Meeting the contraceptive and AIDS prevention needs of people living on a dollar a day.

The new millennium sees the largest cohort of young people in history entering its fertile years. Many of these people are too poor to pay the full cost of modern contraception, but the money available for subsidizing their needs is exceedingly limited. The AIDS pandemic is placing additional, unprecedented demand on already overstretched resources. Existing methods of contraception that are well established and off-patent can be produced in bulk at low cost, and will remain the backbone of future programmes. The use of misoprostol as an abortifacient is likely to spread rapidly. New methods must take into account the limitations of the health infrastructure in developing countries and the imperative of low cost. Given the constraints of money, skills and facilities, it is essential to set realistic priorities for future contraceptive research and development. It is suggested that the greatest needs are for a woman-controlled method of preventing HIV transmission and for a non-surgical method of female sterilization.