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Adding not replacing
None of the prevention technologies discussed in this chapter are likely to remove the need for existing strategies in the foreseeable future.
This means that the evaluation of these technologies must always be undertaken alongside and in combination with existing approaches.
Even the most enthusiastic advocates of antiviral treatment to prevent sexual transmission would see it as a back-up to other methods for use in extreme circumstances, when condoms fail or to protect victims of sexual assault, or to cover limited periods in a person's life when they are at greatest risk of HIV infection.
In relation to microbicides and vaccines, advocates sometimes express concern that condom use, or antiviral treatment could make the evaluation of other options difficult or even impossible. In practice, as more experience is gained with Phase III trials of vaccines and microbicides, this concern seems likely to disappear.
The COL-1492 microbicide trial, discussed later on, was an impressive demonstration that it is possible to show the superiority of one product over another (even if it was the placebo that came out ahead), despite a successful campaign to promote increased condom use among trial participants.
Similarly, the VaxGen trials showed that it was possible to recruit, motivate and retain a large group of volunteers at continuing high risk of HIV without adding to their risk-taking. (Reported risk-taking behaviour declined during the course of the trial and HIV infection rates were stable.)
This highlights the importance of feasibility studies, to identify populations in which there is continuing HIV risk despite the wholehearted promotion of the best available means of HIV prevention.
It may also point to the need for multi-agency as well as multi-disciplinary projects, in which some or all of the prevention education can be provided independently of the researchers.