Travelling far but staying close to home.

A n overwhelming majority of the global burden of morbidity and mortality caused by sexually transmitted infections (STI) and HIV is borne by the world’s poorest countries (fig 1). In a world increasingly ‘‘shrunk’’ by modern communications, what are the common issues preoccupying the international community of researchers in our field? In planning this themed issue, published on World AIDS Day 2007, we sought papers on all topics of global relevance: migration, international travel, the extent and impact of antiretroviral rollout programmes, and wide-reaching strategies for the prevention of STI and HIV transmission. We took the opportunity to seek out international diversity in STI and HIV research. Despite our intention to travel far afield, we have found ourselves closer to home than we had hoped, in respect of the authorship, and ownership of the diversity of studies relating to the populations of the world’s poorer countries. Our 13 original articles include 9 studies conducted in the countries of sub-Saharan Africa, south and south east Asia, 8 Latin America, and 4 in Europe. The provenance of the articles, however, does not reflect their scope (fig 2); the e-mail addresses of corresponding authors of seven of these papers are in the United Kingdom, 5 8 10–13 and another five are in the United States, Canada and Australia. 4 6 7 9 on exploring this further, we found that the pattern of the published content was not the result of the selective acceptance of papers authored from the north; we saw the same pattern in papers that were rejected. Neither is ours an isolated experience. In the six leading tropical medicine journals in 2002, 12.5% of the first and 9.4% of the last authors came from countries with the lowest human development indices (usually poor) compared with 50.6% and 58.8% from high human development index (usually rich) countries. Within the increasingly global research community, it is essential that local research capacity is developed in its fullest form. This means that opportunities must be created for local scientists to be full and active partners in the design, analysis, interpretation and presentation of STI and HIV research with a view to the ownership of research by those whose own destiny lies within those countries. The control of HIV infection, and the reduction of associated morbidity in severely affected countries is a major theme. Boulle and Ford from South Africa give an overview of the benefits and challenges of scaling up antiretroviral therapy in resource-poor settings. Encouragingly, they cite some evidence that in South Africa and Brazil death rates and AIDS-related hospital admissions are decreasing at a population level. Vaginal microbicides are a hotly pursued option for HIV prevention, but the failures and closures of clinical trials, despite extensive safety testing, have dampened enthusiasm recently. Martin Hilber and colleagues suggest that the missing link is a proper understanding of the role of women’s use of vaginal products and practices to tighten, dry, warm and clean their vaginas. The goal, they say, is to achieve a safer vaginal environment. The new global strategy of the World Health Organization (WHO) for the prevention and control of STI is summarised by Lewis and colleagues. It lists the components of comprehensive STI case management, including correct diagnosis, effective treatment, and condom promotion. The need for new technologies to contribute to STI control is further developed by Jones et al, who show in a randomised controlled trial, that allowing women in Gugulethu, South Africa, to take specimens for STI at home and mail them to the laboratory is a feasible and acceptable alternative to going to a clinic. In the same vein, Romoren et al. used decision analysis to show that the use of point of care tests for diagnosis and azithromycin