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It's been a huge year for the AIDS pandemic. The big breakthrough: the discovery that anti-viral drugs can prevent the spread of HIV. It's nearly 100 percent effective. That led President Obama to declare that the U.S. will expand HIV treatment in hard-hit countries.

NPR's Richard Knox reports on what may be the beginning of the end of AIDS.

RICHARD KNOX, BYLINE: As recently as last year, many of those experts were saying that just giving more people with HIV more drugs would never work. Dr. Eric Goosby, the U.S. AIDS czar, explains why.

DR. ERIC GOOSBY: For every one person that was put on antiretroviral therapy or treatment, we would have two to three new infections identified.

KNOX: So that looked like a losing game - but not anymore. The latest research shows antiviral drugs not only save the lives of infected people, they also stop them from spreading the virus and causing new infections, if they can be given early enough after someone gets infected. The new strategy is called treatment as prevention.

GOOSBY: So, we suddenly are looking at a moment where we can treat our way out of the epidemic. That's the turning point that we're looking at.

KNOX: Experts say it'll still take decades to end AIDS, but many say the world has to be much more aggressive about treating HIV.

DR. BRIAN WILLIAMS: The only thing that's more expensive than treatment-as-prevention is not doing treatment-as-prevention.

KNOX: That's Brian Williams, an AIDS expert in South Africa, which has 6 million HIV-positive people - the most anywhere. About a million and a quarter of them are now getting antiviral treatment. Williams says that's saving a lot of lives, but not preventing many new infections.

WILLIAMS: We're getting them really very close to death. And we just have to start finding people much, much earlier.

KNOX: Before they have a chance to infect others. He says the current policy actually works against that. Generally, people with HIV aren't eligible for treatment until a blood test shows the virus has devastated their immune systems. Williams calls that policy test-and-wait. The problem with that is that people with HIV are told to come in for periodic blood tests to see if they're sick enough to be treated. But after a few months of that, they just stop coming.

WILLIAMS: Then they get really sick, and then they can't come. And then they die. So at the moment, our attempts to triage the population are actually making the problem worse and not better.

KNOX: He says South Africa needs to shift gears to test and treat people as early as possible.

WILLIAMS: We know technically, now, that it works, but what we need to know is: Can we make it work in the real world? That's the key.

KNOX: And that's going to take some pilot projects, he says. At Columbia University in New York City, Dr. Wafaa El-Sadr says that's true for America, too.

DR. WAFAA EL-SADR: Even in the United States, the data are still pretty alarming. It's estimated that maybe only about a quarter of those with HIV have suppressed viral loads.

KNOX: That is, most Americans with HIV are not getting antiviral drugs, or not enough to keep the virus in check. So they're infecting others. El-Sadr is leading a project in the Bronx and in Washington, D.C., two of the nation's hottest hot spots for new HIV infection. The aim is to saturate these places with testing-and-treating services. [POST-BROADCAST CLARIFICATION: NPR did not intend to imply that people who are not under treatment invariably infect others. Those who are not taking antiviral drugs, or not enough to keep the virus in check, could be infecting others. Many HIV-infected people use other means, such as consistent condom use, to reduce that risk.]

EL-SADR: Is it doable? Is it feasible to expand testing? Is it feasible to try to link every single individual who is found to be positive to a care clinic? Is it feasible to get them to take medicine and thus prevent transmission to others?

KNOX: Goosby, whose formal title is U.S. global AIDS coordinator, agrees that field testing is necessary and urgent. He's allocated $150 million to answer those questions in South Africa, Tanzania, Zambia and Botswana. But he doesn't want researchers to dither for years.

GOOSBY: You know, we don't have the luxury of figuring it all out before we have to engage. And we have to engage.

KNOX: Some of the answers, he says, should start coming in, in 2012. Richard Knox, NPR News.

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