1. Top Research Priorities of STDWG Impact of a RCT of HSV-2 suppression in prevention of HIV infection (Discretionary funds--039 and R01) Association of male circumcision with risk for HIV infection and RCT to measure public health impact of circumcision for HIV prevention (Discretionary funds-- R01) Utility of a male microbicide for uncircumcised men to prevent HIV acquisition (041) Comprehensive community-based STD interventions with core group, bridging and general population interventions. (Hybrid study) Behavioral intervention for MSM with STDs as outcome (Behavioral and STDWGs)

2. STD Intervention Trials to Prevent HIV LocationDesignInterventionPopulationOutcomePub. MwanzaCRTSyndrome vs. standard of care. CommunityHIV Incid. 42% Lancet 96 RakaiCRTMass Rx vs. Syndromic. CommunityHIV Incid. Unchanged Lancet 99 PeruCRT1. Enh. Syndr 2. Enh. Syndr + Outreach CSW 3. Status Quo Pharmacies (24 cities) HIV high- risk STD gen. population ongoing US, Peru, Zimbabwe, Zambia RCTHSV-2 suppress Rx with acyclovir 2148 HSV-2 + women/MSM HIVHPTN 039 ThailandCRTPrev. behav. Intervention Military conscripts Squadrons Reduction in STDs; HIV trend A. Intern Med 2000

3. STD Intervention Trials to Prevent HIV LocationDesignInterventionPopulationOutcome Pub. Hlabisa, RSACRTHWT + STD Synd Packets vs Routine syndromic 1 0 health clinics Improv. Mgmt of urethral discharge. AIDS 2000 Carletonville, RSA CRTPeer Ed, condoms + improv. STD serv. vs Reg. Ed + health provisions. Mining Commun & CSW CT, GCSTD 2000 ZimbabweCRTSynd & Presumptive Rx vs Syndr only Mine Comm, CSW STDs, HIV Zimbabwe, Zambia CRTPeer ed, presumptive Rx of CSW vs routine Rx & peer ed, vs routine synd Rx Mine Comm, CSW STDs, HIV Ivory CoastRCTMonthly intensive Rx vs Syndromic Rx only CSWSTDs, HIV

4. Acquisition Probabilities per Act by HSV-2 Status of HIV-Negative Partner

5. HSV-2 and HIV: Relevance for HIV prevention Is suppressive ACV for HIV prevention reasonable?  If effective, still a useful intervention when ART becomes more widely available  Increased probability of HIV acquisition among HSV2+ even at lowest HIV viral loads  ACV is cheaper, less infrastructure needed than HAART  Applicable to larger proportion of HIV+ (70-80% HSV2+ in Africa) than HAART based on CD4, and symptoms