The Toronto International Aids Conference ended today with disappointment for those living with HIV/AIDS but researchers optimistic on advances in new technology to prevent infection, writes Shafqat Munir.

While scientists believe it could take another decade before an eventual vaccine is developed, they seem hopeful of slowing down the epidemic with technologies like microbicides, easy to apply gels that could act as an invisible condom to prevent infection.

Microbicides provide hope

"The prospects for microbicides are thrilling. Regardless of their effectiveness, it will inevitably save millions of lives," claimed Stephen Lewis, UN Special Envoy for HIV/AIDS on Africa.

One microbicide 'Carraguard', a seaweed-based gel, creates a physical barrier that keeps HIV from approaching cells where they will latch on and infect a person.

Another, 'Ushercell,' derived from cotton, disables the virus by stripping off its outer covering, while others boosts the body's natural defense mechanisms by raising pH levels and creating acidic environments hostile to viruses.

But they are still in a testing and research phase and the first products are unlikely to materialize before 2009 – if they are proven to work.

Many HIV activists remain cautious, stressing the need to provide care and treatment to people living with HIV/AIDS to prevent the risk of further infection.

"Blocking science could be the easy part, the hard part is developing products that women can access, use and afford. Moreover it is not just the microbicides, it is how they are delivered as women need something they can fit and forget," said Linda Margaret, a gender and women rights activist.

Power issues

She said such solutions are linked to gender and power relations, comparing the possible use of microbicides to condoms, which are seen as an effective means of blocking transmission, are cheap and accessible but still are in low use because women do not have physical, legal and social power to negotiate safer sex with their partners.

"Across Africa and Asia women have to succumb to sex when, where and how their partner chooses, even if he is HIV positive. Every passing day they are at risk of being infected," another activist said.

Like microbicides, male circumcision has been a hot topic at the conference where a number of speakers including Bill Clinton endorsed it, calling on public health officials to act on evidence that male circumcision dramatically reduces the risk of transmission of HIV/AIDS.

Experts and researchers believe that circumcision reduces the risk of HIV infection because the skin that is removed contains more of the cells to which HIV can easily attach. In many cultures circumcision it is an indicator of boys' transition into manhood, but in others it is a highly sensitivities issue.

Moreover, there are fears that if circumcisions are done under national health programmes, misunderstanding could emerge as some people assume that after circumcision they are now safe from the risk of being infected and may abandon existing safe-sex practices.

The body's own defence

According to Barré-Sinoussi of Frances Institute Pasteur the greatest hope for progress lies in recent advances in fundamental immunology, in particular new insights into the body's innate immunity and its critical role in the response to HIV exposure. Another important direction for future research is the therapeutic vaccination of HIV-infected individuals on highly active antiretroviral therapy (HAART).

While medical experts and researchers were pinning hopes on the new technological advances, people living with HIV/AIDS and their supporters were voicing their anger and disappointment at the absence of concrete pledges on HAART.

Comparing the conference to a "Hollywood show," they branded it a “failure” for not delivering commitments on treatment.

Universal treatment

They argue that if universal access to treatment and low cost generic medicines are not guaranteed, prevention itself will fail - everything should start and end with treatment, otherwise more children, women and men will die.

Activists said the time to deliver is now and that stakeholders at every level of the global response should take whatever steps necessary to ensure HIV/AIDS treatment and care to all who need it by 2010.