Purpose of review: The aim of this article is to outline key challenges facing the conduct of efficacy trials for biomedical strategies to prevent HIV infection.
Recent findings: The past 2–3 years have seen tumultuous development in this field. There have been disappointing findings in efficacy trials of vaginal microbicides, vaccines, the diaphragm and suppressive therapy for herpes, but a major breakthrough with the evidence that male circumcision prevents acquisition of infection. Meanwhile, clarity has started to emerge on a number of issues regarding trial conduct, including provision of standard of care, involvement of communities, and preparation for implementing effective interventions.
Summary: HIV prevention practice must continue to rely on condom promotion and other established strategies while biomedical approaches continue to be assessed and their implementation strategies evolve.