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A report released at the conference by the Joint Learning Initiative on Children and H.I.V./AIDS, an independent, international study group, urged governments and donors to develop new approaches to alleviate the plight of children in areas hard hit by the epidemic

A report released at the conference by the Joint Learning Initiative on Children and HIV/AIDS, an independent, international study group, urged governments and donors to develop new approaches to alleviate the plight of children in areas hard hit by the epidemic.

While the world awaits findings from new AIDS prevention trials, millions of people are becoming infected because governments are overlooking studies showing that behavior modification works, AIDS experts said at the 17th International AIDS conference here

While the world awaits findings from new AIDS prevention trials, millions of people are becoming infected because governments are overlooking studies showing that behavior modification works, AIDS experts said Tuesday. The world cannot treat its way out of the AIDS epidemic, many experts have long said, and a scientific debate exists over the extent to which antiretroviral therapy can reduce transmission of the virus. A pressing need exists to combine HIV prevention and treatment efforts, experts said Tuesday

Among the behavior modifications the experts cited: promoting safer sex through delayed intercourse and the use of condoms, decreasing drug abuse, providing access to needle exchange programs and promoting male circumcision

In the face of those bleak findings, some AIDS experts say testing the prophylactic use of antiretroviral drugs - called PrEP for pre-exposure prophylaxis - is now the most promising research in HIV prevention efforts as scientific investigation of vaccines and microbicides continues. The U.S. Centers for Disease Control and Prevention, which released a report Saturday showing that the number of people newly infected with HIV in the United States in recent years was 40 percent higher than has long been reported, said that PrEP was among the strategies that needed to be developed to substantially reduce the incidence of HIV. 'We cannot wait for the study results to begin to prepare for the optimal use and delivery of PrEP,' said Pedro Goicochea, an investigator in a PrEP study under way in Peru and Ecuador. 'Instead, we should look ahead to consider all of the possible outcomes of these trials and make real plans for making PrEP available to those who can benefit from it, as quickly and safely as possible if it is proven effective.'

Initial findings might come early next year, although researchers do not know how they will compare with the disappointing results of recent tests of vaccines and HIV microbicides, which are chemicals that women can put in their vaginas to prevent HIV infection. 'We cannot wait for the study results to begin to prepare for the optimal use and delivery of PrEP,' said Pedro Goicochea, an investigator in a PrEP study under way in Peru and Ecuador. 'Instead, we should look ahead to consider all of the possible outcomes of these trials and make real plans for making PrEP available to those who can benefit from it, as quickly and safely as possible if it is proven effective.'

Dr. Kevin Fenton, who directs HIV- prevention efforts at the agency, said, 'CDC's new incidence estimates reveal that the HIV epidemic is and has been worse than previously known.' A separate historical trend analysis published as part of the study suggests that the number of new infections was probably never as low as the earlier estimate of 40,000 and that it has been roughly stable over all since the late 1990s. Dr. Philip Alcabes, an epidemiologist at Hunter College in New York, raised questions about the validity of the findings. If they are true, Alcabes said in a statement, the agency has undercounted new HIV infections by about 15,000 per year for about 15 years. 'Therefore, there are roughly 225,000 more people living with HIV in the U.S. than previously suspected,' he said. 'The previous estimate was 1 million to 1.1 million.' A number of leading health experts have criticized the agency for not releasing the information earlier. On Nov. 21, CDC officials told AIDS advocacy groups and reporters that the data would be released soon. In an editorial on June 21, The Lancet, an internationally prestigious journal published in London, severely criticized the disease centers for failing to release the information and said, 'U.S. efforts to prevent HIV have failed dismally.'

The findings confirm that HIV, the virus that causes AIDS, has its greatest effect among gay and bisexual men of all races (53 percent of all new infections) and among black American men and women. [Julie Gerberding] said the new findings were 'unacceptable,' adding that new efforts must be made to lower the infection rates. 'We are not effectively reaching men who have sex with men and African-Americans to lower their risk,' she said. CDC officials said the revised figure did not necessarily represent an increase in the number of new infections but reflected the ability of a new testing method to more precisely measure HIV incidence and secure a better understanding of the epidemic

[...] researchers in a number of countries are conducting trials and planning others to test the unproven strategy that a daily pill, or a combination of drugs, can prevent H.I.V. By mid-2009, more people will be enrolled in such trials than in all of those for H.I.V. vaccines and microbicides, the AIDS Vaccine Advocacy Coalition said in a report issued here on Sunday at the start of the 17th International AIDS Conference