With the launch of the latest study of the Global HIV Prevention Working Group, the issue of "prevention vs. treatment" has been resurrected. Helene Gayle, Director, HIV, TB and Reproductive Health programs at the Bill & Melinda Gates Foundation, has emerged with an unambiguous call for more attention on prevention. The Wall Street Journal reported yesterday:

"World-wide, prevention expenditures fall below $2 billion. Dr. Gayle urged that spending on prevention be tripled to roughly $6 billion by 2005. If prevention funding isn't increased, she warned that all the world's drug programs will never keep pace with the spread of HIV."

The "prevention vs. treatment" debate came to a head several ago (in great part due to falling drug prices), but then was replaced by calls to "integrate treatment and prevention", suggesting there was no longer tension. Of course treatment and prevention need to be closely integrated (as the report says clearly), but unfortunately health officials still face difficult budget and program decisions everyday. Congratulations to Helene Gayle for promoting a point of view that is both out of vogue and vital.