The scientific community and the pharmaceutical industry need to redouble their efforts to develop microbicides and pre-exposure prophylaxis methods to prevent HIV transmission, Bill and Melinda Gates said Sunday at the opening session of the XVI International AIDS Conference in Toronto, the Washington Post report (Brown, Washington Post, 8/14). Microbicides include a range of products -- such as gels, films and sponges -- that could help prevent the sexual transmission of HIV and other infections (Kaiser Daily HIV/AIDS Report, 4/26). "We want to call on everyone here and around the world to help speed up what we hope will be the next big breakthrough on the fight against AIDS -- the discovery of a microbicide or an oral prevention drug that can block the transmission of HIV," Bill Gates said (Fox, Reuters, 8/13). Large-scale microbicide trials can require at least $100 million over many years, according to the San Francisco Chronicle (Russell, San Francisco Chronicle, 8/14). Melinda Gates expressed hope that the World Health Organization and other international organizations would draft ethical standards for such trials to accelerate their completion. She also urged advocates and governments to join the call for microbicide research. Before the speech, Bill Gates said the Bill & Melinda Gates Foundation plans to increase funding for research on microbicides and PrEP, although he did not specify how much additional money the foundation would provide (Chong, Los Angeles Times, 8/14). UNAIDS Executive Director Peter Piot at the conference opening joined the Gateses' call for more resources for microbicide research, saying that the development of a vaccine to prevent HIV transmission is many years away (Picard, Globe and Mail, 8/14). Piot said a "top priority is to immediately double funding for microbicide research and development" (Teotonio/Westhead, Toronto Star, 8/14). U.N. Special Envoy for AIDS in Africa Stephen Lewis on Saturday ahead of the conference said the "search for a microbicide is one of the most important things the world is doing" (San Francisco Chronicle, 8/14). According to London's Guardian, the role of women in the developing world is likely to be a key point of discussion at the conference (Boseley, Guardian, 8/14). "We need to put the power to prevent HIV in the hands of women," Bill Gates said, adding, "No matter where she lives, who she is, or what she does, a woman should never need her partner's permission to save her own life" (Globe and Mail, 8/14).

Prevention
According to Bill Gates, the struggle to end HIV/AIDS needs to shift to focus on prevention rather than only on providing treatment for HIV-positive people (San Francisco Chronicle, 8/14). Bill Gates said it will cost more than $13 billion annually to provide antiretroviral drugs to all people who need them (Sternberg, USA Today, 8/14). "When you extrapolate five to 10 years, you quickly see that there is no feasible way to do what morality requires -- treat everyone with HIV -- unless we dramatically reduce the number of new infections," Bill Gates said, adding, "The harsh mathematics of this epidemic proves that prevention is essential to expanding treatment. Treatment without prevention is simply unsustainable" (San Francisco Chronicle, 8/14). Piot also supported greater prevention efforts and long-term planning, saying, "It is now time we move from crisis response to a long-term sustainable response" (Smith, Boston Globe, 8/14). Although Piot said providing universal access to treatment is a crucial goal, he asked, "Who is going to pay for that?" (Guardian, 8/14). According to Melinda Gates, fewer than one in five people who are vulnerable to HIV transmission have access to basic prevention tools -- such as condoms, clean needles, education and testing (Globe and Mail, 8/13). Piot at a youth congress specifically called for efforts to encourage older men to change their sexual behavior in terms of having multiple sex partners and being faithful to their wives.

Stigma
The Gateses also called for an end to the stigma surrounding HIV/AIDS. Melinda Gates called the stigma associated with the disease "cruel" and "irrational," and the couple specifically said stigma against women in developing countries must end because such women usually are not in a position to control their health or sex lives (Duff-Brown, AP/MLive, 8/14). "When Bill and I visit other countries, we are enthusiastically accompanied by government officials on all our stops -- until we go to the sex workers," Melinda Gates said, adding, "If you are turning your back on sex workers, you're turning your back on the faithful mother of four" (San Francisco Chronicle, 8/14). Piot also said stigma, gender inequality and homophobia must be tackled to curb the pandemic. Also at the conference opening, Indonesian HIV/AIDS advocate Frika Chia Iskandar spoke out against the stigma and discrimination that people living with the disease face on a daily basis (Al-Atraqchi, Al-Jazeera, 8/14).

Additional Speakers
The opening session also included speeches by conference Co-Chair and President of CARE Helene Gayle, as well as musical performances by Alicia Keys, Barenaked Ladies and Our Lady Peace (Toronto Star, 8/14). Some delegates -- including conference Co-Chair Mark Wainberg, who directs the McGill University AIDS Centre, and actor Richard Gere -- publicly criticized Canadian Prime Minister Stephen Harper for his decision not to attend the conference (Ubelacker, CP/Cananda.com, 8/13). In addition, about one dozen protestors within 20 minutes of the opening ceremony attempted to interrupt the event by shouting for an end to workplace discrimination against people living with HIV/AIDS (Al-Jazeera, 8/14).