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: Economy, other issues overshadow abortion

DENVER (AP) — As a season of campaigning enters its final, intense weekend, a new Associated Press-GfK poll illustrates the challenge ahead for candidates and their allies trying to rally voters around traditional wedge issues such as abortion and gay marriage. This fall, voters just have other matters on their minds.

Social issues are eclipsed by concerns about the economy, health care, the Islamic State group and Ebola, the poll finds. And hovering over each of these individual issues is a broad dissatisfaction with President Barack Obama and Republican leaders in Congress.

Only 32 percent of likely voters called gay marriage an important issue, compared with 91 percent ranking the economy important, 78 percent with similar concerns about health care and 74 percent naming Ebola important. The issue that some Democrats have emphasized most of all — abortion rights — also has been a relatively low priority, with only 43 percent of likely voters in a September poll ranking it important.

Yet women’s health and reproductive rights have been at the center of campaigns for U.S. Senate in Alaska, Iowa, North Carolina and especially Colorado. There, half of the ads aired by Democratic Sen. Mark Udall and those backing his re-election have criticized his GOP opponent, Rep. Cory Gardner, on women’s health issues. They include a contention the 40-year-old congressman from eastern Colorado wants to ban some forms of birth control.

“Democrats this year clearly think that all that you need is that silver bullet of social issues,” said Katy Atkinson, a GOP political official in Denver. “It’s not. You need more.”

Gardner may have been able to parry the offensive by proposing that birth control pills be sold over-the-counter, without a prescription. After he began airing an ad on his proposal last month — as security concerns rose amid U.S. military action against the Islamic State group in the Middle East and the West Africa outbreak of the Ebola virus — Gardner moved ahead in public polls.

Gardner isn’t the only Republican to propose the sale of birth control over-the-counter. So, too, have Republicans running for Senate in North Carolina, Virginia and Minnesota.

The issue of access to birth control has also found its way into the Senate race in Iowa, where Democratic Rep. Bruce Braley has hammered his Republican opponent, state Sen. Joni Ernst, for her support of bestowing personhood status on a fetus. He says that would outlaw abortion, in-vitro fertilization and most kinds of contraception; she says she supports access to birth control and abortion in some circumstances.

Some voters have scoffed at the emphasis.

“They do a lot of yapping about how contraceptives have to do a lot with women’s health, which is a load of crap,” said Donald Johnson, 82, a staunch Republican in Clinton, Iowa. “If they want contraception, they can go and get it. It doesn’t cost that much. There’s no reason the government should be paying for it.”

On both abortion and same-sex marriage, recent AP-GfK polling has found likely voters more apt to trust Democrats than Republicans. But on issues that have captured more of voters’ attention this midterm season, such as the economy and protecting the country, Republicans have the advantage.

Republicans have emphasized terrorism and Ebola threats in the campaign’s closing days, though the poll suggests Ebola inspires less of a partisan preference than other issues.

Cindy Nath, a 59-year-old high school teacher in Colorado Springs, is most worried about economic inequality but also has concerns about reproductive freedom. A Democrat, she’s already cast an early ballot for Udall. But the issues her students discuss are very different — the Islamic State group and Ebola. “That’s what they’re talking about,” she said. “ISIS comes up every day.”

Women’s votes have shifted sharply between presidential years and midterm elections in recent contests, according to exit polling conducted for the AP and ABC, CBS, CNN, Fox and NBC. In 2012, women broke for Obama by an 11-point margin, while in 2010, when few candidates raised social issues as a major campaign theme, they split evenly between Democratic and Republican House candidates.

Atkinson noted that social issues usually poll low in priority but can be effective in defining candidates as too extreme. That’s how Democrats have won recently in Colorado. Although polling shows Udall slightly behind, his campaign believes he can win with a superior get-out-the-vote operation and by continuing to use women’s health issues to motivate key voting groups. Democrats are particularly targeting single women, whose participation dips in midterm elections.

The model is Sen. Michael Bennet’s 2010 come-from-behind win, where he similarly focused on women’s health. Still, a gender gap cuts both ways. Several recent polls in Colorado have shown Gardner’s advantage among men outpaces Udall’s among women.

But Jill Hanauer, a Denver-based Democratic strategist, said people should not mistake a temporary issue advantage for something permanent.

“Republicans have immediate issues to run on and Democrats have much broader, long-term ones like climate change and reproductive rights,” Hanauer said. “This election is one point in time, not a long-term trend.”

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.

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Agiesta, AP’s director of polling, reported from Washington. Associated Press writers Stacy A. Anderson and Emily Swanson contributed to this report.

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Online:

AP-GfK Poll: 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.

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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.

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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.”

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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.