Beyond ABC in AIDS

DRUGS ALONE will never keep up with HIV-AIDS if there continue to be 4 million new infections every year worldwide. In the United States, the number of new infections stays stubbornly at about 40,000 each year. While researchers hope someday to develop a vaccine and a microbicide that women can use to protect themselves, those breakthroughs are several years off at the least. So for now, health agencies will have to rely on other tools to slow transmission of the disease.

The so-called ABC of AIDS prevention -- Abstinence, Being faithful in marriage, and Condoms -- is a sound, low-cost approach to prevention, but it has not proven equal to the challenge. ABC first came to prominence in Uganda. Its implementation sharply reduced that country's infection rate, but recent data indicate that the rate has stopped declining.

Last week's international AIDS conference in Toronto put a spotlight on two new methods of prevention: adult male circumcision and the use of AIDS treatment drugs as a way to protect uninfected people at high risk of the disease, such as prostitutes. Both approaches need -- and deserve to get -- more funding from donors for wider study.

Interest in circumcision as a prevention method has grown after a study last year in South Africa indicated that circumcised men were less likely to be infected by a female partner than uncircumcised men. New studies are underway to learn whether circumcision also protects the female partners of HIV-positive men.

The AIDS drug tenofovir has shown promise as a prevention method, but testing it on high-risk groups such as prostitutes or injection-drug users presents an ethical quandary. Researchers must tell test subjects to keep using other prevention methods, such as condoms or clean needles -- not least because half of the subjects would be getting a placebo and not the AIDS drug . And even if the drug proves effective against HIV now, the widespread use of tenofovir for prevention presents a risk: Those who become HIV-positive despite taking the drug might develop a strain of the virus that is resistant to tenofovir as a treatment medication.

Circumcision and tenofovir could both create a false sense of security. Health educators will have to make it clear that neither method is foolproof and both should be backed up by the ABC basics.

Donors will have to dig deeper to pay for these approaches if they prove their worth. In Washington, financing will be especially difficult if Congress sticks to its requirement that one-third of all US funds for AIDS prevention go toward abstinence. Policy makers should give health officials the flexibility they need to keep this virus from infecting millions more than it has already.