The AVAC 2010 Report, Turning the Page, highlights that the biomedical prevention field is entering the next chapter of its development. The past year brought the first evidence, from the Thai Prime-Boost trial, that an AIDS vaccine could prevent HIV in humans, as well as significant preclinical findings around potent, HIV-specific neutralizing antibodies.

At the same time, two microbicide trials testing the candidate PRO 2000 yielded seemingly different, but ultimately disappointing results, and the field now prepares for the release of results from CAPRISA 004, the first ARV-based microbicide effectiveness trial.

The 2009 AVAC Report, Piecing Together the HIV Prevention Puzzle, took inspiration from a quotation in the 2006-2008 review of the Bill & Melinda Gates Foundation-funded Collaboration for AIDS Vaccine Discovery, which states that the ultimate goal “is to develop a vaccine that prevents HIV infection or disease, anything less than that can be characterized as progress, but not success.”

The first section of the Report, “Puzzling Out Progress,” reports on the AIDS vaccine field, where there’s an energized focus on discovery, innovation, and basic science. The second section, “Puzzling Out Success,” turns to the implications of PrEP and other strategies in efficacy trials today. Throughout, it is argued that success will depend on combination approaches: on research plus implementation; on vaccines plus PrEP, should either show benefit; and on communities plus researchers working towards common goals.

The 2008 AVAC Report, The Search Must Continue, provides a comprehensive review of recent developments in AIDS vaccine research. It explores the issues that have been raised in the wake of the failure of Merck’s vaccine candidate and provides context for the events and major changes of the last year in HIV prevention research.

The three sections of this year’s report outline some specific deadlines and challenges in AIDS vaccine scientific strategy, clinical trials, and the broader realm of HIV prevention. These arenas mesh like watch gears, and must function just as smoothly if the field is to proceed.

In this report, AVAC offers its first contribution to the scenario planning critical to the success of the field. The next several years bring a variety of scenarios which cannot be encountered unprepared. Instead, the AIDS vaccine field, and the field of prevention research in general, must engage in rigorous debate, dialogue and scenario planning which anticipates the issues that the next few years will bring, and ensures that the wide range of stakeholders are informed and empowered to make decisions to compete against the virus. In this report, four thought-provoking chapters are presented, each of which begins with a future scenario that considers how the world might look in five or six or ten years’ time.