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The challenge of the HIV/AIDS epidemic is to sustain and build on the gains made in the last few decades, but the end of the epidemic is nowhere in sight. To get ahead of the epidemic, it is time to come to terms with its complexity, as stated by UNAIDS executive director, Peter Piot, at the 17th International AIDS Conference (AIDS 2008), held in Mexico City in August. HIV spread is fuelled by a number of factors, including behaviour, some of which are driven by socio-cultural, economic and political determinants. The role of these determinants varies greatly between and within countries. There is no single solution that can reduce new HIV infections. The message of AIDS 2008 is that combination prevention, just like combination treatment, is the only feasible option, which means finding the right mix of prevention interventions and treatment for the local situation. As the largest and most diverse international meeting devoted to a single global health issue, AIDS 2008 drew together scientists, policy makers, advocates for special issues, service providers, people living with HIV/AIDS, sex workers, the gay community, and all those affected or concerned about HIV and AIDS. It is a place where we try to learn from each other about new developments, share experiences of what works in HIV prevention, treatment and care, and to map the road ahead. In the words of Dr Myron Cohen of the University of North Carolina, AIDS 2008 brought the realisation that it is not possible to "treat our way out of the epidemic." We are experiencing more new HIV infections adding to the already large pool of those already living with HIV, suggesting that we are in this for the long haul. Southern Africa contributes disproportionately to these new infections. If the global HIV epidemic among the youth in South Africa has to be halted and reversed by 2015, the country will have to dramatically reduce the new infections through community mobilisation and proceed towards a massive uptake of a combination of treatment and prevention strategies. On the prevention side, these include HIV-prevention technologies such as prevention of mother-to-child transmission, the uptake of male circumcision, increasing a consistent use of condoms, and an increase in the number of people who go for voluntary counselling and testing, reducing multiple and concurrent sex partners, and ending transactional sex. Without a national effort to tackle this epidemic, using multiple approaches and allocating resources, we are unlikely to win the war on AIDS. Half-hearted national approaches will not end this epidemic. The HSRC sent a group of 30 plus researchers to the conference to present their work in a number of forums, including oral presentations, discussion forums, satellite sessions, posters, skills building, chairing and participating in oral sessions and discussion panels, and in the case of Professor Linda Richter, presenting at a plenary session. At such a big event, the work done by the HSRC can easily get lost. For this reason we are devoting a special section of the HSRC Review to our work on pages 30 to 48. We invite our readers to peruse it and give feedback via media@hsrc.ac.za.
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