Mixed blessings.

The lives of two men neighboring Southern cities illustrate the news--good and bad--from the World AIDS Conference in Geneva. The good news is that mortality from AIDS complications continues to drop and that many people on combination therapy are healthier than they have been m years. The bad news is that the advances in treatment have passed others by with little effect. Those still in the earlier phases of HIV infection and those who have not taken any other HIV drugs in the past are most likely to do best on combination therapy. Those who have gone through a battery of treatments often see less impressive results, if any. The bittersweet combination of success and failure is likely to be with us for years to come. Those who are thriving reside throughout the country side by side with those who are as sick as ever, but the lives of the two groups are a world apart.

The afternoon light has an after-the-storm quality as Douglas Ruhren steps out of his Italianate Georgian home in Durham, N.C. Framed by 90-year-old oaks, his yard is a tangle of native and exotic plants: pinkroot, angel's trumpet, Miss Robb's bonnet. It's clear the lanky 42-year-old Ruhren, a professional gardener of some local renown, is most at home among his plants and that he hopes to be landscaping for a long time. "I'm the type of person who doesn't want to retire when I'm 65 because I love what I'm doing."

Three years ago it would have seemed unimaginable that Ruhren would live to age 65. Diagnosed with HIV in the mid 1980s, he suffered a series of opportunistic infections in 1995 that worried his friends and doctors. He came down with Pneumocystis carinii pneumonia twice, landing in the hospital during the second bout. "At that time the doctors came in under the cover of darkness and asked me if I wanted to be resuscitated if I stopped breathing," Ruhren recalls. His T-cell count had fallen below 10. "It was a struggle, the three or five steps from the hospital bed to the bathroom. Still, I didn't have a feeling it was the end."

Ruhren was right. At the end of that year he completed a double-blind drug study in which he had been receiving the placebo. The researchers switched him over to the actual drug, a protease inhibitor. Ruhren's T-cell count edged up to 11, then 50, then eventually 400. He added a second protease inhibitor, which he takes as part of a "cocktail" with two other antiviral drugs. Now his viral load is barely detectable.

"I feel probably as good as any 42-year-old person could feel," Ruhren says. Not only has his energy come back, but he's also regaining muscle tone. Even his sinusitis, common among people with weakened immune systems, is receding. Now a full-time freelance garden designer, he's as busy--and as happy--as he's ever been.

Ruhren has no illusion that he's cured. "I've done every drug that's come down the pike," he says, "and each one has bought more time for something better." Others, though, are less measured with their words. "If you think of HIV as a raging fire, we put out the fire," said researcher Martin Markowitz during the 1996 AIDS conference in Vancouver, Canada. Words like cure have started creeping into the epidemic's vocabulary. One recent study at Johns Hopkins University showed that 39% of gay men had engaged in unsafe sex over the previous six months, in part because they believed the protease inhibitors were a cure or near cure for AIDS.

In fact, not only are protease inhibitors not a cure, but for some people they simply haven't worked. Two miles from Ruhren's house, 43-year-old Mitch Foushee sits in a waiting room at Duke University Medical Center. On this June day he's starting a new three-drug cocktail, this one designed for patients with high viral loads. Foushee is hopeful, but in a sober kind of way: So far none of the protease inhibitors he's tried have lowered the HIV level in his bloodstream. "Those of us with high numbers never seem to benefit from the mix," he says.

Before he retired 2 1/2 years ago, Foushee was legislative director for Sen. Jeff Bingaman (D-N.M.), but when he was diagnosed with AIDS, "I realized I could not keep up with the Senate schedule." He moved from Washington, D.C., to Chapel Hill, N.C., where he does part-time teaching and political consulting.

Even that is sometimes too much. Several months ago Foushee was hit by a fungal infection and had no immune system to fight it off. Doctors had to remove his left eye; today, he wears a patch over the socket. Both the infection and the treatment have left him too exhausted to work. His vanity has taken a hit too. His six-foot frame is down to 116 pounds, and even though his vision remains good, his missing eye has been a source of frustration. Foushee recalls a recent visit to a Chapel Hill restaurant: "I'm sitting at Dip's, and my patch pops, and it's sitting in my gravy, and there were 25 people watching. I mined their dinner."

Foushee hopes that by the end of the summer he'll be able to teach again. And he hopes he will find the right drug combination to start eradicating his HIV. "The toughest thing is going from the Senate, where you're working 18-hour days and you're traveling, and suddenly all that ends," he says. "That took getting used to. But I have refused to accept the terminal aspects of the disease."

RELATED ARTICLE: Geneva roundup

The 12th World AIDS Conference held in Geneva June 28-July 3 offered some positive news, although tempered by the realization that HIV remains a complex and often wily foe. Major topics included:

* A study of Kenyan prostitutes who have been exposed to HIV but have not become infected. Researchers are looking to see what factors protected them.

* Viral load. While the amount of HIV in the bloodstream can drop to undetectable levels with combination therapy, the effect on the quantity of virus in semen and vaginal secretions has remained unknown. A significant drop in viral load in those fluids could also mean a reduction in transmission rates.

* DNA vaccines--which were emphasized over live-virus vaccines--and how to make them produce a better immune response.

* The three drugs closest to approval for clinical use--abacavir, ABT378, and efavirenz.

* The possibility that avoiding protease inhibitors in the earliest stages of treatment could prevent development of the unusual fat deposits some users are experiencing.

RELATED ARTICLE: The virtual vaccine

AIDS Action's Daniel Zingale says a new focus should be placed on prevention and education

In 1996 we got hope. In 1997 we got complacent. In 1998 we get regality.

The official good news about the protease cocktail was declared at the 1996 AIDS conference in Vancouver, Canada, and from then on, HIV infection ceased its synonymity with certain death and ceaseless despair.

But with the good came the bad. The mainstream media, bored with AIDS=DEATH, tacitly collaborated with AIDS-worn communities to prematurely spread a dangerous message of "cure," "end," and "over." Misperception gave way to an increase in risky behavior, consequently increasing infection rates.

Now, at the just-completed World AIDS Conference in Geneva, what we suspected and feared all along has been continued: The protease cocktails don't work for everyone and are a cure for no one. Their potential long-term toxicity and oppressive regimen mean the protease drags are at best a stopgap measure and at worst an inadvertent immunization against the next generation of drugs. A cure never arrived and may not arrive for decades.

So where do we go from here? Back, back to the future, back to where a Reagan administration in denial might have stopped AIDS at the beginning. Back to stopping HIV infection in the first place through prevention and education. And, tragically, back to facing unnecessary obstacles.

If there were a medical vaccine for HIV, imagine health officials mobilizing forces to deploy it. But the irony is that now we have a virtual vaccine--prevention and education--and those forces are paralyzed. During roughly the same two-year period that HIV infection rates have increased, federal prevention funding has remained fiat. At the same time President Clinton advocates an intensive effort to find an HIV vaccine, national support for HIV prevention is stagnant.

Prevention for a new generation at risk means new approaches for a new generation of young people. This group constitutes half of all new HIV infections, yet only 10% of young people even think they are at risk. A new era of prevention also means innovative and positive approaches to education by telling people what they can do, not just what they can't. A natural first step for renewed and modernized prevention would be a heavily publicized prevention Web site featuring anonymous E-mall, with prevention counselors and a national testing referral database. In fact, a May study funded by the National Institutes of Health found that young people are as much as 14 times more likely to discuss high-risk behavior in the anonymity of cyberspace.

For African-Americans and minority communities, who make up 55% of all AIDS cases today, up from about 30% in 1982, national leadership for prevention efforts is scattered and uncoordinated. A recent study by the Henry J. Kaiser Family Foundation found that African-Americans depend primarily on mass media for AIDS information. We should sell HIV prevention to people of color, youth, and other communities at risk the same way Time sells magazines, using demographic data that tell prevention experts exactly where and how to market to audiences at risk.

Those too timid to take on Jesse Helms and his 'insistence on a hypocritical G-rated prevention strategy are simply copping out. With Helms's right-wing colleagues oral sex in the White House on nearly every TV news show, their opposition to truthful HIV prevention information is simply absurd.

Most important, the American people see HIV prevention as a top national priority. As part of the first-ever project to research political popularity of AIDS issues, AIDS Action commissioned a study of key demographic groups and learned that the issue of prevention resonates more strongly than any other and helps reinvigorate support for other AIDS causes such as access to care and research funding.

But prevention as a virtual vaccine is still just that, virtual. It is not a onetime medical vaccine to prevent infections or a cure for those already infected, which must remain a national priority. Unfortunately, the mutable nature of HIV means medical breakthroughs could remain simply a goal rather than a reality for decades. Until then, the most immediate breakthroughs in fighting HIV will come through treating prevention like the vaccine we so desperately crave.

Zingale is executive director of Washington, D. C.-based AIDS Action, which represents more than 2,400 community-based AIDS service organizations.

Yeoman is the senior staff writer at the Durham, N.C., Independent.