But we remain discouragingly far from that goal. The changing demographics of the epidemic demand careful consideration as we plan our research agenda, because different prevention and intervention strategies must be applied to each subepidemic, here and around the world. We do not know how long the benefit of therapy will last or whether immune function of treated individuals can be restored. There are many for whom the new drug regimens have not been effective or for whom the side-effects are not tolerable. Serious complications of therapy are being identified, including metabolic disorders and deforming lipid deposits.
Many patients are unable to adhere to the complicated drug schedules.
Drug resistant viral mutants are beginning to emerge, representing a new and dangerous threat to public health. For example, we are supporting research to understand the pathogenesis of HIV disease in women and to develop effective and acceptable female-controlled methods to block HIV transmission, such as microbicides. NIH has devoted resources to improve research infrastructure and minority training opportunities, and we will continue to assure the participation of minorities in clinical trials and in natural history, epidemiology, and prevention studies. We are focusing on interventions that address co-occurrence of other STDs, hepatitis, drug abuse, and mental illness, and those that consider the role of culture, family, and other social factors in minority communities. To control the pandemic for all individuals, communities, and nations at risk, a safe and effective vaccine is the critical missing element in our armamentarium.