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.”

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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.”

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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.

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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.

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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.

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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.”

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

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Online:

International AIDS conference: http://www.aids2012.org

Poll results: http://www.ap-gfkpoll.com

AP-GfK POLL: PARENTS UNCOMFORTABLE WITH YOUTH FOOTBALL

Parents are worried about their children playing football, but most haven’t decided to keep their kids from putting on a helmet and stepping onto the field.

According to an Associated Press-GfK poll, nearly half of parents said they’re not comfortable letting their child play football amid growing uncertainty about the long-term impact of concussions.

In the poll, 44 percent of parents weren’t comfortable with their child playing football. The same percentage was uncomfortable with ice hockey, and 45 percent were uncomfortable with participation in wrestling. Only five percent, though, said they have discouraged their child from playing in the last two years as concern over head injuries has increased at all levels of the game.

The majority of parents said they are comfortable with participation in a host of other sports — including swimming, track and field, basketball, soccer, baseball and softball, among others.

The AP-GfK poll was conducted from July 24-28. It included interviews with 1,044 adults and has a sampling error of plus or minus 3.4 percentage points.

The parents’ concern comes as several high-profile lawsuits have challenged how concussions have been addressed in pro and college sports. Thousands of pro players sued the NFL and a $675 million settlement that would compensate them for concussion-related claims is pending. A tentative settlement with the NCAA, meanwhile, would create a $70 million fund to test thousands of current and former college athletes for brain trauma.

Youth and high school programs have increased training available for coaches, and helmet companies are releasing new designs with the hope that they reduce the force of impact. But research is murky about whether or not they will be effective.

Participation statistics also show only a slight decline in the overall number of high school students playing football.

According to the National Federation of State High School Associations, nearly 1.1 million students played 11-man football during the 2012-13 school year. The number was down approximately 10,000 from the year before and more than 20,000 since 2009-08.

Cathy Curtin, a high school rifle coach in northeast Pennsylvania, is one parent who has discouraged her children from playing football in recent years.

Curtin, 52, has gone through concussion-related training for her job, but one issue that concerns her is how much of identifying a head injury relies on the student’s input following a collision. She said her 21-year-old son “would have said anything” to remain in the game while in high school, including hiding symptoms such as dizziness from a trainer or coach.

“Our training staff is good, but you can’t always know,” Curtin said. “You’re basing whether they can play on their say. And they are 16-year-old kids, 17-year-old kids who want more than anything to get out there and play.”

Curtin said her younger son broke his collarbone and leg while playing football as a freshman.

“Nowhere in that time did they check him for a concussion,” Curtin said. “So, if he got hit hard enough to break his collar bone and his leg, then how hard did he hit the ground, too?”

Football wasn’t the only sport Curtin said she was uncomfortable with. She also worries about hockey, wrestling and other high-impact competitions such as gymnastics and cheerleading. She’s encouraged by new advances — such as chin straps that change color when a player may have suffered a concussion — aimed at reducing and identifying head injuries, but she is also skeptical about school districts’ ability to afford new helmets.

JeMare Williams, 43, is no stranger to the possibility of getting a concussion while playing football. He thinks he “probably” suffered from one while in high school in St. Louis.

“I don’t really know, but I remember being hurt, being dizzy,” Williams said. “But during that time, there wasn’t a specific diagnosis like now.”

Now living in Henderson, Nevada, and with 17- and 11-year-old sons who play the game, Williams — an auto mechanic — has the same injury concerns as many parents. That said, he’s comfortable with his sons playing football — or any other sport they choose.

One of the primary reasons for Williams’ comfort level is because of the increased attention paid to head injuries over the last few years. He said coaches are trained more closely now to teach proper tackling techniques, as well as watch players for signs of concussions.

“There’s a lot of publicity on (concussions) now, and I think that makes it better,” Williams said. “So, I’m not as worried now.”


AP-GfK Poll: Most say the US is heading the wrong way, hope for new direction come November

By JENNIFER AGIESTA, Associated Press

WASHINGTON (AP) — Congress has checked out, and the American people have noticed.

Three-quarters of Americans doubt the federal government will address the important problems facing the country this year, according to a new Associated Press-GfK poll.

All told, only 28 percent of Americans think the nation is heading in the right direction, the lowest level in August of an election year since 2008. It’s about on par with 2006, when Democrats took control of the U.S. House amid a backlash to the Iraq war.

This time around, it’s not clear whether either party will benefit from the disaffection.

One-third say they hope the Republicans take control of Congress outright this fall — which the GOP can accomplish with a net gain of six seats in the U.S. Senate while holding the U.S. House. The same share want to see Democrats lead Congress — a far less likely possibility.

The final third? They say it just doesn’t matter who takes control of Congress.

Overall, just 13 percent of Americans approve of the way Congress overall is handling its job.

There are some signs in the new poll that Republicans have gained ground as the height of the campaign approaches. In May, they trailed Democrats a bit on who ought to control Congress. Partisans are about equally likely to say they’d like to see their own in charge of Congress after November 4, with about three-quarters in each party saying they hope their side winds up in control. Democrats are a bit less apt to say they want their own party to win than they were in May, 74 percent in the new poll compared with 80 percent then.

And the GOP now holds narrow advantages over Democrats on handling an array of top issues, including the economy, immigration and the federal budget.

But neither party is trusted much to manage the federal government, with 27 percent having faith in the GOP to 24 percent in Democrats. More people, 31 percent, say they trust neither party to run the federal government.

Fewer people have confidence in the federal government’s ability to make progress on the important problems and issues facing the country in 2014 than at the start of the year, with 74 percent saying they have little or no confidence. That’s a slight change from the 70 percent who said so in a December AP-NORC Center for Public Affairs Research survey. That shift in confidence stems from a small drop-off among Democrats. While 56 percent lacked confidence in December, 62 percent say the same now.

Overall, few express faith in those currently on Capitol Hill. Just 36 percent say they’d like to see their own member of Congress re-elected, 62 percent say they want someone else to win this November. So far, just three House incumbents have been ousted in primaries this year, and none in the Senate. The Congressional approval rating, 13 percent in the new poll, lags behind President Barack Obama’s 40 percent.

Though the economy pushed the nation’s “right direction” figures to historic lows in the fall of 2008, that does not seem to be the culprit in the new poll. About a third (35 percent) say the economy is in good shape, about the same as in May, and 58 percent say the economy has stayed about the same in the past month.

The decline in optimism about the country’s path in the new poll seems to mirror those in October 2013 and August 2011, when congressional inaction led to the threat of a government shutdown in 2011 and a partial one in 2013. Among Democrats, the share saying the nation is heading in the right direction dipped 11 points since May, to 49 percent, while among independents, it’s down slightly to 23 percent. Among Republicans, the 9 percent saying the country is heading the right way is similar to May. The October 2013 and August 2011 declines in right direction were also driven by sharp drops among Democrats and independents.

Among those who say they are highly likely to vote this fall, just 8 percent say they approve of the way Congress is handling its job, though 43 percent would like to see their member of Congress re-elected, a bit higher than among all adults. Republicans have an edge among this group as the party more preferred to control Congress, 43 percent to 34 percent, with 23 percent saying it doesn’t matter.

The AP-GfK Poll was conducted July 24-28, 2014, using KnowledgePanel, GfK’s probability-based online panel designed to be representative of the U.S. population. It involved online interviews with 1,044 adults and has a margin of sampling error of plus or minus 3.4 percentage points for all respondents. It is larger for subgroups.

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

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Follow Jennifer Agiesta on Twitter: http://www.twitter.com/JennAgiesta

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Online:

AP-GfK Poll: http://www.ap-gfkpoll.com