From vaccine developers to public health planners, everyone is waiting for good news on the AIDS horizon. But the time has not yet come. In a conference on HIV/AIDS in Sydney, US President George W Bush’s chief adviser concluded that the world is losing the battle against the disease.

Dr Anthony Fauci said progress had been made, but the cohort was still growing: more people were being infected with HIV than were being treated. "For every one person that you put in therapy, six new people get infected. So we're losing the numbers game," he said. AIDS has already killed 25,000,000 people. Only one in ten pregnant women with AIDS receive treatment to stop them passing the disease onto their unborn children.

"We've had one important breakthrough this year, with understanding the role of circumcision in prevention," said Dr Fauci, the director of the US National Institute of Allergy and Infectious Diseases. "We need to do more of that and importantly, we need to make available to the people throughout the world the prevention methods that are proven technologies."

But in many parts of the developing world, effective prevention strategies like condoms and sterile syringes are available to less than 15% of the population. Opinion amongst donors and public health officials may be turning toward a core emphasis on prevention, but movement is painfully, tragically slow.

Other experts concurred with Dr Fauci's unpleasant warning. Dr Brian Gazzard from the British HIV Association said that despite greater access to anti-retroviral drugs, the disease was running out of control in substantial regions. "The HIV epidemic is essentially uncontrolled, uncontrolled in Africa, uncontrolled completely in Asia right now," he said.

Sexual transmission is the main focus but prevention strategies like safe injection programmes to ensure that no transmission occurs through medical treatment are key. Prevention will bring the disease burden under control – and allow limited resources to be channeled into treating victims who already have the disease. While national governments are shifting towards prevention strategies like banning reusable medical syringes, many are waiting for international bodies such as the World Health Organisation to provide and help implement workable safe injection policy guidelines. To date, international efforts have been focused on making child immunisation injections safe, ignoring the vast majority of injections that are for curative or general healthcare purposes. While this has spawned great improvements in child health, many observers believe the time for this discrimination has come to a close.