Where's My Hammer? Did You See My Blusher?

It's been five years since I began my journey into the field of HIV prevention advocacy. And since the beginning, the metaphor of a "toolbox" or "makeup bag" for HIV prevention -- kits made up of various pieces that do different jobs on different occasions for different users and different needs -- has stuck with me. And as we have just commemorated another HIV Vaccine Awareness Day (May 18), I'm reminded that I still need my foundation and my blush, or, rather, I still need an HIV vaccine. I'm reminded of why I -- and many other people like me -- still need to add a vaccine to our kit of HIV prevention options. I feel that like in real life, each piece of your toolbox is useful to build something, or that a makeup bag wouldn't be truly complete without some lipstick, mascara and foundation. We are at a unique moment: We are adding to our prevention toolbox or makeup kit. However, despite recent additions like pre-exposure prophylaxis (PrEP), we aren't done outfitting ourselves to tackle the challenge of ending the epidemic.

In August 2011 the Centers for Disease Control and Prevention (CDC) released "Estimated HIV Incidence in the United States, 2006-2009," highlighting an alarming 48-percent increase in new HIV cases among young black men who have sex with men (MSM) between the ages of 13 and 29. This is why I remain a prevention advocate -- someone who is interested in choice when it comes to HIV prevention. We need to continue implementing the prevention tools we have -- condoms, PrEP and early treatment -- while developing microbicide gels, rings, and even long-lasting injectables and a vaccine. Let's learn from the reproductive justice movement that achieved an array of birth control options. With each additional contraceptive tool, overall rates of unintended pregnancy dropped. Similarly, each HIV prevention option can reduce risk -- in a different setting, for a different population, for a different person on a different day -- to drive down the epidemic as a whole.

We've learned time and again of the the economic and public health viability of vaccines. Major public health crises plaguing our world for centuries have been brought down by vaccine programs. Diseases like polio, measles, and mumps are all but gone in the United States, with only rare cases still mentioned, and smallpox is fully eliminated. And the economic benefits of vaccines are unrivaled by any other public health interventions. A recent "Morbidity and Mortality Weekly Report" from the CDC highlighted the power and cost savings of vaccines: The report found that routine childhood immunization prevented roughly 322 million illnesses and helped avoid more than 21 million hospitalizations over the course of the cohorts' lifetimes and averted 732,000 premature deaths from vaccine-preventable illnesses. Illnesses prevented ranged from 3,000 for tetanus to over 70 million for measles. The highest estimated cumulative numbers of hospitalizations and deaths that will be prevented were 8.9 million hospitalizations for measles and 507,000 deaths for diphtheria.

The HIV prevention toolbox will not be truly finished until there are options for everyone who needs a tool/option to reduce their risk of HIV -- and until the options are acceptable and accessible, both in terms of programming and cost. The recent release of guidance on PrEP use from the CDC gave a stamp of approval and guidance for medical providers to prescribe ARVs as prevention. Additionally, treatment as prevention has demonstrated in two large-scale studies that viral suppression with antiretroviral medication can reduce the risk of HIV transmission to almost zero. These two breakthroughs represent critical new additions to the prevention toolbox or makeup bag.

Education is a key player here, so please think about clicking through the links presented here and checking out what is being talked about, but also, when there are things you don't understand, ask questions. While progress may seem slow, there have been critical advances, such as the Thai vaccine trial. Additionally, there's a lot of information available; it's important to understand the status of the field. Here's the link; check it out. So often, what is not asked can't be answered, and those questions might change the world, the field, and, if nothing else, your life.

The prevention advocate in me stands firmly by our need for an HIV vaccine. It remains a potential critical piece in the long-term strategy to end the AIDS epidemic in my community and around the world. It's important to remember that our battle against HIV has never been easy. It takes us each knowing what options are out there and thinking about how they might be useful in our community, then relaying what we think and feel about the chosen strategies to the right people. Though the information can sometimes seem dense, it's important to learn the available tools best suited for each one of us, individually, until a vaccine is here.