The urge for an AIDS vaccine: perspectives from a developing country.

AIDS is inexorably involving all parts of the country and all strata of society with 10% of the urban and 3% of the rural population infected with HIV. It is increasingly a disease of women and children. The major cofactors for transmission are also sexually transmitted. For most developing countries in spite of all education efforts the "silent epidemic" of AIDS continues. AIDS is known but not understood: counseling modifies behavior in only 10-20% of at-risk persons. Under optimal conditions HIV discordant females have seroconversion rates of 4.7%/per year and pregnancy rates of 10.4%/per year. The recent political unrest in Zaire and Haiti will further enhance the spread of AIDS in these countries. Despite these difficult periods the work can and must continue. After all during the authors 10th year of collaboration with a Haitian private research group the Haitian government and Cornell University Haiti had known 7 different political rulers. Finally the author wants to make a pledge on behalf of the millions of people who face a certain death from HIV infection and AIDS and who will never make the front page of any newspaper. For these people one can make a difference. The author requests the tools to carry on the fight. The clinical trials must be done where they are most needed: the developing countries. Vaccines represent the only viable alternative despite the recognized obstacles of viral heterogeneity immunogenicity and delivery. (authors)