Prevention of sexual transmission of HIV: real results, science progressing, societies remaining behind.

HIV spread has reached a turning point following decades of increasing and sustained incidence. An effective vaccine has not been developed, but critical breakthroughs with prevention based on antiretroviral treatment are promising. The new prevention technologies will have to be combined with condoms and incorporated into the mixes of combination prevention approaches that are tailored to the local epidemic and context. To address the implementation gap, more political will and leadership will be needed to overcome the socio-cultural, legal or religious barriers to prevention. We have learned that the generation of demand for HIV prevention is not easy, as for health promotion in general. Despite optimism about treatment as prevention, many western countries are facing an increase in new HIV cases, and HIV is no longer a collective concern. If we manage to find common ground on combination prevention, customize approaches to people's needs and exercise technical and political leadership, our decade may see the beginning of the end of the epidemic.