From the Houses of Parliament to the sex clubs of Vauxhall: it feels like we’re covering the extremes of the HIV epidemic this month.

On the one hand, we tour the corridors of power to find out what will change in HIV service provision after the election (see Whoever you vote for, the government gets in). As Lisa Power points out, whoever wins, their promises will mean nothing if they’re swept aside by a wave of cutbacks in public spending. HIV, sexual health and contraception organisations are so concerned that they’ve joined together to create ShoutLoud (www.shoutloud.org.uk) a national campaigning resource for people working in the field.  

On the other hand, we’re talking to people at the sharp end of HIV prevention – literally, if reports of an increasing use of injection amongst gay men who use meth are anything to go by (see The lonely drug).

Crystal meth is a casualty of the ‘crying wolf’ phenomenon. There have been so many warnings, about this drug causing a disaster in the gay community, that some commentators still feel that trouble with meth is only ever going to happen to a handful of hardcore men in London. Yet one thing history has taught us is that sudden outbreaks of HIV are most likely in populations whose existence is downplayed or ignored.

The thing that links policy advisers in the House of Commons with gay men just across the Thames is prevention work, and how difficult it is to make the case for it in a climate where it’s hard enough to maintain standards in treatment.

One of the less comforting findings reported from the recent retrovirus conference was that while new HIV infections seem to be declining in a lot of populations, gay men – at least in France – were the one population where they remain high. It would be too easy for cash-strapped health authorities to throw their hands up and conclude that nothing works for gay men.

The equal-and-opposite tendency is to embrace the latest ‘magic bullet’ in HIV prevention. This time it is giving everyone with HIV antiretroviral drugs, and in The ideal and the real in HIV prevention we examine why it’s going to be hard to make that work too.

The truth about HIV prevention is that there are no shortcuts to helping people reduce their vulnerability to acquiring or transmitting the virus. Offering people a combination of strategies and empowering them to use them is what works.

HIV prevention is not about ‘risk behaviours’, it’s about people, and specifically, as our interviewees in the crystal meth piece emphasise, it’s about socialising people, helping bring them in from the cold. As we are reminded once again by the HIV in Mind survey (see Too much pressure), one of the key experiences that a high proportion of people with HIV have in common is a sense of being isolated and marginalised by their infection.

Feeling lonely can make people behave in odd ways, including having a lot of high-risk sex and/or using drink and drugs to dull the pain. Until that’s addressed, the human need for contact will run ahead of any strategy for containing HIV.