By Katrina Woznicki

      Seventeen years after discovery of the Acquired Immune Deficiency Syndrome, scientists returning from the 12th World AIDS Conference are realizing that the optimism they once felt about a possible cure is still many laboratory tests away. Many scientists equate this AIDS conference with a global reality check, and now the focus shifts from finding a cure to developing a vaccine that will protect millions of people from the disease.
      More than 12,000 AIDS experts from around the world attended the conference in Geneva from June 28 to July 3. They pooled ideas and resources in an effort to defeat an epidemic now being compared to the Black Plague of the Middle Ages. The daunting tasks before them include treating the 30.6 million people worldwide – 21 million of them in Africa – who are infected with HIV, and trying to find a cure or a vaccine that will curb the infection rate.
      "The Holy Grail of HIV research is an HIV vaccine," Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and a speaker at the conference, told OnHealth. "It's clear that it's going to be very difficult to completely eradicate the virus from the body."
      The virus will be difficult to eradicate because it uses a cell's biological makeup to reproduce itself, making it a challenge to detect. Researchers are now testing possible vaccines to slow the rate of infection. Last month, vaccine trials began in the United States, where 5,000 volunteers will receive either an "AIDSvax" injection or a placebo in the first large-scale human trial of an AIDS vaccine. Scientists also want to test the vaccine on 2,500 high-risk people in Thailand.
      While the potential vaccines have attracted more attention, researchers have also improved methods of prevention, especially when it comes to the next generation. The July 1 Journal of the American Medical Association, dedicated to HIV and AIDS issues, included a study that found pregnant, HIV-infected women who were treated with the drug AZT and delivered their babies by elective Cesarean section greatly reduced the risk of transmitting the virus to their newborns. Another study, conducted by the U.S. National Institute of Child Health and Human Development, concluded that pregnant women with HIV can reduce the chances of transmitting the virus to their babies by 50 percent if they deliver by elective C-section.
      Researchers at the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention have developed new testing strategies to detect recent HIV infection, according to another JAMA report. Until recently, researchers couldn't determine from HIV antibody tests whether a person had been recently infected or had long carried the virus. A new, more sensitive blood test may help scientists make that determination, and better direct HIV prevention programs.
      The Journal also reports a three-drug combination taken simultaneously is more effective in fighting HIV than taking the drugs consecutively. Dr. Roy M. Gulick of Cornell University Medical College in New York, found that when the drugs indinavir, zidovudine and lamivudine were taken all at once, the number of infection-fighting cells increased. The same drugs taken one at a time did not provide the same results.
      Despite advances in AIDS treatments, only about 5 percent of AIDS patients – most of them in North America and Western Europe – can afford the drugs that have so far been effective at keeping some patients well. Scientists at the conference discussed ways to reduce medication costs so patients in Africa, Asia and Latin America, where HIV and AIDS are rampant, will have access to treatment.
      "There are millions of people in Africa who don't get aspirin let alone AZT," said 45-year-old Richard Eastman, an HIV patient. Eastman, an AIDS activist since his own diagnosis in 1994, spoke at the Geneva conference and is planning a trip to Africa to emphasize the devastating effect of AIDS there. Eastman said he wants to educate the world about his disease because "most of my friends died [of AIDS] and they didn't have a chance to speak about it."
      But advancing prevention, as well as developing a vaccine, are the world's best hopes for slowing the spread of HIV and AIDS, said Dr. Jeffrey Lawrence, director of the Laboratory for AIDS Research at Cornell University Medical College in New York City and a consultant to the American Foundation for AIDS Research. "Drugs are never going to be useful for anyone in the developing world," Lawrence said. "That might as well be drugs on the moon."
      The unavailability of HIV and AIDS drugs in developing nations has scientists working to improve AIDS education strategies. "Condoms have made a major impact," Lawrence said. Researchers say condom use has increased in commercial sex, but preventing HIV transmission between married couples will be difficult.
      It is unclear what scientists will have to report at the 13th World AIDS Conference, to be held in Durban, South Africa two years from now. Experts estimate that 10 million people have contracted the disease since the 11th World AIDS Conference in 1996 and 12 million people have died of AIDS since the early 1980s. For the first time, AIDS cases and deaths in the United States declined in 1996, but scientists caution there's still a long road ahead.
      In another JAMA report, the CDC estimated 40,000 Americans will become infected with HIV each year. Women and minority groups are the most vulnerable to AIDS, which they contract mainly through heterosexual sex and by injecting drugs with tainted needles, according to Dr. Helene Gayle of the CDC.
      The CDC also says that as more people live with HIV and AIDS, attitudes about the disease have relaxed, particularly among young gay men.
       "We cannot confuse progress with victory," Gayle said in a prepared statement. "This epidemic is far from over."