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

Foreign policy no longer a strong point for Obama as troubles pile up across globe, AP-GfK poll shows

By CONNIE CASS and JENNIFER AGIESTA, Associated Press

WASHINGTON (AP) — Foreign policy used to be a bright spot in Americans’ dimming opinion of President Barack Obama. Not anymore. Associated Press-GfK polling found a spring and summer of discontent with the president’s handling of world events.

Obama’s consistently low marks across crises such as the fighting in Ukraine and the conflict between Israel and Hamas could benefit Republicans aiming to win control Congress in the fall.

“The problem is saying something and not doing anything — making grandiose threats and never following any of them up,” said Dwight Miller, 71, a retiree and volunteer firefighter in Robertson County, Texas. Miller, who describes himself as a libertarian-leaning Republican, says Obama should either stay out of other nations’ business or commit to going “all in.”

In Hawaii, another retiree, Kent Killam, also worries about the U.S. response to cascading troubles in Ukraine, the Middle East and elsewhere. But he blames former President George W. Bush for eroding the nation’s clout abroad and Republican lawmakers for limiting Obama’s ability to act.

“I’m not saying it’s going well at all,” said Killam, 72, a Democratic-leaning independent. “On the other hand, I don’t think he has too many options.”

The foreign conflicts that have consumed so much of Washington’s attention lately aren’t rated as especially pressing by most Americans surveyed for the AP-GfK poll. It’s unclear how their unhappiness with Obama’s performance will affect the midterm elections in November.

Asked about world trouble spots:

—42 percent say the conflict between Israel and Hamas is “very” or “extremely” important to them; 60 percent disapprove of the way Obama has handled it.

 

—40 percent consider the situation in Afghanistan highly important; 60 percent disapprove of Obama’s handling of it.

 

—38 percent give high importance to the conflict in Ukraine; 57 percent disapprove of what Obama has done about that.

 

—38 percent find the situation in Iraq of pressing importance; 57 percent disapprove of Obama’s handling of it.

 

Opinion of Obama’s foreign policy has slid nearly as low as his overall approval rating.

 

Just 43 percent were OK with the president’s handling of foreign relations in the new poll, while 40 percent approved how he’s doing his job overall. AP-GfK polls in March and May show a similar picture.

 

The late-March poll, which came after Russia seized upon an uprising in Ukraine to annex the Crimean Peninsula, marked a significant drop from January’s 49 percent foreign policy rating. In September 2012, shortly before Obama’s re-election, it was 57 percent.

 

Republicans line up more uniformly behind their party on foreign policy than Democrats do.

 

Asked whom they trust more to protect the country, 71 percent of Republicans chose their party. Only 39 percent of Democrats said their party most; about as many Democrats trusted both parties equally.

 

Sixty-three percent of Republicans have more confidence in their party in an international crisis, while 44 percent of Democrats put faith in their party alone. Most Democrats did prefer their party for managing the U.S. image abroad — 51 percent said it would handle that better.

 

About half of independents don’t trust either major party in a world crisis.

 

“I think they’re both a little bit more aggressive than they need to be in using armies instead of going through the U.N.,” said Cameron Wooley, 18, of Orlando, Florida, who’s still deciding whom to support when she votes for the first time this year.

 

“Maybe if we didn’t spend these massive chunks of our budget on the military we wouldn’t have the other concerns we have because of money,” Wooley said. An aspiring opera singer attending the University of North Florida in the fall, she would like to see some of that defense money handed over to the states to spend on things like education and roads.

 

Only about half of those polled see foreign relations as highly important right now, and concern about the United States’ relationship with other countries hasn’t increased despite recent news.

 

Jay Lofstead, a Democrat in Albuquerque, New Mexico, wants to see more involvement in the world’s problems, and he gives Obama a mixed review.

 

“I’d like to see him get more involved on a humanitarian basis in more areas, not military support — no financial support, no weapons — but strictly humanitarian aid,” said Lofstead, 44, a supercomputer researcher at Sandia National Laboratories, who stressed that he speaks only for himself.

 

The AP-GfK Poll was conducted July 24-28, 2014, using KnowledgePanel, GfK’s probability-based online panel designed to be representative of the U.S. population. It involved online interviews with 1,044 adults, and has a margin of sampling error of plus or minus 3.4 percentage points for all respondents. It is larger for subgroups.

 

Respondents were first selected randomly using phone or mail survey methods, and were 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.

 

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Online:

 

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

 


AP-GfK Poll: Sanctions and Russia

MOSCOW (AP) — U.S. and European sanctions against Russia’s energy and finance sectors are strong enough to cause deep, long-lasting damage within months unless Moscow persuades the West to repeal them by withdrawing support for Ukrainian insurgents.

The U.S. and European Union released details Wednesday of new sanctions aimed at hurting Russia’s economy without doing undue damage to their own trade interests, punishment for alleged Russian support for Ukrainian rebels and Russia’s annexation of the Ukrainian peninsula of Crimea.

The sanctions go further than earlier penalties — which had largely targeted individuals — by broadly limiting the trade of weapons and of technology that can be used in the oil and military industries. The EU also put its capital markets off-limits to Russian state-owned banks.

Experts said the sanctions wouldn’t have a tremendous impact in the short term, but if left in place for months will stifle development in the Russian economy and sap its financial sector. Already, economists have revised downward their predictions for Russian growth this year, with some saying the country will go into recession.

The biggest immediate impact is likely to come from the financial sanctions. U.S. officials said roughly 30 percent of Russia’s banking sector assets would now be constrained by sanctions.

In a first sign of concern, Russia’s central bank said Wednesday that it would support banks targeted by the penalties.

“State-owned banks are the core of the Russian banking system,” said Vladimir Tikhomirov, chief economist at financial services group BCS. He noted the banks are already having trouble raising money. “That would mean their ability to lend to other banks, smaller banks, is going to be more restricted also.”

Last year, about a third of the bonds issued by Russia’s majority state-owned banks — 7.5 billion euros ($10 billion) — were placed in EU financial markets, according to EU officials.

The measures against Russian banks, which exempt short-term borrowing, are meant to inflict just enough pain without causing them to collapse.

“The aim is not to destroy these banks,” said a senior EU official, briefing reporters on condition of anonymity prior to the sanctions’ official announcement. “We do not want them to get into a liquidity crisis.”

Russia’s foreign ministry complained vocally about the sanctions, criticizing the U.S. for “advancing baseless claims” about its role in Ukraine in a “pretentious, prosecutorial manner.” It criticized the EU for allowing its policy to be “dictated by Washington.”

The key will be how long the sanctions stay in place.

In the short term, Russia has low public debt and enough money to support its banks. The lenders themselves have large reserves.

In the longer term, the sanctions could hurt by fostering a climate of uncertainty — something investors loathe. Some foreign investors are likely to stay away from the sanctioned companies.

Already, as the Ukraine crisis deepened, Russia’s central bank has been forced to raise interest rates several times to stabilize the currency as foreign investors sold it off; investors are expected to pull more than $100 billion out of Russia this year. The central bank last raised rates on Friday in anticipation of the latest sanctions.

Rising rates hurt the economy by making borrowing more expensive; VTB bank chairman Mikhail Zadornov told the Financial Times that the company’s retail arm cut new loans to small business by 20 percent in the first half of 2014.

Even ordinary Russians were worried.

“I have some concerns for my own savings,” said Indira Minigazimova, a resident of southern Siberia who was visiting Moscow.

It is less clear what the impact may be of another key sanction: the EU’s block on exports of technology that can be used for oil exploration and economic development. Russia relies heavily on Western expertise, for example in drilling for oil in Arctic regions.

This area has significantly more risk to Western companies — particularly BP and ExxonMobil — that have big investments in Russia. The sanctions were not expected to affect current deals and shareholdings, though it was unclear what the long-term repercussions for investments might be.

EU officials noted the prohibition would target just one-tenth of overall energy tech exports to Russia.

The reaction in Moscow’s stock markets was mixed Wednesday, as investors had sold off shares in Russian companies for the past two weeks, since the downing of Malaysia Airlines Flight 17 over eastern Ukraine. Reports last week that the new, tougher sanctions were due had also caused markets to tumble ahead of their formal announcement Tuesday.

On Wednesday, the MICEX benchmark index rose 0.9 percent, mainly thanks to a rise in the shares of companies that were spared sanctions. Shares in VTB Bank, Russia’s second-largest and one of the sanctions targets, were down 1.3 percent.

EU officials emphasized that while the latest measures last for one year, they can be annulled at any time — intended as an incentive for Russia to dial back its support for the Ukrainian rebels.

So far, the sanctions have had little effect on Russia’s actions in Ukraine. If anything, Russia appears to have stepped up its engagement in the conflict in recent weeks, with the U.S. and its allies saying Russia has built up troops along its border with Ukraine and sent heavy weapons to the separatists.

Russia, meanwhile, slapped a ban Wednesday on fruit and vegetable imports from Poland, a vocal supporter of tougher EU penalties. Moscow said the ban was for violations of health regulations and documentation procedures for some Polish produce; Poland accused Moscow of retaliation.

An Associated Press-GfK poll conducted just before the latest expansion of sanctions found 53 percent of Americans felt the U.S. had not gone far enough in sanctioning Russia, up from 41 percent who felt that way in March. A majority also supported expanding sanctions to target the Russian economy, including its energy sector, according to the survey of 1,044 Americans. The expanded sanctions drew rare cross-party support among the American public, with majorities of both Democrats and Republicans backing the move.

Indeed, President Barack Obama announced more sanctions Tuesday against three major Russian banks, and said he would block future technology sales to the oil industry.

Fewer of those polled felt the U.S. ought to provide military or financial support to countries if they are targeted by Russia.

Despite the sanctions, Obama said the West is not entering a Soviet-era standoff with Russia.

“It’s not a new Cold War,” he said.

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

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Baetz reported from Brussels. Julie Pace in Washington, Geir Moulson in Berlin, Danica Kirka in London and Vladimir Isachenkov in Moscow contributed to this report.