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.