Urgent need for effective interventions in resource poor countries

What has happened to AIDS? Headlines are now rare, and advances in research and treatment occur in only small increments.1 An ambitious programme of vaccine trials has been delayed owing to the absence of promising candidate vaccines.2 In industrialised countries the incidence of AIDS is expected to have continued to rise in 1994 and then to stabilise for the rest of the decade. This implies continuing transmission of HIV infection and thus some failure of prevention. Men who have sex with men, the group most heavily affected by HIV and AIDS in industrialised countries, have shown that behavioural change to prevent infection is possible. Nevertheless, concern is growing about the lack of sustained behavioural change among people at high risk and especially about the incidence of new infections in younger members of affected communities.3 The incidence of heterosexually acquired AIDS in Britain continues to rise, as does the proportion of cases of AIDS attributable to heterosexual transmission17% in 1993.4 Maintaining preventive measures is a long term challenge.

In contrast to the relative stability of AIDS in industrialised countries, the epidemic is …