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

Prevoditelj: Marko Culjat Recezent: Mislav Ante Omazić - EFZG

"People do stupid things.

"Ljudi rade glupe stvari.

That's what spreads HIV."

Zbog toga se širi HIV."

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

To je bio naslov u novinama u Velikoj Britaniji,

The Guardian, not that long ago.

u Guardianu, ne tako davno.

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

Zanima me, dignite ruke, tko se slaže s tim?

Well, one or two brave souls.

Pa, jedna ili dvije hrabre duše.

This is actually a direct quote from an epidemiologist

To je u stvari stvarni citat epidemiologa

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

koji se bavi HIV-om već 15 godina,

worked on four continents,

radio je na četiri kontinenta,

and you're looking at her.

i upravo je gledate.

And I am now going to argue

Sada cu pokušati obraniti tezu

that this is only half true.

kako je to tek napola istina.

People do get HIV because they do stupid things,

Ljudi doista dobiju HIV zato što rade glupe stvari,

but most of them are doing stupid things

ali mnogi od njih rade glupe stvari

for perfectly rational reasons.

zbog potpuno razumnih razloga.

Now, "rational" is the dominant paradigm

Dakle, "razumno" je dominantna paradigma

in public health,

u javnom zdravstvu,

and if you put your public health nerd glasses on,

i ako stavite javnozdravstvene štreberske naočale,

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

vidjet ćete da ako damo ljudima informacije koje su im potrebne,

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

o tome što je dobro za njih, a što loše,

if you give them the services

ako im pružite usluge

that they can use to act on that information,

koje mogu koristiti da iskoriste te informacije,

and a little bit of motivation,

i nešto motivacije,

people will make rational decisions

ljudi će donijeti racionalne odluke

and live long and healthy lives.

i imat će duge i zdrave živote.

Wonderful.

Predivno.

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

To je pomalo problematično za mene, jer radim sa HIV-om

and although I'm sure you all know

i premda sam sigurna da svi vi znate

that HIV is about poverty and gender inequality,

kako je HIV povezan sa siromaštvom i nejednakosti spolova,

and if you were at TED '07

a ako ste bili na TED-u 2007.

it's about coffee prices ...

znate da je povezan i s cijenama kave...

Actually, HIV's about sex and drugs,

No, HIV je povezan sa seksom i drogom,

and if there are two things that make

i ako postoje dvije stvari koje

human beings a little bit irrational,

čine ljude pomalo nerazumnima,

they are erections and addiction.

to su erekcija i ovisnost.

(Laughter)

(Smijeh)

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

Hajmo razmisliti što je razumno za ovisnika.

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

Sjećam se kad sam razgovarala sa svojim prijateljem iz Indonezije, Frankiejem.

We were having lunch and he was telling me

Ručali smo i pričao mi je

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

o vremenu kada je bio u zatvoru na Baliju zbog korištenja droge.

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

Netko je slavio rođendan, i vrlo ljubazno je

smuggled some heroin into jail,

prokrijumčario nešto heroina u zatvor,

and he was very generously sharing it out

i bio je vrlo velikodušan u dijeljenju

with all of his colleagues.

sa svim svojim kolegama.

And so everyone lined up,

I tako su se svi poredali,

all the smackheads in a row,

svi narkići u nizu,

and the guy whose birthday it was

i tip koji je slavio rodendan

filled up the fit,

je napunio špricu,

and he went down and started injecting people.

išao je i uštrcavao je heroin.

So he injects the first guy,

Tako je uštrcao prvom tipu,

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

onda je obrisao iglu o svoju košulju,

and he injects the next guy.

pa je uštrcao heroin drugom tipu.

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

I Frankie je rekao, "Ja sam 22. po redu,

and I can see the needle coming down towards me,

i vidim iglu kako se mi se približava,

and there is blood all over the place.

i krv je posvuda.

It's getting blunter and blunter.

Postaje sve tuplja.

And a small part of my brain is thinking,

I mali dio moga mozga razmišlja,

'That is so gross

'Ovo je tako odvratno

and really dangerous,'

i stvarno opasno',

but most of my brain is thinking,

ali veći dio moga mozga razmišlja

'Please let there be some smack left

'Molim te, neka ostane barem malo

by the time it gets to me.

kad dođe do mene.

Please let there be some left.'"

Molim te neka ostane barem malo.'"

And then, telling me this story,

I onda, dok mi je pričao ovu priču,

Frankie said,

Frankie je rekao,

"You know ... God,

"Znas... pobogu,

drugs really make you stupid."

droga te stvarno učini glupim."

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

I znate, ne možete reći kako nema pravo.

But, actually, Frankie, at that time,

Ali, u stvari, Frankie je u to vrijeme

was a heroin addict and he was in jail.

bio ovisnik o heroinu i bio je u zatvoru.

So his choice was either

Znači njegov izbor je bio ili

to accept that dirty needle or not to get high.

prihvatiti to prljavu iglu ili ne doživjeti taj vrhunac.

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

I ako postoji ijedno mjesto gdje se želite ušlagirati,

it's when you're in jail.

to je zatvor.

But I'm a scientist

Ali ja sam znanstvenica

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

i ne želim izvlačiti podatke iz anegdota,

so let's look at some data.

pa pogledajmo neke podatke.

We talked to 600 drug addicts

Razgovarali smo sa 600 ovisnika

in three cities in Indonesia,

u tri indonezijska grada,

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

i rekli smo, "Pa, znate li kako se dobije HIV?"

"Oh yeah, by sharing needles."

"O da, dijeljenjem igala."

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

Mislim, skoro 100 posto. Da, dijeljenjem igala.

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

I, "Znate li gdje možete dobiti čistu iglu

at a price you can afford to avoid that?"

po pristupačnoj cijeni, da izbjegnete to?"

"Oh yeah." Hundred percent.

"O, da!" 100 posto.

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

"Narkići smo, znamo gdje možemo dobiti čiste igle."

"So are you carrying a needle?"

"Dobro, imate li sada iglu kod sebe?"

We're actually interviewing people on the street,

Intervjuirali smo ljude na ulici,

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

na mjestima gdje se druže i uzimaju drogu.

"Are you carrying clean needles?"

"Imate li čiste igle?"

One in four, maximum.

Jedan od četiri, najviše.

So no surprises then that

Stoga nije bilo iznenađujuće

the proportion that actually used clean needles

da udio ljudi koji je stvarno koristio čiste igle

every time they injected in the last week

svaki put kada su si davali drogu prošli tjedan

is just about one in 10,

bio oko jedan od deset,

and the other nine in 10 are sharing.

dok su ostalih devetoro dijelili igle.

So you've got this massive mismatch;

Tako da imate ovaj veliki nesrazmjer.

everyone knows that

Svi znaju da

if they share they're going to get HIV,

će dobiti HIV ako dijele igle,

but they're all sharing anyway.

ali svi ih svejedno dijele.

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

Što je s tim? Je li vrhunac bolji kada dijelite igle ili što?

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

Pitali smo to narkiće i rekli su, "Jesi ti luda?"

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

Ne želiš dijeliti igle isto kao što

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

ne želiš dijeliti četkicu za zube, čak ni s nekim s kim spavaš.

There's just kind of an ick factor there.

To je kao neki "fuj" čimbenik u cijeloj priči.

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

"Ne, ne. Dijelimo igle zato što ne želimo ići u zatvor."

So, in Indonesia at this time,

Trenutačno u Indoneziji

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

ako nosite iglu i policija vas privede

they could put you into jail.

mogu vas smjestiti u zatvor.

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

I to blago mijenja računicu, zar ne?

Because your choice now is either

Zato što je sada vaš izbor ili

I use my own needle now,

koristiti svoju vlastitu iglu sada,

or I could share a needle now

ili dijeliti iglu sada

and get a disease that's going to

i dobiti bolest koja će

possibly kill me 10 years from now,

me možda ubiti za 10 godina,

or I could use my own needle now

ili mogu koristiti svoju iglu sada

and go to jail tomorrow.

i otići u zatvor sutra.

And while junkies think that

I dok narkići misle

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

kako je jako loše izložiti se HIV-u,

they think it's a much worse idea

misle da je ipak mnogo gora ideja

to spend the next year in jail

provesti sljedeću godinu u zatvoru,

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

gdje će vjerojatno završiti u Frankievoj situaciji

and expose themselves to HIV anyway.

i svejedno se izložiti HIV-u.

So, suddenly it becomes perfectly rational

Tako da odjedamput postaje savršeno razumno

to share needles.

dijeliti igle.

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

Pogledajmo to sada sa stajališta ljudi koji stvaraju politiku.

This is a really easy problem.

To je stvarno jednostavan problem.

For once, your incentives are aligned.

Odjedamput, vaši poticaji su usklađeni.

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

Imamo ono što je razumno za javno zdravstvo.

You want people to use clean needles --

Želite da ljudi koriste čiste igle –

and junkies want to use clean needles.

i narkići žele koristiti čiste igle.

So we could make this problem go away

Tako da jedostavno možemo riješiti ovaj problem

simply by making clean needles universally available

tako da učinimo igle dostupnima svima

and taking away the fear of arrest.

i uklonimo strah od uhićenja.

Now, the first person to figure that out

Naime, prva osoba koja je shvatila to

and do something about it on a national scale

i učinila nešto na državnoj razini

was that well-known, bleeding heart liberal

je bila dobro poznata, iskrena liberalka,

Margaret Thatcher.

Margaret Thatcher.

And she put in the world's first

Pokrenula je prvi svjetski

national needle exchange program,

program razmjene igala.

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

I ostale su zemlje pratile: Australija, Nizozemska i nekolicina ostalih.

And in all of those countries, you can see,

I, kao što vidite, u svim tim zemljama

not more than four percent of injectors

manje od četiri posto ljudi koji si ubrizgavaju heroin

ever became infected with HIV.

postanu inficirani HIV-om.

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

Sada, u mjestima koja to nisu to ucinila, New York primjerice,

Moscow, Jakarta --

Moskva, Jakarta,

we're talking, at its peak,

govorimo u vrijeme vrhunca,

one in two injectors

jedan od dva korisnika

infected with this fatal disease.

je inficirana ovom smrtonosnom bolesti.

Now, Margaret Thatcher didn't do this

Margaret Thatcher nije ovo napravila

because she has any great love for junkies.

zato što obožava narkiće.

She did it because she ran a country

Napravila je to zato što je vodila državu

that had a national health service.

koja je imala socijalnu zdravstvenu zaštitu.

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

Da nije uložila u učinkovitu prevenciju,

she was going to have pick up the costs

morala bi kasnije platiti troškove

of treatment later on,

liječenja,

and obviously those are much higher.

koji su očito višestruko veći.

So she was making a politically rational decision.

Tako da je donijela politički racionalnu odluku.

Now, if I take out my

Ako sada izvadim svoje

public health nerd glasses here

naočale javnozdravstvenog štrebera

and look at these data,

i pogledam ove podatke,

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

čini se kako ne moramo puno razmišljati, zar ne?

But in this country,

Ali u ovoj zemlji,

where the government apparently does not feel compelled

u kojoj se vlada ne osjeća pozvanom da

to provide health care for citizens, (Laughter)

pruži zdravstvenu skrb svojim građanima, (Smijeh)

we've taken a very different approach.

krenuli smo s drugim pristupom.

So what we've been doing in the United States

Dakle, ono što smo radili u Sjedinjenim Američkim Državama

is reviewing the data -- endlessly reviewing the data.

je pregledavanje podataka – beskrajno pregledavanje podataka.

So, these are reviews of hundreds of studies

Ovo je, dakle, pregled stotina studija

by all the big muckety-mucks

svih glavonja

of the scientific pantheon in the United States,

znanstvenog panteona SAD-a,

and these are the studies that show

i ovo su studije koje pokazuju

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

da su programi zamjene igala učinkoviti – mnogo njih.

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

Sada studije koje pokazuju da ti programi nisu učinkoviti --

you think that's one of these annoying dynamic slides

sigurno mislite kako je ovo jedan on onih iritantnih dijapozitiva s animacijom

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

i da ću stisnuti gumbić i da će se pojaviti ostatak,

but no -- that's the whole slide.

ali ne, ovo je cijeli dijapozitiv.

(Laughter)

(Smijeh)

There is nothing on the other side.

Nema ništa na drugoj strani.

So, completely irrational,

Dakle, pomislili biste,

you would think.

potpuno nerazumno.

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

Ali, pričekajte trenutak, političari su također razumni,

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

i ponašaju se onako kako misle da bi glasači htjeli.

So what we see is that voters respond

I vidimo da ono na što glasači pozitivno reagiraju

very well to things like this

su stvari poput ove

and not quite so well to things like this.

i ne tako pozitivno na stvari poput ove.

(Laughter)

(Smijeh)

So it becomes quite rational

Tako da postaje prilično razumno

to deny services to injectors.

uskratiti usluge korisnicima droga.

Now let's talk about sex.

Hajdemo razgovarati o seksu.

Are we any more rational about sex?

Jesmo li iole razumniji kada je u pitanju seks?

Well, I'm not even going to address

Neću niti komentirati

the clearly irrational positions

očito nerazumna stajališta

of people like the Catholic Church,

ljudi poput Katoličke crkve,

who think somehow that if you give out condoms,

koja misli kako ćete dijeljenjem kondoma

everyone's going to run out and have sex.

potaknuti ljude da spavaju zajedno.

I don't know if Pope Benedict

Ne znam gleda li papa Benedikt

watches TEDTalks online,

TEDTalks na netu,

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

ali ako gledate, imam novosti za Vas,

I carry condoms all the time

ja uvijek imam kondome sa sobom

and I never get laid.

i nikad se ne ševim.

(Laughter) (Applause)

(Smijeh) (Pljesak)

It's not that easy!

Nije to tako jednostavno!

Here, maybe you'll have better luck.

Evo, možda ćete vi biti bolje sreće.

(Applause)

(Pljesak)

Okay, seriously,

U redu, ali ozbiljno,

HIV is actually not that easy

HIV se u stvari ne može

to transmit sexually.

prenijeti tako lako spolnim putem.

So, it depends on how much virus there is

Dakle, ovisi o tome koliko je virusa prisutno

in your blood and in your body fluids.

u vašoj krvi i tjelesnim tekućinama.

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

I ono što imamo je izrazito visoka razina virusa

right at the beginning when you're first infected,

točno na početku, kada postanete zaraženi,

then you start making antibodies,

onda počnete proizvoditi protutijela,

and then it bumps along at quite low levels

i onda se održava na dosta niskim razinama

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

dugo vremena, 10 ili 12 godina,

you have spikes if you get another sexually transmitted infection.

imate povišenja ako dobijete drugu spolno prenosivu bolest.

But basically, nothing much is going on

Ali, u osnovi se ne događa mnogo toga

until you start to get symptomatic AIDS,

sve dok ne počnete dobivati simptome AIDS-a,

and by that stage,

a u tom stadiju

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

ne izgledate bajno, ne osjećate se odlično,

you're not having that much sex.

ne seksate se toliko puno.

So the sexual transmission of HIV

Tako da spolno prenošenje HIV-a

is essentially determined by how many partners you have

je u stvari određeno s brojem partnera

in these very short spaces of time

koji imate u ovim kratkim vremenskim razmacima

when you have peak viremia.

kada imate vršnu viremiju.

Now, this makes people crazy

E pa, ovo izluđuje ljude

because it means that you have to talk about

zato što morate razgovarati o tome

some groups having more sexual partners

da neke skupine imaju više spolnih partnera

in shorter spaces of time than other groups,

u kraćem vremenskom periodu od drugih skupina,

and that's considered stigmatizing.

a to se smatra stigmatizacijom.

I've always been a bit curious about that

Uvijek bi mi to bilo zanimljivo

because I think stigma is a bad thing,

jer mislim kako je stigma loša stvar,

whereas lots of sex is quite a good thing,

dok je mnogo seksa prilično dobra stvar,

but we'll leave that be.

ali pustit ćemo to na miru.

The truth is that 20 years

Istina je kako je 20 godina

of very good research

vrlo dobrog istraživanja

have shown us that

pokazalo da

there are groups that are more likely to turnover

postoje skupine koje imaju veću vjerojatnost

large numbers of partners in a short space of time.

da će imati veliki broj partnera u kratkom vremenskom periodu.

And those groups are, globally,

A, globalno, te su skupine

people who sell sex and their more regular partners.

ljudi koji prodaju seks i njihovi učestaliji partneri.

They are gay men on the party scene

Potom, homoseksualci na noćnoj sceni

who have, on average, three times more partners

koji u prosjeku imaju tri puta više partnera

than straight people on the party scene.

od heteroseksualaca na noćnoj sceni

And they are heterosexuals

Potom heteroseksualci

who come from countries that have

iz zemalja koje imaju

traditions of polygamy

tradiciju poligamije

and relatively high levels of female autonomy,

i relativno visoku razinu autonomije žena,

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

i skoro sve te zemlje se nalaze u istočnoj i južnoj Africi.

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

I to se očituje u epidemiji koju imamo danas.

You can see these horrifying figures from Africa.

Možete vidjeti ove zastrašujuće brojke iz Afrike.

These are all countries in southern Africa

Ovo su sve zemlje južne Afrike,

where between one in seven,

gdje je između jednog od sedam

and one in three

i jednog od troje

of all adults,

svih odraslih ljudi

are infected with HIV.

inficirano HIV-om.

Now, in the rest of the world,

U ostatku svijeta

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

se praktički ništa ne događa u općoj populaciji,

very, very low levels --

vrlo, vrlo niske razine,

but we have extraordinarily high levels of HIV

ali imamo iznimno visoku razinu HIV-a

in these other populations who are at highest risk:

u ovim drugim poplacijama koji imaju veći rizik:

drug injectors, sex workers

narkomani, prostitutke

and gay men.

i homoseksualci.

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

I primjetit ćete, ovo su lokalni podaci iz Los Angelesa:

25 percent prevalence among gay men.

25 postotna prevalencija medu homoseksualcima.

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

Dakako, ne možete dobiti HIV samo zato što imate nezaštićeni spolni odnos.

You can only HIV by having unprotected sex

Možete dobiti HIV samo ako imate nezaštićeni odnos

with a positive person.

s HIV pozitivnom osobom.

In most of the world,

U većem dijelu svijeta,

these few prevention failures

bez obzira na manjkavost

notwithstanding,

prevencije,

we are actually doing quite well these days

dosta se dobro držimo ovih dana

in commercial sex:

u komercijalnom seksu:

condom use rates are between 80 and 100 percent

postotak upotrebe kondoma je između 80 i 100 posto

in commercial sex in most countries.

u komercijalnom seksu u većini zemalja.

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

I, opet, to je zbog usklađivanja inicijativa.

What's rational for public health

Što je razumno za javno zdravstvo

is also rational for individual sex workers

je isto tako razumno i za pojedine seksualne radnike,

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

zato što je jako loše za posao ako imate još jednu spolno prenosivu infekciju.

No one wants it.

Nitko je ne želi.

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

I, u stvari, ni mušterije ne žele doći kući s kapavcem.

So essentially, you're able to achieve

Tako da u biti, možete postići

quite high rates of condom use in commercial sex.

vrlo visoke razine upotrebe kondoma u komercijalnom seksu.

But in "intimate" relations

Ali u "intimnim" odnosima

it's much more difficult because,

mnogo je teže, jer

with your wife or your boyfriend

s vašom ženom ili dečkom

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

ili s nekim za koga se nadate da će postati nešto od tog dvoje,

we have this illusion of romance

imamo tu iluziju romantike

and trust and intimacy,

i povjerenja i intimnosti,

and nothing is quite so unromantic

i ništa nije toliko neromantično

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

kao pitanje "Moj ili tvoj kondom, draga?"

So in the face of that,

Dakle, suočeni s time

you really need quite a strong incentive

morate imati dosta jaki poticaj

to use condoms.

za korištenje kondoma.

This, for example, this gentleman is called Joseph.

Primjerice, ovo je gospodin koji se zove Joseph.

He's from Haiti and he has AIDS.

Sa Haitija je i ima AIDS.

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

I vjerojatno se u ovom trenutku puno ne seksa,

but he is a reminder in the population,

ali je podsjetnik u populaciji

of why you might want to be

zašto biste htjeli

using condoms.

koristiti kondome.

This is also in Haiti and is a reminder

Ovo je isto snimljeno na Haitiju i podsjetnik je

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

zašto biste se možda htjeli seksati.

Now, funnily enough, this is also Joseph

No, zanimljivo je da je ovo isto Joseph

after six months on antiretroviral treatment.

nakon šest mjeseci antiretrovirusne terapije.

Not for nothing do we call it the Lazarus Effect.

Ne zovemo ovo Lazarov učinak bez razloga.

But it is changing the equation

Ali ovo mijenja računicu

of what's rational

o tome što je razumno

in sexual decision-making.

u donošenju odluka o spolnom odnosu.

So, what we've got --

Dakle, ono što imamo...

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

Neki ljudi govore "To i nije toliko važno,

because, actually, treatment is effective prevention

jer je liječenje u stvari učinkovita prevencija,

because it lowers your viral load and therefore

jer smanjuje vašu razinu virusa u krvi

makes it more difficult to transmit HIV."

i zbog toga je teže prenijeti HIV."

So, if you look at the viremia thing again,

I ako opet pogledate graf viremije,

if you do start treatment when you're sick,

ako počnete liječenje kad ste bolesni,

well, what happens? Your viral load comes down.

što se dogodi? Vaša razina virusa u krvi padne.

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

Ali u usporebi s čim? Što se dogodi ako se ne liječite?

Well, you die,

Pa, umrete,

so your viral load goes to zero.

i vaša razina virusa padne na nulu.

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

I ovo zeleno na grafu, uključujući vrškove,

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

koji se javljaju zato što niste uspjeli doći do ljekarne,

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

ili im je ponestalo lijekova, ili ste tri dana partijali

and forgot to take your drugs,

i zaboravili ste uzeti lijekove,

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

ili ste počeli razvijati otpornost, ili štogod,

all of that is virus

sve to znači kako je virus

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

prisutan, samo zbog liječenja.

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

Govorim li "Oh, odlična strategija prevencije.

Let's just stop treating people."

Hajdemo prestati liječiti ljude."

Of course not, of course not.

Naravno da ne, naravno da ne.

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

Moramo proširiti liječenje antiretrovirusnim lijekovima što više možemo.

But what I am doing is calling into question

Ali dovodim u pitanje

those people who say that more treatment

tvrdnje ljudi koji kažu kako je više liječenja

is all the prevention we need.

sva prevencija koju trebamo.

That's simply not necessarily true,

To jednostavno nije nužno tako,

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

i mislim da možemo mnogo naučiti iz iskustva homoseksualaca

in rich countries where treatment has been widely available

bogatih zemalja, gdje je liječenje široko dostupno

for going on 15 years now.

zadnjih 15 godina.

And what we've seen is

I ono što smo vidjeli

that, actually, condom use rates,

da se razina korištenja kondoma,

which were very, very high --

koja je bila vrlo visoka,

the gay community responded very rapidly to HIV,

i homoseksualna zajednica se vrlo brzo prilagodila na HIV,

with extremely little help

uz vrlo malo pomoći

from public health nerds, I would say --

javnozdravstvenih štrebera, rekla bih,

that condom use rate has come down dramatically since treatment

no razina korištenja kondoma je dramatično pala otkako je počelo liječenje

for two reasons really:

zbog dva razloga.

One is the assumption of, "Oh well,

Jedan je pretpostavka, "Pa dobro,

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

ako je inficiran, vjerojatno pije lijekove,

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

i njegova razina virusa je niska, pa sam prilično siguran."

And the other thing is that people are simply

A druga stvar je da se ljudi jednostavno

not as scared of HIV

ne boje HIV-a

as they were of AIDS, and rightly so.

toliko koliko su se bojali AIDS-a, i s razlogom.

AIDS was a disfiguring disease that killed you,

AIDS je bila bolest koja vas je unakazila i ubila,

and HIV is an invisible virus

a HIV je nevidljivi virus

that makes you take a pill every day.

zbog kojeg uzmeš tabletu svaki dan.

And that's boring,

I to je zamorno,

but is it as boring as

ali je li jednako zamorno kao

having to use a condom every time you have sex,

korištenje kondoma svaki put kad se seksaš,

no matter how drunk you are,

bez obzira koliko si pijan,

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

bez obzira na to koliko si poppera uzeo, štogod?

If we look at the data, we can see that

Ako pogledamo podatke, možemo vidjeti

the answer to that question

da je odgovor na to pitanje

is, mmm.

mmmm...

So these are data from Scotland.

Ovo su podaci iz Škotske.

You see the peak in drug injectors

Vidite vrh kod intravenskih korisnika

before they started the national needle exchange program.

prije nego je počeo nacionalni program zamjene igala.

Then it came way down.

I od tada je jako pao.

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

I kod heteroseksualaca, većinom u komercionalnom seksu,

and in drug users,

i kod ovisnika o drogama,

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

ne događa se mnogo toga nakon početka liječenja,

and that's because of that alignment of incentives

i to je zbog onog usklađivanja inicijativa

that I talked about earlier.

o kojem sam ranije govorila.

But in gay men,

Ali kod homoseksualaca,

you've got quite a dramatic rise

imate dramatičan porast

starting three or four years

koji počinje tri-četiri godine

after treatment became widely available.

nakon što je liječenje postalo široko dostupno.

This is of new infections.

Ovo su nove infekcije.

What does that mean?

Što to znači?

It means that the combined effect of being less worried

To znači da združeni učinak manje zabrinutosti

and having more virus out there in the population --

i veće prisutnosti virusa u populaciji,

more people living longer, healthier lives,

više ljudi koji žive duže, zdravije,

more likely to be getting laid

koji imaju veću vjerojatnost da će spavati s nekim

with HIV --

s HIV-om,

is outweighing the effects of lower viral load,

prevaguje učinak nižih razina virusa u krvi,

and that's a very worrisome thing.

a to je vrlo zabrinjavajuća stvar.

What does it mean?

Što to znači?

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

To znači da moramo vršiti više prevencije što imamo više liječenja.

Is that what's happening?

Događa li se to?

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

Ne, i ja to nazivam "zagonetkom suosjećanja".

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

Puno smo pričali o suosjećanju zadnjih nekoliko dana,

and what's happening really is that people are

a ono što se stvarno događa je da se ljudi

unable quite to bring themselves to put in

ne mogu natjerati

good sexual and reproductive health services for sex workers,

da osposobe dobru zdravstvenu spolnu i reproduktivnu skrb za seksualne radnike,

unable quite to be giving out needles to junkies.

i da dijele igle narkićima.

But once they've gone from being

Ali kada oni prestanu biti

transgressive people whose behaviors we don't want to condone

prekršitelji, čije ponašanje ne želimo odobravati

to being AIDS victims,

i postanu žrtve AIDS-a,

we come over all compassionate

postanemo suosjećajni

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

i kupujemo im neopisivo skupe lijekove ostatak njihova života.

It doesn't make any sense

Nema nikakvog smisla

from a public health point of view.

sa stajališta javnog zdravstva.

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

Želim dati posljednju riječ Ines.

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

Ines je transrodna prostitutka na ulicama Jakarte.

she's a chick with a dick.

Ona je ženska s pimpekom.

Why does she do that job?

Zašto se bavi tim poslom?

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

Naravno, zato što je prisiljena da to radi,

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

zato što nema boljih opcija, itd., itd.

And if we could just teach her to sew

I kad bismo je samo naučili šivati

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

i našli joj dobar posao u tvornici, bila bi dobro.

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

I ovoliko radnici u tvornici zarade na sat u Indoneziji:

on average, 20 cents.

u prosjeku, 20 centi.

It varies a bit province to province.

Malo varira od provincije do provincije.

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

Razgovarala sam sa radnicama u seksualnoj industriji, njih 15.000

for this particular slide,

za ovaj dijapozitiv

and this is what sex workers

i kažu kako toliko zarade

say they earn in an hour.

na sat.

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

Dakle to nije odličan posao, ali za mnoge ljude

it really is quite a rational choice.

stvarno je razuman odabir.

Okay, Ines.

U redu, Ines.

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

Imamo mnogo oruđa, znanja i love,

and commitment to preventing HIV too.

i predanosti za prevenciju HIV-a.

Ines: So why is prevalence still rising?

Ines: I zašto prevalencija jos uvijek raste?

It's all politics.

To je politika.

When you get to politics, nothing makes sense.

Kada dođete do politike, više ništa nema smisla.

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

Elizabeth Pisani: "Kada dođete do politike, više ništa nema smisla."

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

Dakle, sa stajališta seksualne radnice

politicians are making no sense.

političari nemaju smisla.

From the point of view of a public health nerd,

Sa stajališta javnozdravstvenog štrebera,

junkies are doing dumb things.

narkići rade glupe stvari.

The truth is that everyone has a different rationale.

Istina je da svatko ima drugačiju logičku podlogu.

There are as many different ways of being rational

Postoji toliko različitih načina da budete razumni

as there are human beings on the planet,

koliko ima ljudi na zemlji,

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

i to je jedna od predivnih stvari ljudskog postojanja.

But those ways of being rational

Ali ti načini da budemo razumni

are not independent of one another,

nisu međusobno nezavisni,

so it's rational for

tako da je razumno za

a drug injector to share needles

intravenskog korisnika dijeliti igle

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

zbog glupe odluke koju je donio političar,

and it's rational for a politician

i razumno je da političar

to make that stupid decision

donese tu glupu odluku

because they're responding to

jer odgovaraju na

what they think the voters want.

ono što misle da glasači žele.

But here's the thing:

Ali u ovome je stvar:

we are the voters.

mi jesmo glasači.

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

Naravno, nismo svi, ali TED jest zajednica ljudi koji oblikuju mišljenja.

And everyone who's in this room,

I svatko tko je u ovoj prostoriji

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

i svatko tko ovo gleda na netu,

I think, has a duty to demand of their politicians

mislim kako ima dužnost zahtjevati od svojih političara

that we make policy based on scientific evidence

da donose odluke temeljene na znanstvenim dokazima

and on common sense.

i zdravom razumu.

It's going to be really hard for us

Bit će nam teško

to individually affect what's rational

da pojedinačno utječemo na ono što je razumno

for every Frankie and every Ines out there,

za svakog Frankieja i svaku Ines,

but you can at least use your vote

ali možete barem iskoristiti svoj glas

to stop politicians doing stupid things

da zaustavite političare da rade glupe stvari

that spread HIV.

koji šire HIV.

Thank you.

Hvala.

(Applause)

(Pljesak)