Elizabeth Pisani: Sex, drugs and HIV -- let's get rational

Translator: Òscar Aznar Alemany Reviewer: Sonia Redondo

"People do stupid things.

"La gent fa estupideses.

That's what spreads HIV."

Això és el que escampa el VIH."

This was a headline in a U.K. newspaper,

Això és un titular d'un diari britànic,

The Guardian, not that long ago.

<i>The Guardian</i>, de no fa gaire.

I'm curious, show of hands, who agrees with it?

Podeu aixecar les mans si hi esteu d'acord?

Well, one or two brave souls.

Bé, hi ha un parell de valents.

This is actually a direct quote from an epidemiologist

Això és una cita textual d'una epidemiòloga

who's been in field of HIV for 15 years,

que ha estudiat el VIH durant 15 anys,

worked on four continents,

ha treballat en 4 continents

and you're looking at her.

i que us parla ara mateix.

And I am now going to argue

I ara argumentaré

that this is only half true.

que això és només mig cert.

People do get HIV because they do stupid things,

La gent agafa el VIH perquè fa estupideses,

but most of them are doing stupid things

però molts fan estupideses

for perfectly rational reasons.

per motius ben racionals.

Now, "rational" is the dominant paradigm

De fet, la racionalitat és el model base

in public health,

de la salut pública,

and if you put your public health nerd glasses on,

i si us poseu les ulleres d'entesos en salut pública,

you'll see that if we give people the information that they need

veureu que si donem a la gent la informació

about what's good for them and what's bad for them,

sobre el que és bo i dolent per ells,

if you give them the services

si els donem els serveis

that they can use to act on that information,

que poden usar amb aquesta informació

and a little bit of motivation,

i els donem una empenta,

people will make rational decisions

prendran decisions racionals

and live long and healthy lives.

i tindran vides llargues i sanes.

Wonderful.

Genial.

That's slightly problematic for me because I work in HIV,

Això és un pèl problemàtic quan treballes amb el VIH.

and although I'm sure you all know

Estic segura que sabeu que el VIH

that HIV is about poverty and gender inequality,

té a veure amb la pobresa i la desigualtat de gènere,

and if you were at TED '07

i si vau ser al TED 2007,

it's about coffee prices ...

té a veure amb el preu del cafè...

Actually, HIV's about sex and drugs,

De fet, el VIH va de sexe i droga

and if there are two things that make

i, si hi ha res que torni

human beings a little bit irrational,

els humans un xic irracionals,

they are erections and addiction.

són les ereccions i les addiccions.

(Laughter)

(Rialles)

So, let's start with what's rational for an addict.

Vegem què és racional per a un addicte.

Now, I remember speaking to an Indonesian friend of mine, Frankie.

Recordo una conversa amb un amic d'Indonèsia, el Frankie.

We were having lunch and he was telling me

Mentre dinàvem em parlava de quan

about when he was in jail in Bali for a drug injection.

va ser a la presó de Bali per injectar-se droga.

It was someone's birthday, and they had very kindly

Era l'aniversari d'algú i havien aconseguit

smuggled some heroin into jail,

heroïna de contraband

and he was very generously sharing it out

i el de l'aniversari la repartia generosament

with all of his colleagues.

amb tots els companys.

And so everyone lined up,

Tots van fer cua,

all the smackheads in a row,

heroïnòmans en fila,

and the guy whose birthday it was

i el noi de l'aniversari

filled up the fit,

va omplir la xeringa

and he went down and started injecting people.

i va començar a injectar a tothom.

So he injects the first guy,

Injecta el primer,

and then he's wiping the needle on his shirt,

eixuga l'agulla amb la samarreta

and he injects the next guy.

i injecta el següent.

And Frankie says, "I'm number 22 in line,

I el Fankie diu: "Sóc el 22è de la cua

and I can see the needle coming down towards me,

i veig l'agulla que se m'acosta

and there is blood all over the place.

i està plena de sang.

It's getting blunter and blunter.

S'està desafilant cada cop més.

And a small part of my brain is thinking,

I en part penso

'That is so gross

«Això és repugnant

and really dangerous,'

i molt perillós»,

but most of my brain is thinking,

però en realitat penso

'Please let there be some smack left

«Si us plau, que en quedi una mica

by the time it gets to me.

quan m'arribi.

Please let there be some left.'"

Si us plau, que en quedi una mica.»"

And then, telling me this story,

Llavors,

Frankie said,

em va dir:

"You know ... God,

"Saps... Hòstia,

drugs really make you stupid."

les drogues et tornen idiota."

And, you know, you can't fault him for accuracy.

I no li pots negar que té tota la raó.

But, actually, Frankie, at that time,

Però, en aquells temps, el Frankie

was a heroin addict and he was in jail.

era un heroïnòman i era a la presó.

So his choice was either

Havia d'escollir entre

to accept that dirty needle or not to get high.

acceptar una agulla bruta o no col·locar-se.

And if there's one place you really want to get high,

I si hi ha un lloc on et vols col·locar,

it's when you're in jail.

és a la presó.

But I'm a scientist

Però jo sóc una científica

and I don't like to make data out of anecdotes,

i no converteixo les anècdotes en dades.

so let's look at some data.

Vegem dades de debò.

We talked to 600 drug addicts

Vam parlar amb 600 drogoaddictes

in three cities in Indonesia,

de 3 ciutats d'Indonèsia

and we said, "Well, do you know how you get HIV?"

i els vam preguntar: "Sabeu com agafeu el VIH?"

"Oh yeah, by sharing needles."

"I tant, compartint les agulles."

I mean, nearly 100 percent. Yeah, by sharing needles.

De debò, quasi el 100%, compartint les agulles.

And, "Do you know where you can get a clean needle

"I sabeu on podeu aconseguir agulles netes

at a price you can afford to avoid that?"

a un preu assequible per evitar-ho?"

"Oh yeah." Hundred percent.

"I tant." El 100%.

"We're smackheads; we know where to get clean needles."

"Som heroïnòmans; sabem on trobar-les."

"So are you carrying a needle?"

"I ara portes cap agulla?"

We're actually interviewing people on the street,

Entrevistàvem gent al carrer,

in the places where they're hanging out and taking drugs.

en llocs on prenien drogues.

"Are you carrying clean needles?"

"Portes cap agulla neta ara?"

One in four, maximum.

1 de cada 4 com a màxim.

So no surprises then that

No ens ha de sorprendre que

the proportion that actually used clean needles

la proporció que havia usat

every time they injected in the last week

agulles netes la setmana anterior

is just about one in 10,

fos 1 de cada 10

and the other nine in 10 are sharing.

i que els altres 9 les compartissin.

So you've got this massive mismatch;

I hi ha aquesta discordança abismal;

everyone knows that

tothom sap que

if they share they're going to get HIV,

si comparteixen agafaran el VIH,

but they're all sharing anyway.

però malgrat tot ho fan.

So what's that about? Is it like you get a better high if you share or something?

Per què? La col·locada és millor si comparteixes?

We asked that to a junkie and they're like, "Are you nuts?"

Ho vam preguntar a un jonqui: "Esteu bojos?"

You don't want to share a needle anymore than you want

Vols compartir una agulla tant com vols compartir

to share a toothbrush even with someone you're sleeping with.

un raspall de dents, fins i tot amb la persona amb qui vas al llit.

There's just kind of an ick factor there.

Fa una mica de fàstic.

"No, no. We share needles because we don't want to go to jail."

"No. Les compartim perquè no volem anar a la presó."

So, in Indonesia at this time,

A Indonèsia, actualment,

if you were carrying a needle and the cops rounded you up,

si portes una agulla i la policia te la troba,

they could put you into jail.

et poden enviar a la presó.

And that changes the equation slightly, doesn't it?

I això altera l'equació lleugerament, no?

Because your choice now is either

Però ara has d'escollir entre

I use my own needle now,

faig servir la meva agulla

or I could share a needle now

o podria compartir

and get a disease that's going to

i agafar una malaltia

possibly kill me 10 years from now,

que probablement em matarà en 10 anys,

or I could use my own needle now

o podria fer servir la meva agulla

and go to jail tomorrow.

i anar a la presó demà.

And while junkies think that

I, tot i que els jonquis creuen

it's a really bad idea to expose themselves to HIV,

que és molt mala idea exposar-se al VIH,

they think it's a much worse idea

creuen que és molt pitjor

to spend the next year in jail

passar el següent any a la presó,

where they'll probably end up in Frankie's situation

on segurament acabaran en la situació del Frankie

and expose themselves to HIV anyway.

i s'exposaran al VIH igualment.

So, suddenly it becomes perfectly rational

I, de sobte, sona perfectament racional

to share needles.

compartir les agulles.

Now, let's look at it from a policy maker's point of view.

Vegem què passa a l'hora de fer polítiques.

This is a really easy problem.

És un problema fàcil de resoldre.

For once, your incentives are aligned.

En això, tots tenim els mateixos interessos.

We've got what's rational for public health.

Una cosa que és racional en salut pública.

You want people to use clean needles --

Tu vols que la gent utilitzi agulles netes

and junkies want to use clean needles.

i els jonquis volen utilitzar agulles netes.

So we could make this problem go away

Per tant, podríem resoldre el problema

simply by making clean needles universally available

fent accessibles universalment les agulles netes

and taking away the fear of arrest.

i eliminant la por de l'arrest.

Now, the first person to figure that out

La primera persona que ho va pensar

and do something about it on a national scale

i que va fer alguna cosa a escala nacional

was that well-known, bleeding heart liberal

va ser aquesta popular i sentimetal liberal:

Margaret Thatcher.

Margaret Thatcher.

And she put in the world's first

Va posar en marxa el primer

national needle exchange program,

programa de distribució d'agulles del món

and other countries followed suit: Australia, The Netherlands and few others.

i altres països la van imitar, com Austràlia o Holanda.

And in all of those countries, you can see,

I podeu veure que en aquells països

not more than four percent of injectors

menys del 4% dels addictes

ever became infected with HIV.

es van infectar amb el VIH.

Now, places that didn't do this -- New York City for example,

En llocs que no ho van fer, com Nova York,

Moscow, Jakarta --

Moscou o Jakarta,

we're talking, at its peak,

veiem, en el seu punt màxim,

one in two injectors

que 1 de cada 2

infected with this fatal disease.

va contraure aquesta malaltia mortal.

Now, Margaret Thatcher didn't do this

Margaret Thatcher no ho va fer

because she has any great love for junkies.

pel seu gran amor pels jonquis.

She did it because she ran a country

Ho va fer perquè dirigia un país

that had a national health service.

amb un sistema de salut pública.

So, if she didn't invest in effective prevention,

I si no invertia en la prevenció efectiva

she was going to have pick up the costs

hauria d'assumir els costos

of treatment later on,

del tractament més tard,

and obviously those are much higher.

que eren molt més elevats.

So she was making a politically rational decision.

Va prendre una decisió políticament racional.

Now, if I take out my

Si ara em poso

public health nerd glasses here

les ulleres d'expert en salut pública

and look at these data,

i miro aquestes dades,

it seems like a no-brainer, doesn't it?

sembla una obvietat, no?

But in this country,

Però en aquest país,

where the government apparently does not feel compelled

on el govern no sembla que es consideri responsable

to provide health care for citizens, (Laughter)

d'oferir un servei de salut als ciutadans,

we've taken a very different approach.

hem escollit un altre camí.

So what we've been doing in the United States

El que hem fet als Estats Units

is reviewing the data -- endlessly reviewing the data.

és revisar les dades; fins a l'extenuació.

So, these are reviews of hundreds of studies

Això són informes de centenars d'estudis

by all the big muckety-mucks

de tots els mestretites

of the scientific pantheon in the United States,

del panteó científic dels Estats Units

and these are the studies that show

i aquests estudis demostren

needle programs are effective -- quite a lot of them.

que els programes d'agulles són efectius.

Now, the ones that show that needle programs aren't effective --

I els que demostren que no són efectius...

you think that's one of these annoying dynamic slides

Pensareu que és una d'aquelles estúpides

and I'm going to press my dongle and the rest of it's going to come up,

diapositives dinàmiques i que ara apareixerà la resta,

but no -- that's the whole slide.

però no; ja hi és tot.

(Laughter)

(Riures)

There is nothing on the other side.

No hi ha res a l'altra banda.

So, completely irrational,

Del tot irracional

you would think.

pensareu.

Except that, wait a minute, politicians are rational, too,

Però, un moment, els polítics també són racionals

and they're responding to what they think the voters want.

i responen al que creuen que volen els votants.

So what we see is that voters respond

I veiem que els votants responen

very well to things like this

molt bé a ajudar els nens

and not quite so well to things like this.

i no tant bé a ajudar els jonquis.

(Laughter)

(Riures)

So it becomes quite rational

Per això és prou racional

to deny services to injectors.

negar els serveis als jonquis.

Now let's talk about sex.

Parlem de sexe ara.

Are we any more rational about sex?

Som més racionals respecte al sexe?

Well, I'm not even going to address

No penso mencionar

the clearly irrational positions

les posicions clarament irracionals

of people like the Catholic Church,

de gent com l'Església Catòlica,

who think somehow that if you give out condoms,

que pensen que si proporciones condons

everyone's going to run out and have sex.

tothom correrà a practicar el sexe.

I don't know if Pope Benedict

No sé si el papa Benet

watches TEDTalks online,

mira TEDTalks,

but if you do, I've got news for you Benedict --

però si ho fas, et diré una cosa, Benet.

I carry condoms all the time

Sempre porto condons

and I never get laid.

i mai no tinc sexe.

(Laughter) (Applause)

(Riures i aplaudiments)

It's not that easy!

No és tan fàcil!

Here, maybe you'll have better luck.

Teniu. Potser vosaltres tindreu més sort.

(Applause)

(Aplaudiments)

Okay, seriously,

Bé, de debò,

HIV is actually not that easy

el VIH no és transment sexualment

to transmit sexually.

tan fàcilment.

So, it depends on how much virus there is

Depèn de quants virus hi ha

in your blood and in your body fluids.

a la teva sang i en els teus fluids.

And what we've got is a very, very high level of virus

Hi ha un nivell molt molt elevat de virus

right at the beginning when you're first infected,

al principi quan t'infectes per primer cop,

then you start making antibodies,

llavors fabriques anticossos

and then it bumps along at quite low levels

i es manté en nivells baixos

for a long time -- 10 or 12 years --

durant molt de temps, 10 o 12 anys,

you have spikes if you get another sexually transmitted infection.

hi ha alguna pujada si agafes una altra ITS.

But basically, nothing much is going on

Però, de fet, no passa gaire res

until you start to get symptomatic AIDS,

fins als símptomes de la SIDA,

and by that stage,

i a aquestes alçades

you're not looking great, you're not feeling great,

no fas bona cara, no et trobes genial i

you're not having that much sex.

no tens tant de sexe.

So the sexual transmission of HIV

La transmissió sexual del VIH

is essentially determined by how many partners you have

es determina principalment pel nombre de parelles

in these very short spaces of time

en aquests períodes breus

when you have peak viremia.

dels pics de virus a la sang.

Now, this makes people crazy

Aquí la gent s'ofèn

because it means that you have to talk about

perquè això porta a parlar

some groups having more sexual partners

d'alguns grups amb més parelles sexuals

in shorter spaces of time than other groups,

en menys temps que d'altres grups

and that's considered stigmatizing.

i això es considera estigmatitzant.

I've always been a bit curious about that

Sempre ho he trobat curiós

because I think stigma is a bad thing,

perquè crec que un estigma és dolent,

whereas lots of sex is quite a good thing,

mentre que tenir molt sexe és bastant bo,

but we'll leave that be.

però tant fa.

The truth is that 20 years

El cas és que 20 anys

of very good research

de recerca

have shown us that

demostren que

there are groups that are more likely to turnover

hi ha grups amb més tendència a tenir

large numbers of partners in a short space of time.

grans quantitats de parelles en poc temps.

And those groups are, globally,

Aquests grups són, principlament,

people who sell sex and their more regular partners.

els que venen sexe i les seves parelles habituals.

They are gay men on the party scene

Són gais de vida nocturna

who have, on average, three times more partners

que tenen el triple de parelles

than straight people on the party scene.

que els heteros de vida nocturna.

And they are heterosexuals

I són heterosexuals

who come from countries that have

de països amb tradició

traditions of polygamy

de poligàmia

and relatively high levels of female autonomy,

i nivells relativament alts d'autonomia femenina

and almost all of those countries are in east or southern Africa.

i quasi tots estan a l'est o al sud de l'Àfrica.

And that is reflected in the epidemic that we have today.

Això es reflecteix en l'epidèmia que hi ha avui.

You can see these horrifying figures from Africa.

Aquí teniu dades terribles de l'Àfrica.

These are all countries in southern Africa

Són països del sud de l'Àfrica

where between one in seven,

on entre 1/7

and one in three

i 1/3

of all adults,

dels adults

are infected with HIV.

tenen el VIH.

Now, in the rest of the world,

A la resta del món

we've got basically nothing going on in the general population --

quasi no passa res en la població general,

very, very low levels --

nivells molt baixos.

but we have extraordinarily high levels of HIV

Però hi ha nivells extraordinàriament alts

in these other populations who are at highest risk:

en les poblacions amb riscos més alts:

drug injectors, sex workers

drogoaddicció, prostitució

and gay men.

i homosexualitat.

And you'll note, that's the local data from Los Angeles:

Aquí teniu dades de Los Àngeles:

25 percent prevalence among gay men.

25% d'incidència entre gais.

Of course, you can't get HIV just by having unprotected sex.

I no pots agafar el VIH només fent sexe sense protecció.

You can only HIV by having unprotected sex

El pots agafar només si tens sexe sense protecció

with a positive person.

amb seropositius.

In most of the world,

En la major part del món,

these few prevention failures

malgrat aquests fracasos

notwithstanding,

de prevenció,

we are actually doing quite well these days

ho fem prou bé actualment

in commercial sex:

en el sexe comercial.

condom use rates are between 80 and 100 percent

El condó s'utilitza entre un 80 i un 100%

in commercial sex in most countries.

dels casos en la majoria de països.

And, again, it's because of an alignment of the incentives.

Això és, un altre cop, per interessos comuns.

What's rational for public health

El que és racional per a la salut pública

is also rational for individual sex workers

també ho és per als treballadors sexuals

because it's really bad for business to have another STI.

perquè és dolent per al negoci tenir una ITS.

No one wants it.

Ningú no ho vol.

And, actually, clients don't want to go home with a drip either.

Els clients no volen tornar a casa amb una malaltia.

So essentially, you're able to achieve

És a dir, es poden aconseguir

quite high rates of condom use in commercial sex.

índex alts d'ús de condons en el sexe comercial.

But in "intimate" relations

Però en les relacions <i>íntimes</i>

it's much more difficult because,

és molt més difícil perquè,

with your wife or your boyfriend

amb la teva dona o xicot

or someone that you hope might turn into one of those things,

o algú que creus que s'hi podria convertir,

we have this illusion of romance

tenim la il·lusió romàntica

and trust and intimacy,

de confiança i intimitat,

and nothing is quite so unromantic

però res és menys romàntic

as the, "My condom or yours, darling?" question.

que "El meu condó o el teu, amor?"

So in the face of that,

Davant d'això

you really need quite a strong incentive

cal un incentiu bastant fort

to use condoms.

per usar condons.

This, for example, this gentleman is called Joseph.

Per exemple, aquest home es diu Joseph.

He's from Haiti and he has AIDS.

És d'Haití i té la SIDA

And he's probably not having a lot of sex right now,

i segurament no té gaire sexe ara mateix,

but he is a reminder in the population,

però és un recordatori de

of why you might want to be

perquè podries voler

using condoms.

utilitzar condons.

This is also in Haiti and is a reminder

Això també és a Haití i és un recordatori

of why you might want to be having sex, perhaps.

de perquè podries voler tenir sexe, potser.

Now, funnily enough, this is also Joseph

Curiosament, també és el Joseph

after six months on antiretroviral treatment.

després de sis mesos de tractament antiretroviral.

Not for nothing do we call it the Lazarus Effect.

No li diuen l'efecte Llàtzer perquè sí.

But it is changing the equation

Però això canvia l'equació

of what's rational

del que és racional

in sexual decision-making.

en les decisions sexuals.

So, what we've got --

El cas és

some people say, "Oh, it doesn't matter very much

que alguns diuen: "No importa

because, actually, treatment is effective prevention

perquè el tractament ja és una previsió efectiva

because it lowers your viral load and therefore

perquè disminueix la càrrega viral i

makes it more difficult to transmit HIV."

dificulta la trasmissió del VIH."

So, if you look at the viremia thing again,

Si tornem a mirar la càrrega en sang,

if you do start treatment when you're sick,

si comences el tractament quan estàs malalt,

well, what happens? Your viral load comes down.

la càrrega viral disminueix.

But compared to what? What happens if you're not on treatment?

Comparat amb què? Què passa si no et tractes?

Well, you die,

Que mors,

so your viral load goes to zero.

i la càrrega viral baixa a zero.

And all of this green stuff here, including the spikes --

I tot això en verd, inclosos els pics,

which are because you couldn't get to the pharmacy,

que hi són perquè no vas poder anar a la farmàcia

or you ran out of drugs, or you went on a three day party binge

o et vas quedar sense medicaments o vas passar tres dies de festa

and forgot to take your drugs,

i te'n vas oblidar

or because you've started to get resistance, or whatever --

o perquè hi desenvolupes resistència o el que sigui...

all of that is virus

Tot és virus

that wouldn't be out there, except for treatment.

que no hi seria sense el tractament.

Now, am I saying, "Oh, well, great prevention strategy.

Per tant, "Gran estratègia de prevenció;

Let's just stop treating people."

deixem de tractar la gent."

Of course not, of course not.

No. És clar que no.

We need to expand antiretroviral treatment as much as we can.

Hem d'expandir el tractament tant com puguem.

But what I am doing is calling into question

El que faig és qüestionar

those people who say that more treatment

els que diuen que més tractament

is all the prevention we need.

és tota la prevenció que ens cal.

That's simply not necessarily true,

Això no és necessàriament cert

and I think we can learn a lot from the experience of gay men

i crec que podem aprendre molt dels gais

in rich countries where treatment has been widely available

de països rics on el tractament ha estat disponible

for going on 15 years now.

durant 15 anys ja.

And what we've seen is

El que veiem és

that, actually, condom use rates,

que l'índex d'ús de condons,

which were very, very high --

que eren molt molt alts

the gay community responded very rapidly to HIV,

-la comunitat gai va repondre ràpidament al VIH

with extremely little help

amb molt poca ajuda

from public health nerds, I would say --

de la salut pública, diria jo-

that condom use rate has come down dramatically since treatment

l'ús de condons ha disminuit dràsticament des que hi ha tractament

for two reasons really:

per dues raons.

One is the assumption of, "Oh well,

Una és la creença de

if he's infected, he's probably on meds,

"Si té el VIH, segurament es medica

and his viral load's going to be low, so I'm pretty safe."

i la càrrega viral és baixa i és prou segur."

And the other thing is that people are simply

D'altra banda, la gent ja no està

not as scared of HIV

espantada del VIH

as they were of AIDS, and rightly so.

com ho estava de la SIDA.

AIDS was a disfiguring disease that killed you,

La SIDA et desfigurava i et matava,

and HIV is an invisible virus

el VIH és un virus invisible

that makes you take a pill every day.

que et fa prendre una pastilla al dia.

And that's boring,

I fa mandra,

but is it as boring as

però en fa tanta com

having to use a condom every time you have sex,

fer servir un condó cada cop que tens sexe,

no matter how drunk you are,

encara que vagis begut,

no matter how many poppers you've taken, whatever?

encara que hagis pres poppers o el que sigui?

If we look at the data, we can see that

Mirant les dades, veurem que

the answer to that question

la resposta és

is, mmm.

"Mmm."

So these are data from Scotland.

Això són dades d'Escòcia.

You see the peak in drug injectors

Veieu el pic en drogoaddictes

before they started the national needle exchange program.

abans del programa d'agulles.

Then it came way down.

Llavors va baixar.

And both in heterosexuals -- mostly in commercial sex --

I tant en heteros, la majoria en sexe comercial,

and in drug users,

com en drogoaddictes

you've really got nothing much going on after treatment begins,

no hi ha gaire a fer quan ha començat el tractament

and that's because of that alignment of incentives

a causa dels interessos comuns

that I talked about earlier.

que hem dit abans.

But in gay men,

Però en els gais

you've got quite a dramatic rise

hi ha un increment dràstic

starting three or four years

3 o 4 anys després

after treatment became widely available.

que el tractament es fes accessible.

This is of new infections.

Això són infeccions noves.

What does that mean?

Què vol dir?

It means that the combined effect of being less worried

Que l'efecte combinat de menys preocupació

and having more virus out there in the population --

i d'haver-hi més virus entre la població,

more people living longer, healthier lives,

que viuen vides sanes més anys i

more likely to be getting laid

probablement tindran sexe

with HIV --

amb el VIH,

is outweighing the effects of lower viral load,

sobrepassa els efectes de la baixa càrrega viral

and that's a very worrisome thing.

i això és molt preocupant.

What does it mean?

Què vol dir?

It means we need to be doing more prevention the more treatment we have.

Que hem de fer més prevenció com més tractament tinguem.

Is that what's happening?

I això ho fem?

No, and I call it the "compassion conundrum."

No. Ho anomeno l'<i>enigma de la compassió</i>.

We've talked a lot about compassion the last couple of days,

Hem parlat de compassió els últims dies,

and what's happening really is that people are

però en realitat la gent

unable quite to bring themselves to put in

és incapaç d'aconseguir

good sexual and reproductive health services for sex workers,

bons serveis de salut per a treballadors sexuals

unable quite to be giving out needles to junkies.

o de donar agulles als jonquis.

But once they've gone from being

Però quan han passat

transgressive people whose behaviors we don't want to condone

de ser trangressors amb conductes inacceptables

to being AIDS victims,

a víctimes de la SIDA,

we come over all compassionate

ens tornem compassius

and buy them incredibly expensive drugs for the rest of their lives.

i els paguem medicines increïblement cares per tota la vida.

It doesn't make any sense

No té cap sentit

from a public health point of view.

des del punt de vista de la salut pública.

I want to give what's very nearly the last word to Ines.

Quasi per acabar parlaré de la Ines.

Ines is a a transgender hooker on the streets of Jakarta;

Ella és una puta transexual de Jakarta;

she's a chick with a dick.

una noia amb polla.

Why does she do that job?

Per què fa aquesta feina?

Well, of course, because she's forced into it

Perquè hi està obligada, és clar.

because she doesn't have any better option, etc., etc.

Perquè no té cap alternativa, etc.

And if we could just teach her to sew

Si li poguéssim ensenyar a cosir

and get her a nice job in a factory, all would be well.

i donar-li feina en una fàbrica, estaria bé.

This is what factory workers earn in an hour in Indonesia:

Els treballadors d'una fàbrica a Indonèsia guanyen

on average, 20 cents.

uns 0,20 €/h.

It varies a bit province to province.

Canvia un xic entre províncies.

I do speak to sex workers, 15,000 of them

Parlant amb treballadors sexuals,

for this particular slide,

15.000 en aquest cas,

and this is what sex workers

això és el que diuen

say they earn in an hour.

que guanyen en una hora.

So it's not a great job, but for a lot of people

No és una gran feina, però

it really is quite a rational choice.

és una escolla ben racional.

Okay, Ines.

Vegeu l'Ines.

We've got the tools, the knowledge and the cash,

Tenim les eines, el coneixement, els diners i

and commitment to preventing HIV too.

el compromís a prevenir el VIH.

Ines: So why is prevalence still rising?

I per què augmenten les infeccions?

It's all politics.

Política.

When you get to politics, nothing makes sense.

En política, res no té sentit.

Elizabeth Pisani: "When you get to politics, nothing makes sense."

Diu: "En política, res no té sentit."

So, from the point of view of a sex worker,

Per a un treballador sexual

politicians are making no sense.

la política no té sentit.

From the point of view of a public health nerd,

Per a un entès en salut pública

junkies are doing dumb things.

els jonquis fan estupideses.

The truth is that everyone has a different rationale.

Tothom té un concepte diferent de <i>racional</i>.

There are as many different ways of being rational

Hi ha tants conceptes diferents

as there are human beings on the planet,

com humans hi ha al planeta,

and that's one of the glories of human existence.

i aquesta és una de les meravelles dels éssers humans.

But those ways of being rational

Però cap d'aquests conceptes

are not independent of one another,

és independent dels altres.

so it's rational for

Compartir és racional

a drug injector to share needles

per a un drogoadicte

because of a stupid decision that's made by a politician,

per la decisió estúpida d'un polític,

and it's rational for a politician

i per al polític és racional

to make that stupid decision

aquesta decisió estúpida

because they're responding to

perquè respon al que

what they think the voters want.

creu que els votants volen.

But here's the thing:

El cas és que

we are the voters.

nosaltres som els votants.

We're not all of them, of course, but TED is a community of opinion leaders.

No tot ells, però a TED som un model d'opinió.

And everyone who's in this room,

Tots els d'aquesta sala

and everyone who's watching this out there on the web,

i tots els que ens veuen per Internet

I think, has a duty to demand of their politicians

tenim el deure d'exigir als polítics

that we make policy based on scientific evidence

que es basin en les dades científiques

and on common sense.

i en el sentit comú.

It's going to be really hard for us

És molt difícil que individualment

to individually affect what's rational

canviem el que és racional

for every Frankie and every Ines out there,

per a cada Frankie i Ines,

but you can at least use your vote

però podem fer servir el vot

to stop politicians doing stupid things

per evitar les polítiques estúpides

that spread HIV.

que escampen el VIH.

Thank you.

Gràcies.

(Applause)

(Aplaudiments)