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: Sharp divisions after high court backs gay marriage

NEW YORK (AP) — The Supreme Court’s ruling last month legalizing same-sex marriage nationwide has left Americans sharply divided, according to an Associated Press-GfK poll that suggests support for gay unions may be down slightly from earlier this year.

The poll also found a near-even split over whether local officials with religious objections should be required to issue marriage licenses to same-sex couples, with 47 percent saying that should be the case and 49 percent say they should be exempt.

Overall, if there’s a conflict, a majority of those questioned think religious liberties should win out over gay rights, according to the poll. While 39 percent said it’s more important for the government to protect gay rights, 56 percent said protection of religious liberties should take precedence.

The poll was conducted July 9 to July 13, less than three weeks after the Supreme Court ruled states cannot ban same-sex marriage.

According to the poll, 42 percent support same-sex marriage and 40 percent oppose it. The percentage saying they favor legal same-sex marriage in their state was down slightly from the 48 percent who said so in an April poll. In January, 44 percent were in favor.

Asked specifically about the Supreme Court ruling, 39 percent said they approve and 41 percent said they disapprove.

“What the Supreme Court did is jeopardize our religious freedoms,” said Michael Boehm, 61, an industrial controls engineer from the Detroit area who describes himself as a conservative-leaning independent.

“You’re going to see a conflict between civil law and people who want to live their lives according to their faiths,” Boehm said.

Boehm was among 59 percent of the poll respondents who said wedding-related businesses with religious objections should be allowed to refuse service to gay and lesbian couples. That compares with 52 percent in April.

Also, 46 percent said businesses more generally should be allowed to refuse service to same-sex couples, while 51 percent said that should not be allowed.

Claudette Girouard, 69, a retiree from Chesterfield Township, Michigan, said she is a moderate independent voter who has gradually become supportive of letting same-sex couples marry.

“I don’t see what the big hoopla is,” she said. “If they’re happy, why not?”

Girouard said local officials should be required to perform same-sex marriages, but does not think that wedding-related businesses should be forced to serve same-sex couples.

“If the official doesn’t like what he’s being asked to do, then quit,” she said. “But businesses are kind of independent, so if they have a strong belief against it, there are enough other businesses out there for someone to use.”

The poll found pronounced differences in viewpoints depending on political affiliation.

For example, 65 percent of Democrats, but only 22 percent of Republicans favored allowing same-sex couples to legally marry in their state. And 72 percent of Republicans but just 31 percent of Democrats said local officials with religious objections should be exempt from issuing marriage licenses.

By a 64-32 margin, most Democrats said it’s more important to protect gay rights than religious liberties when the two are in conflict. Republicans said the opposite, by 82-17.

Clarence Wells, 60, a conservative from Rockwood, Tennessee, said he strongly disapproved of the Supreme Court’s ruling. He anticipates friction as gay couples try to exercise their newfound rights and people with religious objections to same-sex marriage balk at accepting them.

“I don’t believe it’s going to go over smoothly,” said Wells. “I think a lot of them will be shunned in church. … I think there will businesses that are going to close, because some people are stubborn enough to not want to deal with it.”

Andrew Chan, 41, a moderate independent from Seattle, said he has tried to remain neutral on same-sex marriage.

“For me, it’s always been about tolerating,” said Chan, who works for a nonprofit organization. “I’ve got friends on both sides.”

Chan said he was happy for gays and lesbians who have found someone they want to marry, and he expressed some wariness toward politicians who might try to roll back the Supreme Court ruling.

“That just creates more division,” he said. “Are we looking to move the country forward or move it backward?”

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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. Some questions were ask of half samples of respondents and have smaller margins of error. 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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Swanson reported from Washington.

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Reach David Crary on Twitter at http://twitter.com/CraryAP and Emily Swanson at http://twitter.com/EL_Swan

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Online:

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


AP-GfK Poll: Minorities, young Americans still backing Obama

WASHINGTON (AP) — Even as the public remains closely divided about his presidency, Barack Obama is holding on to his support from the so-called “Obama coalition” of minorities, liberals and young Americans, an Associated Press-GfK poll shows, creating an incentive for the next Democratic presidential nominee to stick with him and his policies.

Hillary Rodham Clinton, by comparison, is viewed somewhat less favorably by the key voting groups whose record-setting turnout in 2008 propelled Obama to the White House and will be crucial to her own success.

Roughly two-thirds of Hispanics view Obama favorably, compared to just over half of Hispanics who say the same about Clinton. Among self-identified liberals, Obama’s favorability stands at 87 percent, to Clinton’s 72 percent. Half of Americans under the age of 30 view Obama favorably, compared to just 38 percent for his former secretary of state.

The findings offer a window into the factors at play as Clinton decides how closely to embrace Obama, his record and his policies in her campaign for president. Although associating herself with Obama could turn off some independent and Republican-leaning voters, electoral math and changing demographics make it critical for Democrats to turn out high numbers of Hispanics, African Americans and young voters.

Overall, Obama’s job approval rating stands at 43 percent, a leveling off following an AP-GfK poll conducted in early February that put his approval at 47 percent — slightly higher than it had been through most of 2014. The number of Americans who disapprove of Obama’s job performance has stayed relatively steady at 55 percent.

“He just seems to have something in his mind that he wants to accomplish and keeps trying to get it done,” said Christine Klauder, a self-described liberal from southern New Jersey. Klauder said she voted for Obama in 2008 and 2012 and that her support hasn’t dropped off. “He’s more oriented toward the kind of people that I feel that we are, have been all my life.”

Contrast that with Klauder’s views about Clinton, who has yet to win her enthusiastic support. “Being a woman, I think it would be wonderful to see her in — but I’m not sure,” Klauder said. “I think maybe her time has passed.”

Obama, whose troubles in the polls were seen as a drag on Democratic in last year’s midterm elections, has also managed to hold on to recent gains he’s made among core supporters.

When AP-GfK polled in October 2014, Obama’s approval rating among Hispanics had plummeted to 39 percent, as Hispanic advocacy groups demanded that Obama take aggressive action on immigration. One month later, he did just that — and his job approval among Hispanics now stands at 56 percent. Whereas 72 percent of liberals approved of Obama’s performance in October, that number now appears to have climbed, to 82 percent.

The survey reinforces a concern expressed by many Democrats about Clinton’s candidacy: that she just doesn’t inspire the levels of enthusiasm among traditional Democratic constituencies that were so critical to Obama’s success.

In the first weeks of her campaign, Clinton has promoted a number of populist ideas surrounding immigration, voting rights and economics that hew closely to themes that Obama has made central to his presidency. Although she distanced herself from Obama by suggesting she would have voted against giving him expedited authority to negotiate trade deals, she offered explicit support for the controversial nuclear deal with Iran that Obama announced this week.

Esther Danner, a 61-year-old from Hanover, Maryland, said she’s continued to support Obama because she feels he’s made progress on overhauling health care, promoting same-sex marriage and lifting the ban on gays in the military. Danner, who works part time at an African American heritage museum, said she thought Obama’s full-throated support would go a long way to persuade minorities and young Americans to show up to vote for the next Democratic nominee.

“The last eight years have been preparing for the 2016 election,” Danner said. “The current generation that voted for Obama, like myself, will probably continue the journey with the next Democratic candidate.”

In an AP-GfK poll conducted in January and February, nearly half of Americans — 47 percent — described the economy as “good,” almost as many as the 51 percent who called it “poor.” Since then, views of the economy have grown slightly more negative, with 41 percent now saying the economy is “good” and 57 percent saying it’s “poor.”

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The AP-GfK Poll of 1,004 adults was conducted online from Thursday to Monday, 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, but higher for subgroups such as Hispanics and African Americans.

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Associated Press writer Stacy A. Anderson contributed to this report.

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Reach Josh Lederman on Twitter at http://twitter.com/joshledermanAP and Emily Swanson at http://twitter.com/EL_Swan