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Celebrating the Possible in the Fight against AIDS

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For more than two decades, we've paused every December 1st to take stock of where we are in the fight against AIDS. We mark the number of new infections, the number of deaths, and prepare ourselves for another year of battling a formidable enemy.

This year, we have some good news to celebrate alongside the sobering statistics. The new UNAIDS report showed an important decrease over the past eight years in HIV infections in some of the hardest hit areas of the world. It is clear that HIV treatment and prevention programs are having an impact in the fight against this disease, and it is clear that we can make even more of an impact if we scale up effective programs to reach even more men, women and children with lifesaving treatment and prevention.

On this World AIDS Day, we also celebrate the possibility of an AIDS vaccine. Announced in September, the results from the world's largest AIDS vaccine trial, which took place in Thailand, showed that an AIDS vaccine is possible. We're still far from the finish line in our search for an AIDS vaccine, but we're farther down the road than we've ever been. Data from this trial will give researchers clues that can help speed the development of a safe and effective AIDS vaccine.

There is also great potential in other HIV prevention research. In the coming months we will see results from an efficacy trial of a microbicide gel that could be used by women to protect themselves from HIV infection. We will also learn the results of a safety study looking at a strategy called PrEP in which researchers are investigating whether the use of antiretroviral drugs can help reduce the risk of HIV infection. There are several additional PrEP studies that will generate important data later in 2010 and beyond.

A decade of increasing funding for HIV programs - in prevention, treatment and research - is paying off. Ironically, though, this good news comes at the same time that the global economic crisis and political arguments threaten the future of HIV funding.

The stark realities of post-crash budgets in developed and developing countries are leading to flat or reduced funding for many health and development programs around the world, including HIV treatment, prevention and research. Arguments that too much money is going to AIDS programs or that funding should be prioritized for delivery of existing interventions over expansion of research for new, more effective methods, are false dichotomies at best, and at worst, threaten to derail the successes we've achieved to date.

The possibilities and the victories that we celebrate this World AIDS Day could sadly be transitory unless we act now to solidify and sustain funding and support for HIV treatment, prevention and research programs. To avoid losing ground, we must take a long view of what is needed to respond most effectively to AIDS and to capitalize on the possibilities before us.

Taking the long view is not merely ensuring sustainable funding. It requires developing a broad and coordinated response. We must use the funding we have prudently. This requires careful examination of effective treatment and prevention programs so that they can be replicated and expanded. It also requires an unprecedented level of pressure to cooperate so that funding is not wasted on duplicative programs.

For HIV prevention research, the long view means bringing the field together to make common and informed decisions about what candidates should go forward in human trials. It requires courageous sharing of knowledge, new information and innovative ideas. The vaccine field has begun to make great strides in this area. Similar efforts are needed for other prevention research modalities. At the same time, there must be more coordination across prevention research disciplines and among researchers, implementers and communities.

For three decades the world has been living with and responding to AIDS. Our response has often been too late or too little - and often both.

But it has also often been unprecedented, groundbreaking and unpredictable. Activists and researchers have found common ground to work side by side to beat this disease. Together, they've developed new ways of conducting research and new ways of delivering healthcare in response to the AIDS pandemic. They've learned unexpected lessons and developed strategies that work against HIV and against other diseases. They've revolutionized public health.

So this year as we don our red ribbons and think about where we are in the fight against AIDS, let us also think about how we take the small victories - the possibilities - of this year and push forward in our quest to end the AIDS epidemic.

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