Just over a year ago, while driving through the Ugandan countryside on my way to an AIDS conference, I stopped by the roadside near a small shack, where coffins were being made. Several men planed the wood, while others stacked the finished coffins up against the shacks. Young children played nearby; older ones were helping the men. As I watched coffin after coffin being lifted into the air, I thought about how AIDS had inadvertently boosted a small Ugandan industry and how countries everywhere desperately need solutions to this devastating epidemic.

In this issue of the Harvard AIDS Review, we focus on a range of strategies for ending the worldwide epidemic. The special report summarizes our research on HIV-2--the second AIDS virus--and illustrates how drawing from a diversity of disciplines, such as biology, epidemiology, and clinical research, has led to findings that may eventually culminate in the development of a vaccine.

The special report also illustrates how crossing geographic borders helps catalyze AIDS research. Over a twelve-year period, for example, Institute researchers, with our Senegalese and French colleagues, have followed more than one thousand women at a clinic in Dakar, Senegal. Now one of the oldest AIDS collaborations in the world, our partnership has helped provide clues to the worldwide epidemic.

To complement this special report, Harvard physicians focus on the future of protease inhibitors. In a roundtable discussion, the physicians discuss issues of toxicity, resistance, and treatment strategies. While the discussants express enthusiasm for the drugs remarkable results in obstructing the course of the disease, they also voice doubt that the drugs are the answer to solving the epidemic. One-third of HIV-infected people in this country cannot tolerate the drugs. And more than 90 percent of all people infected with HIV are in the developing world, where they cannot afford even basic antibiotics, much less the $14,000 to $20,000 per year price tag for protease inhibitor therapies.

Also in this issue, Richard Marlink, executive director of the Harvard AIDS Institute, raises important questions about the restructuring of the National Institutes of Healths AIDS vaccine program. In his article, Dr. Marlink urges bolder and more creative strategies in the search for a vaccine. With 30 million people throughout the world already infected with HIV, we cannot afford further delay in vaccine development.

As I continued my drive through the Ugandan countryside that Sunday morning, I watched young children dressed in white hurrying along the road on their way to church. I thought about how fully one-third of adults in Uganda are infected with HIV, and I wondered how many of the children walking along the road were orphaned or about to become orphaned. I vowed at that moment to increase our research momentum against the epidemic, so that children can play and grow without the threat of AIDS in their lives, without the shadow of more and more coffins rising into the air.