Money for AIDS research

Scientists believe that AIDS funding should stake on proven prevention strategies and new research approaches.

The failure of Merck & Co.'s AIDS vaccine last year highlights the need for more money to understand the immune response to the human immuno- deficiency virus, which causes the disease. Increasing circumcision among men, proved in several studies to slow the spread of AIDS, should become a top priority of the World Health Organization.

HIV, an incurable immune-system virus, infects more than 33 million people worldwide, with most cases occurring in Africa. Without a working vaccine or the prospect of one in the next 10 years, male circumcision is the best way to limit the rise of cases, said Daniel Halperin, a Harvard School of Public Health epidemiologist.

"Condom promotion has only been effective in epidemics where HIV is spread through prostitution," he said in a telephone interview. "Male circumcision, a one-time intervention for individuals, has the potential to make a much larger impact."

Circumcision, the removal of the foreskin from the penis, may reduce men's chance of catching HIV by as much as 60 percent, Halperin said. That roughly equals the impact that some vaccines, such as Merck's, were expected to have, he said.

The WHO's AIDS agency, UNAIDS, proposes spending $157 million over the next three years out of the $15 billion it has requested for HIV prevention, Halperin said.

Scientists are still puzzling over why the Merck vaccine didn't work. The National Institutes of Health should focus more on determining what makes successful vaccines against smallpox, polio and other diseases, and how that might be replicated for HIV, said Bruce Walker, a Harvard immune-system researcher. "We've been lucky with a lot of vaccines in the past," he said. "We need a lot more study to find out why they've worked and how we can predict whether new vaccines will be effective."

The National Institute of Allergy and Infectious Diseases granted $476 million to scientists for HIV vaccine research, including about $234 million for testing existing shots and $225 million to discover new approaches.