A dominant theme in this year's AIDS conference will be the importance of tying prevention and treatment efforts. The latest report of the Global HIV Prevention Working Group entitled "HIV Prevention in the Era of Expanded Treatment Access" cogently illustrates the necessity of this linkage. Not only are both prevention and treatment efforts greatly enhanced by the synergies between the two, there are convincing reasons why inattention to the linkage -- or excessive focus on treatment -- could actually make things worse:

• the number of people treated are unlikely to catch up with new infections anytime soon;


• there are likely to emerge drug-tolerant strains of HIV;


• the introduction of therapies (or perceived therapies) can enhance risky behavior;


• treated people live longer, and therefore can in theory infect others.

I don't intend to be Cassandra-like in deriding the promise of treatment efforts -- I just hope enthusiasm for 3x5 won't eclipse the need for greatly expanded prevention, tied as closely as possible to growing treatment programs.

I arrived this morning to Bangkok and was pleased to see in my conference welcome materials -- along with the typical maps and schedules -- four brightly wrapped condoms. Congratulations to the Thai organizers for making this statement on the importance of condoms in fighting AIDS. I regret that in my country, inclusion of condoms would be pitifully controversial.

One of the most remarkable information resources online is Wikipedia, a volunteer-driven online encyclopedia which combines impressive scope (over 300,000 articles) with admirable quality (see, for example, the entry on AIDS). A number of additional "wiki" projects have spun off -- dictionary, textbooks, quotes resource -- all also demonstrating impressive dynamism.

I could imagine a team of motivated volunteers (ok, some foundation stipends might help) doing something similar for AIDS, building "AIDSpedia.org" (I have the domain in case anyone wants to take the lead :) ). Right now an online search on topics of interest to global AIDS professionals, such as MTCT, surveillance, or monitoring and evaluation, provide a jumble of results. An AIDSpedia effort could simplify a lot of our lives by pulling together best resources on topics of interest. A good place to start would be to convert each of the 100 main session topics at the Bangkok conference as outlined in the conference wiki into a full AIDSpedia home page including definitions, news, key resources, background data, and individuals of note. This could grow to be an impressive free-standing resource, or possibly rolled back into Wikipedia in the future if that made sense.

Over five billion dollars will be allocated by international donors in 2004 to combat global AIDS. Is that money allocated appropriately?

Ideally, funding decisions would reflect experts' best advice on the smartest use of resources. Unfortunately, the policy recommendations emanating from UNAIDS, the Global HIV Prevention Working Group, or other normative bodies rarely give dollars and cents recommendations on how to allocate budgets. Decisions are therefore left to government officials who may have some understanding of effective interventions, but will be heavily influenced by both politics and guesswork. How could this situation be improved?

1) Policy bodies should provide not only policy recommendations, but budget recommendations. Much as the Copenhagen Consensus allocated a fictional $50 billion, policy groups should routinely include notional budgets (by region and intervention) in their recommendations.

2) UNAIDS, Kaiser, or one of the other capable organizations that review statistics should compile annual global expenditures by region and intervention type.

3) An annual conference, potentially overseen by UNAIDS, should compare recommended spending with actual spending and advise on "rebalancing the portfolio". Experts frequently comment on areas receiving inadequate funding (see for example Helene Gayle's recent comments on this), but rarely are these comments backed up by any sort of comprehensive analysis.

The gap between what should be funded and what is funded in global AIDS is enormous -- certainly representing one of the most serious problems to be tackled in confronting the disease. There are clear steps that can be taken to minimize this gap.