Hope and optimism were in abundance for tens of thousands of those in attendance at the the 19th International AIDS Conference (AIDS 2012) held this year in Washington D.C. "Turning the Tide Together" was the conference theme, and 24,000 activists, researchers and clinicians from 183 countries were in agreement that an end to the epidemic may be in sight.

Since the AIDS 2010 conference in Vienna there have been extraordinary breakthroughs in the fight against HIV. Although no gigantic advances were announced at AIDS 2012 what was presented demonstrated that HIV is becoming an increasingly vulnerable viral foe.

"AIDS 2012 represented many milestones in the history of the International AIDS Conference, but most importantly, it is the first time we have been united around the one goal to end AIDS," said Dr. Diane Havlir, AIDS 2012 U.S. Co-Chair.

Defying tradition, the host countries head of state, President Obama, failed to put in an appearance at the conference. Instead he irked many in attendance by just sending a video tape message. However, other illustrious speakers did descend upon AIDS 2012, including Bill and Hillary Clinton, Elton John, Bill Gates and former First Lady Laura Bush. All sought to remind the experts in attendance what was at stake if the goal of ending AIDS is not achieved.

And the numbers are daunting. Around 35 million have died from HIV infection and 34 million now live with the virus worldwide. Of those 34 million, well more than half will probably die unless they gain access to treatment.

Several topics dominated the conference: Finding a cure for the virus (a topic for another article) and Treatment as Prevention, or TasP. Tasp is the recent breakthrough demonstrating that putting those with HIV infection on therapy can reduce transmission of the virus to others by up to 96%. There was an overwhelming consensus on TasP at AIDS 2012.

"I think that this conference puts an end to any doubts or or any discussion about this issue" said Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS. "The evidence that treating people effectively with HIV is beneficial to them, but secondarily, can dramatically decrease HIV transmission, is now definitive."

More importantly, Montaner added, is that that policy leaders such as Hillary Clinton appreciate that these new prevention tools can end the AIDS pandemic. But a worldwide scale-up up these new interventions will require billions of dollars of funding at a time of government budget shortfalls and cutbacks.

An important cost/benefit study presented at AIDS 2012 showed the viability of implementing TasP on a massive scale. The analysis showed that early treatment interventions will keep new generations from becoming infected making it more cost effective than delaying treatment. Study author Dr. Rochelle Walensky of the Harvard Center for AIDS Research explained why.

"Early ART [antiretroviral therapy] is a triple winner: HIV-infected patients do better, their partners are protected and it is very cost-effective. Regardless of the country setting, over the long term treatment as prevention offers excellent return on its investment," she said.

Treating infected people to drastically reduce the spread of HIV will require the international community to step-up and make widespread TasP a priority.

"These data call for decisive action by the US global AIDS program, WHO and by national governments," said Asia Russell of Health GAP.

Russell stressed that HIV treatment guidelines and government programs should act to accelerate treatment access that will save lives and reduce new infections. "There is no excuse," she added.

Dr. Montaner added "The return on investment has increased so dramatically that we can no longer afford not to implement this [TasP]. It is not a matter if we want or we can't, its a matter that we have to do it!"

To coincide with AIDS 2012, the prestigious journal The Lancet, published a special issue focusing on HIV and Men Who Have Sex with Men (MSM). A conference symposium was held on The Lancet's data, which had a global focus.

Dr. Stefan Baral started off the session noting that HIV prevalence rates among MSM are 15% or higher in the USA, Spain, Chile, Thailand, Malaysia, South Africa, as well as a cluster of African and Caribbean nations. Yet in many high-income settings, overall HIV transmission rates, deaths, etc., are in steep decline. Among MSM there and in poorer nations, the HIV epidemic rages even where treatment is available. In the U.S., MSM infection rates have been increasing by around 8% per year since 2001. One reason? The transmission rate of receptive anal sex is roughly 18-times greater than heterosexual intercourse.

The Lancet symposium shed more light on why MSM continue to be infected with HIV: stigma and homophobia. At a conference abundant with successes and optimism, Lancet Editor, Richard Horton told of Thapelo Makutle, an openly gay South African man who was targeted and murdered because of his sexuality. Horton then described the recent brutal gay bashing of Michael Hall and Michael Roike only a few miles from the Washington convention center.

Ken Mayer of the Boston's Fenway Institute added that same sex behavior and gender nonconformity are still not accepted throughout the world. That MSM are given a societal messages that they're not welcome or wanted. The resulting isolation MSM feel from loss of peer and family support, religious abandonment, as well as verbal or physical abuse, often lead to risky behavior.

"This internalized stigma may lead to internalized homophobia, which results in depression and substance use," Dr. Mayer said. "We have to face the reality that sexual expression is happening earlier so these internal tensions are occurring at earlier ages for younger, more vulnerable individuals."

Dr. Mayer added that for MSM, early self-acceptance results in better safe sexual practices. Particularly so among racial, ethnic, and sexual gender minorities. However, for many stigmatized MSM living in homophobic environments, the challenge of surviving and thriving can be difficult.

In the U.S., black MSM now make up nearly one in six of all people with HIV. In another session, Dr. Karen Oster presented data on the black MSM "brothers" study. It found that over just one year, new HIV infections among these men increased by 2.3%. Among those under the age of 30 the infection rate was an alarming 6%! The later strongly suggests that if the trend continues by the time they are in their 40’s most urban black MSM will have the virus.

Longtime AIDS activists such as the Rev. Franklin Hobbs of Boston’s Healing Our Land feel immediate action is needed to stem this tidal wave of new infections.

"We have an unprecedented and small window of opportunity to respond to the national black HIV/AIDS state of emergency," declared  Rev. Hobbs.

Dr. Greg Millett of the CDC told AIDS 2012 attendees that the reason for all the black MSM infections are not because these men are having more at risk sex than their white counterparts. He said studies show that generally these men are more sexually cautious. In fact, on Tuesday, the CDC presented data showing that risky behavior among all black teens has declined significantly over the past 20 years. Instead, sexual ecology is driving the black MSM epidemic according to Dr. Millet. The new infections are resulting from repeat partnering within a highly infected community. The takeaway is to be aware of the risk of exposure within these high prevalence "pools" and not just minimize risk during sex.

Women’s issues were also on the program at AIDS 2012. Around the world women still bear much of the HIV/AIDS burden. Among those 34 million adults worldwide living with HIV and AIDS, half are women. Women are also at greater risk of HIV heterosexual infection through unsafe sex, less likely to be able to negotiate condom use, and more likely to be subjected to non-consensual sex.

"We cannot even begin to talk about ending AIDS when so much of the impact of the HIV/AIDS epidemic continues to be so heavily skewered towards women," said Dr. Diane Havlir, AIDS 2012 U.S. Co-Chair and Professor at UCSF.

On Monday researchers discussed two new published studies on gender-based violence and how it increases transmission of the virus. Co-author of both studies, Edward Machtinger, MD, directs the Women’s HIV Program at UCSF.

"For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing poorly despite the availability of effective treatment," Dr. Machtinger said. "This work clearly shows that trauma is a major factor in the HIV epidemic among women."

The studies showed how childhood or adult physical and sexual abuse fuel the women's HIV epidemic. They demonstrated that American women with HIV are more than five times more likely to have PTSD and twice as likely to have been the victim of partner violence. HIV infected women who experience trauma are also more likely to fail their HIV treatment and engage in risky sexual behavior.

Although the planet is economically exhausted it still must garner the needed resources to fulfill the extraordinary promise of AIDS 2012. Cities like the conference host, Washington D.C. are trying to do their part. Washington is now a hotbed of the epidemic with HIV prevalence in some parts of the city as high as in Africa.

At a press conference, the Washington D.C. Department of Public Health showcased its efforts in HIV testing and treatment including regular screening at the cities DMV, supermarkets, schools, houses of worship, city welfare agencies, even barbershops. For those who test positive, nine out of ten see a doctor within three days.

"The goal is to provide HIV testing in unprecedented settings."said Mahlon Isaacs of D.C. Public Health. "A lot of people do want to know their status and from there, once you have received your results you can be directed to care if you have been identified as being positive"

D.C. even set up a condom drop off service. However, after a week of endless AIDS 2012 meetings this reporter was too exhausted to find a reason for giving them a call. Perhaps in Melbourne at AIDS 2014.