Prevention is still the key.

During the opening ceremonies of the 17th International AIDS Conference in Mexico City, the United Nations secretary general said that all countries must step up on their HIV prevention programs and, to be successful at this, it is necessary to end discrimination against men who have sex with men.

The head of the World Health Organization China unit emphasized that health officials of all countries — the U.S. included — have to accept there have been setbacks in HIV prevention among gay men. There is a need for health authorities to engage this group in all efforts to combat HIV.

The presidents of Mexico and St. Kitts and Nevis, along with the former president of Botswana, all appealed for ending discrimination against gay men.

Gay populations have been disregarded by many HIV prevention programs over the last quarter century largely because of discrimination and, in the case of several countries, outright criminalization. The UNHIV executive director said that homosexual activity in many nations is against the law. Gay activity thus tends to go underground, putting them out of reach of prevention programs.

Even in the U.S., although homosexual activity is not illegal, the Bush government has taken a reactionary stance on HIV prevention. Since it took office in 2001, the Bush administration spent billions of dollars on messages encouraging abstinence instead of focusing programs on the most heavily affected populations.

The government’s strategy to combat HIV has been to preach abstinence to young people, to dismiss the use of condoms as ineffective, and to deny access by drug users to crucial services for HIV prevention. Its foreign policy on HIV follows much of the same tack, disbursing foreign aid only to support abstinence-only programs.

The Centers for Disease recently reported a 75 percent increase in new infections among gay men over the last 15 years. Among males infected by HIV, more than 7 out of 10 are men who have sex with other men.

Outside the formal conference sessions, various groups working with HIV-infected people, including national AIDS foundations, also meet in informal interaction. Everyone appreciates the chance to network with people committed to the same goals, and to exchange information and experiences with scientists and researchers attending the conference.

All health professionals inside the hall and activist groups outside agree that the use of condoms is an effective prevention tool and should be promoted. According to many studies, condoms are 90 percent effective in preventing virus transmission.

But the most important policy for governments is to decriminalize homosexuality and sex work, and to reshape illicit drugs policy so that health treatment for people with addictions will be more important than criminal prosecution.

Prevention is still the key. But it will take a more enlightened approach than the reactionary programs governments have put in place so far.