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ROBERT SIEGEL, HOST:

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

AUDIE CORNISH, HOST:

And I'm Audie Cornish.

More than 22,000 people from all over the world have flown into Washington, D.C. for the International AIDS Conference. The theme is turning the tide. As we've been reporting, there's new evidence that AIDS can be ended through prevention measures, such as condoms and treatment for everyone with the virus. At today's opening session, Secretary of State Hillary Clinton embraced this new era of AIDS.

SECRETARY HILLARY CLINTON: HIV may be with us into the future until we finally achieve a cure, a vaccine. But the disease that HIV causes need not be with us.

CORNISH: Secretary Clinton said the Obama administration will press forward with efforts to expand HIV treatment, both abroad and in the U.S.

SIEGEL: Several American cities are already pursuing universal treatment. The idea is to find everybody infected with HIV and get them antiviral treatment soon after they test positive. That way they can live longer and also help slow the spread of the virus to others. San Francisco is at the forefront of that new approach.

But as NPR's Richard Knox reports, the city is finding universal testing and treatment to be a challenge.

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RICHARD KNOX, BYLINE: Nurse Diane Jones has been working on HIV since the beginning. She's seen thousands of patients get sick and die of AIDS.

DIANE JONES: We're here at the emergency department at San Francisco General Hospital. It's our level one trauma center for the whole area.

KNOX: The vast majority of AIDS patients at this hospital have been gay men. And they still make up 90 percent of San Francisco's epidemic. Nearly all gay and bisexual men in San Francisco who have HIV know they're infected. But that's not the case among other people. So, San Francisco General is offering HIV tests to many patients who show up in this emergency department for all sorts of reasons. They're finding that four percent are testing positive for HIV.

Diane Jones says many of these new-found infections are not among gay men.

JONES: The profile of the people who tested positive was really significantly different. There were more women, more people of color, more heterosexuals, more transgender.

KNOX: Not surprisingly, many are shocked to come to the emergency room for a fever or a broken bone and end up with a diagnosis of HIV.

JONES: Many of these people who ended up testing positive never perceived themselves to be at risk.

DR. MONICA GANDHI: Women often do not know they're at risk.

KNOX: Dr. Monica Gandhi specializes in treating women with HIV.

GANDHI: Men kind of know, often. But women, if it's the risk of their sexual partner, they may not know. So there is a lot more surprise, I think.

KNOX: Patients are devastated, of course. But Dr. Gandhi and her colleagues try to get them past that right away.

GANDHI: It can go both ways. Someone's reeling from a diagnosis. And then, they are also reeling from the fact that they suddenly have to be on chronic lifelong therapy when they've never been on medications. That can be shocking. Or it can go the other way; that you were just hit with this terrible, scary diagnosis. But then you're told right away, we have ways to control it, you can get on medication, you're going to be fine, your lifespan's almost going to be normal, you're going to do great.

KNOX: And sometimes, getting HIV-positive people plugged into regular care helps them make big changes in other parts of their lives.

DARNELL HOLLIE: Hi, how are you? I'm Darnell.

KNOX: Darnell Hollie is 47. She had a rocky life long before she got HIV.

HOLLIE: Well, I'd been a crack user for years and years, up until I was 25.

KNOX: Then she started injecting heroin and got HIV from sharing a needle with a fellow user who she didn't know had the virus.

HOLLIE: I thought I was going to die. So I went full-blown back into the streets. So, was like, if I'm going to die anyway, I'm just going to do it and do it, and do it, and do it until I'm dead. After five years, by the time I was 32 and I was still living, I was still getting high and it was like, I wasn't dying. I wasn't sick. There wasn't nothing happening. I was like, OK, well, let's try something different. So I got clean. I went into treatment. I met my husband. Hey, here I am, 15 years later.

KNOX: She acknowledges it wasn't quite that simple. It took a lot of support from Dr. Ghandi and her co-workers, from other women with HIV, from her family and daily discipline.

HOLLIE: It's a lot of work.

(LAUGHTER)

HOLLIE: But if you want it, it's there for you.

KNOX: Monica Gandhi says Hollie is a model patient. But not all of her patients are doing so well.

TAMMY ST. GERMAINE: My name is Tammy St. Germaine. I'm 47 years old. I'm originally from Honolulu, Hawaii. I'm a mother of one child.

KNOX: St. Germaine ran away from home when she was 13 and quickly got into the drug scene.

GERMAINE: I've tried just about everything except the new drugs that are out. You know, acid, cocaine, heroin, speed, anything. Morphine. I've done everything.

KNOX: Are you still using?

GERMAINE: Yes, I'm currently using, yeah. I smoke a lot of crack.

KNOX: She got diagnosed with HIV four years ago and eventually got into Dr. Gandhi's care and on antiviral treatment. But even though the medicine didn't cause her side effects, she admits she wasn't good about staying on treatment.

GERMAINE: I can't say mostly on. I'd say mostly off.

GANDHI: She admits it very freely that she's very heavily into her addiction. And it's been incredibly difficult for her to stay in care because of that.

KNOX: And that's caused a big new problem. When somebody doesn't take HIV drugs every day, the virus mutates, it becomes resistant to those particular drugs. And if test and treat is going to work, the treatment has to be effective.

GANDHI: We just got that news yesterday that she'd become resistant because of off-and-on use of this medication.

GERMAINE: I didn't realize how valuable it was until it was already lost. I might have worked harder to try to keep it, you know.

KNOX: Dr. Gandhi has decided to try another drug regimen. In the past, she might have waited until St. Germaine had gone through detox and was off illicit drugs. Otherwise she might start skipping antiviral pills again and blow another regimen.

GANDHI: And that's a risk that we're taking. But we don't want to go the other ways in terms of risking her not being on the meds. So it's an incredible balance and it's incredibly difficult and complicated.

KNOX: One difficulty is that the new drugs can cause more side effects than the last ones. So, St. Germaine will have to be monitored closely. The last thing Dr. Gandhi wants is for her to lose this set of drugs, because soon she might run out of options.

As Darnell Hollie says, it's a lot of work. But in the big picture, all this effort seems to be paying off. Recent studies, including some presented at the AIDS conference in Washington, show that as more San Franciscans get tested and treated, there's less HIV circulating in the community.

The payoff: Over the past half-dozen years, the number of new infections in San Francisco has fallen by almost half.

Richard Knox, NPR News

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KNOX: The International AIDS Conference in Washington continues through the week. And you can find all our coverage at NPR.org.

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