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

Prevodilac: Ivana Korom Lektor: Sandra Gojic

"People do stupid things.

"Ljudi rade glupe stvari.

That's what spreads HIV."

To dovodi do širenja HIV-a."

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

Ovo je nedavno bio naslov u britanskim novinama,

The Guardian, not that long ago.

The Guardian.

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

Interesuje me - podignite ruke - ko se slaže sa ovim?

Well, one or two brave souls.

Dakle, jedna ili dve hrabre duše.

This is actually a direct quote from an epidemiologist

Ovo je zapravo direktan citat jednog epidemiologa

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

koji se bavi temom HIV-a 15 godina,

worked on four continents,

ko je radio na četiri kontinenta

and you're looking at her.

i u koga gledate.

And I am now going to argue

A sada ću obrazložiti

that this is only half true.

da je ovo samo do pola istinito.

People do get HIV because they do stupid things,

Ljudi dobijaju HIV zato što čine glupe stvari,

but most of them are doing stupid things

ali većina njih čini glupe stvari

for perfectly rational reasons.

iz savršeno razumnih razloga.

Now, "rational" is the dominant paradigm

Sad, "razumno" je dominantna paradigma

in public health,

u javnom zdravlju.

and if you put your public health nerd glasses on,

I ako stavite svoje naočare za štrebera javnog zdravlja,

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

videćete da, ako ljudima damo informacije koje su im potrebne

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

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

if you give them the services

ako im date službe

that they can use to act on that information,

preko kojih mogu da iskoriste te informacije,

and a little bit of motivation,

malo motivacije,

people will make rational decisions

ljudi mogu donositi razumne odluke

and live long and healthy lives.

i živeti duge i zdrave živote.

Wonderful.

Divno.

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

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

and although I'm sure you all know

i mada sam sigurna da svi znate

that HIV is about poverty and gender inequality,

da se kod HIV-a radi o siromaštvu i nejednakosti među polovima,

and if you were at TED '07

i ako ste bili na TED-u '07,

it's about coffee prices ...

radi se o cenama kafe;

Actually, HIV's about sex and drugs,

ustvari, kod HIV-a se radi o seksu i drogama.

and if there are two things that make

I ako postoje dve stvari koje čine

human beings a little bit irrational,

ljudska bića pomalo iracionalnima,

they are erections and addiction.

to su erekcije i adikcija.

(Laughter)

(smeh)

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

Počnimo s tim šta je racionalno za zavisnika.

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

Sećam se razgovora sa jednim prijateljem Indonežaninom, Frenkijem.

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 tome kako je bio u zatvoru na Baliju zbog jedne injekcije droge.

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

I bio je nečiji rođendan i veoma ljubazno su

smuggled some heroin into jail,

prokrijumčarili malo heroina u zatvor,

and he was very generously sharing it out

i on ga je velikodušno delio

with all of his colleagues.

sa svim svojim kolegama.

And so everyone lined up,

Tako su se svi poređali,

all the smackheads in a row,

svi narkomani u red.

and the guy whose birthday it was

A momak čiji je rođendan bio

filled up the fit,

napunio je špric

and he went down and started injecting people.

i krenuo da ubrizgava ljudima.

So he injects the first guy,

Ubrizga prvom momku

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

pa briše iglu o svoju majicu,

and he injects the next guy.

i onda ubrizga sledećem.

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

A Frenki kaže, "Ja sam broj 22 u redu,

and I can see the needle coming down towards me,

i mogu da vidim kako mi se igla približava,

and there is blood all over the place.

a svuda okolo ima krvi.

It's getting blunter and blunter.

Postaje sve tuplja i tuplja.

And a small part of my brain is thinking,

I mali deo mog mozga misli,

'That is so gross

'To je tako odvratno

and really dangerous,'

i stvarno opasno',

but most of my brain is thinking,

ali veći deo mog mozga misli,

'Please let there be some smack left

'Molim te da ostane nešto horsa

by the time it gets to me.

kad dođe na mene red'.

Please let there be some left.'"

Molim te da ostane.'"

And then, telling me this story,

I onda dok mi je pričao ovu priču,

Frankie said,

Frenki kaže,

"You know ... God,

"Bože, znaš,

drugs really make you stupid."

droga te stvarno čini glupim."

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

I znate, ne možete reći da nije u pravu,

But, actually, Frankie, at that time,

ali zapravo, Frenki je u to vreme

was a heroin addict and he was in jail.

bio zavisnik od heroina i bio je u zatvoru.

So his choice was either

Tako je njegov izbor bio ili

to accept that dirty needle or not to get high.

da prihvati prljavu iglu ili da se ne uradi.

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

I ako postoji jedno mesto gde zaista želite da se drogirate,

it's when you're in jail.

to je kad ste u zatvoru.

But I'm a scientist

Ali ja sam naučnik

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

i ne volim da pravim podatke od anegdota,

so let's look at some data.

pa pogledajmo neke podatke.

We talked to 600 drug addicts

Pričali smo sa 600 zavisnika

in three cities in Indonesia,

u tri grada u Indoneziji

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

i pitali smo ih, "Da li znate kako se dobija HIV?"

"Oh yeah, by sharing needles."

"O, da. Deljenjem igala."

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

Mislim, skoro 100%. Da, deljenjem igala.

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

I "Da li znate gde možete nabaviti čistu iglu

at a price you can afford to avoid that?"

po dostupnoj ceni, kako biste izbegli to?"

"Oh yeah." Hundred percent.

"O, da." 100%.

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

"Mi smo narkomani; znamo gde da nabavimo čiste igle."

"So are you carrying a needle?"

"Pa da li nosite iglu?"

We're actually interviewing people on the street,

Zaista intervjuišemo ljude na ulici,

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

na mestima gde se okupljaju i drogiraju.

"Are you carrying clean needles?"

"Da li nosite čiste igle?"

One in four, maximum.

Jedan od četvoro, najviše.

So no surprises then that

Dakle onda ne iznenađuje

the proportion that actually used clean needles

da je proporcija onih koji su zaista koristili čiste igle

every time they injected in the last week

svaki put kad su se drogirali u toku prošle nedelje

is just about one in 10,

otprilike 1 od 10,

and the other nine in 10 are sharing.

a onih 9 od 10 deli igle.

So you've got this massive mismatch;

Dakle imate ogromno nepoklapanje.

everyone knows that

Svi znaju da će

if they share they're going to get HIV,

ako dele igle dobiti HIV,

but they're all sharing anyway.

ali bez obzira na to, svi dele.

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

O čemu se tu radi? Kao, bolje se uradite ako delite ili nešto slično?

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

Postavili smo to pitanje jednom džankiju i rekao je, "Jeste ludi?

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

Ne želite da delite iglu baš kao što ne želite da delite

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

četkicu za zube čak ni s nekim s kim spavate.

There's just kind of an ick factor there.

Tu postoji taj neki bljak faktor.

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

Ne, ne. Delimo igle jer ne želimo da idemo u zatvor."

So, in Indonesia at this time,

Dakle, u Indoneziji trenutno,

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

ako nosite iglu sa sobom i policija vas zaustavi,

they could put you into jail.

mogu vas poslati u zatvor.

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

To malo menja jednačinu, zar ne?

Because your choice now is either

Jer vaš izbor je sada

I use my own needle now,

ili da koristim svoju iglu sada,

or I could share a needle now

ili da delim iglu sada

and get a disease that's going to

i dobijem bolest koja će me

possibly kill me 10 years from now,

možda ubiti za 10 godina,

or I could use my own needle now

ili da koristim svoju iglu sada

and go to jail tomorrow.

i odem u zatvor sutra.

And while junkies think that

Koliko god da džankiji misle

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

da je stvarno loša ideja da se izlože HIV-u,

they think it's a much worse idea

misle da je mnogo gora ideja

to spend the next year in jail

da provedu sledeću godinu u zatvoru,

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

gde će se verovatno naći u Frenkijevoj situaciji

and expose themselves to HIV anyway.

i izložiti se HIV-u svakako.

So, suddenly it becomes perfectly rational

Dakle odjednom postaje savršeno racionalno

to share needles.

da se dele igle.

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

Sada pogledajmo na to iz ugla zakonodavca.

This is a really easy problem.

Ovo je stvarno jednostavan problem.

For once, your incentives are aligned.

Barem jednom, motivi su u istoj ravni.

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

Imamo ono što je racionalno za javno zdravlje.

You want people to use clean needles --

Želite da ljudi koriste čiste igle

and junkies want to use clean needles.

i narkomani žele da koriste čiste igle.

So we could make this problem go away

Dakle možemo otkloniti ovaj problem,

simply by making clean needles universally available

tako što ćemo učiniti da čiste igle budu svima dostupne

and taking away the fear of arrest.

i otkloniti strah od hapšenja.

Now, the first person to figure that out

Pa, prva osoba koja je to shvatila

and do something about it on a national scale

i koja je uradila nešto na državnom nivou

was that well-known, bleeding heart liberal

je ta poznata liberalka mekog srca,

Margaret Thatcher.

Margaret Tačer.

And she put in the world's first

Ona je osnovala prvi na svetu

national needle exchange program,

državni program razmene igala,

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

a ostale zemlje su pratile, Australija, Holandija i još nekoliko drugih,

And in all of those countries, you can see,

i u svim tim zemljama, vidite,

not more than four percent of injectors

nikada se HIV-om nije zarazilo više od

ever became infected with HIV.

četiri posto intravenskih narkomana.

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

U mestima koja ovo nisu učinila, Njujorku na primer,

Moscow, Jakarta --

Moskvi, Džakarti,

we're talking, at its peak,

govorimo o vrhuncu,

one in two injectors

jedan od dvoje narkomana

infected with this fatal disease.

zarazio se ovom smrtnom bolešću.

Now, Margaret Thatcher didn't do this

Margaret Tačer nije uradila ovo

because she has any great love for junkies.

jer gaji veliku ljubav prema narkomanima.

She did it because she ran a country

Uradila je to jer je vodila zemlju

that had a national health service.

koja je imala državni zdravstveni sistem.

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

Dakle, da nije ulagala u učinkovitu prevenciju,

she was going to have pick up the costs

morala bi da nadoknadi na troškovima

of treatment later on,

lečenja kasnije,

and obviously those are much higher.

a očigledno je da su oni mnogo veći.

So she was making a politically rational decision.

Dakle ona je donela politički razumnu odluku.

Now, if I take out my

Sad, ako uzmem svoje

public health nerd glasses here

naočare štrebera javnog zdravlja

and look at these data,

i pogledam ove podatke,

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

ovo deluje prosto kao pasulj, zar ne.

But in this country,

Ali u ovoj zemlji,

where the government apparently does not feel compelled

gde vlada očigledno ne oseća da mora

to provide health care for citizens, (Laughter)

da obezbedi zdravstvenu negu svojim građanima,

we've taken a very different approach.

imamo mnogo drugačiji pristup.

So what we've been doing in the United States

Ono što radimo u Sjedinjenim Državama

is reviewing the data -- endlessly reviewing the data.

je da analiziramo podatke, beskrajno ih analiziramo.

So, these are reviews of hundreds of studies

Znači ovo su analize stotina studija

by all the big muckety-mucks

koje su radile glavne face

of the scientific pantheon in the United States,

naučnog panteona Sjedinjenih Država,

and these are the studies that show

i ovo su studije, priličan broj njih, koje pokazuju

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

da su programi razmene igala učinkoviti.

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

Sad, one koje pokazuju da ovi programi nisu učinkoviti -

you think that's one of these annoying dynamic slides

mislite da je ovo jedan od onih dosadnih dinamičnih slajdova

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

i da ću da pritisnem svoje dugme i ostatak će da se pojavi,

but no -- that's the whole slide.

ali ne, to je ceo slajd.

(Laughter)

(smeh)

There is nothing on the other side.

Nema ništa sa druge strane.

So, completely irrational,

Dakle, potpuno racionalno,

you would think.

mislili biste

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

osim što, čekaj malo, političari su takođe racionalni,

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

i oni odgovaraju na ono što misle da glasači žele.

So what we see is that voters respond

Znači vidimo da glasači prilično

very well to things like this

dobro reaguju na ovakve stvari,

and not quite so well to things like this.

a ne tako dobro na ovakve.

(Laughter)

(smeh)

So it becomes quite rational

Znači postaje prilično razumno

to deny services to injectors.

da se intravenskim narkomanima uskrate usluge.

Now let's talk about sex.

Pričajmo sada o seksu.

Are we any more rational about sex?

Da li smo razumniji kad se radi o seksu?

Well, I'm not even going to address

Pa, neću ni da spominjem

the clearly irrational positions

očigledno iracionalna stanovišta

of people like the Catholic Church,

ljudi kao što je Katolička crkva,

who think somehow that if you give out condoms,

koji nekako misle da ako ljudima date kondome,

everyone's going to run out and have sex.

svi će da pojure i da upražnjavaju seks.

I don't know if Pope Benedict

Ne znam da li Papa Benedikt

watches TEDTalks online,

gleda TEDTalks na netu,

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

ali ako gledaš, imam vesti za tebe, Benedikt.

I carry condoms all the time

Ja stalno nosim kondome,

and I never get laid.

ali nikad nemam seks.

(Laughter) (Applause)

(smeh)

It's not that easy!

To nije tako lako.

Here, maybe you'll have better luck.

Evo, možda ćete vi imati više sreće.

(Applause)

(aplauz)

Okay, seriously,

Ok, ozbiljno,

HIV is actually not that easy

HIV ustvari nije tako lako

to transmit sexually.

preneti seksualnim putem.

So, it depends on how much virus there is

Znači, to zavisi od toga koliko virusa

in your blood and in your body fluids.

ima u vašoj krvi i telesnim tečnostima.

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

Imamo na početku vrlo, vrlo visok nivo virusa,

right at the beginning when you're first infected,

kad se tek zarazite,

then you start making antibodies,

tad počinjete da proizvodite antitela,

and then it bumps along at quite low levels

i onda se spusti na prilično nizak nivo

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

u toku dugog vremenskog perioda, 10 ili 12 godina,

you have spikes if you get another sexually transmitted infection.

vidite povišenje ako dobijete još neku seksualno prenosivu bolest,

But basically, nothing much is going on

ali u osnovi, ništa se ne dešava

until you start to get symptomatic AIDS,

dok ne dobijete simptome SIDE.

and by that stage,

I do tog stadijuma, ovde,

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

ne izgledate dobro, ne osećate se dobro,

you're not having that much sex.

nemate baš puno seksa.

So the sexual transmission of HIV

Znači seksualno prenošenje HIV-a

is essentially determined by how many partners you have

u osnovi određeno je time koliko partnera imate

in these very short spaces of time

u ovim kratkim vremenskim intervalima

when you have peak viremia.

kada ste tek zaraženi.

Now, this makes people crazy

Ovo neke ljude dovodi do ludila,

because it means that you have to talk about

jer znači da morate da pričate o tome

some groups having more sexual partners

da neke grupe imaju više seksualnih partnera

in shorter spaces of time than other groups,

u kraćim vremenskim periodima nego neke druge grupe,

and that's considered stigmatizing.

a to se smatra stigmatizujućim.

I've always been a bit curious about that

To me je uvek interesovalo,

because I think stigma is a bad thing,

jer smatram da je stigma loša,

whereas lots of sex is quite a good thing,

dok je mnogo seksa dobra stvar,

but we'll leave that be.

ali ostavićemo to kako jeste.

The truth is that 20 years

Istina je da nam je

of very good research

20 godina vrlo dobrog istraživanja

have shown us that

pokazalo da

there are groups that are more likely to turnover

postoje grupe ljudi koje su sklonije promeni

large numbers of partners in a short space of time.

velikog broja partnera u kratkom vremenskom roku

And those groups are, globally,

i te grupe su, na globalnom nivou,

people who sell sex and their more regular partners.

ljudi koji prodaju seks i njihovi redovniji partneri,

They are gay men on the party scene

to su gej muškarci iz sveta zabave

who have, on average, three times more partners

koji imaju, u proseku, tri puta više partnera

than straight people on the party scene.

nego strejt ljudi u svetu zabave,

And they are heterosexuals

i to su 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 visok nivo ženske autonomije

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

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

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

I to se odražava u epidemiji koju danas imamo.

You can see these horrifying figures from Africa.

Možete videti ove zastrašujuće cifre iz Afrike.

These are all countries in southern Africa

Ovo su sve zemlje u južnoj Africi

where between one in seven,

gde su između jedne od sedam

and one in three

i jedne od tri

of all adults,

svih odraslih osoba

are infected with HIV.

inficirane HIV virusom.

Now, in the rest of the world,

U ostatku sveta

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

skoro da se ništa ne događa u široj populaciji,

very, very low levels --

nivoi su vrlo, vrlo niski,

but we have extraordinarily high levels of HIV

ali imamo neobično visoke nivoe HIV-a

in these other populations who are at highest risk:

u ovim populacijama koje su izložene najvećem riziku,

drug injectors, sex workers

dakle kod intravenskih narkomana, seksualnih radnika,

and gay men.

i gej muškaraca.

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

Primetićete da su to lokalni podaci iz Los Anđelesa.

25 percent prevalence among gay men.

Prevalenca među gej muškarcima je 25%.

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

Naravno, ne možete dobiti HIV samo upražnjavanjem nezaštićenog seksa.

You can only HIV by having unprotected sex

HIV možete dobiti samo upražnjavanjem nezaštićenog seksa

with a positive person.

sa pozitivnom osobom.

In most of the world,

U većem delu sveta,

these few prevention failures

ovih nekoliko neuspeha prevencije

notwithstanding,

ne odolevaju,

we are actually doing quite well these days

ovih dana prilično nam dobro ide

in commercial sex:

u komercijalnom seksu.

condom use rates are between 80 and 100 percent

Stopa korišćenja kondoma je između 80 i 100%

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 zato što su motivi ujednačeni.

What's rational for public health

Ono što je razumno za javno zdravlje

is also rational for individual sex workers

je takođe razumno za pojedinačne seksualne radnike

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

jer zaista je loše za posao da imate još jednu seksualno prenosivu bolest.

No one wants it.

Niko to ne želi.

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

A ni klijenti zaista ne žele da odu kući bolesni.

So essentially, you're able to achieve

Znači možemo da postignemo

quite high rates of condom use in commercial sex.

prilično visoku stopu korišćenja kondoma u komercijalnom seksu.

But in "intimate" relations

Ali u "intimnim" odnosima

it's much more difficult because,

to je mnogo teže jer,

with your wife or your boyfriend

sa vašom ženom ili momkom,

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

ili nekim za koga se nadate da bi mogao postati nešto od toga,

we have this illusion of romance

imamo tu iluziju romantike

and trust and intimacy,

i poverenja i bliskosti,

and nothing is quite so unromantic

a ništa nije toliko neromantično

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

kao pitanje "Moj kondom ili tvoj, dušo?".

So in the face of that,

Znači, suočeni sa ovim,

you really need quite a strong incentive

potrebni su vam prilično jaki motivi

to use condoms.

da biste koristili kondome.

This, for example, this gentleman is called Joseph.

Na primer ovo. Ovaj gospodin se zove Džozef.

He's from Haiti and he has AIDS.

Sa Haitija je i ima SIDU,

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

verovatno trenutno nema mnogo seksa,

but he is a reminder in the population,

ali on je podsetnik u narodu

of why you might want to be

zašto biste možda hteli

using condoms.

da koristite kondome.

This is also in Haiti and is a reminder

Ovo je takođe na Haitiju i podsetnik je

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

zašto biste želeli da imate seks, verovatno.

Now, funnily enough, this is also Joseph

Sad, za divno čudo, ovo je takođe Džozef

after six months on antiretroviral treatment.

posle 6 meseci antiretrovirusnog tretmana.

Not for nothing do we call it the Lazarus Effect.

Ne zovemo ga džabe Lazarov efekat.

But it is changing the equation

Ali to menja jednačinu

of what's rational

o tome šta je racionalno

in sexual decision-making.

u donošenju odluka u vezi sa seksom.

So, what we've got --

Znači, šta imamo -

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

neki ljudi kažu, "O, nije bitno

because, actually, treatment is effective prevention

jer, ustvari lečenje je efikasna prevencija

because it lowers your viral load and therefore

jer snižava vaše virusno opterećenje i na taj način

makes it more difficult to transmit HIV."

čini prenošenje HIV-a težim."

So, if you look at the viremia thing again,

Dakle, ako ponovo pogledate prisutnost virusa u krvi,

if you do start treatment when you're sick,

ako započnete lečenje dok ste bolesni

well, what happens? Your viral load comes down.

šta se dešava? Virusno opterećenje vam opadne.

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

Ali u poređenju sa čim? Šta se dešava ako se ne lečite?

Well, you die,

Pa, umrete,

so your viral load goes to zero.

tako da vaše virusno opterećenje padne na nulu.

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

I sve ovo zeleno ovde, uključujući i šiljke

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

koji predstavljaju to da niste mogli stići do apoteke,

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

ili vam je nestalo lekova, ili ste bili na trodnevnoj neprekidnoj žurci

and forgot to take your drugs,

i zaboravili da uzmete lekove,

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

ili ste razvili toleranciju na lek, bilo šta,

all of that is virus

sve to predstavlja virus

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

koji ne bi bio tamo, da nije lečenja.

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

Sada, da li ja govorim, odlična strategija prevencije,

Let's just stop treating people."

hajde da prestanemo da lečimo 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 da proširimo antiretrovirusno lečenje što je više moguće.

But what I am doing is calling into question

Ali ja zapravo preispitujem

those people who say that more treatment

one ljude koji kažu da je više lečenja

is all the prevention we need.

sva prevencija koja nam je potrebna.

That's simply not necessarily true,

To nije baš istinito,

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

mislim da možemo da naučimo mnogo iz iskustva gej muškaraca

in rich countries where treatment has been widely available

iz bogatih zemalja gde je lečenje široko dostupno

for going on 15 years now.

i traje već 15 godina,

And what we've seen is

i ono što vidimo je

that, actually, condom use rates,

da ustvari stopa upotrebe kondoma,

which were very, very high --

koja je bila vrlo, vrlo visoka -

the gay community responded very rapidly to HIV,

gej zajednica je veoma brzo reagovala na HIV

with extremely little help

uz izuzetno malo pomoći

from public health nerds, I would say --

štrebera javnog zdravlja, rekla bih -

that condom use rate has come down dramatically since treatment

stopa upotrebe kondoma dramatično je opala zbog lečenja

for two reasons really:

iz dva razloga.

One is the assumption of, "Oh well,

Jedan je pretpostavka, "O, pa

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

ako je zaražen onda je verovatno na lekovima,

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

njegovo virusno opterećenje je nisko, pa sam prilično bezbedan."

And the other thing is that people are simply

A druga stvar je ta da se ljudi jednostavno

not as scared of HIV

ne plaše HIV-a

as they were of AIDS, and rightly so.

kao što su se plašili SIDE, i to sa pravom.

AIDS was a disfiguring disease that killed you,

SIDA je deformišuća bolest koja vas ubija,

and HIV is an invisible virus

a HIV je nevidljivi virus

that makes you take a pill every day.

zbog kog uzimate tabletu svakog dana.

And that's boring,

I to je dosadno,

but is it as boring as

ali da li je dosadno kao

having to use a condom every time you have sex,

to da morate da koristite kondom svaki put kad imate seks,

no matter how drunk you are,

bez obzira koliko ste pijani,

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

bez obzira koliko ste droge uzeli, šta god?

If we look at the data, we can see that

Ako pogledamo podatke, vidimo

the answer to that question

da je odgovor na to pitanje

is, mmm.

mhmm.

So these are data from Scotland.

Ovo su podaci iz Škotske.

You see the peak in drug injectors

Vidite šiljak kod intravenskih narkomana

before they started the national needle exchange program.

pre nego što je počeo nacionalni program zamene igala.

Then it came way down.

Onda je opao,

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

i kod heteroseksualaca, uglavnom u komercijalnom seksu

and in drug users,

i kod narkomana,

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

ne dešava se mnogo pošto je tretman otpočeo

and that's because of that alignment of incentives

a to je zbog izjednačavanja motiva

that I talked about earlier.

o čemu sam pričala ranije.

But in gay men,

Ali kod gej muškaraca

you've got quite a dramatic rise

imate dramatičan porast

starting three or four years

koji počinje tri ili četiri godine

after treatment became widely available.

pošto je lečenje postalo široko dostupno.

This is of new infections.

Ovo važi za novoinficirane.

What does that mean?

Šta to znači?

It means that the combined effect of being less worried

To znači da udruženi efekat 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 živote,

more likely to be getting laid

uz veću verovatnoću da imaju seks

with HIV --

sa HIV-om,

is outweighing the effects of lower viral load,

ima veću težinu od efekata niskog virusnog opterećenja,

and that's a very worrisome thing.

a to je veoma zabrinjavajuća stvar.

What does it mean?

Šta to znači?

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

Znači da što više lečenja imamo, moramo više da se bavimo prevencijom.

Is that what's happening?

Da li se to dešava?

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

Ne, a ja to nazivam zagonetkom saosećanja.

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

Mnogo smo pričali o saosećanju poslednjih nekoliko dana.

and what's happening really is that people are

A zaista se dešava to da ljudi

unable quite to bring themselves to put in

ne mogu da se nateraju da obezbede

good sexual and reproductive health services for sex workers,

dobre zdravstvene i seksualne službe za seksualne radnike,

unable quite to be giving out needles to junkies.

ne mogu da dele igle narkomanima,

But once they've gone from being

ali kad oni prestanu da budu

transgressive people whose behaviors we don't want to condone

prestupnici, čije ponašanje ne želimo da praštamo,

to being AIDS victims,

i postanu žrtve SIDE,

we come over all compassionate

mi postanemo previše saosećajni

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

i kupujemo im neverovatno skupe lekove do kraja njihovih života.

It doesn't make any sense

To nema nikakvog smisla

from a public health point of view.

sa tačke gledišta javnog zdravlja.

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

Želim da prepustim poslednju reč Ines.

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

Ines je prostitutka transseksualac, na ulicama Džakarte.

she's a chick with a dick.

Ona je devojka s kitom.

Why does she do that job?

Zašto se bavi tim poslom?

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

Naravno, jer je primorana na to,

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

jer nema bolju opciju, itd itd,

And if we could just teach her to sew

i kad bismo samo mogli da je naučimo da šije

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

i našli joj lep posao u fabrici, sve bi bilo dobro.

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

Ovoliko zarađuju radnici u fabrici na sat, u Indoneziji,

on average, 20 cents.

u proseku, 20 centi.

It varies a bit province to province.

To varira od pokrajine do pokrajine.

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

Ja razgovaram sa seksualnim radnicima, sa njih 15.000

for this particular slide,

za ovaj konkretni slajd.

and this is what sex workers

A seksualni radnici kažu da

say they earn in an hour.

zarade ovoliko za sat vremena.

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.

to je stvarno prilično razuman izbor.

Okay, Ines.

OK, Ines.

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

Imamo načine, imamo znanje i novac

and commitment to preventing HIV too.

i obavezu da sprečimo HIV.

Ines: So why is prevalence still rising?

Ines: I zašto onda broj zaraženih raste?

It's all politics.

Sve je to politika.

When you get to politics, nothing makes sense.

Kada dođete do politike, ništa nema smisla.

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

Elizabet Pizani: "Kada dođete do politike, ništa nema smisla."

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

Dakle, sa tačke gledišta seksualne radnice,

politicians are making no sense.

političari su besmisleni.

From the point of view of a public health nerd,

Sa tačke gledišta štrebera javnog zdravlja,

junkies are doing dumb things.

narkomani prave gluposti.

The truth is that everyone has a different rationale.

Mislim, istina je da svako ima drugačije načelo.

There are as many different ways of being rational

Koliko ima ljudskih bića na planeti,

as there are human beings on the planet,

toliko ima i načina da se bude racionalan,

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

a to je jedna od divota ljudske egzistencije.

But those ways of being rational

Ali ti načini da se bude razuman

are not independent of one another,

nisu nezavisni jedni od drugih.

so it's rational for

Znači razumno je

a drug injector to share needles

za narkomana da deli igle

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

zbog glupe odluke koju su doneli političari,

and it's rational for a politician

a za političare je razumno

to make that stupid decision

da donesu tu glupu odluku

because they're responding to

jer oni odgovaraju na ono

what they think the voters want.

što misle da glasači žele.

But here's the thing:

Ali o čemu se radi:

we are the voters.

mi smo glasači.

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

Nismo svi glasači, naravno, ali TED je zajednica lidera u idejama,

And everyone who's in this room,

i mislim da su svi koji su u ovoj sobi

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

i svi koji gledaju ovo preko interneta

I think, has a duty to demand of their politicians

dužni da zahtevaju od svojih političara

that we make policy based on scientific evidence

da prave propise zasnovane na naučnim dokazima

and on common sense.

i zdravom razumu.

It's going to be really hard for us

Biće nam veoma teško

to individually affect what's rational

da pojedinačno utičemo na ono što je razumno

for every Frankie and every Ines out there,

za svakog Frenkija i svaku Ines u svetu.

but you can at least use your vote

Ali barem možete iskoristiti svoj glas

to stop politicians doing stupid things

da sprečite političare da donose glupe odluke

that spread HIV.

koje šire HIV.

Thank you.

Hvala vam.

(Applause)

(aplauz)