HPV is a Gay Men's Health Crisis

via Advocate, by Ilan H. Meyer

A committee from the Centers for Disease Control and Prevention recently made headlines by recommending human papillomavirus (HPV) vaccinations for boys and young men.

Previously, vaccination, which also protects women from cervical and other cancers, was recommended for girls only.

I commend the committee’s decision: Vaccination can all but eliminate HPV-related cancers. Almost all instances of anal cancer are caused by HPV, which is sexually transmitted.

HPV also causes many oral and other so-called head and neck cancers.

HPV is a gay men’s health issue. Anal cancer affects about two in 100,000 people in the U.S., but the rate of anal cancer among gay and bisexual men is as much as 44 times higher.

 Although vaccination is an important step, this recommendation is not enough. Prejudice and stigma continue to hinder an adequate public health response to HPV.

 As with HIV/AIDS, for HPV and anal cancer silence equals death.

Even though the HPV vaccine, called Gardasil or Silgard, was approved and recommended for use in girls since 2006, it has been hard to get girls vaccinated.

The exchange about HPV in a recent debate among Republican presidential contenders sheds light on Americans’ reluctance:

As former senator Rick Santorum charged, “this disease is spread through sexual contact... unless 11- and 12-year-olds in the state of Texas are somehow encouraged to participate in that activity, this is not something that the state or federal government should be doing.”

The argument is that vaccinating girls encourages them to engage in sex. This is a ludicrous suggestion because Gardasil protects against infection at any time over a lifetime — it is not specific to sex in youth.

Other arguments — concerning the safety of the vaccine, for example — have been repudiated repeatedly by medical authorities.

If it has been so hard to get girls vaccinated, for fear of encouraging heterosexual sex, it is no surprise that public health authorities in the U.S. have been reluctant to recommend HPV vaccination to protect boys who, when they become sexually active, may engage in same-sex anal sex.


Read the rest

Study: HPV Vaccine Cost Effective for Gay Men

via Medical News, by Nancy Walsh

Vaccinating men who have sex with men (MSM) against human papillomavirus (HPV) may be a cost-effective approach to the prevention of anal cancer and genital warts, according to a study using decision-analysis models.

Read the rest.

HIV-Positive Men Need a Booster Dose of the Hep A Vaccine

via AIDSmeds

It took an extra “booster-dose” of the hepatitis A virus (HAV) vaccine for HIV-positive men who have sex with men (MSM) to have an equivalent response to the vaccine as HIV-negative men. This finding was reported September 12 at the 50th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Boston.

HIV-positive MSM are about three times as likely to become infected with HAV than HIV-negative MSM. For this reason, the Centers for Disease Control and Prevention (CDC) in Atlanta recommends that all HIV-positive MSM receive the HAV vaccine. Numerous studies have found, however, that vaccines generally don’t work as well in people with HIV, particularly those with low CD4 counts.

Read the rest.

We got iPads and 4G networks - how about an HIV vaccine, hmm?

A Day That Even a Mother Could Love
via Huffington Post, by Johnathon Briggs

For the past 12 years, shortly after Mother's Day, scientists and AIDS activists have commemorated HIV Vaccine Awareness Day. It is likely perceived as an obscure observance by most Americans, but one that deserves our attention given this sobering reality: Twenty-eight years after the discovery of HIV, we still have no effective vaccine.

In a 21st century world of iPods and iPhones, of 3-D televisions and 4G networks, male and female condoms remain the most effective tools we have to prevent the spread of HIV during sexual activity. It seems we have more ways to entertain ourselves than to protect ourselves.

But what if there was a vaccine that could protect you from HIV infection? Or delay illness in people who do become infected? What if there was a microbicide in the form of a cream or gel that could be used vaginally or rectally to protect against HIV?

Read the rest.

Q&A - What's up with the new vaccine trial in Chicago?

We really need the public to engage with us and be in this fight for the long haul... It took over 45 years to find the vaccine for polio!

An exclusive LifeLube interview with Sanford E. Gaylord, 
Community Educator, Project WISH

LifeLube - What HIV vaccine is being tested in the new study just launched in Chicago?

Sanford - At the University of Illinois at Chicago - Project WISH (We’re Invested In Stopping HIV), we launched HVTN 505, September 2009. HVTN stands for the HIV Vaccine Trials Network (www.hvtn.org). There are two types of vaccines that will be used in the study: DNA and Adenovirus vectored vaccines. The DNA vaccine is a synthetic replication of pieces of the HIV virus. It’s made in a laboratory and cannot give anyone HIV infection. Adenovirus vector is a common cold virus that is used to carry synthetic pieces of the HIV virus. This combination of vaccines has been used previously to stimulate the immune system in other studies and has been shown to be well tolerated.

Project WISH has been affiliated with the HVTN since 2001 and we’ve conducted clinical trials in partnership with them since 2004.

-What will the trial tell us?

The purpose of HVTN 505 is to teach us more about how a vaccine can stimulate production of T-cells to help the immune system respond to HIV if a person is exposed. We hope to learn if this vaccine can decrease the viral load of people who become infected with HIV. The lower the viral load, the longer it may take before a person develops symptoms of AIDS. An HIV vaccine that lowers viral load may delay the onset of illness, even if it doesn’t prevent HIV. A lower viral load may also reduce transmission of the virus to others. If the 505 vaccine does lower viral loads, scientists will know they are on the right track with vaccines which stimulate cellular (T-Cell) immunity. 

-Where else is the trial taking place? 

There are a total of 14 sites across the nation. In addition to Project WISH, trial is taking place simultaneously in the following cities: Atlanta, GA, Boston, MA; Birmingham, AL; Los Angeles, CA; Nashville, TN; New York, NY; Philadelphia, PA; Rochester, NY; San Francisco, CA; Seattle WA; and Washington, D.C. Check out www.hopetakesaction.org for a complete listing of sites.

-Who is being recruited for this study and why? How many people are you looking for in Chicago, and nationally?

Men who have sex with men (MSM) and Male to Female Transgender individuals 18-45 years of age who are fully circumcised are being recruited. The MSM population within the U.S. still bears the burden of HIV within our country.

We’re looking to recruit 80 people at Project WISH; nationally, we’re looking to recruit 1,350 people to participate in HVTN 505. 675 study participants will get vaccine and 675 will get a placebo.

- If I were to participate, how much time would it take, and what could I expect?

We’re looking for a 5 year commitment from study volunteers. The DNA vaccine will be given on 3 separate visits and the adenovirus vaccine at month 6. Then we continue to follow people for safety and we continue to provide HIV risk reduction counseling and HIV testing every three months. We’re also looking to see how their body is responding to the vaccine. There will also be physical exams and behavioral risk questionnaires. Each volunteer will receive a stipend of $ 40-95 per visit, depending on the type of visit.

-What are some of the benefits for me to participate in this trial?

This study may help in the search for a preventive HIV vaccine. At this point in the epidemic, we all must do our part so we can create a difference, especially for the generations that follow us all.

Being in this study might be beneficial to some of the study volunteers. The counseling that volunteers receive as part of the study may help them avoid getting HIV infection. The lab tests and physical exams may detect unknown health problems.

-Will this trial find a cure for HIV?

No, but it will advance our prevention efforts. Scientists believe that an effective preventive HIV vaccine is possible and are working to speed up the research process. Developing safe, effective and affordable vaccines are the best hope for controlling and/or ending the AIDS epidemic.

-Why does vaccine research take so long? Shouldn't we have something by now?

Research always requires multiple trials to find the right answer. For example, most of us wouldn’t think twice about taking Tylenol for a headache. Many may not have any idea how many trials it took to find a new pain reliever. Similarly, vaccine research has taken many years for other diseases as well. It took over 45 years to find the vaccine for polio!

I think what is important to remember is that even in trials where the product didn’t work as well as we hoped, we have still learned a great deal. Each trial is helping us to refine and retool our strategies so that we can move forward in our search. We really need the public to engage with us and be in this fight for the long haul.

-What are some of the risks to me as a trial participant?

Most common side effects from the vaccine are mild and include headache, tiredness, injection site pain or a small bump and/or scab at the injection site.

-Can I get HIV from being in this trial?

It is impossible to get HIV infection or develop AIDS from experimental vaccines. They are not made from live HIV, killed HIV, weakened HIV, or HIV-infected cells; they are synthetic replications. The investigational vaccines in this trial cannot cause HIV infection.

-I heard that some people test "false positive" in vaccine trials. What does that mean? How do you know if the positive result is truly false, or if in fact the person has seroconverted?

If you received the vaccine you might appear positive on the most common HIV tests. These tests are designed to look for the presence of antibodies to HIV and not the virus itself. We actually hope that the study vaccines will cause people to create antibodies; that is one indication that the vaccine is stimulating the immune system. This is what people may be referring to as a “false positive.” We encourage our study volunteers to only get their HIV testing done at our clinic during the trial because we can use tests that are able to tell the difference between vaccine-induced antibodies and a true HIV infection.

At the end of the study, volunteers who are showing antibodies from the vaccine will be provided HIV testing for free as long as they test “false positive.” Previous vaccine studies have shown this “false positive” may remain for years or may go away after some time.

-Would you encourage your best friend, or a close relative, to participate in this trial?

That’s a good question! I believe that this trial is well designed and well monitored but each person really needs to decide for themselves. I would encourage people I know to call or go to the website www.hopetakesaction.org and learn more about the study and meet with one of the study staff to get all of their questions answered.

Being in a study isn’t always the best decision for each individual or they may not be eligible for this particular trial, so its important to have all the facts and consider whether this seems like the right thing for you.

Even if people decide not to join the study, they can still help support our efforts in other ways. They can help educate others about vaccine research and help us to break down myths and misinformation that are out there. They may also want to join our Community Advisory Board.

-If I am interested in participating, what are my next steps?

Interested individuals can check out www.hopetakesaction.org for details. If you’re in the Chicago area, contact Project WISH toll free at 800-575-5758 or email us at wish@uic.edu. You can speak with our study staff for more information and see if you are eligible to participate, and learn how you can join us in the effort to stop HIV. 

Got Five Dollars?

Nice little video by Covalent Immunology encouraging people to pony up for vaccine research. The Cast includes Lady Bunny, Justin Bond, Ben Andrews, Angie Pontani, Kristen Renton, Thea Gill, Wilson Cruz, The Pixie Harlots, and Hydeia Broadbent.

Gay men needed for vaccine trial

Every 10 minutes, someone in the United States is infected with HIV. A preventive vaccine against HIV offers the best long-term hope to end this worldwide epidemic. Finding a safe and effective HIV vaccine that will protect people is a huge task. We cannot do it without your help.

* The trial is  currently seeking 1350 men who have sex with men to participate in a vaccine trial.
* You cannot become infected with HIV from the vaccines
* The study will take place in several cities in the United States.

Safety is a primary goal of the vaccine trial. This is a Phase II study, designed to yield limited information on the effectiveness of the vaccine. The research vaccines have been found to be safe in animals and hundreds of humans in previous trials. One of the vaccines is made from an inactivated cold virus known as an adenovirus. The vaccines do NOT contain the HIV virus, and CANNOT cause HIV infection. Since these vaccines are still being researched, we urge all of our participants to practice safe sex.

Find out more.

Hope Takes Action - DO YOU?

CHICAGO: Men 18-45 yrs old Needed for HIV Vaccine Research Study

Men 18-45 yrs old Needed for HIV Vaccine Research Study

HIV negative men, who are circumcised and 18-45 years old are needed to participate in an HIV Vaccine research study. Subjects will receive compensation for participating. The study should last approximately 3 years. Subjects cannot get HIV from the vaccine. This is a randomized study which means you may get the vaccine or a placebo.

The Principal Investigator for this study is Dr. Richard M. Novak, Dept. of Medicine, 840 S Wood. For more information, please call 800-575-5758, 312-413-8597 or email wish@uic.edu

Also. visit Hope Takes Action for tons of info on this trial.

Protocol # 2009-0355

Vaccine trial “is the beginning” of a new path of research

Vaccine trial “is the beginning” of a new path of research, says US health chief

via Aidsmap, by Gus Cairns

General Eric Schumaker, Surgeon-General of the US Army, said today that the result of the RV144 HIV vaccine trial - see this report - “opened new doors and switched on lights” in the field of HIV vaccine research but emphasised that the “modest” efficacy seen in the trial posed more new questions than it provided answers.

Dr Anthony Fauci, the Director of the US National Institute of Allergies and Infectious Diseases (NIAID), said: “This is the beginning of a new HIV vaccine research effort, not the end.”

But he added: “This is a welcome and exciting result in a field characterised by disappointment in the last two decades.”

The trial today produced an unexpectedly positive result when 31% fewer infections were seen in recipients of the combined ALVAC/AIDSVAX prime-boost vaccine than in placebo recipients, despite previous trials of both individual vaccine concepts producing negative results.

“This trial poses fundamental ‘black box’ questions,” Fauci continued. “What are the correlates of HIV immunity? Has this trial overturned our understanding of what might constitute a protective response to HIV? Can we improve on this efficacy? And does this result mean we should refocus more on clinical research than basic science?”

He answered his own last question by saying “Not at all. NIAID’s commitment to keeping an appropriate balance between basic science and vaccinology versus empirical clinical trials has not changed.”

Read the rest of this article (and check out other resources) here.

Also of interest: AVAC held a civil society call to discuss the trial and the initial results on Thursday, September 24. This call provided an opportunity for advocates to discuss the results with the researchers and to ask questions about the results and related issues the data may raise. Click here to listen to a recording of the call.

More info on the trial, via AVAC.

Moving Forward! HIV Vaccine Shows Promise for First Time, Study Shows

via Bloomberg, by Simeon Bennett

An experimental vaccine prevented HIV infections for the first time, a breakthrough that has eluded scientists for a quarter century.

A U.S.-funded study involving more than 16,000 volunteers in Thailand found that a combination of ALVAC, made by Paris- based Sanofi-Aventis SA, and AIDSVAX, from VaxGen Inc., of South San Francisco, cut infections by 31.2 percent in the people who received it compared with those on a placebo, scientists said today in Bangkok. Neither vaccine had stopped the virus that causes AIDS when tested separately in previous studies.

The finding represents a revival in a campaign that appeared to stall just two years ago when use of Merck & Co.’s experimental Ad5 vaccine boosted some people’s chances of infection in a study. The latest result will transform future research, said Mitchell Warren, director of the New York-based AIDS Vaccine Advocacy Coalition.

“Wow,” said Warren, who was not involved in the study, in a telephone interview today. “We are in a new place in the search for an AIDS vaccine. It’s safe to say that the scientific community is caught off-guard.”

The findings don’t mean the vaccine can be delivered worldwide, because of the complexity of the process and the fact that it’s based on old technology, Warren said. Instead they will serve to spur scientists to look for better combinations in more user-friendly regimens with higher success rates, he said.

Read the rest.

RELATED: Check out commentary by Keith Alcorn on Aidsmap
An unpopular vaccine study produces surprising result

Hearing on HPV Vaccine for Boys: Public Comments Welcome

via POZ

Should the federal government pay for the Gardasil HPV vaccine for boys and young men covered by government-funded health programs? The Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for Disease Control and Prevention (CDC) is holding a public hearing October 21 and 22 in Atlanta to discuss this important question and would like to hear from concerned community members, both in person and in writing.

Gardasil was approved in 2006 to help protect young women from the strains of human papilloma virus (HPV) that are most likely to cause cervical cancer and genital warts. Current guidelines recommend treating girls before they become sexually active, because a majority of women become infected with HPV within a short time after sexually activity has commenced.

The Food and Drug Administration (FDA) is now poised to approve the same vaccine to protect men from the same HPV strains that cause anal and penile warts and cancer. The FDA is expected to approve the vaccine’s use in preteen and teenage boys who have not yet become sexually active.

FDA approval is more scientific than political. The same is not true, however, when it comes to government decisions to pay for certain components of medical care. When ACIP recommended that government funds be used to vaccinate girls and young women, conservative activists objected strongly, claiming that the vaccine promoted promiscuity.

HIV and gay men’s health activists anticipate similar controversy at the ACIP hearing to determine whether the government should pay for the vaccine to protect men.

The mobilization of HIV and gay health activists is due, in part, to the fact that men who have sex with men have the highest rates of HPV infection and are likely to need the vaccine the most. Conservative groups are also expected to advocate against the government recommending payment for the vaccine, suggesting that it will promote both promiscuity and homosexuality.

Information about the ACIP hearing, which is open to the public, can be found on the CDC website. Written comments can also be submitted to the ACIP by e-mail at acip@cdc.gov.

Give Gardasil to boys too, experts say

Source

Recent evidence shows the human papilloma virus (HPV), which causes cervical cancer in women, is poised to become one of the leading causes of oral cancer in men because of changing sexual behaviours.

The findings have reignited the debate over whether boys should be given the cervical cancer vaccine, Gardasil.

A visiting British virologist, Professor Margaret Stanley, says governments around the world need to examine the long-term economic and health benefits of immunising boys and young men.

The head of Microbiology and Infectious Diseases at Melbourne's Royal Women's Hospital, Professor Suzanne Garland, says Australia is leading the way in the rollout of the cervical cancer vaccine Gardasil, which immunises against HPV.

"We are in our third year of rolling out the vaccine and we are in the order in the school-based group, in the high 70s, whereas in many other countries, they have only got 30 per cent who have been vaccinated," she said.

But now the vaccination debate has switched genders.

There are growing calls from the medical community for boys and young men to also be vaccinated against HPV.

Advocates include one of Britain's top cervical cancer specialists, Professor Margaret Stanley from Cambridge University, who says a cervical cancer jab in the arms of boys would not just be for the sake of girls.

"These HPVs don't just cause cancer in women. They cause it in men as well. Cancer in the mouth, cancer in the anus and those cancers are very hard to treat," she said.

Read the rest.

HPV Vaccine Found to be Effective in Men

New research suggests that Gardasil, the vaccine developed to protect women against some strains of the cervical cancer-causing human papilloma-virus (HPV), is also effective in preventing HPV infections in men.

The clinical trial, conducted by researchers from the University of California, San Francisco (UCSF) with financial backing from Gardasil manufacturer Merck, may help to get the vaccine approved for use in men in Canada.

Results of the trial were presented at the 25th annual International Papillomavirus Conference in Sweden in May. Lead researcher Joel Palefsky noted that Gardasil appears slightly less effective in preventing HPV infection in men than in women.

“The numbers right now look not quite as good as the girls’ but still very, very good,” says Palefsky. “The vaccine was nearly 100 percent effective [in women] so you obviously can’t do better than that.”

Read the rest at Xtra.

Alternatives to condom use can help reduce HIV transmission among gay men

via Fridae - empowering gay Asia - by Jan Wijngaarden

The HIV epidemic among gay men in Asia is continuing to grow. 30.7 percent of Thai men who have sex with men are now infected with HIV in Bangkok; in Cambodia, Vietnam and Indonesia between 5-10 percent of men who have sex with men have HIV. In a cross-sectional study among MSM in Taipei in 2004, the HIV prevalence was 8.5 percent; in Singapore in 2007, 4.2 percent; and in Hong Kong in 2006-7, 4.1 percent. In most places our transgender sisters are even harder hit.

And that while transmission of HIV is quite hard, with a relatively low per-contact-transmission chance – HIV is much less efficient than other viruses, such as the ones causing flu or measles. Preventing HIV is relatively simple – covering our favorite organ with a 0.06 mm thick coating whenever we have anal sex...

Yes indeed, I am talking about condoms. So why are – even in places were significant numbers of men are infected with HIV – significant numbers of men still not using condoms? Are they not thinking clearly or what?

Well – perhaps so. A recent study from Sydney, Australia that appeared in the AIDS journal earlier this year (Jin F, Crawford J, Prestage GP et al, 2009) found that even when men do not use condoms, they still employ certain strategies to reduce their risk for HIV infection (or for transmitting HIV to their partners, if they are already HIV positive). Three of these strategies were found to reduce the chance of getting HIV significantly, compared to men who did not use any strategy (and no condoms).

These strategies are not as effective and not as safe as always using condoms, but nevertheless, they are protective.

What were these strategies?

Read the rest.

Gay men likely to be highly sexually experienced before they are willing to 'come out' to obtain HPV vaccine

via Aidsmap

Gay men will have a high level of sexual experience before they are willing to disclose their sexuality to healthcare providers so they can obtain a vaccine for human papilloma virus, an Australian study published in the online edition of Sexually Transmitted Infections has shown. This could mean that many gay men would already have been infected with human papilloma virus (HPV) before they were willing to come forward for vaccination, meaning that its protective effect for these individuals would, at best, be extremely limited.

Earlier research has suggested that there is a high prevalence of genital and anal infection with human papilloma virus amongst gay men, with particularly high levels of infection seen amongst gay men with HIV. Infection with human papilloma virus increases the risk of anal cancer, which occurs with greater frequency in gay men, most notably HIV-positive gay men.

Two vaccines that offer a high level of protection against the strains of human papilloma virus most associated with cervical (and anal) cancer have recently been approved. Their use is currently restricted to women, and to ensure that they have the maximum possible protective effect, UK guidelines state that they should be given to girls aged between twelve and 13 before they become sexually active.

Studies are currently evaluating the safety and effectiveness of these vaccines in men (and people with HIV).

Researchers in Melbourne, Australia, wanted to see how acceptable gay men would find a vaccine for human papilloma virus (assuming the results of trials were favourable). Furthermore, they wanted to gain an impression of how useful the vaccine would be at preventing infection with human papilloma virus.

Read the rest.

WE ALL FORGOT THE CONDOM

You may have heard that HIV infection is on the rise, or that the effort to develop a vaccine has dead-ended.

But in recent years, with every new setback and breakthrough—including sensational word of a new “morning after” pill—gay men have been changing their behavior, adopting ingenious methods to keep the virus at bay. As a result, the one commandment of the past twenty-five years—always wear a condom—is fast becoming a relic.

Read the rest in GQ.

[note from LifeLube - it is too damn bad that the author virtually ignored the research, development and advocacy around the creation of safe, effective and acceptable rectal microbicides. Currently in development, a microbicide is a cream or gel, or maybe a douche or an enema, that could be used to reduce a person’s risk of HIV infection vaginally or rectally. Rectal microbicides could offer both primary protection in the absence of condoms and back-up protection if a condom breaks or slips off during anal intercourse. For those unable or unwilling to use condoms, rectal microbicides could be a safe and effective alternative means of reducing risk, especially if they were unobtrusive and/or enhanced sexual pleasure enough to motivate consistent use. Such alternatives are essential if we are to address the full spectrum of prevalent sexual practices and the basic human need for accessible, user-controlled HIV and STD prevention tools. Click here for the site of the International Rectal Microbicide Advocates (IRMA) and learn more.]

Beyond Condoms - Nashville hosts community forum on new prevention technologies - May 21

read a news item on this event

click image to enlarge

A pivotal moment in HIV prevention

GLENDA GRAY AND MITCHELL WARREN
GUEST COLUMNISTS via seattlepi.com

Last week's announcement about the failure of the leading AIDS vaccine candidate developed by Merck & Co. is another in a series of disappointing setbacks in HIV prevention. How we as a global community choose to respond to this news, however, is the real test.

Historically, it has taken decades -- and more setbacks than advances -- from the discovery of a virus or bacteria until an effective vaccine is licensed. Typhoid was discovered in 1884, but there was no vaccine until 1989. Malaria, discovered in 1893, still has no vaccine. The measles vaccine took 42 years to develop.

In the 1930s, two experimental polio vaccines failed because they were determined to be unsafe, and polio vaccines were almost abandoned. At the time, we understood how to prevent infection by sanitation and avoiding public swimming areas, just as we know how to stop HIV infection today. We needed new tools then, and we need them now.

Today's question of how we deal with these setbacks will loom large in any reckoning of our response to the most severe epidemic of our time.

There are more than 4 million new infections every year. In South Africa, where three of this year's prevention trials have taken place, there are communities where nearly one-third of women between 25 and 29 are infected with HIV. For every one individual who starts on life-saving antiretroviral medications, there are six others who are newly diagnosed.

These are mind-numbing, tragic figures. They remind us that there is only one viable answer to the question -- "What do we do now?" -- that has been posed by many observers inside and outside of the HIV prevention field in recent weeks.

We do more of everything.

There is a drastic shortfall in funds for implementing proven prevention strategies, including male and female condoms, clean needles, prevention of mother-to-child transmission and risk-reduction counseling. In December 2006, we learned that male circumcision showed strong protective benefits for HIV-negative men. This strategy must also be made available in communities where it can have an impact.

We must do more to bring comprehensive care, treatment and support to people already living with HIV worldwide. Global targets have been set and missed and are in danger of being missed again.

And while we do those things, we must continue to search for additional prevention strategies, including vaccines, microbicides, oral prevention or pre-exposure prophylaxis and herpes treatment.

To pit proven prevention and treatment against research is a false and dangerous dichotomy. The range of tools that we have today is not reaching every person at risk. And even if it did, it is not enough. Women and men, adolescents, boys and girls and infants need more choices when it comes to HIV prevention.

The best approach to prevention is one that provides the most options. There will be no magic bullet, be it a condom or a clean needle today or a vaccine tomorrow. There is only the ethical and moral imperative to develop a multi-faceted response that is a match for the multiple drivers of the epidemic.

In the wake of the failure of the Merck vaccine, the AIDS vaccine field will need to make carefully considered decisions about whether to move forward with planned trials of other vaccine candidates, but the field will keep moving forward. It must, as the history of other epidemic diseases tells us that an essential tool to stopping epidemics is an effective vaccine.

As disappointing as recent failures are, donors and advocates, scientists and physicians, volunteers and their families must all guard against "failure fatigue." We must respond loudly and clearly to suggestions that enough money has been spent; that it would be easier and wiser to move on rather than to press on.

To do so would be to ignore the reality of the epidemic today, and to overlook the lessons from history about the long, slow process of vaccine discovery. We cannot afford to walk away from science, or from the generations to come. Rather than giving up hope, we must redouble our efforts in prevention research and stand firm in our commitment to scientific inquiry. Millions of lives -- today and tomorrow -- depend on it.

Glenda Gray is the co-director of the Perinatal HIV Research Unit in South Africa. Mitchell Warren is the executive director of the AIDS Vaccine Advocacy Coalition in New York.