NIAID director Dr. Anthony Fauci addressed the United Nations General Assembly special session on HIV/AIDS on June 10.

NIAID director Dr. Anthony Fauci addressed the United Nations General Assembly on June 10 during its high-level meeting on AIDS in New York City. The goals were to review member- nations’ progress toward achieving universal access to HIV prevention, treatment, care and support by 2010; to discuss remaining challenges; and to identify sustainable ways to overcome them.

In his address before five heads of state, two prime ministers and more than 150 delegations, Fauci emphasized the need to close the so-called “implementation gap”—the delay between biomedical research discoveries and the delivery of the fruits of those advances to all who need them. This gap is most acute for low- and middle-income countries, he noted.

Striving to provide anti-HIV drugs to every person who needs them is a “moral imperative,” he said, but the pace of HIV’s spread may make it “logistically impossible to achieve this goal.” While praising the work of national and international programs and organizations that have dramatically broadened the distribution of anti-HIV medications in recent years, he described the enormity of the challenge in reaching universal treatment access.

In 2007, 1 million people started treatment for HIV, but 2.5 million people were newly infected and only one-third of those individuals in low- and middle-income countries who needed anti-HIV drugs were receiving them. Fauci emphasized that although much progress has been made in recent years to increase access to effective HIV therapies in developing nations, “Treatment alone is not the solution to the problem. The solution is prevention.”

Furthermore, he pointed out that “the treatment and care of people with HIV cannot be done in a vacuum, but must be implemented in the context of their overall health needs.” He added that the development of public health infrastructure for delivering HIV/AIDS services “should serve as an opportunity for synergism in addressing the multitude of health problems that beset so many poorer nations and communities.”

On the subject of prevention, Fauci cited numerous available, scientifically proven approaches: condom distribution, prevention of HIV transmission from mother to baby; the provision of clean needles and syringes to drug users and—most recently—medically supervised adult male circumcision. However, he said only one-fifth of people at risk of HIV infection have access to these services.

Research to develop even more prevention methods continues, he noted. A microbicidal gel or cream to be applied before sex may one day empower women to protect themselves from HIV infection when the use of condoms or the refusal of sexual intercourse are not feasible. And the search for a vaccine continues despite a recent setback and the extraordinary scientific challenges involved. “A preventive HIV vaccine,” he said, “remains the greatest hope for halting the relentless spread of HIV/AIDS.”