I think there are four ways:

* Install http://www.cygwin.com and compile with gcc.

* Get the sources and compile with Activestate Perl and MS Visual Studio.

* Use the Win32 mod_perl Binaries made by Randy Kobes - ftp://theoryx5.uwinnipeg.ca/pub/other/

* Use the Win32 ActivePerl mod_perl ppms. You can install this by, within the ppm shell, setting the repository to http://theoryx5.uwinnipeg.ca/cgi-bin/ppmserver?urn:/PPMServer

More information on http://perl.apache.org/distributions.html