AIDS is alive and well in a new generation of teenagers and young adults, most of them young men, who are having risky sex, often fueled by drugs or alcohol, U.S. officials said Tuesday.

The Centers for Disease Control and Prevention issued a new report showing that more than a quarter of new U.S. infections are in youths aged 13 to 24, and 60 percent of them don’t even know it. That means they can spread the virus and, worse, aren’t getting treated for it.

The human immunodeficiency virus (HIV) that causes AIDS cannot be cured, and it will kill people who are not treated for it. But a cocktail of drugs can keep patients healthy and if they take their medication consistently, they are far less likely to infect someone else.

The CDC estimates that 12,200 young men and women aged 13 to 24 became infected with HIV in 2010. And by far most of them were boys and men. Nearly three-quarters were boys and men having sex with other men. And more than half of the newly infected youths were African American.

The report “really provides shocking data on the higher rate of risky behavior and the lower rate of condom use” among young men, CDC Director Dr. Thomas Frieden told reporters on a conference call.

The report finds that just 13 percent of high school students have been tested for the virus and just 35 percent of 18 to 24 year olds have been.

“Young gay and bisexual men report much higher levels of risky sexual behavior than their heterosexual peers,” Frieden said. They are more likely to have multiple sex partners, use drugs and alcohol before sex – which makes them in turn more likely to skip using condoms and tsake on other risks, too.

A separate CDC survey of high school kids and young adults found that young gay and bisexual men were more likely to report having had sex with four or more partners. They were also more likely to have injected drugs – another risk factor for AIDS, although most are infected sexually.

The answer, the CDC says, is a combination of testing, treatment and good sex education in schools.

“I don’t think there is a simple answer for this but we are not in support of mandatory testing,” Frieden said.

"The key here is to make it routine screening, just like we have cholesterol screening," Frieden added. "If someone refuses, that is their right, but we should say, ‘This is what we do’."

People who are tested can get treated. “If we double the number of people treated effectively, we we cut in half, roughly, the number of new infections that will occur,” Frieden added.

But kids are not getting this information now, said the CDC’s Dr. Kevin Fenton, who leads the AIDS branch. “I have to tell you, it is astonishing, the level of ignorance about basic physiology among middle school and high school students,” Fenton said.

“Kids who are gay or bisexual were less likely to say they had received sex education in schools,” Fenton added. It’s crucial they get medically accurate sex education, and multi-faceted programs that help young men and women learn about sex, sexually transmitted disease, and how to say no not only to sex but to drugs and alcohol, too.

“Youth who are sexually active can reduce their risk of HIV infection by choosing to stop having sex. They can also limit their number of sex partners, not have sex with an older partner who may be more likely to already have HIV, and use a condom every time,” CDC says.

The CDC estimates that 50,000 people are infected with HIV in the United States each year, and that about 1 million Americans are currently infected with the virus.

“Nearly 60 percent of new infections in youth occur in African Americans, about 20 percent in Hispanics/Latinos, and about 20 percent in whites," Tuesday’s report says.

“About 87 percent  of young males got HIV from male-to-male sex, 6 percent from heterosexual sex, 2 percent from injection drug use and about 5 percent from a combination of male-to-male sex and injection drug use," the report adds. 

Saturday is World AIDS Day and the HIV research and advocacy organization AVAC released its own report Tuesday questioning last week’s UNAIDS report that raised the hope that HIV might be eliminated.

“Recent scientific breakthroughs give us reason to be optimistic like never before, but our chances of success are already imperiled,” said AVAC executive director Mitchell Warren.  “Right now, the world isn’t moving as fast as it should be to begin ending the epidemic.”

 AVAC’s report notes that far too few people are getting HIV drugs.

“A range of studies is looking at ways to narrow this gap, but these efforts are uncoordinated and incomplete. In 2013, researchers and funders need to convene and establish a clear research and implementation agenda to close the gaps in the treatment cascade,” the group said.

There's no vaccine for HIV, although researcher feel they may be getting close. Researchers have also shown that circumcision can protect men from being infected by sex with women -- although it's not effective among gay or bisexual men. And work is also progressing on a microbicide -- a gel or cream that might protect people from sexual transmission of HIV and other diseases.

Related stories: 

• 75 percent of US AIDS patients lack effective care
• The female face of HIV: 'We don't have to care for ourselves'
• As HIV infections fall, U.N. says ending AIDS 'feasible'

LONDON -- An end to the worldwide AIDS epidemic is in sight, the United Nations says, mainly due to better access to drugs that can both treat and prevent the human immunodeficiency virus (HIV) that causes the disease.

Progress over the past decade has cut the death toll and helped stabilize the number of people infected with HIV, the U.N. AIDS program said in its annual report on Tuesday.

"The global community has embarked on an historic quest to lay the foundation for the eventual end of the AIDS epidemic. This effort is more than merely visionary. It is entirely feasible," UNAIDS said.

Some 34 million people were living with HIV at the end of 2011, the report said. Deaths from AIDS fell to 1.7 million in 2011, down from a peak of 2.3 million in 2005 and from 1.8 million in 2010.

Worldwide, the number of people newly infected with HIV, which can be transmitted via blood and by semen during sex, is also falling. At 2.5 million, the number of new infections in 2011 was 20 percent lower than in 2001.

"Although AIDS remains one of the world's most serious health challenges, global solidarity in the AIDS response during the past decade continues to generate extraordinary health gains," the report said.

It said this was due to "historic success" in bringing HIV programs to scale, combined with the emergence of new combination drugs to prevent people from becoming HIV infected and from dying from AIDS.

"The pace of progress is quickening - what used to take a decade is now being achieved in 24 months," said Michel Sidibé, executive director of UNAIDS. "We are scaling up faster and smarter than ever before. It is the proof that with political will and follow through we can reach our shared goals."

Since 1995, AIDS drug treatment - known as antiretroviral therapy - has saved 14 million life-years in poorer countries, including 9 million in sub-Saharan Africa, the report said. 

Sub-Saharan Africa is the most severely affected region with almost one in every 20 adults infected, nearly 25 times the rate in Asia, there are also almost 5 million people with HIV in south, southeast and east Asia combined.

Some 8 million people were being treated with AIDS drugs by the end of 2011, a 20-fold increase since 2003. The United Nations has set a target to raise that to 15 million people by 2015.

"Scaling up HIV treatment to 15 million people ... is feasible and has the crucial triple benefit of reducing illness, reducing death, and reducing the risk of transmission," said Manica Balasegaram of the charity Medecins Sans Frontieres.

But he said the pace must be stepped up "so that every month more people are started on life-saving HIV treatment than the month before." 

Scientific studies have shown that getting timely treatment to those with HIV can also cut the number of people who become newly infected with the virus.

UNAIDS said the sharpest declines in new HIV infections since 2001 were in the Caribbean and in sub-Saharan Africa - where new infections were down 25 percent in a decade.

Despite this, sub-Saharan Africa still accounted for 71 percent of people newly infected in 2011, underscoring the need to boost HIV prevention efforts in the region, UNAIDS said. Of the 1.7 million AIDS-related deaths in 2011, 1.2 million were in sub-Saharan Africa.

HIV trends are also a concern in other regions, it said.

Since 2001, the number of new HIV infections in the Middle East and North Africa was up more than 35 percent from 27,000 to 37,000, it said, and evidence suggests HIV infections in Eastern Europe and Central Asia began increasing in the late 2000s after being relatively stable for several years.

Related stories:

New push for most in U.S. to get at least one HIV test

Two more men with HIV now virus-free. Is this a cure? 

By Lauran Neergaard, The Associated Press

There's a new push to make testing for the AIDS virus as common as cholesterol checks.

Americans ages 15 to 64 should get an HIV test at least once — not just people considered at high risk for the virus, an independent panel that sets screening guidelines proposed Monday.

The draft guidelines from the U.S. Preventive Services Task Force are the latest recommendations that aim to make HIV screening simply a routine part of a check-up, something a doctor can order with as little fuss as a cholesterol test or a mammogram. Since 2006, the Centers for Disease Control and Prevention also has pushed for widespread, routine HIV screening.

Yet not nearly enough people have heeded that call: Of the more than 1.1 million Americans living with HIV, nearly 1 in 5 — almost 240,000 people — don't know it. Not only is their own health at risk without treatment, they could unwittingly be spreading the virus to others.

The updated guidelines will bring this long-simmering issue before doctors and their patients again — emphasizing that public health experts agree on how important it is to test even people who don't think they're at risk, because they could be.

"It allows you to say, 'This is a recommended test that we believe everybody should have. We're not singling you out in any way,'" said task force member Dr. Douglas Owens of Stanford University and the Veterans Affairs Palo Alto Health Care System.

And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV — which includes gay and bisexual men and injecting drug users — were eligible for that no-copay screening.

There are a number of ways to get tested. If you're having blood drawn for other exams, the doctor can merely add HIV to the list, no extra pokes or swabs needed. Today's rapid tests can cost less than $20 and require just rubbing a swab over the gums, with results ready in as little as 20 minutes. Last summer, the government approved a do-it-yourself at-home version that's selling for about $40.

Free testing is available through various community programs around the country, including a CDC pilot program in drugstores in 24 cities and rural sites.

Monday's proposal also recommends:

—Testing people older and younger than 15-64 if they are at increased risk of HIV infection,

—People at very high risk for HIV infection should be tested at least annually.

—It's not clear how often to retest people at somewhat increased risk, but perhaps every three to five years.

—Women should be tested during each pregnancy, something the task force has long recommended.

The draft guidelines are open for public comment through Dec. 17.

Most of the 50,000 new HIV infections in the U.S. every year are among gay and bisexual men, followed by heterosexual black women.

"We are not doing as well in America with HIV testing as we would like," Dr. Jonathan Mermin, CDC's HIV prevention chief, said Monday.

The CDC recommends at least one routine test for everyone ages 13 to 64, starting two years younger than the task force recommended. That small difference aside, CDC data suggests fewer than half of adults under 65 have been tested.

"It can sometimes be awkward to ask your doctor for an HIV test," Mermin said — the reason that making it routine during any health care encounter could help.

But even though nearly three-fourths of gay and bisexual men with undiagnosed HIV had visited some sort of health provider in the previous year, 48 percent weren't tested for HIV, a recent CDC survey found. Emergency rooms are considered a good spot to catch the undiagnosed, after their illnesses and injuries have been treated, but Mermin said only about 2 percent of ER patients known to be at increased risk were tested while there.

Mermin calls that "a tragedy. It's a missed opportunity."

By Rachael Rettner, MyHealthNewsDaily

A plastic ring containing a drug and inserted into the vagina could prevent HIV transmission during sex, a new study in animals suggests.

In the study, monkeys that received drug-releasing vaginal rings were less likely than other female monkeys to be infected when a version of the AIDS virus was injected by catheter into their vaginas.

The findings suggest that drug-containing vaginal rings have the potential to prevent HIV infection, as well as other sexually transmitted diseases, such as herpes and human papillomavirus (HPV) infections, the researchers said.

While oral anti-retroviral drugs andmicrobicide gels also have been shown to protect against HIV infection, oral drugs need to be used on a daily basis, and gels need to be applied every time a person has sex. The researchers would like to develop a ring that women could leave in place and "forget about" for at least three months, said study researcher Tom Zydowsky.

"The idea is to give people choices," said Zydowsky, senior scientist at the Population Council, a nonprofit organization in New York City that researches HIV/AIDS and reproductive health.

(Condoms are also very effective at preventing HIV transmission when used properly, but "getting a man to use a condom isn't always in a woman's control," Zydowsky added.)

The study is just a first step in the development of an anti-HIV vaginal ring, and because it was conducted with animals, it is not clear how well the findings will translate to people. The researchers plan to test alternative formulations of the vaginal ring that could protect against a strain of herpes virus as well as HIV, Zydowsky said.

The vaginal rings in the study contained an anti-HIV drug called MIV-150.

Rhesus macaques were given either a vaginal ring containing MIV-150 or a vaginal ring with a placebo. The rings were inserted either two weeks or 24 hours before the monkeys were exposed to a virus called SHIV, which contains genes from both HIV and SIV, the monkey form of HIV.

Among monkeys that received the MIV-150 vaginal ring, two out of 17 (11.7 percent) became infected with the virus, whereas 11 of the 16 monkeys (68.7 percent) became infected. Overall, the vaginal ring was 83 percent effective at preventing SHIV infection compared to the placebo, the researchers said.

The rings protected against HIV regardless of whether they were inserted two weeks or 24 hours before infection, the researchers said. But it was critical that the ring was in place when the monkey was exposed to the virus. Among monkeys that had the ring removed just before exposure, the infection rate was 57 percent (four out of seven monkeys).

The researchers plan to start a human trial with the ring within two years, Zydowsky said.

The study was published today (Sept. 5) in the journal Science Translational Medicine.

More from MyHealthNewsDaily:

• 7 Facts Women (And Men) Should Know About the Vagina
• 7 Surprising Reasons for Erectile Dysfunction
• STDs Blocked by Nano Gel, Study Suggests

A new report on teen sex contradicts a popular notion that teens are turning to oral sex as a way to delay “real” intercourse. The government study shows fewer teenage girls are having oral sex, compared to a few years ago.

The study, based on in-depth interviews with 6,300 young men and women aged 15 to 24, shows two-thirds in that age group have had oral sex, and just about the same proportion have had vaginal intercourse. But just about 42 percent of 15 to 19-year-old girls have given or received oral sex, down from 45 percent when the last survey was done in 2006-2008.

This is good news, the researchers say, because the earlier young people start any sexual activity at all, the more likely they are to get a sexually transmitted disease or to get pregnant.

The bad news is that teenagers and young adults are still highly likely to get sexually transmitted infections or STIs. “Despite the decline in the percentage of teenagers who ever had vaginal intercourse and increases in condom use, the rate of STIs has not decreased, particularly among teenagers 15–19 and young adults aged 20–24 years,” says the report, from the Centers for Disease Control and Prevention’s National Center for Health Statistics.

“In 2010, about one-half of all new STIs occurred among people aged 15–24.”

The report shows that only 7 percent of girls aged 15 to 19 had had oral sex without ever having had vaginal intercourse. By age 22 to 24, just 2.7 percent of young women said they had given or received oral sex but not had vaginal intercourse.

“This new CDC analysis debunks many myths about when young people are initiating oral sex, and underscores the need for the kind of sex education that Planned Parenthood provides, which emphasizes not only pregnancy prevention, but sexually transmitted disease prevention as well,” said Leslie Kantor, vice president for education for Planned Parenthood Federation of America.

“Although there has never been data to support it, there has been the perception that many teens engage in oral sex as a ‘risk-free’ alternative to intercourse. But the CDC analysis shows that sexually active young people are likely to engage in both activities.”

Planned Parenthood advocates for comprehensive sex education, and the Obama administration does too. The CDC researchers who did the study declined to comment on what it might mean, policy-wise, and said they were simply gathering statistics.

But the researchers also noted that teenagers often don’t understand the risks associated with sexual activity. “Research suggests that adolescents perceive fewer health-related risks for oral sex compared with vaginal intercourse. However, young people, particularly those who have oral sex before their first vaginal intercourse, may still be placing themselves at risk of STIs or HIV before they are ever at risk of pregnancy,” they wrote.

 “The risk of sexually transmitted infections (STIs), including human immunodeficiency virus or HIV, the virus that causes AIDS, is lower for oral sex than for vaginal intercourse or anal sex,” the report adds. “However, several studies have documented that oral sex can transmit certain STIs, including chlamydia, genital herpes, gonorrhea and syphilis. Teenagers and young adults engaging in sexual activity are at increased risk of STIs or HIV.”

Kantor said this calls for more sex education. “We need to make sure that young people have the skills to negotiate what they do and don’t want to do in sexual relationships, as well as education about and access to condoms and birth control so that they can protect themselves from STDs and pregnancy and remain healthy,” she said.

The study, based on hour-long, in-person interviews done from 2007 to 2010, also demonstrates racial disparities. Black girls and women aged 15 to 24 were far more likely than similar white girls to have had intercourse. The survey found that 74 percent of African-American females had vaginal intercourse at least once, compared to 68 percent of Hispanic females and 66 percent of whites.

And the study, meant to shed light on sexual practices, suggests that different types of sexual contact go together. “Among females aged 15–24 years, 26 percent had first oral sex before first vaginal intercourse; 27 percent had oral sex after first intercourse; 7.4 percent had oral sex on the same occasion as first intercourse; and 5.1 percent had oral sex, but no vaginal intercourse,” says the report.

But fewer girls were having oral sex than before. “About the same percentage of girls aged 15–19 years reported giving or receiving oral sex (41 percent and 43 percent, respectively),” the report says. This compares to 45 percent in 2006-2008.

“A higher percentage of  boys aged 15–19 years had oral sex (49 percent) than had vaginal intercourse (44 percent),” it adds. This was about the same as 2006-2008.

Related links:

Sex a taboo subject for Latinas

Giving credit to sex education

More teens are using condoms

Sweet. The Milton Hershey School, a world-renowned residential school for lower income and socially disadvantaged students, has finally cried "uncle" on its controversial rejection of an HIV-positive student.

The pre-K to 12th grade boarding school made a decision last fall that reached back to the fear-filled days of the mid-1980s: It would not take him for fear he might put the other kids at risk -- this, despite the fact that the boy is a strong student who could benefit from the opportunity that Hershey could provide to him. (The school was founded in 1909 and is owned by a trust that holds the controlling interest in the giant candy company that shares its name.)

A lawsuit was filed, as it should have been, for a violation of the Americans with Disabilities Act. Ever since the legal battle that exploded when Ryan White got expelled from his Indiana middle school in 1984 for being HIV-positive, it has been clear that excluding children from school, any school, due to their being HIV-positive is wrong. Careful study has shown that kids with HIV do not pose any serious risks to their fellow students or staff -- and that is why it is illegal to discriminate against kids or anyone else with HIV.

Now the head of Milton Hershey has announced they will admit the boy to school. They sent him an apology, too. The Department of Justice in Washington welcomed the school's decision, since the Hershey School was almost certainly breaking the law.

Still the school president, Anthony Colistra, is not going down without a fight. In reversing the decision, he issued a statement that defended the school's previous denial of admission to the HIV-positive teenager.

"Although we believed that our decisions regarding [his] application were appropriate, we acknowledge that the application of federal law to our unique residential setting was a novel and difficult issue. The U.S. Department of Justice recently advised us that it disagrees with how we evaluated the risks and applied the law. We have decided to accept this guidance."

Good call.

Had the lawsuit gone forward, the kid who could not get in might well have come away with enough money to keep a good portion of the student body amply supplied with Hershey’s kisses for a long time.

Still, the grudging tone of the decision to let the boy in reveals that there is still work to be done at the Hershey School.  A symposium to air out all the issues and points of view would be a great idea. And I can think of a pretty good person to serve as the keynote speaker: the boy who had to sue for the right to be there.

Related:

Bioethicist: Shame on school for rejecting boy with HIV

Only a quarter of Americans infected with the AIDS virus are getting effective treatment, according to a U.S. government report released Friday -- and the youngest patients are the worst off.  The numbers could worsen if states don’t broaden health care as called for under the 2010 health reform law, scientists worry.

It’s the first comprehensive look by the Centers for Disease Control and Prevention at who is getting effective care, and it doesn’t paint a promising picture. The findings raise even more alarm bells as study after study presented at the International AIDS Conference in Washington this week show that treatment can help stop the spread of HIV.

“The majority of people living with HIV in the United States are not on antiretroviral treatment, not in stable care,” Dr. Kenneth Mayer of The Fenway Institute and Harvard Medical School in Boston told a news conference. “They need to be in care first and then able to get treatment.”

The study finds that just over a third of  HIV patients have steady care -- 34 percent  of African-Americans, 37 percent of Latinos and 38 percent of whites.

Younger patients are the least likely to be getting the cocktails of drugs that can keep them healthy and help keep them from infecting others. Just 15 percent of those aged 25-34 had the virus suppressed to desired levels, compared to 36 percent of those aged 55-64. Only 22 percent of young adults were even getting HIV drugs to treat their infection, the CDC found.

There’s no cure for the human immunodeficiency virus that causes AIDS and no vaccine. HIV has killed 25 million since it first started spreading globally in the early 1980s, and more than 33 million people are infected worldwide. About 1.1 million people in the United States have HIV, and the CDC estimates that 20 percent of them don’t even know it.

“We have to continue to raise the alarm,” CDC’s top AIDS official, Dr. Kevin Fenton, said in an interview. “We have to find that sense of outrage.”

The same factors are driving high transmission and poor treatment rates among some U.S. groups: poverty, a lack of access to medical care, and a lack of education about what causes HIV and what people can do about it. Policymakers need to understand that treating people with HIV saves money, Fenton said. 

“What we now know is that treating HIV is cost-effective. For every dollar spent, you save $2,” Fenton said.

Fenton said the U.S. should pull out the stops on providing condoms, counseling, testing and treatment.

“We need to ensure that states have policies that support routine HIV testing,” Fenton said. “Clearly, this is going to be more challenging in some states than in others.”

Top AIDS experts in the U.S. say no matter what people may think about the moral implications of some of the behavior that leads to HIV infection, it will benefit everyone to get people tested, treated and counseled about controlling their infection.

“Every state really must enact the Affordable Care Act,” said Dr. Judith Aberg, president of the HIV Medicine Association and an AIDS expert at New York University. “States need to fund HIV treatment and prevention. We need to continue this fight.”

Governors of several states have said they will not expand Medicaid, required by the health care law, because they cannot afford it. The U.S. Supreme Court ruled last month that states can decide whether to abide by that provision. States refusing expansion now include Texas, Florida, South Carolina and Louisiana. Medicaid, the state-federal health insurance plan for the poor, currently does not cover most low-income adults with HIV. AIDS activists say it’s essential to controlling the epidemic to get coverage for young adults with HIV, and at risk for HIV.

Related stories:

• Circumcision advocate tackles the cringe factor
• Two patients with HIV now virus-free. Is this a cure?
• The female face of AIDS -- not who might think

Pate Marovich for NBC News

Sthokozo Mabaso (maroon top) and Mandisa Madikane (blue top), with GlobalGirl Media at the 2012 International AIDS Conference in Washington, D.C. on Wednesday.

Mandisa Madikane was just six years old when her neighbor grabbed her outside her mother’s home.

“All I saw was black coming out of my legs, his big body on top of my small body,” says Madikane, now 21. “I had no power to fight back. I kicked, screamed, cried but nobody heard. He had all the power to do what he wanted to do.”

That assault in Soweto, South Africa, the sprawling, crowded township where much of Johannesburg’s blacks live, left her more than traumatized. Her attacker gave her HIV.

Now 21, Madikane sees the chance for some power for herself.  As she covers AIDS2012 in Washington, D.C, the giant international AIDS conference that brings together policymakers, advocates, protesters and scientists, Madikane is throwing questions at leaders. 

“I want answers from people in government,” Madikane told NBC News in an interview. “I had a chance to ask the minister of health for South Africa about discrimination.”

The answer she got from Health Minister Dr. Aaron Motsoaledi might have come across as a bit patronizing to some, but not to Madikane.

“He said if I got discriminated against, to put it on Facebook and people would let me know,” she said. “It was the most beautiful experience,” she said. “I love the feeling of being a journalist.”

Madikane was chosen to work with a non-profit called GlobalGirl Media, which trains high school girls from underprivileged backgrounds in digital media. Madikane and Sthokozo Mabaso, a 22-year-old  who is also from Soweto and who is also HIV-positive, take turns interviewing conference delegates, operating their small digital camera and doing stand-ups. (Pronounced sto-KO-zo)

Pate Marovich for NBC News

Sthokozo Mabaso (maroon top) and Mandisa Madikane (blue top), with GlobalGirl Media at the 2012 International AIDS Conference in Washington, D.C. on Wednesday.

They both looked a little dazed as they negotiated the hordes of conference attendees at the Washington Convention Center, some in outrageous costumes. Madikane’s head turned as she heard some African rhythms in the Global Village, part of the conference open to the public that features noisy demonstrations, plays about HIV, violence and discrimination and booths offering everything from free condoms to crafts made by sex workers. Soon she was dancing to pop music while Mabaso interviewed passers-by.

Mabaso was attending the University of Johannesburg on a scholarship, studying management, when she applied to join GlobalGirl Media a year ago. Her reports about domestic abuse caught some eyes and she is not only covering the conference, but presenting at it.

“Everyone likes to be in front of a camera,” she said. “Without this, I wouldn’t have the opportunity to be on a panel talking about abused women.”

Tumi Mosadi, a filmmaker who works with Global Girl Media in Johannesburg, said the girls and young women get opportunities and training that can change their lives -- and perhaps change the lives of the people they report about.

“We give them a platform to talk about what is happening in their community,” Mosadi said as she watched Mabaso and Madikane interview AIDS workers. “It’s stuff that affects them.”

Neither young woman had been out of South Africa before. “It was wonderful, watching them get on a flight for the first time, watching them step off in the United States,” Mosadi said.

After the conference ends Friday, they head to New York for some intensive training in digital editing. Then it’s back home to Johannesburg.

Mabaso is not entirely happy with the conference coverage.

“I wanted to hear scientists say they actually have a cure for AIDS,” she said.

Scientists told those attending the conference this week that they have some tantalizing clues, but predicted a cure would be at least a decade away, if not more.

Madikane hopes to get in some shopping on her first trip abroad. She isn’t sure what career opportunities might come from her year with Global Girl Media. She’s a high school graduate but her family doesn’t have money for college.

“I don’t know if my life will change,” she said softly. “What I know is my voice is out there.”

 More AIDS conference coverage: 

• Two patients now virus-free. Is this a cure?
• Circumcision advocate tackles the cringe factor
• New focus on AIDS treatment saves lives, global report finds
• AIDS research turns scientists into advocates
• AIDS conference opens with eye to a cure

“Treatment is Prevention.” It is a simple slogan that has dominated this year’s International AIDS Conference, springing from a 2011 study that showed when HIV patients receive proper drug treatment, they not only remain healthy, but are also virtually incapable of infecting others. 

The solution to AIDS -- the terrible plague that has killed 64,000 Americans and 35 million people worldwide over the past 31 years -- does not require waiting for a vaccine, which remains at least a decade away, or exploring research avenues towards a “cure,” something achieved in one man with a dangerous, terribly expensive and complex bone marrow transplant. All that needs to be done is to find all who are infected, get them treatment and the virus will die out. That would lead us to a future “generation without AIDS,” another refrain heard often at the conference.

Slideshow: International AIDS Conference in Washington DC

Jacquelyn Martin / AP

The world's largest AIDS conference returns to the United States for the first time since 1990.

Launch slideshow

As America’s leading AIDS physician, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases puts it: “Now we have the tools that we know work and that if we implement them, we know they will ultimately be effective."

But Fauci and most other experts are well aware that it is not so simple.

In the United States there are 1.2 million people living with HIV infection, the virus that causes AIDS. About 20 percent of them don't know they are infected.

“Between 60-70 percent of all new infections come from an individual who's infected, does not know that he or she is infected and infects someone else,” Fauci says. “So if you just imagine if you can get into the community, penetrate the community to the higher risk people, get them voluntarily tested and linked to this continuum of care, you would have a major impact that would be almost immediate.”

But there are massive problems facing this strategy, according to numerous sessions at the AIDS conferences. There are reports of people losing their homes, their friends, their jobs and their family connections when others learn they are HIV positive. The stigma of AIDS may be less than it once was, but it is far from gone. 

No wonder many people do not volunteer for the test, even though screening now only involves a cheek swab and a wait of 20 minutes. All too often men have sex with men and yet do not want to admit it to themselves it has happened, let alone to the community in which they live.

And just testing is hardly enough. People have to get medical treatment and then stick with it. For example, physicians have long known that many well-off heart patients with access to good health care fail to properly take their medicines after they have had a heart attack, putting themselves at greater risk for another. Take that general problem and put it into heavily AIDS-infected populations that have long lacked access to adequate medical care, such as African-Americans and Hispanic men and women, and one can see that “a continuum of care” is often difficult to achieve. Efforts to cut expenditures on medical care for poor people will make the challenges even greater.

But success stories can also be heard at the conference sessions. Washington, D.C. has brought down its huge HIV rate by offering testing in many places, including the Department of Motor Vehicles, drug stores and mobile vans. The nation’s capital has also made great efforts to reduce the stigma and get people into proper treatment. Rwanda, the east African country that was the scene of one of the most brutal massacres of modern times, has managed to bring down its huge infection rate through testing and treatment. 

However, those positive stories do remain rare, existing only when there is a huge commitment from the top levels of society, a source of funds and a political will to support the programs. Sadly, in many parts of the United States and much of the world, both are still lacking.

Follow Robert Bazell on Facebook and Twitter

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The female face of AIDS: Not who you'd expect

Most teens use condoms but sex ed cuts raise HIV worries

Chris Vanek paid attention in middle school sex education classes. When he first had sex at the age of 16, both he and his partner used condoms, even though both were virgins. Vanek, now 26, credits an open attitude about sex and frank talk about protection.

Vanek is a living example of one success story being reported at the 19^th International AIDS Conference in Washington -- an improvement in the number of U.S. high school students who are having risky sex.

CDC data presented on Tuesday show just 47 percent of high school students have ever had sex, down from 54 percent in 1991 and holding steady since about 2001. Much progress has been seen among black students: in 1991, 82 percent of black high school students had started having sex but this plummeted to 60 percent by 2011. Just 15 percent of all students have had more four or more sex partners, down from 19 percent in 1991.

And 60 percent of those who are sexually active used a condom, which can protect against pregnancy and sexually transmitted diseases including the human immunodeficiency virus that causes AIDS.

“I knew from a very young age that I was gay. I knew gay men were more at risk from HIV and AIDS than maybe the heterosexual population,” Vanek told NBC News in a telephone interview. “I guess I always just knew that I had to protect myself and the risks of being sexually active.”

Those risks later caught up with Vanek, a road manager and make-up artist for the singer Macy Gray. He learned he was infected with the AIDS virus in 2011 and is now a spokesman for a new Centers for Disease Control and Prevention campaign against HIV stigma. 

“I think I took sex education two or three times,” says Vanek, who grew up in Los Angeles. “It was definitely a topic in school. I even went to a Catholic high school. We would talk about it in religion class. We would talk about it in PE and health. While the schools in California are not the best schools, I definitely think they did a good job of educating me about sex and sexual health and puberty.”

Even Vanek’s conservative blue-collar parents took on the uncomfortable subject, he said. He remembers when he was 13 and learned an older teenaged cousin was pregnant. “They said, ‘Obviously, we would rather you not have sex but we know you are at an age where you are curious. We want you to protect yourself’. And they gave me a package of condoms. It was a really awkward conversation with them.”

The CDC’s Dr. Kevin Fenton says it’s the frank talk about sex that works. “The more comprehensive an education you provide, the better,” Fenton said in an interview. But he noted there is variation across the country, with some school districts choosing abstinence-only education while others offer a full curriculum that includes discussion of lesbian gay and transgender themes as well as how to respect one another in a relationship.

Budget cuts aren’t helping. “Data show that fewer schools provide the comprehensive HIV education needed to ensure that this trajectory continues,” Fenton said. Another barrier: socially conservative movements that reject sex education. Fenton is diplomatic when he is asked about school districts and parents who fear that sex education teaches poor morals.

“Part of what we are committed to doing is to provide evidence,” he said. “We try to make our recommendations on the best available evidence.” Studies show that a comprehensive sex education program can influence sexual behavior more than a limited approach.

It worries Fenton that the numbers of high school students having sex, having unprotected sex, and having multiple partners have leveled off. “The challenge that these data highlight is the need for us to sustain our efforts,” he said.

And CDC and other public health agencies are now looking for better ways to reach young adults after they leave high school. Young, gay men like Vanek are a particular target. Men in his demographic are by far the most likely Americans to become infected with HIV and CDC is acutely aware of the need to keep the momentum going after they leave those middle school sex education classes.

Vanek says he made just one mistake. “I met a guy and we hit it off and we did have sex without a condom,” he said. “We had talked about it. He said he had just been tested, and I had just been tested and we thought we were safe.”

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Shawn Thew / EPA

US Secretary of State Hillary Clinton appeared on a large video screen at the 19th International AIDS Conference this week. Many presentations target women, who make up more than a quarter of new HIV infections in the U.S.

Del’Rosa Winston thought she’d done everything right. She kept herself in steady employment, and waited until she was married to start having children. When her marriage ended, she started having regular HIV tests, just in case. So when she settled into a new, steady relationship, she never dreamed she’d end up infected with the AIDS virus.

“I had a job. I had been in the military. I was educated,"  said Winston, a soft-spoken, well-groomed woman with fashionably cropped red hair. "I just got it from a straight man in a monogamous relationship."

More than a quarter of new infections in the United States every year are in women, and of the 1.1 million Americans with the AIDS virus, 280,000 are women, according to the Centers for Disease Control and Prevention. Black women are especially vulnerable – their infection rate is 15 times the infection rate for white American women.

Winston’s smooth skin and easy smile represent the hidden face of the AIDS epidemic in the United States – the people who don’t look like “typical” HIV patients. The 50-year-old mother of three hopes that speaking out at the 19^th International AIDS Conference, being held in Washington, D.C., will help reduce the stigma and ignorance that fuel the spread of the virus.

 “There are so many people who are getting it because they loved someone,” Winton told NBC News in an interview. Winston couldn’t wait to be in a steady, safe relationship so she could stop using condoms, which she found uncomfortable to use. Her boyfriend, who has since died, told her he had no idea he was infected. But he was, and so was Winston. “We didn’t fit the parameters of what an HIV-positive person looked like,” she said.

She can remember the moment in 1990 when she was told her test came back positive. “The room was gray,” she said. “Like stainless steel. I know there were objects in it but I couldn’t see them. I just flowed like water to the floor.”

Health experts at the conference say they are trying to find new and better ways to reach not only the people at the highest risk – young gay and bisexual men – but others, like Winston, who may not intuitively know how easily and insidiously the virus can move during a moment of passion.  “Everyone’s at risk, whether you have the greatest trust relationship or not,” Winston, who now works as an HIV counselor in Atlanta, said.

Health experts are also trying to figure out some of the factors that make women vulnerable and keep them from protecting themselves even if they do understand the risks. Winston has some ideas – women are often too busy looking after others. “We put everyone else first – kids, school, even the PTA. We get into the mind frame that we don’t have to care for ourselves,” she said.

Another factor may be domestic abuse. A team at the University of California San Francisco published a study on Monday showing that physical and sexual abuse and trauma are major factors affecting which women become infected.

“For a long time we have been looking for clues as to why so many women are becoming infected with HIV and why so many are doing poorly despite the availability of effective treatment,” said Dr. Edward Machtinger, who led the study. “Women who report experiencing trauma often do not have the power or self-confidence to protect themselves from acquiring HIV.”

Their team did a study called a meta-analysis, looking at data from other studies involving 5,900 women. They found 30 percent of women infected with HIV had post-traumatic stress disorder, or PTSD, compared to 5 percent of the general population.  Twice as many women with HIV reported they had been victims of partner violence as women without the virus, they found.

Kat Griffith thinks she knows why. The slender redhead from Peoria, Illinois has been HIV positive for 21 years and she blames a violent boyfriend from high school. “I had a jealous and controlling partner who called me names, demeaned me,” she said. “I had no self-esteem.”

But Griffith went away to college and, she thought, started a fresh new life. “I knew that HIV could affect me and I thought I asked all the right questions,” she said. “But my abuse made me feel I was not worthy of protection." Her college boyfriend infected her.

Women may often put others first but they also lack a good way to protect themselves, Griffith noted.

For years, researchers have been looking for ways to protect women against the virus. There’s been hit-and-miss progress with microbicides – gels or creams that women can use quietly to reduce the chance they’ll become infected during sex. On Tuesday, researchers will announce the start of an advanced, Phase 3 trial of a device called a vaginal ring impregnated with dapivirine, a drug used to treat people with HIV. Researchers will enroll 3,500 women in the two-year study to be conducted in Africa, where half of all HIV patients are women.

Studies have shown that microbicide gels or creams can work - at the last AIDS conference in Vienna in 2010, researchers reported on one that reduced a woman’s risk of infection by 39 percent. But other studies haven’t done so well and experts fear inconsistent use may be one problem.

A flexible, silicone ring may be easier to use and less intrusive than a gel that must be applied before and after sex, the researchers hope. So does Griffith. “After 30 years, we still do not have a completely female controlled prevention technique,” she said.