By Jason Straziuso
Associated Press

NYUMBANI, Kenya--  There are no middle-aged people in Nyumbani. They all died years ago, before this village of hope in Kenya began. Only the young and old live here.

Nyumbani was born of the AIDS crisis. The 938 children here all saw their parents die. The 97 grandparents — eight grandfathers among them — saw their middle-aged children die. But put together, the bookend generations take care of one another.

Saturday is World AIDS Day, but the executive director of the aid group Nyumbani, which oversees the village of the same name, hates the name which is given to the day because for her the word AIDS is so freighted with doom and death. These days, it doesn't necessarily mean a death sentence. Millions live with the virus with the help of anti-retroviral drugs, or ARVs. And the village she runs is an example of that.

"AIDS is not a word that we should be using. At the beginning when we came up against HIV, it was a terminal disease and people were presenting at the last phase, which we call AIDS," said Sister Mary Owens. "There is no known limit to the lifespan now so that word AIDS should not be used. So I hate World AIDS Day, follow? Because we have moved beyond talking about AIDS, the terminal stage. None of our children are in the terminal stage."

In the village, each grandparent is charged with caring for about a dozen "grandchildren," one or two of whom will be biological family. That responsibility has been a life-changer for Janet Kitheka, who lost one daughter to AIDS in 2003. Another daughter died from cancer in 2004. A son died in a tree-cutting accident in 2006 and the 63-year-old lost two grandchildren in 2007, including one from AIDS.

"When I came here I was released from the grief because I am always busy instead of thinking about the dead," said Kitheka. "Now I am thinking about building a new house with 12 children. They are orphans. I said to myself, 'Think about the living ones now.' I'm very happy because of the children."

As she walks around Nyumbani, which is three hours' drive east of Nairobi, 73-year-old Sister Mary is greeted like a rock star by little girls in matching colorful school uniforms. Children run and play, and sleep in bunk beds inside mud-brick homes. High schoolers study carpentry or tailoring. But before 2006, this village did not exist, not until a Catholic charity petitioned the Kenyan government for land on which to house orphans.

Everyone here has been touched by HIV or AIDS. But only 80 children have HIV and thanks to anti-retroviral drugs, none of them has AIDS.

"They can dream their dreams and live a long life," Owens said.

Nyumbani relies heavily on U.S. funds but it is aiming to be self-sustaining.

The kids' bunk beds are made in the technical school's shop. A small aquaponics project is trying to grow edible fish. The mud bricks are made on site. Each grandparent has a plot of land for farming.

The biggest chunk of aid comes from the United States President's Emergency Plan for AIDS Relief (PEPFAR), which has given the village $2.5 million since 2006. A British couple gives $50,000 a year. A tree-growing project in the village begun by an American, John Noel, now stands six years from its first harvest. Some 120,000 trees have already been planted and thousands more were being planted last week.

"My wife and I got married as teenagers and started out being very poor. Lived in a trailer. And we found out what it was like to be in a situation where you can't support yourself," he said. "As an entrepreneur I looked to my enterprise skills to see what we could do to sustain the village forever, because we are in our 60s and we wanted to make sure that the thousand babies and children, all the little ones, were taken care of."

He hopes that after a decade the timber profits from the trees will make the village totally self-sustaining.

But while the future is looking brighter, the losses the orphans' suffered can resurface, particularly when class lessons are about family or medicine, said Winnie Joseph, the deputy headmaster at the village's elementary school. Kitheka says she tries to teach the kids how to love one another and how to cook and clean. But older kids sometimes will threaten to hit her after accusing her of favoring her biological grandchildren, she said.

For the most part, though, the children in Nyumbani appear to know how lucky they are, having landed in a village where they are cared for. An estimated 23.5 million people in sub-Saharan Africa have HIV as of 2011, representing 69 percent of the global HIV population, according to UNAIDS. Eastern and southern Africa are the hardest-hit regions. Millions of people — many of them parents — have died.

Kitheka noted that children just outside the village frequently go to bed hungry. And ARVs are harder to come by outside the village. The World Health Organization says about 61 percent of Kenyans with HIV are covered by ARVs across the country.

Paul Lgina, 14, contrasted the difference between life in Nyumbani, which in Swahili means simply "home," and his earlier life.

"In the village I get support. At my mother's home I did not have enough food, and I had to go to the river to fetch water," said Lina, who, like all the children in the village, has neither a mother or a father.

When Sister Mary first began caring for AIDS orphans in the early 1990s, she said her group was often told not to bother.

"At the beginning nobody knew what to do with them. In 1992 we were told these children are going to die anyway," she said. "But that wasn't our spirit. Today, kids we were told would die have graduated from high school."

Jim Watson / AFP - Getty Images

Secretary of State Hillary Clinton, left, is hugged by United Nations AIDS Executive Director Michel Sidibe during an event in recognition of World AIDS Day at the State Department in Washington, D.C., on Nov. 29.

The United States announced an ambitious new push to fight the AIDS virus by providing treatment to more people, especially vulnerable women and children.

The new U.S. plan – immediately welcomed by AIDS researchers and advocates --  also promises to target drug addicts, gay men, prostitutes and other sex workers who are at especially high risk, despite reluctance and stigma.

“We are committing to rapidly scaling up the most effective interventions and treatment,” Secretary of State Hillary Clinton told a news conference.

She released new numbers showing that PEPFAR, the U.S. plan for AIDS relief, had provided AIDS drugs to more than 5 million people.

The goal is to treat as many people as possible, both to keep them well and to help keep them from infecting others. Several studies have demonstrated that people who take AIDS drugs are far less likely to pass along the virus.

“Eventually we will be able to treat more people than become infected every year,” Clinton said. “That will be the tipping point. We then will get ahead of the pandemic and an AIDS-free generation will be in sight.”

The announcement sets the U.S. firmly on the path of providing drugs overseas -- an approach that was controversial only a few years ago, when many politicians wanted to focus on promoting prevention, often through restraining sexual practices but also by distributing condoms.

“For us working in the field, this is great news,” said AIDS expert Dr. Michael Saag of the HIV Medicine Association (HIVMA) and the University of Alabama at Birmingham.

“With all the discussion about the fiscal cliff, it always becomes a concern that they are going to start cutting programs like this that are lifesaving.” Congress has until the end of December to stop an automatic budget-cutting process that will force severe budget cuts that most experts fear would push the United States back into recession.

“As HIV clinicians and researchers, the HIV Medicine Association (HIVMA) and the Infectious Diseases Society of America (IDSA) Center for Global Health Policy believe the result of that commitment can be a lasting triumph over the longest and most costly epidemic in human history,” Saag’s group said in a separate statement.

“We are especially encouraged that the blueprint provides concrete numbers in affected countries to illustrate the work that must be done to reach a tipping point, when the numbers of people becoming infected with HIV are surpassed by the numbers receiving life-saving medicine,” said Dr. Kenneth Mayer, co-chair of the Center for Global Health Policies Scientific Advisory Committee.

Other AIDS researchers gushed over the plan, even though it did not dedicate any money to achieving its goals. “In a sense, it is quite inspiring,” said Dr. Myron Cohen, a longtime AIDS researcher at the University of North Carolina, Chapel Hill, and an IDSA spokesman.

He said while former president George W. Bush’s launching of PEPFAR in 2003 was a big move, the Obama administration’s new approach broadens the goals. “Hillary Clinton herself has undertaken this,” Cohen told NBC News. “That lends a gravitas.”

The new PEPFAR plan has five goals:

• Make strategic, scientifically sound investments to rapidly scale up core HIV prevention, treatment and care interventions and maximize impact.
• Work with partner countries, donor nations, civil society, people living with HIV, faith-based organizations, the private sector, foundations and multilateral institutions to effectively mobilize, coordinate and efficiently utilize resources to expand high-impact strategies, saving more lives sooner. 
• Focus on women and girls to increase gender equality in HIV services.
• End stigma and discrimination against people living with HIV and key populations, improving their access to, and uptake of, comprehensive HIV services.
• Set benchmarks for outcomes and programmatic efficiencies through regularly assessed planning and reporting processes to ensure goals are being met. 

In addition, Clinton said, the U.S. will pressure countries getting aid to do more. “Partner countries must step up,” she said. They’ll be asked to define what sevrices they need the most, and reach out to get more funding on their own.

Cohen said he was impressed the the administration has made a point of relying on science. AIDS research has been stymied in the past by politics, including squabbles about whether AIDS is really caused by the human immunodeficiency virus – South Africa resisted treating HIV patients for years because of that quarrel.

Bush administration policy limited funding for clinics that even addressed the possibility of abortion, but Clinton said the new PEPFAR policy would push countries to integrate HIV treatment into women’s health clinics, reproductive health services and programs to fight violence against women.

“It is science that has brought us to this point. It is science that will allow us to finish this job,” Clinton said.

The AIDS virus has killed 25 million people and newly infects a million people every year. There is no cure or vaccine, but a cocktail of drugs can keep patients healthy.  

The United States spends more on AIDS than any other country, having spent $37 billion in direct international funding and $7 billion in the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Related stories:

• CDC says AIDS epidemic fresh in risk-taking youth
• UN says an end to AIDS is feasible
• AIDS conference opens with an eye to a cure

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.

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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
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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.

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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.”

Related links:

The female face of HIV: 'Everyone's at risk'

HIV rates soar in black, gay men

AIDS turns researchers into activists

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.

Outside, protesters were marching through the streets, demanding that everyone who needs them get drugs to treat and prevent infection with the AIDS virus and declaring, “Yes, we can control AIDS.”

Mandel Ngan / AFP - Getty Images

Activists take part in the Keep the Promise Alive 2012 AIDS march and rally on the streets of Washington on July 22,2012.

Inside, scientists were doing the same thing.

The 19^th International AIDS Conference, which opened in Washington on Sunday, is demonstrating like no other forum that, when it comes to AIDS, science and advocacy have the same goals. In the 1980s, it was flamboyant but articulate demonstrators, mostly gay men, who persuaded policymakers to fund research into AIDS. Now, that very research has turned the scientists into advocates.

The thousand or so demonstrators who took to the streets of Washington D.C. on Sunday were a little louder and a little more colorful than the scientists, physicians and policymakers inside the convention center. But their messages were virtually identical inside and outside: People must stop judging patients infected with HIV, governments need to make drugs and testing more widely available, and people who might be infected need help and encouragement to get tested and treated.

In one of the first presentations made on Sunday, even before the conference officially opened, Dr. Melanie Thompson of the International Antiviral Society-USA presented recommendations that everyone get treated for the human immunodeficiency virus that causes AIDS as soon as they know they are infected.

It’s a controversial recommendation. Many doctors fear that people won’t take the drugs properly and their bodies will breed drug-resistant HIV mutants. They also worry about the toxic side-effects of the powerful drugs. But Thompson said the 15 panel members from six countries looked at the evidence and found it showed treating is better.

Then she went a step further. “We need activism, activism on the part of individuals and organizations,” said Thompson, a physician who treats AIDS patients in Atlanta.

Part of the goal of activism is to remove the embarrassment of  being diagnosed with HIV,  she said.

“Stigma keeps people from being diagnosed. It keeps them from being in care,” Thompson said.

Stop judgments about gay men, sex workers, drug users
In the United States and elsewhere, this means stopping judgments about gay and bisexual men, sex workers and drug users, experts stress.

“Men who have sex with men deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information,” Dr. Ken Mayer of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston and colleagues write in a special issue of the Lancet medical journal released to coincide with the conference.

Treating HIV is expensive. The cocktails of drugs that keep HIV patients healthy can cost $12,000 and more a year in the United States. But Thompson points out that some private insurance companies -- which should avoid spending money on unnecessary treatments -- have opted to pay for immediate treatment for anyone diagnosed with HIV.

Government-sponsored insurance plans should do the same, she suggested.

“It is important for us to realize that the idea of not having enough money may be that we don’t prioritize the money that we do have,” she said. “I reject the idea that we don’t have enough money. I think it is a matter of political will.”

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has made scientific activism work. He’s been leading AIDS research since the epidemic was identified in the 1980s, working with both Republican and Democratic administrations and convincing even the toughest budget bears in Congress to pay for AIDS research and treatment. He thinks the activist approach works when there’s hard evidence to back it up.

One good example, he said, is PEPFAR, the President’s Emergency Plan for AIDS Relief, which provides treatment to 4 million people globally. “I cannot imagine not reauthorizing an overwhelming success,” Fauci told a news conference.

But Fauci said it was determined advocacy that got it going. “To think that you can come down to Congress or to the administration on a one-shot basis and say, ‘This is important, please fund it’ …I don’t think there has ever been a time when I got what I asked for the first time around,” he said. “It is usually the 50^th time around.”

Fauci praised the first AIDS activists of the 1980s, even if they were sometimes loud and theatrical. “But they were amazingly well-informed. They knew exactly what they were talking about. You can’t dismiss them as being some kind of group that is disruptive,” he said.

The same can happen now, Fauci said, as scientists and doctors push for universal testing and treatment as a way to benefit not only people with HIV, but society as a whole. Delegates to the conference will be highlighting the growing body of studies that show if HIV patients take drug cocktails as directed, they  suppress the virus enough not only to keep it from destroying their own immune systems, but to keep it from infecting others.

But to encourage people to get treated, they first have to be tested and know they are infected. And to ensure that everyone gets tested, Fauci and other medical experts at the meeting will stress, societies need to work harder to reduce the stigma of a diagnosis, work to get hospitals and clinics to test everyone, and then get public and private health insurers to pay for treatment.

Related links: 

• Panel calls for HIV drugs for everyone infected
• AIDS conference opens with an eye to a cure
• A critical turning point for HIV