Access to promising HIV prevention measures could be delayed or denied in many parts of the world because of obstacles to research, warns a report published this week.
It says new prevention measures, such as male circumcision and microbicides — anti-viral gels that women can apply to their vaginas before sex — could prove effective within one to five years.
But practical and ethical challenges, such as the need for thousands of trial participants, threaten to slow or derail critical research on these and other measures.
The report, by the Global HIV Prevention Working Group, was released on Tuesday (15 August) at the 16th International AIDS Conference in Toronto, Canada.
Fifty HIV/AIDS experts worked on the study, which surveyed the state of research on six promising approaches to HIV prevention.
They found significant financial, logistical and ethical obstacles that, if not quickly addressed, could delay the completion of clinical trials.
The report's authors say the capacity of developing countries to conduct research into ways of preventing infection is severely limited.
They urge relevant agencies to work together to assess existing capacity, "identify specific needs and sites for scale-up, and prioritise prevention approaches for testing".
The group also says that existing ethical guidelines for medical research do not adequately address key issues that have emerged in HIV prevention clinical trials.
For example, there is no formal consensus on which existing prevention services should be provided to all trial participants, or how to facilitate access to drugs for participants who become infected during a trial.
The working group call for UNAIDS and the World Health Organization to gather a panel of experts to develop updated guidance on these and other ethical issues relating to such research.
"The development of effective new HIV prevention approaches could help millions avoid crippling illness and death," said David Serwadda, co-chair of the working group. "But unless we prepare to make new, lifesaving tools accessible in developing countries, this scientific triumph will turn into a moral failure."
The working group was convened in 2002 by the Bill & Melinda Gates Foundation and the Henry J. Kaiser Family Foundation.