The 16th International AIDS conference opened with over 24,000 registered delegates and 3,000 journalists. Flagged by Peter Piot as a battle that could take decades, Bill and Melissa Gates have identified the special vulnerability of women in this global tragedy. The conference has given a timely reminder that AIDS does not respect the boundaries of "shoulds". If humanity wants to survive the AIDS pandemic it is going to take resources, pragmatism of accepting the world as it really is and acknowledging what really works, and the courage to embrace visions and conventions that can slow the epidemic until a cure is found. If we can not find this courage then humanity risks literally raping its way into extinction.