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: End game: No immigration deal, just divisions

WASHINGTON (AP) — A Congress that began with bright hopes for immigration legislation is ending in bitter divisions on the issue even as some Republicans warn that the political imperative for acting is stronger than ever for the GOP.

In place of a legislative solution, President Barack Obama’s recent executive action to curb deportations for millions here illegally stands as the only federal response to what all lawmakers agree is a dysfunctional immigration system. Many Democrats are convinced Latino voters will reward them for Obama’s move in the 2016 presidential and Senate elections, while some Republicans fear they will have a price to pay.

“If we don’t make some down payment toward a rational solution on immigration in 2015, early 2016, good luck winning the White House,” said Republican Sen. Lindsey Graham of South Carolina, an author of the comprehensive immigration bill that passed the Senate last year with bipartisan support, but stalled in the GOP-led House.

With the expiration of the 113th Congress this month, that bill will officially die, along with its path to citizenship for the 11 million immigrants in this country illegally.

Immigration is certain to be a focus for the new, fully Republican-led Congress when it convenes in January — but there’s little expectation the GOP will make another attempt at comprehensive reforms.

Instead, GOP leaders in the House and Senate have pledged to take action to block Obama’s executive moves, setting up a battle for late February when funding expires for the Department of Homeland Security, which oversees immigration matters. House Speaker John Boehner, R-Ohio, has promised action on a border security bill as part of that.

Whether Congress can do anything to stop Obama remains unclear, since he’s certain to veto any effort to undo his executive moves. It’s also not clear lawmakers could pass a border bill, or that Obama would sign it if they did.

While some congressional Republicans are arguing for action on piecemeal reforms, most advocates are resigned to waiting until a new president takes office in 2017 for lawmakers to make another attempt at a comprehensive overhaul that resolves the central immigration dilemma — the status of the millions here illegally.

“They had the best chance in a generation and they couldn’t get enough support from the Republican caucus,” said Frank Sharry, executive director of America’s Voice, an immigrant advocacy group. “It may well be that they’re going to have to lose the White House and both chambers of Congress for us to get comprehensive immigration reform.”

When Obama won a second term in 2012 with strong Hispanic and Asian support, many national Republican leaders decided they needed to support policies that would attract those growing blocs of voters. The Republican National Committee formally embraced support for comprehensive immigration reform as a guiding principle for the GOP.

But legislative efforts stalled in the House as conservative Republicans balked at Boehner’s efforts to advance the issue. Last summer’s crisis over an influx of unaccompanied Central American minors arriving at the border caused shelter overloads and case backlogs, straining resources and creating the impression that the border was out of control — further souring political prospects for reform legislation.

In absence of congressional efforts, Obama promised he would act on his own, and he made good on that shortly after last month’s midterm elections, announcing an array of changes that will include work permits and three-year deportation stays for some 4 million immigrants here illegally. It mostly applies to those who’ve been here more than five years and have kids who are U.S. citizens or legal permanent residents.

The move inflamed Republicans, who have been fighting about it ever since, including a failed effort by Sen. Ted Cruz, R-Texas, to block Obama in a Senate floor vote this past weekend. On Tuesday the dispute spilled over into debate on Obama’s nominee to lead the Immigration and Customs Enforcement agency, Sarah Saldana, the U.S. attorney in Dallas. She was confirmed 55-39 by the Senate over objections from Republicans who had initially supported her but turned against her because of her support for Obama’s executive actions.

Meanwhile, some immigration advocates complained that the steps didn’t go far enough as Obama faced criticism from both sides of the political divide.

A new Associated Press-GfK poll found that most Americans support allowing immigrants living in the country illegally a way to stay here lawfully. But only 43 percent of them think Obama was right to take executive action to make those changes, while 54 percent of them say he should have kept trying to make a deal with Republicans. Still, the poll also showed little sign of blowback for Obama. Although 57 percent disapprove of Obama’s handling of the immigration issue, that was down slightly from 63 percent in October.

A group of 24 states joined in a federal lawsuit filed in Texas alleging that Obama overstepped his constitutional powers in a way that will only worsen the humanitarian problems along the southern U.S. border. And Arizona Sheriff Joe Arpaio is in federal court in Washington, contending that the policy is a magnet for more illegal entries into the country that will impose a burden on law enforcement.

In a court filing late Monday, the Justice Department argued for dismissal of Arpaio’s case, saying he has failed to substantiate his claims.

Congressional Republicans say that Obama’s actions created an even tougher climate for immigration legislation, but many Democrats and advocates contend that Republicans were terminally stalled on the issue anyway. Some Republicans question whether immigration legislation really is a political imperative for the GOP. “It’s really mixed out there — some people want a big immigration bill, others don’t,” said Sen. Orrin Hatch, R-Utah, a supporter of reform efforts.

And two years after a “Gang of Eight” senators launched an immigration overhaul drive on Capitol Hill, some of those same players say they have no plans to initiate another such effort.

“I’m not going to start it in the Senate,” said Sen. John McCain, R-Ariz. “We’ve tried that.”

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Associated Press News Survey Specialist Emily Swanson and writer Pete Yost contributed to this report.


AP-GfK Poll: Crunch time again for health insurance sign-ups

By Ricardo Alonso-Zaldivar

WASHINGTON (AP) – President Barack Obama’s push to cover America’s uninsured faces another big test Monday.

 

This time, it’s not only how the website functions, but how well the program itself works for millions who are starting to count on it.

 

Midnight Monday, Pacific time is the deadline for new customers to pick a health plan that will take effect Jan. 1, and for current enrollees to make changes that could reduce premium increases ahead of the new year.

 

HealthCare.gov and state insurance websites are preparing for heavy online traffic before the deadline, which gives consumers in the East three hours into Tuesday to enroll.

 

Wait times at the federal call center started creeping up around the middle of last week, mainly due to a surge of current customers with questions about their coverage for next year. Many will face higher premiums, although they could ease the hit by shopping online for a better deal. Counselors reported hold times of 20 minutes or longer for the telephone help line.

 

About 6.7 million people now have coverage through Obama’s signature law, which offers subsidized private insurance. The administration wants to increase that to 9.1 million in 2015. To do that, the program will have to keep most of its current enrollees while signing up more than 2 million new paying customers.

 

People no longer can be turned down because of health problems, but picking insurance still is daunting for many consumers. They also have to navigate the process of applying for or updating federal subsidies, which can be complex for certain people, including immigrants. Many returning customers are contending with premium increases generally in the mid-to-high single digits, but much more in some cases.

 

Consumers “understand it’s complicated but they appreciate the ability to get health insurance,” said Elizabeth Colvin of Foundation Communities, an Austin, Texas, nonprofit that is helping sign up low-income residents. “People who haven’t gone through the process don’t understand how complicated it is.”

 

Last year’s open enrollment season turned into a race to salvage the reputation of the White House by fixing numerous technical bugs that crippled HealthCare.gov from its first day. With the website now working fairly well, sign-up season this year is a test of whether the program itself is practical for the people it is intended to serve.

 

New wrinkles have kept popping up, even with seemingly simple features of the Affordable Care Act.

 

For example, most current customers who do nothing will be automatically renewed Jan. 1 in the plan they now are in. At this point, it looks like that is what a majority intends to do.

 

While that may sound straightforward, it’s not.

 

By staying in their current plans, people can get locked into a premium increase and miss out on lower-priced plans for 2015. Not only that, they also will keep their 2014 subsidies, which may be less than what they legally would be entitled to for next year.

 

Doing nothing appears to be a particularly bad idea for people who turned 21 this year, according to the Center on Budget and Policy Priorities, a Washington group that advocates for low-income people.

 

Researchers at the center estimate that 21-year-olds will see a 58 percent increase in the sticker price for their premiums just because they’re a year older. An age-adjustment factor used to compute premiums jumps substantially when a person turns 21. A 20-year-old whose premium was $130 per month in 2014 will see the premium climb to $205 a month in 2015, solely because of that year’s difference.

 

Tax-credit subsidies can cancel out much or even all of the impact. But if consumers default to automatic renewal, their tax credits will not be updated and they will get the same subsidy as this year.

 

“Even in the best possible scenario of how many people we can expect to come in, we will still see a substantial number of people defaulting,” said Judy Solomon, a health care policy expert at the center. She worries that some young adults may get discouraged and drop out.

 

Reviews of HealthCare.gov and state health insurance exchanges are mixed.

 

An Associated Press-GfK poll this month found that 11 percent of Americans said they or someone else in their household tried to sign up since open enrollment began Nov. 15. Overall, 9 percent said the insurance markets are working extremely well or very well. Twenty-six percent said the exchanges are working somewhat well, and 39 percent said they were not working well. The remaining 24 percent said they didn’t know enough to rate performance.

 

So far it has been a frustrating experience for Marie Bagot, of Fort Lauderdale, Florida. She and her husband are in their 60s, but not yet old enough for Medicare. The husband, who works as a chef, will turn 65 around the middle of next year and qualify for Medicare. Bagot said they were happy with their insurance this year under Obama’s law.

 

“As you get older, you worry about your health,” she said. “I was very pleased with the price we got.”

 

But Bagot said she received a notice from her insurer that her current plan will not be available next year in her community. The closest alternative would involve a premium increase of more than $350 a month, even with their tax credit subsidy. After days of trying to find a comparable plan through the federal call center and after visiting a counselor, Bagot said she opted to keep their current coverage, while hoping costs go down after her husband joins Medicare.

 

“I cannot afford it, but I’m going to try to,” she said.

 

Monday is not the last chance for consumers like Bagot. Open enrollment doesn’t end until Feb. 15.

 

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Associated Press Director of Polling Jennifer Agiesta contributed to this report.