San Francisco Chronicle - August 20, 2008

It may be a long wait for the next name change. Will there be a breakthrough cure or vaccine? A treatment drug that will prove cheap and easy to dispense, or a prevention plan that will cut down on the 2 million infected last year with HIV, which causes AIDS?

The epidemic, which has killed 25 million and infected another 33 million, is at a frustrating yet tantalizing turning point, as evidenced at a worldwide conference that drew 20,000 scientists and health care experts to a Mexico City conference this month.

The yearly infection rate has curved down from a peak of 2.2 million in 2005 and life-prolonging drugs sustain 3 million, the largest number ever. Also, the United States has approved a five-year plan to spend $40 billion in the fight, by far the biggest expenditure by any nation.

But slow and steady isn't good enough. As infection rates drop, so has the sense of urgency. Former President Bill Clinton, who has championed AIDS research in his elder-statesman years, spoke at the Mexico City gathering, but no other big-country leader showed up. No medical breakthroughs premiered. Protests were absent in hallways dotted with drug company trade-show displays. The public attention surrounding AIDS has faded.

There are doubts along the frontlines in the battle as well. AIDS is vacuuming up scarce medical money in poor countries, critics say. Also, life-sustaining drug regimens, such as those paid for by the giant U.S. aid program, amount to a costly future obligation. On a broader scale, will it ever be possible for national leaders to focus on a topic that touches so many hot-button topics: prostitution, drug use, women's rights and civil liberty protections for HIV-infected people?

But these could be momentary quandaries if something good emerges from the world's research labs. In the 1980s, scientists predicted a cure within years, a failed boast that few scientists will go near today. Another home-run answer - a preventive vaccine - remains a distant hope, given the lengthy list of failed attempts.

Instead there are small-scale innovations to try, such as circumcision for men, microbicides for women and prevention plans using condoms, counseling and abstinence. All of these ideas come loaded with controversies, setbacks and doubts, but they need tryouts in a landscape with no solid answers.

It's worth remembering how hopeless the AIDS scourge once seemed. There were demonstrations outside drug firms and government offices to demand attention and medical help. Big-city newspapers ran lists of obituaries of single young men. Washington rushed to bar foreigners who tested positive for the virus, a policy finally repealed this month.

AIDS remains lethal and unsolved. That should be reason enough to fight it. But the world should be encouraged by small steps that are paying off - and take even more of them.

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Always watch for outdated information. This article first appeared in 2008. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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