The global epidemic of HIV infection is causing unprecedented destruction. It eclipses most other health issues and casts a long shadow over our future. On this first World AIDS Day of the new millennium we must look afresh at the epidemic. We must find a better and more effective response.

Today, tens of millions women, men and children are vulnerable to HIV. Many, particularly women and children, cannot easily protect themselves. In most societies men have more power than women. When women are dependent on the men who have sex with them, they face particular risks. The short term consequences of refusing sex can be more threatening than the long-term health risks associated with compliance.

Men Make a Difference is the theme of this year’s World AIDS Campaign. As fathers, grandfathers, brothers, sons, friends, husbands and partners, men determine the shape of the epidemic. The campaign recognizes that men could have the greatest impact on the speed with which the epidemic subsides. Men are also well positioned to address the consequences of HIV infection and to ensure adequate care for those who are affected.

Some 20 years ago, when AIDS was recognized, the response was triggered by men who have sex with men. These men initiated action to reduce the risk of HIV by promoting healthy sex, caring for those affected by AIDS and advocating for more attention to HIV throughout society. Men must continue to make a difference through the strengthening of effective prevention of HIV spread.

Men have a key role to play in controlling HIV epidemics among injecting drug users. The overwhelming majority of injecting drug users in all regions are men, particularly young men. Men usually control drug injecting situations. In drug sharing occasions usually the men inject first, passing the potentially contaminated injecting equipment onto their female injecting partners, increasing the partner’s exposure to HIV and other blood-borne infections.

There is evidence from Brazil and the USA that, given the opportunity, male drug injectors will also change their behaviour to protect both themselves and their sexual and drug-using partners.

More - and urgent - action is needed. We must reach men through networks of peers, providing information on ways to reduce risks of HIV infection, encouraging healthy behaviours and ensuring that they can access condoms and - if they are injectors - sterile injecting equipment.

WHO is scaling up efforts for the better reproductive and sexual health of men and women. More effort is needed to help:

• prevent and treat infections acquired through sex;
• increase the number of people who know their HIV status;
• promote condom use;
• prevent transmission of HIV from mother to newborn;
• promote needle exchanges and other interventions for injecting drug users;
• ensure blood safety;
• develop effective vaccines and microbicides;
• provide care for people living with HIV/AIDS.

WHO contributes to the global effort to track the epidemic and to monitor the effectiveness with which it is tackled.

WHO encourages attention to the gender implications of each of these strategies: this may mean different approaches for men and women.

However, until men take responsibility for preventing HIV, the epidemic will continue to grow. This means that men must face up to realities of sexual experiences, gender stereotypes and the coercion of women – often through violence – to act against their will.

To achieve sustainable change, we must focus on boys; the values they learn and the way they develop – starting before they are sexually active and drawing on their openness, their creativity and their willingness to take responsibility for themselves and others.

Men – whatever their age and wherever they live – can make a difference. It is the least we can expect of them.