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 shows divide over increasing money for transit

WASHINGTON (AP) — A slight majority of Americans prefer living in a single-family house in the suburbs or a rural area with more land, even if it means driving long distances to get to work or run errands, according to a poll by The Associated Press-GfK.

However, a significant minority, 44 percent, would choose an apartment or smaller house in an urban area that comes with a short drive to work or the opportunity to use public transportation, bike or walk. The split also has a political aspect: Sixty-seven percent of Republicans and 53 percent of independents prefer suburban or rural living, while 55 percent of Democrats prefer urban areas.

The share of Americans who prefer suburban or rural living — 53 percent — is identical to the share who say the government should increase spending to build and improve roads, bridges and interstate highways. About 1 in 3 think current spending levels are about right, while just over 1 in 10 would like to see less money spent on roads.

Many states are struggling just to maintain current spending levels, and Congress has been unable to come up with a long-term plan to pay for highway aid that closes the gap between current spending and federal gas tax revenue.

Americans are more divided over building and improving public transportation such as rail and bus systems. Four in 10 say spending on public transportation should be increased, but just as many say current spending is about right. Only 18 percent say transit spending should be cut.

Contrary to the widely held notion that the millennial generation is flocking to cities and giving up their cars, younger people are not significantly more or less likely than older people to prefer urban living with a shorter commute and access to public transit, the poll found.

Matthew Wild, 33, an airline pilot living in the Los Angeles suburb of Hawthorne, said he favors increasing spending on both public transit and highways. The region’s freeways “take a real beating” from the traffic and need to be maintained, he said, but no new lanes should be added.

“We definitely don’t need to be expanding freeways anymore,” Wild said. “We’ve maxed out.”

He cited a highway near his home that was recently widened and now is as full as ever. He does, however, strongly support building more light rail transit locally and high-speed rail between California cities.

Wild said he’d much rather take a convenient local train than fight traffic in his car. He currently takes trains only a few times a year because there are no direct routes from where he lives to the places he wants to go, and indirect routes take too long, he said.

“The big problem with L.A. is that, given the lack of public transportation, sitting in traffic in your own car is still faster than taking public transit,” Wild said.

Jane McEntire, 62, who lives in Cartersville, Georgia, on the northwest fringe of the Atlanta metropolitan area, says traffic is horrible and getting worse.

Even so, she’d rather keep spending on roads and cut spending on public transportation. She says she’s lost confidence in the ability of state and local transportation officials to make improvements and not fritter money away on wasteful projects.

She is particularly incensed that officials used federal transit aid to build a slow-moving streetcar line in downtown Atlanta that is used primarily by tourists.

“I think they look really cute, but as far as usefulness — no,” she said. “When you have federal dollars that are coming into a state that are available and you spend it on these cars in Atlanta that go six or eight blocks back and forth … Why didn’t they take that money and spend it on something to help commuters?”

The AP-GfK Poll of 1,077 adults was conducted online from April 23 to 27 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

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Follow Joan Lowy on Twitter at http://www.twitter.com/AP_Joan_Lowy


AP-GfK Poll: Many approve Iran deal; Most don’t trust Tehran
WASHINGTON (AP) — Many Americans like the idea of the preliminary deal that would limit Iran’s nuclear program but very few people really believe Tehran will follow through with the agreement.

An Associated Press-GfK poll finds that just 3 percent said they were very confident that Iran would allow inspections of its nuclear facilities, remove plutonium from the country and shut down close to half of its uranium-enriching centrifuges as the preliminary deal says would be required. Nearly seven in 10 people said they were not confident, while 25 percent said they were only moderately confident.

The U.S., Germany, Britain, France, Russia and China are aiming to finalize a deal with Iran by June 30 that puts limits on Iranian programs that could be used to make nuclear arms. In exchange, economic sanctions on Iran would be lifted over time. Tehran denies any interest in such weapons but is negotiating in hopes of relief from billions of dollars in economic sanctions.

The next round of nuclear talks between Iran and six world powers will start Tuesday in Vienna.

Although more than half of Americans polled say they approve of making the deal, few people — 16 percent — are actually paying close attention to the complex Iran negotiations that have angered Israel and unnerved Gulf nations who are concerned about Tehran’s rising influence and aggressive behavior in the region.

The Senate last week passed legislation that would give Congress time to vote to reject any deal before sanctions are lifted. President Barack Obama would retain the right to veto lawmakers’ disapproval.

Israel’s strong objections to the deal could make a difference to many Americans. If forced to choose, a majority say it’s more important to maintain the U.S. relationship with Israel than to strike a deal with Iran. But respondents are divided along party lines, with nearly six in 10 Democrats saying the Iran deal is more important while seven in 10 Republicans believe ties with Israel are more critical.

Israeli Prime Minister Benjamin Netanyahu has been one of the harshest critics of the deal with Iran. Israel considers a nuclear-armed Iran an existential threat, citing hostile Iranian rhetoric toward the Jewish state, Iran’s missile capabilities and its support for violent militant groups.

More broadly, the poll found that Americans are increasingly interested in the U.S. role in world affairs, with 60 percent saying it’s an extremely important issue, up from 52 percent less than five months ago. Slightly more people also approve of Obama’s handling of the issue, increasing from 38 percent in December to 42 percent in the latest poll. Fifty-seven percent disapprove of Obama’s handling of the issue.

But overall, Americans are more likely to trust Republicans than Democrats to handle protecting the country.

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The AP-GfK Poll of 1,077 adults was conducted online April 23-27, 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