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.

___

Online:

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

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

AP-GfK Poll: 2 of 3 Americans think the threat posed by Islamic State is very important

By DEB RIECHMANN and EMILY SWANSON, Associated Press

WASHINGTON (AP) — Sixty-five percent of Americans now say the threat from the Islamic State group is very or even extremely important, and nearly half think the U.S. military response in Iraq and Syria has not gone far enough, according to an Associated Press-GfK poll. Most want to see America’s partners step up their contribution to the fight,

Less than half, 43 percent, approve of the way President Barack Obama is handling the danger posed by the extremist militants.

Greg Franke, 24, of Columbia, South Carolina, was among the 55 percent of those who disapproved. Franke, a 24-year-old assistant editor at a research library, said he thought Obama was too hesitant in responding to the militants, who have employed brutal tactics to swiftly seize territory.

“I understand the need to be hesitant, but this was a group that was marching across parts of the Middle East, which is already unstable,” Franke said. “I think it warranted a swift and more decisive response.”

“I also think that his declaration that U.S. troops would not be involved was premature,” he said. “I don’t want U.S. troops involved. But I don’t think we need to close doors.”

A majority, 66 percent, favor the airstrikes the United States has been launching against the militants, yet 65 percent of those surveyed say Obama has not clearly explained America’s goal in fighting the Islamic State group. The president met with his national security team on Friday to discuss the Islamic State and talk via video teleconference with U.S. officials at the American Embassy in Baghdad and consulates in Irbil and Basra.

Here’s a look at the poll:

IS ENOUGH BEING DONE?

Forty-six percent said the U.S. military response has not gone far enough — up from 40 percent in September. Fifty-six percent said the military response from countries that have joined the U.S. in the fight against Islamic State militants has not gone far enough. The U.S. and partner countries, including Qatar, Saudi Arabia and the United Arab Emirates, have been bombing Islamic State targets since August.

“It shouldn’t just be us. It shouldn’t just be ‘Oh, the United States is policing.’ It should be everyone is there policing and everybody believes this is wrong and everyone — worldwide — is trying to stop this,” said Kathy Robinson, 24, a Sterling, Virginia, woman who works at an information technology company.

At the same time, she thinks the United States eventually will put troops on the ground in the region “just to make sure nothing starts back up — to keep the peace.”

Only 32 percent think Obama has done a good job in clearly stating U.S. policy against the IS group. More than six in 10 of them think it’s either not likely or only moderately likely that the U.S. and its partners will achieve their goal in fighting IS.

___

ARE AMERICANS FOLLOWING DEVELOPMENTS IN IRAQ, SYRIA?

While 47 percent of those surveyed said there’s a very or extremely high risk of another terror attack inside the United States, just a third said they have been keenly following the news about the U.S. military action against IS. An additional 38 percent said they were following the action somewhat closely, and 31 percent said they were keeping up not too closely or not closely at all.

___

DO PEOPLE SUPPORT THE AIRSTRIKES?

While Americans support the airstrike, when it comes to supporting the idea of deploying U.S. ground troops, respondents were more guarded.

Thirty-seven percent said they opposed putting American forces on the ground, 33 percent favored the idea and 28 percent said they were neither for nor against it.

Obama has said repeatedly that he has no plans to send ground troops to Iraq or Syria. However, 28 percent thought it was very or extremely likely that he would, and an additional 45 percent thought it was moderately likely. Just 24 percent said it was not likely.

Michael Rainwater, 64, of Sammanish, Washington, doesn’t particularly want to see U.S. troops sent in, but thinks they might be deployed at some point.

“I think all of these things tend to escalate,” he said. “You can’t keep pouring fuel on the fire and expect the fire to get smaller. So every time we bomb or send in armed drones, you are creating more terrorists.”

He does not think, though, that the Islamic State is in a position to mount a 9/11-style attack against the U.S.

Said Rainwater, a retired software company owner: “It is more of a criminal entity because basically what they are doing is kidnapping people for ransom, taking over oil refineries for the income.”

___

The AP-GfK Poll was conducted Oct. 16-20 using KnowledgePanel, GfK’s probability-based panel designed to be representative of the U.S. population. It involved online interviews with 1,608 adults, and had a margin of sampling error of plus or minus 2.8 percentage points for all respondents. Respondents were selected randomly using phone or mail survey methods, and later interviewed. People selected for KnowledgePanel who didn’t otherwise have access to the Internet were given free access.

 


AP-GfK Poll: Disapproval, doubt dominate on Ebola

By LAURAN NEERGAARD and EMILY SWANSON

WASHINGTON (AP) — Americans have at least some confidence that the U.S. health care system will prevent Ebola from spreading in this country but generally disapprove of the way President Barack Obama and the Centers for Disease Control and Prevention have handled the crisis so far.

Most disapprove of Obama’s handling of the Ebola outbreak, according to an Associated Press-GfK Poll. Just 1 in 5 approve of the CDC’s work on Ebola so far, and only 3 in 10 say they trust that public health officials are sharing complete and accurate information about the virus. And only 18 percent have deep confidence that local hospitals could safely treat a patient with Ebola.

Amid worry here, most Americans say the U.S. also should be doing more to stop Ebola in West Africa. Health authorities have been clear: Until that epidemic ends, travelers could unknowingly carry the virus anywhere.

“It seems to me we have a crisis of two things. We have a crisis of science, and either people don’t understand it or … they don’t believe it,” said Dr. Joseph McCormick, an Ebola expert at the University of Texas School of Public Health. And, “we have a crisis in confidence in government.”

Some findings from the AP-GfK poll:

HEALTH CARE GETS MIXED REVIEWS

Nearly a quarter of Americans are very confident the U.S. health care system could prevent Ebola from spreading widely, and 40 percent are moderately confident.

But nearly half don’t think their local hospital could safely treat an Ebola case, and 31 percent are only moderately confident that it could.

After all, Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., at first was mistakenly sent home by a Dallas emergency room, only to return far sicker a few days later. Then, two nurses caring for him somehow became infected. The family of one of the nurses, Amber Vinson, said Wednesday doctors no longer could detect Ebola in her as of Tuesday evening.

Asked how the Centers for Disease Control and Prevention handled those cases, 42 percent of people disapprove and 22 percent approve.

FEAR VS. KNOWLEDGE

Despite months of headlines about Ebola, nearly a quarter of Americans acknowledge they don’t really understand how it spreads. Another 36 percent say they understand it only moderately well.

Ebola doesn’t spread through the air or by casual contact, and patients aren’t contagious until symptoms begin. Ebola spreads through close contact with a symptomatic person’s bodily fluids, such as blood, vomit, feces, urine, saliva, semen or sweat.

People who say they do understand are less concerned about Ebola spreading widely in this country. Among those who feel they have a good grasp on how it spreads, 46 percent are deeply concerned; that rises to 58 percent among those who don’t understand it as well.

Likewise, a third of those with more knowledge of Ebola are confident in the health system’s ability to stem an outbreak, and 27 percent think their local hospital could safely treat it. Among those who don’t understand Ebola, fewer than 1 in 5 shares either confidence.

WHAT SHOULD BE DONE

A whopping 93 percent of people think training of doctors and nurses at local hospitals is necessary to deal with Ebola, with nearly all of them, 78 percent, deeming it a definite need.

Nine out of 10 also think it’s necessary to tighten screening of people entering the U.S. from the outbreak zone, including 69 percent who say that’s definitely needed.

Some would go even further: Almost half say it’s definitely necessary to prevent everyone traveling from places affected by Ebola from entering the U.S. Another 29 percent say it’s probably necessary to do so.

More than 8 in 10 favor sending medical aid to Ebola-stricken countries and increasing government funding to develop vaccines and treatments.

SOME NEW STEPS

The CDC had issued safe-care guidelines to hospitals long before Duncan arrived last month, and it made some changes this week after the unexpected nurse infections. Now, the CDC says hospitals should use full-body garb and hoods and follow rigorous rules in removing the equipment to avoid contamination, with a site manager supervising. Possibly more important, workers should repeatedly practice the donning and doffing and prove they can do it correctly before being allowed near any future patients.

While Duncan wasn’t contagious during his flight, his arrival spurred U.S. officials to begin checking passengers arriving from Liberia, Sierra Leone and Guinea for fever, an early Ebola symptom, just like they’re checked before leaving those countries.

Wednesday, the CDC moved to fill a gap in that screening: Starting next week, all of those travelers must be monitored for symptoms for 21 days, the Ebola incubation period. They’ll be told to take their temperature twice a day and must report the readings to state or local health officials.

That’s not just for West African visitors. It includes U.S. government employees, who had been doing their own 21-day fever watches upon return from fighting the epidemic, as well as doctors and other workers for aid organizations and journalists.

The AP-GfK Poll was conducted Oct. 16-20, using KnowledgePanel, GfK’s probability-based panel designed to be representative of the U.S. population. It involved online interviews with 1,608 adults and has a margin of sampling error of plus or minus 2.8 percentage points for all respondents. 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 with the ability to access the Internet at no cost to them.

___

Online:

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