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: Americans favor farmers & food during drought
LOS ANGELES (AP) — When water gets scarce and the government slaps restrictions on its use, who should be first in line at the spigot? Farmers, according to an Associated Press-GfK poll.

The national survey provides a glimpse into how Americans think water should be managed at a time when abnormally dry weather has afflicted swaths of the country, and water shortages in some states have led to conflict over who should get water and how much.

Two-thirds of Americans believe water is a limited resource that can be depleted if people use too much, the poll found, and 70 percent believe that government should restrict how much residents and businesses use when drought takes hold.

When asked to rate the importance of competing needs when water is scarce, 74 percent said agriculture should be a top or high priority, followed by residential needs (66 percent), wildlife and ecosystems (54 percent) and business and industry (42 percent).

To Cheryl Hendricks in parched California, it’s simple: To put food on the table “we rely on agriculture.”

“It’s getting kind of serious when you are not giving water to people who are producing food,” said Hendricks, 63, of Rancho Cucamonga, about 40 miles east of downtown Los Angeles.

She and her husband are taking shorter showers and removing lawn in response to California’s four-year drought, but for growers and ranchers “it’s more important for them to have it.”

The poll’s findings appear to run against criticism of farming practices that demand vast amounts of water. In California, for example, agriculture accounts for 80 percent of all water drawn from rivers, streams and the ground. Producing California’s almond crop consumes more water than all the showering, dish-washing and other indoor household water use of the state’s 39 million people.

The drought has been acute in California, where rainfall has dipped to record lows, reservoirs are depleted and state regulators have ordered conservation from cities, businesses and agriculture. Some communities have been given nine months to cut their use by 36 percent compared to 2013 levels.

Nevada’s Lake Mead, the largest reservoir in the country, is hovering near its historic low water mark and residents in the Las Vegas area have limits on lawn watering. In Oakridge in western Oregon, a community well is 23 feet below normal and restrictions prevent residents from washing cars and filling swimming pools.

“We need to take care of people first — and food,” said William Clarke-Jessimy, 33, from Queens, New York, who thinks homes and agriculture should be favored for water rights.

He’s watched prices spike for California fresh fruits and vegetables in his local markets, and he worries about friends and family in the San Francisco area who are living with the scarcity of water, with no relief in sight.

“It’s really scary,” he said. “They need to find ways to deal with the drought on a long-term basis. I don’t think a lot of people realize how bad it really is.”

Earlier this month, the House passed Republican-backed legislation designed to bring more water to California’s farm belt. Republicans have blamed some cutbacks on environmental regulations designed to protect salmon and the threatened Delta smelt, a three-inch-long fish that is disappearing. California Democratic Sen. Dianne Feinstein has proposed spending $1.3 billion over a decade for reservoirs, desalination projects and water recycling.

According to the survey, Republicans are slightly more likely than Democrats to call water for agriculture a top priority, 81 percent to 74 percent, respectively. Democrats were more likely than Republicans to see water for wildlife and ecosystems as a top need, 61 percent to 49 percent.

There was little variation in regions around the nation in picking top priorities.

The poll also found most Americans — nearly 80 percent — think government should limit developers to building only in places with an adequate, long-term water supply.

The advocacy group Food & Water Watch has urged Gov. Jerry Brown to place a moratorium on groundwater use for irrigating crops in some parts of the heavily farmed San Joaquin Valley. California director Adam Scow said the poll’s findings reflect that people value food production but the group believes “we simply don’t have the water” to support crops in some drought stricken regions.

David Abbott has witnessed the toll in his hometown.

The resident of Winton, California, in the heart of the state’s Central Valley farm belt, has seen fields turn to dusty patches and farm workers end up jobless. Friends’ wells have gone dry.

In California, farmers have seen allocations of water from rivers and reservoirs slashed by government agencies in amounts greater than at any other time in California history, forcing many to tap depleted groundwater sources or buy it at high prices.

Abbott, 27, a part-time college business professor, places home use and the needs of agriculture on about equal footing. For his part, he’s watering less outdoors at home, has changed shower heads to conserve and waits to get a full load of dirty laundry before turning on the washing machine.

“I know it’s hard when we don’t have water,” said Abbott, who lives amid farms and almond orchards. “They say we are going to have a real wet winter, but I don’t think that’s going to be enough.”

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The AP-GfK Poll of 1,004 adults was conducted online July 9-13, 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 3.4 percentage points.

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Online:

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


AP-GfK Poll: Majority of Americans favor diplomatic ties with Cuba

WASHINGTON (AP) — Nearly three-fourths of Americans think the United States should have diplomatic ties with Cuba, but they’re not sure how far to go in lifting sanctions, according to an Associated Press-GfK poll released Monday as full diplomatic relations between the two countries were formally restored.

“Relations between Cuba and the U.S. I think are long overdue. There’s no threat there,” said Alex Bega, 30, of Los Angeles. “I think the sanctions we have on them are pretty much obsolete.”

The resumption of normal ties ended decades of acrimony between the two nations that was hardened when President John F. Kennedy and Cuba’s Fidel Castro fought over Soviet expansion in the Americas. The new diplomatic status, however, does not erase lingering disputes, such as mutual claims for economic reparations, Havana’s desire to end a more than 50-year-old trade embargo and the U.S. push for Cuba to improve human rights and democracy.

The new poll also found that 58 percent of Americans approve of President Barack Obama’s handling of the U.S. relationship with Havana while 40 disapprove. By contrast, only 39 percent approve of his handling of the U.S. role in world affairs more generally, while 59 percent disapprove.

“I just disapprove of his politics in general,” said Julie Smith, 40, a university administrator from Bowling Green, Kentucky. “I just don’t think that us trying to improve relations with Cuba is beneficial to the United States.”

Respondents were split on what to do about the sanctions on Cuba. Forty-eight percent thought they should be decreased or eliminated entirely while 47 percent favored keeping them at their current level or increasing them. Five percent didn’t answer.

The story was different when it came to Iran.

Seventy-seven percent said they thought sanctions on Tehran should be kept where they are or increased, according to the poll, which was conducted just days before the U.S. signed an agreement to curb Iran’s nuclear program in exchange for economic sanctions relief. Under the agreement, Iran’s nuclear program will be curbed for a decade in exchange for potentially hundreds of billions of dollars’ worth of relief from international sanctions.

Mary Barry, 57, of Arlington, Texas, is happy that the Obama administration opened diplomatic efforts with both Cuba and Iran, but is wary about lifting sanctions on the two countries.

“I think we need to have diplomatic relations with Iran and monitor their nuclear weapon,” said Berry, who works producing and staging corporate business meetings. But, she said: “I think we need to keep the sanctions in place on Iran to make sure they’re doing what they’ve promised they’re going to do because I think Iran is a country that you can’t really trust.”

On Cuba, she thinks it’s “just time” to restore diplomatic relations. But she favors a gradual lifting of sanctions on Cuba. “I don’t think they should be lifted immediately,” she said.

There is some momentum in Congress, however, to lift the trade embargo.

Sen. Amy Klobuchar, D-Minn., backs a bipartisan bill in the Senate to lift the embargo, which she said must be done for the U.S. to avoid losing investment opportunities that will come with loosening of travel restrictions to the island.

“Once millions of American tourists are going, they will need places to stay and they will need food to eat. … So when they come, they are going to be starting to sleep in Spanish hotels and eat German foods because those countries will be able to supply what they need in the tourism industry, not to mention the computers and Wi-Fi and everything else,” Klobuchar said in an interview.

She predicted the legislation, which has 20 co-sponsors so far, would pass, although maybe not this year. “I know there are some people who have long been opposed to this,” she said.

Democratic Sen. Bob Menendez of New Jersey thinks the Obama administration’s work to restore relations is an attempt to validate the Castro regime’s “brutal behavior.”

“I remain deeply concerned with ongoing human rights violations in Cuba,” Menendez said Monday. “There have been over 2,800 political arrests on the island this year alone.”

The AP-GfK Poll of 1,004 adults was conducted online July 9 to July 13, 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 3.4 percentage points. Respondents were first selected randomly using phone 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.

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Online:

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