In the fight against the HIV/AIDS pandemic different approaches can be dist
inguished, reflecting professional backgrounds, world views and political i
nterests. One important distinction is between the biomedical and the devel
opment paradigms. The biomedical paradigm is characterized by individualiza
tion and the concept of "risk". This again is related to the concept of the
market where health is a product of services and progress a series of new
discoveries that can be marketed. The development paradigm is characterized
by participation of the different stakeholders and by community work. The
concept "vulnerability" is important in the development paradigm and emphas
is is placed on efforts to decrease this vulnerability in a variety of sust
ainable ways. Biomedical technology is definitely one of the tools in these
efforts. In the beginning of the pandemic the biomedical approach was impo
rtant for the discovery of the virus and understanding its epidemiology. La
ter, stakeholders became involved. In the light of absence of treatment or
vaccines, the development paradigm became more important and the two approa
ches were more in balance. However, since the reports about effective treat
ment of AIDS and hope of development of vaccines, the biomedical paradigm h
as become a leading principle in many HIV/AIDS prevention programmes. There
is a need for a better balance between the two paradigms. Especially in de
veloping countries, where it is not realistic to think that sustainable bio
medical interventions can be organized on a short-term basis, it would be c
ounterproductive to base our efforts to deal with HIV/AIDS exclusively on t
he biomedical approach.