(Photo: Panelists Craig McClure (L), Debrework Zewdie (2nd-L), Michael Lederman (2nd-R) and Brian Gazzard (R), listen to a journalists question during an International AIDS Society (IAS) press conference in Sydney, 23 July 2007. Greg Wood/AFP/Getty Images. )
They say an ounce of prevention is worth a pound of cure. But when it comes to HIV/AIDS, there is no cure. That makes prevention priceless. At the International AIDS Society conference in Sydney, Australia this week, scientists are sharing the latest research on some prevention methods currently in clinical trials. Thanks to a fellowship from the National Press Foundation , KPBS Health Reporter Kenny Goldberg is there.
Esther Nakkazi is a science journalist from Uganda, a nation that's been hard hit by HIV.
Nakkazi says in her country, condoms are widely available, and they're inexpensive. But she says it's not culturally acceptable for women to ask men to use them.
Nakkazi: Women in Uganda, especially the uneducated ones, who are in the majority, do not have control over their sexual, you know, decisions. It is basically the men who decide for them what to do and how to do it.
Recent surveys show the percentage of Ugandan men who've had at least two casual partners within the previous month has increased. Still, Nakkazi says even married women don't ask their husbands to wear condoms because it's like accusing them of being unfaithful.
Nakkazi: I think that is why we have the highest rates of HIV in women, and right now in Uganda we actually have high rates among married people. I think women are very vulnerable.
In fact, women are more than twice as likely as men to get HIV through sexual intercourse. And in countries where men call the shots regarding condoms, women are at high risk.
These are some of the reasons why the search is on for a prevention method that women could control. The idea is to come up with something women could use without the permission, or even knowledge, of their partner.
Microbicides are one possibility. These are substances applied to the vagina or anus that could reduce or prevent the transmission of HIV.
Dr. Ian McGowan is with the Microbicides Trial Network , a group that's funding research worldwide.
McGowan says there are a number of challenges to designing effective microbicides. First, of course, is to develop a drug, or combination of drugs, that prevent HIV infection. And then it's crucial to come up with a product that's culturally acceptable to women, so they'll actually use it.
McGowan: And so they have to be attractive. They have to, you know, feel nice, they have to be taste neutral, odor neutral, and so on and so forth. The usual consumer characteristics that would facilitate people using it when it's available.
McGowan says there are a number of microbicides currently in clinical trials. Over the next few years, a study will test the effectiveness of one drug McGowan considers to be especially promising. But he concedes earlier this year, an international trial of the microbicide cellulose sulphate was terminated.
McGowan: We don't know the full story yet, what happened. Clearly in one case there seemed to be a slight, but significant increase in risk with women who used the drug, but then a second study didn't show that at all. So I think it's going be a modest risk associated with it. But clearly, any risk is not something we want.
Diaphragms are another potential means of HIV prevention. And then there's the holy grail -- a vaccine for both men and women that could prevent transmission of HIV.
Here again, there are a variety of possibilities being evaluated in the clinic. There are even two vaccines in the final stages of clinical trials.
Gust: Nevertheless, despite the large number of candidate vaccines, I think the general feeling is that none of the ones that are currently in the clinic are likely to be highly effective.
Dr. Ian Gust is on the board of the non-profit International AIDS Vaccine Initiative . Gust says designing an effective vaccine against HIV is exceedingly difficult. He says that's because the virus mutates rapidly. Still, Gust believes a vaccine is the only way to go.
Gust: If we're looking at actually controlling and eventually eradicating the disease, it is unlikely that you could do that in any other way than through widespread immunization.
For the time being however, a vaccine against HIV is a pipe dream.
Dr. Ian McGowan concedes other prevention methods under development haven't borne fruit, either.
McGowan: But I think we still have to carry on. I mean the need is still there. I mean rolling out treatment is not the solution to the HIV pandemic.
Indeed, the World Health Organization says for every person who started HIV therapy last year, six people became infected with the virus.
Reporting from Sydney Australia, Kenny Goldberg, KPBS News.
