By LAURAN NEERGAARD, Associated Press

WASHINGTON (AP) – An AIDS-free generation: It seems an audacious goal, considering how the HIV epidemic still is raging around the world.

Yet more than 20,000 international HIV researchers and activists will gather in the nation’s capital later this month with a sense of optimism not seen in many years – hope that it finally may be possible to dramatically stem the spread of the AIDS virus.

“We want to make sure we don’t overpromise,” Dr. Anthony Fauci, the National Institutes of Health’s infectious disease chief, told The Associated Press. But, he said, “I think we are at a turning point.”

The big new focus is on trying to get more people with HIV treated early, when they’re first infected, instead of waiting until they’re weakened or sick, as the world largely has done until now. Staying healthier also makes them less likely to infect others.

That’s a tall order. But studies over the past two years have shown what Fauci calls “striking, sometimes breathtaking results,” in preventing people at high risk of HIV from getting it in some of the hardest-hit countries, using this treatment-as-prevention and some other protections.

Now, as the International AIDS Conference returns to the U.S. for the first time in 22 years, the question is whether the world will come up with the money and the know-how to put the best combinations of protections into practice, for AIDS-ravaged poor countries and hot spots in developed nations as well.

“We have the tools to make it happen,” said Dr. Elly Katabira, president of the International AIDS Society, which organizes the world’s largest HIV conference, set for July 22-27. He points to strides already in Botswana and Rwanda in increasing access to AIDS drugs.

But Fauci cautioned that moving those tools into everyday life is “a daunting challenge,” given the costs of medications and the difficulty in getting people to take them for years despite poverty and other competing health and social problems.

In the U.S., part of that challenge is complacency. Despite 50,000 new HIV infections here every year, an AP-GfK poll finds that very few people in the United States worry about getting the virus.

Also, HIV increasingly is an epidemic of the poor, minorities and urban areas such as the District of Columbia, where the rate of infection rivals some developing countries. The conference will spotlight this city’s aggressive steps to fight back: A massive effort to find the undiagnosed, with routine testing in some hospitals, testing vans that roam the streets, even free tests at a Department of Motor Vehicles office, and then rapidly getting those patients into care.

“These are the true champions,” Dr. Mohammed Akhter, director of the city’s health department, said of patients who faithfully take their medication. “They’re also protecting their community.”


A few miles east of the Capitol and the tourist-clogged monuments, the Community Education Group’s HIV testing van pulls into a parking lot in a low-income neighborhood with a particularly high infection rate. An incentive for the crowd at a nearby corner is the offer of a $10 supermarket gift card for getting tested.

Christopher Freeman, 23, is first in line. He was tested earlier this year and says showing off that official paper proclaiming him HIV-negative attracts “the ladies.”

“Forget money, it’s the best thing you can show them,” he said.

But that test was months ago, and Freeman admits he seldom uses condoms. He climbs into the van and rubs a swab over his gums. Twenty minutes later, he’s back for the result: Good news – no HIV. But counselor Amanda Matthews has Freeman go through a list of the risk factors; it’s education to try to keep him and his future partners safe.

“Just try to get yourself in the habit of using condoms,” she said. “You say it’s hard to use condoms but what if you do contract the virus? Then you’ve got to take medications every day.”

Freeman waves his new test result with a grin, and walks off with a handful of free condoms.

At a nearby bus stop, counselor Laila Patrick encounters a little resistance while handing out condoms, when a woman says that encourages sex outside of marriage.

“Stopping AIDS is everyone’s business. You’re looking out for the next person,” Patrick said. “You might just want to help someone be safe.”


About 34 million people worldwide have HIV, including almost 1.2 million Americans. It’s a very different epidemic from the last time the International AIDS Conference came to the United States, in 1990. Life-saving drugs emerged a few years later, turning HIV from a death sentence into a manageable chronic disease for people and countries that can afford the medications.

Yet for all the improvements in HIV treatment, the rate of new infections in the U.S. has held steady for about a decade. About 1 in 5 Americans with HIV don’t know they have it, more than 200,000 people who unwittingly can spread the virus.

Government figures show most new U.S. infections are among gay and bisexual men, followed by heterosexual black women. Of particular concern, African-Americans account for about 14 percent of the population but 44 percent of new HIV infections.

Your ZIP code plays a role in your risk, too. Twelve cities account for more than 40 percent of the nation’s AIDS cases: New York, Los Angeles, Washington, Chicago, Atlanta, Miami, Philadelphia, Houston, San Francisco, Baltimore, Dallas and San Juan, Puerto Rico. Many are concentrated in specific parts of those cities.

“Maps tell the story,” said Brown University assistant professor Amy Nunn, who is beginning a campaign that will bring a testing van door-to-door in the hardest-hit Philadelphia ZIP code.

“It’s not just what you do, it’s also where you live. There’s just a higher chance that you will come into contact with the virus,” she explained.


Prospects for a vaccine are so far elusive and health disparities are widening, so why the optimism as expressed by the Obama administration’s goal of getting to an AIDS-free generation?

Consider the potential strategies, to add to tried-and-true steps such as condom use and treating HIV-infected pregnant women to protect their unborn babies:

-Studies found treatment-as-prevention could lower an HIV patient’s chance of spreading the virus to an uninfected sexual partner by a stunning 96 percent. In the U.S., new guidelines recommend starting treatment early rather than waiting until the immune system has weakened. Abroad, the United Nations hopes to more than double the number of patients being treated in poor countries to 15 million by 2015.

-Other studies show a longtime AIDS medication named Truvada can prevent infection, too, if taken daily by healthy people who are at risk from their infected sexual partners. The U.S. Food and Drug Administration is expected to decide by fall whether to formally approve sale of Truvada as an HIV preventive.

-A study from South Africa found a vaginal gel containing anti-AIDS medication helped protect women when their infected partners wouldn’t use a condom, generating more interest in developing women-controlled protection.

-Globally, experts also stress male circumcision, to lower men’s risk of heterosexually acquired HIV.


Testing is a key step in improving prevention. The AP-GfK poll found 57 percent of adults say they’ve been tested at some point, a bit higher than federal estimates, but not enough. The government recommends at least one test for adults, and that populations at higher risk get tested at least once a year.

Following those recommendations depends in part on people’s concern about AIDS. The poll found just over half of Americans consider HIV as much or more of a problem now than two decades ago. But less than 20 percent are worried about getting it themselves, and even populations at higher risk don’t consider HIV a big threat. Some 16 percent of black respondents said they’re very worried about HIV, compared with 4 percent of whites.

“We’ve become complacent about HIV in America, and it’s a real tragedy because hundreds of thousands of people in our own country aren’t getting the care they need,” said Chris Collins of amFAR, The Foundation for AIDS Research.

The drugs can cost up to $15,000 a year in the U.S., and overall treatment costs are rising as people with HIV live longer. In developing countries, those drugs can cost less than $400 a year.

The AP-GfK Poll was conducted June 14-18 by GfK Roper Public Affairs and Corporate Communications. It involved landline and cellphone interviews with 1,007 adults nationwide. Results for the full sample have a margin of sampling error of plus or minus 4.0 percentage points.


In the U.S., the government is targeting the hardest-hit communities as part of a plan to reduce HIV infections by 25 percent by 2015, said Assistant Secretary of Health Howard Koh. Work is under way to learn the best steps to get people treated early, including in cities such as Washington, where 2.7 percent of residents have HIV, roughly four times the national rate.

Washington resident Zee Turner knows it’s hard to stick with care. She’s had HIV for two decades, learning the news when her baby was born sick. Health workers helped mom and daughter receive then-newly emerging treatments, and they’re doing well today.

“I felt that I should get out here and try to help somebody else, because somebody had to help us get into care,” said Turner, now 53 and a community health worker.

The city’s latest HIV count suggests progress, with a slight decrease in new diagnoses and a majority of patients being connected with medical care. Community workers such as Turner are called to try to help people stay on treatment when other problems intervene.

“If they’re on drugs, I take them to the drug program. If they need help going on Medicaid, I go with them to Medicaid,” Turner said. “Any problem they have, I’m going to try to fix it and get them back into care.”


Associated Press Deputy Director of Polling Jennifer Agiesta and News Survey Specialist Dennis Junius contributed to this report.



International AIDS conference:

Poll results:

AP-GfK Poll: Clerks must issue gay marriage licenses
WASHINGTON (AP) — Linda Massey opposes gay marriage. But she was incensed last summer to see that Kim Davis, a Kentucky county clerk, was refusing to issue marriage licenses to gay couples.

“If the government says you have to give out those marriage licenses, and you get paid to do it, you do it,” says the 64-year-old retiree from Lewiston, Michigan. “That woman,” she said of Davis, “should be out of a job.”

Americans like Massey are at the heart of a shift in public opinion, an Associated Press-GfK poll has found. For the first time, most Americans expect government officials to issue marriage licenses to same-sex couples, even over religious objections.

It’s partly a matter of expecting public servants to do their jobs. But more broadly, the issue touches on a familiar dispute over which constitutional value trumps which: religious freedom, or equality under the law?

The question in recent months has entangled leaders with political sway, among them Pope Francis and the 2016 presidential contenders. But it’s not a new conflict for a nation that has long wrestled with the separation of church and state.

Where Davis’s answer was the First Amendment’s protection of religious freedom — and she served jail time to back it up — a majority of respondents don’t buy that argument when it comes to public officials issuing marriage licenses. That’s a shift since an AP-GfK survey in July, when Americans were about evenly split. Then, 49 percent said officials with religious objections should be exempt from issuing marriage licenses to same-sex couples and 47 percent said they should be required to issue them.

Now, just 41 percent favor an exemption and 56 percent think they should be required to issue the licenses.

That shift was especially stark among Republicans. A majority of them —58 percent — still favor religious exemptions for officials issuing marriage licenses, but that’s down 14 points since 72 percent said so in July.

The timing of the surveys is important, coming during rapid developments in the politics of gay rights and religious freedom.

Public opinion has favored same-sex marriage in recent years and some politicians — President Barack Obama, 2016 presidential contender Hillary Rodham Clinton and some members of Congress among them — have come around to that view. In June, the Supreme Court effectively legalized gay marriage nationwide.

The cultural change has influenced the governing bodies of some of the most conservative religions, including the Catholic Church under Pope Francis and the Mormon Church, which last week called for compromises between protecting religious liberties and prohibiting discrimination. Both institutions are trying to accommodate society’s shifting views while keeping a firm grip internally on their own doctrines against gay marriage and homosexual activity. And both churches steered clear of the appearance of backing Davis. The Vatican said the pope’s brief meeting with her in Washington should not be construed as a sign of support.

Mormon leader Dallin H. Oaks last week told a closed gathering of judges and clergy in Sacramento, California, that when conflicts between religion and law rise and are decided, citizens of a democracy must follow court rulings.

Davis, a Democrat, Apostolic Christian and clerk of Rowan County, Kentucky, became the face of religious Americans who bristle at government requirements that conflict with their beliefs, whether those mandates cover gay marriage, contraception or abortion referrals. On June 27 — the day after the high court ruling — Davis refused to issue same-sex marriage licenses. In September she spent five days in jail for defying a court order to issue the licenses. Affixing her name to the certificate, she wrote in a statement, “would violate my conscience.” After serving her jail sentence, Davis returned to work — but her name no longer appears on marriage licenses for gay couples.

Nick Hawks, a business consultant in Ararat, North Carolina, agrees with Davis.

“We’ve got to decide at some point who’s going to be protected first,” said the father of three boys, 50, who says he’s a Republican-leaning independent. “It doesn’t seem quite fair” to allow a minority such as gay people to “control the policy.”

More generally, the poll offers evidence that Americans remain slightly more likely to say that it’s more important for the government to protect religious liberties than the rights of gays and lesbians when the two come into conflict, 51 percent to 45 percent. But that, too, is a slight shift since July, when 56 percent said it’s more important to protect religious liberties.


The AP-GfK Poll of 1,027 adults was conducted online Oct. 15 to Oct. 19, using a sample drawn from GfK’s probability-based KnowledgePanel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 3.3 percentage points.

Respondents were first selected randomly using telephone or mail survey methods, and later interviewed online. People selected for KnowledgePanel who didn’t otherwise have access to the Internet were provided access at no cost to them.



Poll results:

AP-GfK Poll: Americans still feeling economic gloom

WASHINGTON (AP) — Americans are more likely than they were a year ago to have positive views of the nation’s economy, but they’re still feeling more pessimism than optimism, according to a new Associated Press-GfK poll conducted ahead of CNBC’s GOP primary debate on Wednesday.

The candidates will attempt to impress Republicans in particular, who the poll finds feel much gloomier about the economy than Democrats.

Here are some things to know about opinions on the economy from the latest AP-GfK poll:



A majority of Americans — 54 percent — say the nation’s economy is poor, the new poll shows. Just 45 percent call it good. Still, views of the economy are slightly rosier than they were over the summer, when a July AP-GfK poll found 41 percent of Americans described the economy as good, and more positive than they were a year ago, when just 38 percent said so.

Half of men, but just 4 in 10 women, describe the economy as good.

Americans are even less likely to see the nation heading in a positive direction overall. Just 36 percent think the country is heading in the right direction, while 63 percent think it’s headed in the wrong direction.

More than 8 in 10 Americans in the new poll described the economy as an extremely or very important issue, down slightly since July. Still, the economy rates higher in importance than any other issue in the poll.



The candidates will aim their messages at a Republican Party that has a particularly negative view of the economy.

While 65 percent of Democrats describe the economy as good, just 29 percent of Republicans say the same. Seven in 10 Republicans say the economy is poor, including more than 8 in 10 GOP supporters of the tea party. Eight-five percent of Republicans say the country is heading in the wrong direction.

Independents, too, are unhappy with the economy, with 33 percent seeing it as good and 62 percent poor.



Few Americans — just 17 percent — think the economy has improved over the past month, while 21 percent think it has gotten worse and the bulk — 60 percent — think it’s stayed about the same.

Most Americans don’t expect to see improvement in either the nation’s economy or their own financial situations in the next year, either.

Thirty-one percent say they expect the general economic situation to get better, 32 percent expect it to get worse, and 34 percent expect it to stay about the same. Likewise, 29 percent expect their household financial situation to get better, 25 percent expect it to get worse, and 44 percent expect it to stay the same.

Republicans are more likely than Democrats to say the economy has gotten worse in the last month, 31 percent to 13 percent. Democrats are more likely than Republicans to expect it to get better in the next year, 40 percent to 21 percent.



Whichever GOP candidate emerges victorious in next year’s presidential primaries will need to convince Americans that the party can do a better job than Democrats at handling economic issues.

Americans are slightly more likely to say they trust Democrats than Republicans more on handling the economy, 29 percent to 24 percent, the poll shows.

But neither party’s a clear winner on the issue — 15 percent say they trust both equally and 30 percent say they trust neither party.

Republicans are more likely than Democrats to say they trust neither party, 29 percent to 17 percent. A majority of independents — 55 percent — don’t trust either party.



Americans are slightly more likely to disapprove than approve of President Barack Obama’s handling of the economy, 52 percent to 46 percent, according to the new poll. But that’s an apparent rise in his approval rating on the issue since July, when just 42 percent said they approved.

Americans’ rating of Obama on the economy is nearly identical to how they feel about how he’s handling his job overall, with 46 percent approving and 52 percent disapproving.


The AP-GfK Poll of 1,027 adults was conducted online from Oct. 15 to 19. The sample was drawn from GfK’s probability-based KnowledgePanel, which is designed to be representative of the U.S. population. The margin of sampling error for all respondents is plus or minus 3.3 percentage points.

Respondents were selected randomly using telephone or mail survey methods and interviewed online. People selected for KnowledgePanel without Internet access were provided it for free.



Poll results: