New optimism about stemming AIDS virus

People visit the AIDS Memorial Quilt on display Thursday as part of the Smithsonian Folklife Festival on the National Mall in Washington. More than 20,000 international HIV researchers and activists will gather in the nation's capital this month.

WASHINGTON — 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 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 AP. But, he said, “I think we are at a turning point.”

Earlier treatment 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 last 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.

“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.

Mobile testing 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, was tested earlier this year and said 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: 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 said 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.”

Not knowing About 34 million people worldwide have HIV, including almost 1.2 million Americans. 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, blacks account for about 14 percent of the population but 44 percent of new HIV infections.

Your ZIP code plays a role in your risk. Twelve cities account for more than 40 percent of U.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.

Giving back 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, 53, 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.”