People with and without HIV, living in the same HIV-affected community, may have very different perspectives on all aspects of life, with major implications for HIV prevention programmes. In particular, gay and bisexual men are both united and divided in responding to AIDS, with one of the major divisions being on the basis of HIV status (Odets). It is therefore essential in planning any primary prevention programme, including vaccine research, to consider its impact on people with HIV as well as on those without.

For people with HIV, the call for vaccine research has sometimes been perceived as a kind of abandonment and as a potential diversion of funds away from therapeutic research.

Some of these concerns are realistic: large-scale vaccine trials would certainly be expensive. There can be no absolute guarantee that funding for any particular kind of AIDS research will be maintained, since this depends on political will and judgements, including scientific judgements, of the strength of competing priorities.

Some of the concerns, as has been argued in this chapter, may now be outdated. Insights from preventive vaccine research are likely to be of genuine value to people living with HIV. If therapeutic vaccines prove feasible, these will be of direct value to people with HIV.

In any case, many people with HIV passionately want to see an end to the epidemic, since they have lost more than anyone else and can see preventive vaccines as a part of the answer.

Since some of the stigma of being HIV-positive arises from fear of infection, a vaccine which offers genuine protection is also a potential remedy for social stigma.