/AIDS. It requires prevention and treatment, activist pressure and government commitment, advanced scientific research and community involvement, and above all, a human rights-based approach designed to support vulnerable individuals and groups.

An integrated approach is essential – acknowledging who is most at risk, the need to build adequate health care systems, train doctors, nurses and communities and to inject new resources to prevent and treat the pandemic.

In the words of Prof Denis Altman, political scientist and president of the AIDS Society of Asia and the Pacific, ‘€œthe greatest tragedy of HIV/AIDS is that we know how to stop its spread and yet in most parts of the world we are failing to do so.’€

Across Asia and the Pacific 7,4 million people have been infected with HIV. Epidemiologists predict that by 2010, 20 million people will be infected in India and between 10 to 15 million people in China.

Unless governments in these regions acknowledge and respond to the epidemic while it is still in its emerging stages, the numbers of people likely to contract HIV will surpass Africa’€™s 25 million infections.

Facing up to HIV/AIDS, particularly as it expands beyond Africa to Asia, requires humane and effective measures to address the needs of injecting drug users, men who have sex with men and sex workers.

The American Foundation for AIDS Research (amfAR), a non-profit organization dedicated to support AIDS research, reports that in Asia HIV is spreading along truck routes, among traveling salesmen, sailors, soldiers, fishermen, migrant workers and within the sex industry.

Any temptation to dismiss HIV as a virus restricted to marginalized groups such as gay men, sex workers and injection drug users is to miss a crucial point.

Many men who have sex with men, as well as men who visit sex workers, return home to a female partner. This exposes women, and very often married women, to a risk about which they can do little. Where young girls are forced to marry young or where wives are unable to negotiate when and how they wish to have sex the chances of HIV infection rise sharply.

The other emerging epidemic is in Russia which now has one of the world’€™s highest rates of new HIV infections. Between 700 000 and 1,5 million Russians are HIV positive ‘€“ representing 1-2 percent of the population.

According to the Russian health and social development ministry, the epidemic is growing fastest among the general heterosexual population. In 2001 heterosexual transmission stood at 4 percent rising to over 18 percent in 2003.

At the conference opening United Nations Secretary-General Kofi Annan stressed the impact of HIV/AIDS on women. He said women accounted for nearly half of all adult infections worldwide and in Africa made up 58 percent of the number of people living with HIV/AIDS. Among youths under the age of 24, young women comprised nearly two thirds of those living with HIV.

There are growing calls for more funds to go into research that allows women to minimize their risk to HIV exposure.

One possibility is a microbicide, a substance in the form of a gel or cream women can apply vaginally to help prevent transmission.

According to Dr Zeda Rosenberg, CEO of the International Partnership for Microbicides, computer modeling by the London School of Hygiene and Tropical Medicine has shown that a microbicide that is 60 percent effective, introduced into 73 low income countries and used by only 20 percent of women would avert 2,5 million infections over three years in women, men and infants.

However, unlike the search for a safe and effective vaccine against AIDS, there has been virtually no private sector investment in microbicide development. Funding permitting, along with leadership and collaboration among researchers, a safe and effective microbicide is still most likely five to ten years away.

The prospects for an HIV vaccine are also distant. Since the first small scale phase I trial in 1987 more than 80 trials have been conducted with some 30 candidate vaccines.

Major challenges in developing a vaccine still outweigh the progress according to Chris Adasiewicz, communications director for the International AIDS Vaccine Initiative.

So in the absence of significant scientific progress towards the holy grail of a vaccine, prevention efforts must be redoubled and treatment expanded to everyone who needs it.

 The more people who have access to effective prevention, the fewer people who will need treatment.When the 16th international conference on HIV/AIDS meets in 2006 the numbers will tell whether the world has shown itself capable of new levels of openness, honesty and innovation that tackling the epidemic demands.

E-mail Sue Valentine