Nearly 40 million people are living with HIV/AIDS worldwide. The vast majority reside in developing countries where medications to treat the virus are often either unavailable locally or unaffordable. An estimated 14,000 new cases of the disease occur every day. While a vaccine may be the best hope for conquering the epidemic, significant challenges remain ahead. Ever since HIV, the virus that causes AIDS, was identified more than 25 years ago, scientists have been trying to unlock its secrets. Their research has recently led the National Institutes of Health into large-scale vaccine trials worldwide. Gary Nabel is director of the Vaccine Research Center at NIH. He says the purpose of the so-called T-cell vaccines trials is to induce a cellular immune response that would both reduce levels of the virus and also preserve cells critical for protection against infection. He says within five years researchers will know whether or not the approach works. "If it does it will be important for us because it is an area that we can improve upon, and it's an area that we have lots of room to make progress." Nabel says another promising avenue for vaccine exploration has been to use antibodies that can fight or neutralize the HIV virus. "If we can make progress there then we really have some great opportunities ahead of us." Nabel says what makes an AIDS vaccine so problematic is the HIV virus itself, which is constantly mutating. "We're not really making a vaccine against a single virus, we are really making a vaccine that has to protect against millions of different viruses." Nabel says the virus also has an extraordinary ability to evade the human immune system, which is why developing broadly neutralizing antibodies to fight HIV has been so difficult. "And part of the reason for that is the protein on the surface of the virus that is the target of those antibodies not only differs in sequence among different viruses, but even on any given virus." Nabel says, "The virus is always lopping around and changing its shape on the surface making it a moving target." Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says the trial vaccines won't provide blanket protection. But he notes that if they are successful, they will alter the disease by lowering the population of the virus and slowing its proliferation. "Ultimately this may and likely will have a positive effect in decreasing the efficiency whereby those infected people infect other people." Fauci says this approach combined with neutralizing antibodies that prevent infection could be the first big step towards an HIV vaccine. An estimated 20,000 volunteers are participating in trials in 24 countries. But science alone cannot conquer the AIDS epidemic. Advocates for a vaccine say it will also take financial support, political commitment, private-sector involvement, and greater attention to the economies and health care systems of developing countries.

WOMEN & HIV…While there are many unanswered questions about HIV's ongoing spread, one thing is clear: THE HIV VIRUS DOES NOT DISCRIMINATE BETWEEN MEN & WOMEN! Either can be infected, and both can infect others. But there are considerable differences between men living with HIV and women living with HIV. Infection rates and infection prevalence are not the same across the sexes, and there are needs and concerns unique to women living with the disease. Let’s take a look at women and HIV. What are those differences and how do they impact women who live with this disease? Here are some facts:

* Today, roughly 40 million people worldwide are living with HIV.
* It’s estimated that 50 percent of those people living with the disease are women.
* While men still make up the majority of HIV cases in the United States, about 300,000 women are living with HIV.
* The proportion of HIV cases that are women has tripled from about eight percent to 27 percent since 1985.
* From 2000 to 2004, the number of men living with HIV has increased by seven percent while the number of women infected has increased 10 percent.

There are some disturbing trends emerging in the world with regard to HIV and women. In this time of increasing HIV infection among women, young women and women of color have been the hardest hit. It’s obvious that women are being impacted by HIV at an alarming rate. But why is this? If HIV does not discriminate, how can this be explained? The sad truth is that women are more vulnerable to HIV infection in many ways. There are vulnerabilities to HIV that are unique to women. These help to account for the differences in infection rates between men and women worldwide. Some of those vulnerabilities include:

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Physical Differences - Women are especially susceptible to heterosexual transmission physically because the mucosal lining of the vagina offers a large surface area to be exposed to HIV-infected seminal fluid.
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Easier to Transmit from Men to Women than Women to Men – Again, anatomical differences between men and women mean transmission from men to women is easier than the other way around. Much like the rectal mucosa makes transmission during anal intercourse easier; the mucosal lining of the vagina offers a large surface area to be exposed to infected seminal fluid. Plus, the vagina is more susceptible to small tears and irritation during intercourse than is the penis. These properties offer a portal for HIV to enter the body and infect the woman.
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Gender Inequities – Especially in developing countries, prevailing gender inequities leads to higher-risk behaviors. For instance, in many cultures women are not free to refuse sex or to insist on safer sex using condoms. Men assume a position of power and control over women, minimizing the amount of input and consent from women. In addition, women have less access to employment and education in these developing countries. Often, the sex trade is one of the few options for women trying to earn money and support themselves and their children. Finally, sexual violence against women is very high in some areas, again exposing them to high-risk behaviors without their consent.

What Challenges Do Women Face? Obviously, HIV impacts anyone who has the disease, whether male or female. An HIV diagnosis, while not a death sentence, will most certainly be a life-changing event. However, there are some challenges that are unique to women:

* There is an increased risk of reproductive illnesses including vaginal yeast infections, pelvic inflammatory disease (PID), Human Papillomavirus (HPV) and cervical cancer.
* Because women often have lower incomes than men or work lower paying jobs with minimal benefits, women have less access to HIV care and affordable medical insurance.
* Women are more likely to postpone health care due to illness or lack of transportation than are men.
* Women assume more family care responsibilities and are more likely to sacrifice their own health care in order to care for their family, especially their children.

Is Anything Being Done? The disparities between men and women who live with HIV have not gone unnoticed. In fact, the National Institute of Allergy and Infectious Diseases (NIAID) have placed a new emphasis in women-focused HIV research, funding and sponsoring studies around the world. Once such example is the research being done in hopes of developing a microbicide gel or cream that would provide an inexpensive and easy-to-use product that would allow women to assume more control over safer sex. While work is being done to close the gap between men and women, the fact remains that a disparity does exist. Until that gap is closed, we will see infection rates among women continue to climb, something none of us can really afford to let happen.