The number of people in the world’s poorer countries receiving HIV treatment jumped by 35% last year, a World Health Organization report reveals. If progress is maintained, more than half the people in the world who need HIV treatment will be getting it next year. Not enough, but amazing when you consider that in 2002 the figure was 3%.

Treatment depends crucially on testing, and, in people at high risk of HIV, frequent testing. Sixty per cent of the world’s HIV-positive people have never tested, and 30% remain undiagnosed in the UK. As Test early, test often… reveals, the UK lags behind a number of other countries in how frequently people take HIV tests, though progress is being made.

Testing mainly has to be about reducing the number of people who turn up with AIDS. Most AIDS deaths are avoidable, but every time a chance to test is missed the avoidable inches towards the inevitable. When researching our piece on HIV testing strategies (Don’t live in ignorance), the most common remark people made was we have to change the “testing culture” in the UK. Whether failing to test is due to shame and anxiety in the patient, or ignorance and fear of giving offence in the doctor, we have to turn HIV testing into something routine.

Who would want to have an HIV test if the result were isolation from the one group of friends you have? Such is the situation of many African immigrants to the UK, who turn to the established network of African churches as the nearest thing to a home from home. Some may fear that pastoral embrace may become cold rejection if they mention their status, or that they will be pressured into dumping their pills and praying for a cure. As Kerri Wells’ feature (Faith in the community) shows, the reality is more complex, with pastors and churchgoers finding ways of reconciling modern medicine with the power of prayer.

Increased testing is also mentioned as a preventive measure, diagnosing people when they are at their most infectious, youngest and most sexually active. Yet raising testing rates to near-universal in places like Australia hasn’t reduced HIV incidence in gay men. Maybe it will in the longer term, but, like most other things in HIV prevention, testing is not the ‘magic bullet’ that will stop the epidemic in its tracks.

Neither will two other ideas, microbicides and pre-exposure prophylaxis. But swallowing a couple of pills before you have sex or using protective lube during it could at least provide additional safety and a wider range of choices for people who want to stay safe. The big question now, debated in The perils of success, is not whether we’ll find something that works, but whether we can persuade governments to pay for it.

Only one thing has ever reduced once-feared diseases to things of the past – a vaccine. Like everything else so far in the history of HIV vaccine research, the modest success of the AVAC/AIDSVAX vaccine may be a false dawn. Certainly researchers shouldn’t go overboard in celebrating 23 fewer infections than expected in a study involving 16,000 people. But if they find that something really is working in the blood of the volunteers, then 24 September 2009 may go down in history.