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The research community's failure in the past 25 years to develop either a vaccine or a cure for HIV/AIDS underlines the need to be more, not less, scientific.

When the virus that causes AIDS was identified in the early 1980s, some confidently claimed that a safe vaccine would be available within ten years — which even then seemed far away. Others predicted, equally confidently, that a few years of focused research by the world's leading biomedical research laboratories, both in the public and private sector, would lead to a cure.

Some 25 years later, however, both goals seem as far out of reach as ever. Although several vaccine candidates have been tested, none offers the breakthrough required to reverse a pandemic that kills 2.8 million every year. Similarly, various antiretroviral drugs (ARVs) have been developed that can keep the disease under control, but none eliminates it from the body.

Faced with such facts, there is a temptation to claim that science has failed to meet one of the major challenges of the modern world. Indeed, some policymakers prefer to advocate non-scientific remedies.

South Africa's health minister Manto Tshabalala-Msimang, for example, espouses herbal remedies. And the US President's Emergency Plan for AIDS Relief insists that projects in developing countries that it provides ARVs to must include a programme promoting abstinence.

But the key message to emerge from last week's 16th International AIDS Conference in Toronto was that HIV/AIDS can only be beaten by a scientific approach. What has failed so far is the 'magic bullet' approach — the idea that the solution lies in a single vaccine or drug. What seems to be succeeding, however, is a wide range of less high-profile research.

Muted optimism

Microbicides — gels that a woman can apply to her vagina before sex — are a good example of the promising, but less headline-grabbing, lines of research under investigation. Tests are also being done on ARV-impregnated diaphragms that could also greatly improve women's protection against HIV.

The conference also heard about major trials of the impact of male circumcision currently underway in Africa, following evidence from South African research that this could reduce a man's risk of becoming infected by 60% (see Male circumcision could save millions from HIV/AIDS).

There are also growing indications that ARVs can limit the transmission of HIV from infected people to their partners. One study in Spain, for example, suggests that using a combination of ARVs to reduce the amount of virus an infected person carries in their bloodstream stopped the infection being passed to a partner.

All this has given grounds for muted optimism. Bill Gates, whose philanthropy underpins much of the current research in the area, told the Toronto delegates he believed microbicides and oral prevention drugs "could be the next big breakthrough in the fight against AIDS". And, after listening to reports of ongoing research, Stephen Lewis, the UN's special envoy for AIDS in Africa, closed the Toronto conference on an upbeat note.

"It feels as though we may have articulated at this conference a potential turning point," Lewis said. "We may look back on this as an important moment."

Causes of concern

But there were also grounds for concern, particularly in the statements of those who fail to accept that HIV/AIDS can only be beaten through a combination of science and pragmatism. There was much ridicule, for example, of Tshabalala-Msimang's statements about the preventative value of eating lemon, garlic and beetroot.

The minister claimed that the South African government wanted to give AIDS patients a choice between traditional remedies and ARVs. But critics spoke of how, in practice, patients were frequently being encouraged to use anonymous concoctions rather than modern drugs — often with tragic consequences. The deputy editor of City Press, a prominent South African newspaper with a large circulation in black communities, described the minister's remarks as reducing the country "to an international joke".

Sexual conservatism was not seen as a viable way of preventing the spread of HIV either. Delegates pointed out that in countries such as Thailand, the distribution of free condoms had succeeded where admonitions against visiting prostitutes had failed. There was also evidence that in Uganda, touted by the US administration as a country in which its policy of abstinence was achieving remarkable successes, the tide may be turning and HIV/AIDS prevalence may be on the increase again.

A scientific approach

But focusing on laboratory-based science alone is not the answer. Indeed, as even Bill Gates has admitted, progress is needed across a broad range of fronts, from the cutting edge of biomedical research to the rigorous evaluation of intervention strategies.

As the conference heard, a commitment to a scientific, evidence-based approach is as necessary as ever. HIV/AIDS remedies must be proven to work using rigorous testing methods.

Journalists have a key role in creating this demand for evidence. Nothing does more damage and raises more unjustified hope than the uncritical reporting of a new "miracle cure". And the same goes for statements by government officials that they either do not see a problem or are successfully combating the disease, when evidence speaks to the contrary.

If journalists had been more sceptical about such comments when they were being made widely in the developing world in the late 1980s and early 1990s, who knows how many millions of lives would have been saved.

David Dickson
Director, SciDev.Net