From the Advisory Council

By Deeda Blair

AIDS is the most threatening and lethal new epidemic of the twentieth century. UNAIDS experts released figures last fall showing that they had seriously underestimated the spread of HIV worldwide. They now believe new infections are occurring twice as fast as they had thought the year before-approximately 16,000 people become infected each day. UNAIDS estimates that 2 to 3 million people will die of AIDS this year alone, and more than 30 million people are infected with HIV.

Ten years ago, Harvard increased its already considerable efforts in the AIDS field. Recognizing the HIV epidemic as a global public health issue and realizing the immense complexity of this retrovirus, Harvard scientists formed the Harvard AIDS Institute-a university-wide endeavor aimed at conducting research on all aspects of AIDS.

As a founding member of the Harvard AIDS Institute International Advisory Council, I have seen important progress. Medical research has been spectacularly successful in developing totally new concepts in antiviral drugs, and many lives have been prolonged. However, there is a very harsh reality-the epidemic continues to spread, and the rate of HIV infection among young people is escalating. Clearly, our prevention programs are failing.

The single greatest factor that could change the course of the AIDS epidemic would be the development of a vaccine-in fact, it is the only real hope in terms of the virus's devastating spread throughout the world. The unprecedented pace of evolution shown by this virus also is working against us. Mutant subtypes, which were found only in Asia or Africa a few years ago, have already been found in North America and Europe. These rapidly moving subtypes are efficiently transmitted through heterosexual contact, and if they take hold on these continents, they may unleash larger waves of HIV infection.

For this reason, we are devoting this issue of the Harvard AIDS Review to "emerging epidemics," in which the appearance of HIV has been recent, dramatic, or unexpected, thus requiring urgent attention. In this issue, we examine the epidemic's continued progression across Southeast Asia, where HIV threatens additional countries. In southern Africa, where HIV is spreading faster than any other region in the world, we look at some of the implications of the epidemic's astronomic growth. Meanwhile, in gay communities in the United States-once models of successful prevention-a new generation of young gay men is becoming infected at alarming rates.

Early in the epidemic, Halfdan Mahler, then director general of the World Health Organization, said, "AIDS cannot be stopped in any country until it is stopped in all countries." We know that controlling HIV in a single country will not work. The lives of millions of people will depend on vaccine research that crosses international boundaries and targets all subtypes. Until a successful vaccine is found, the Harvard AIDS Institute will continue to bring all of its resources and commitment to bear on this epidemic of staggering and tragic proportions.

Deeda Blair, Co-Chair, Harvard AIDS Institute International Advisory Council