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

翻译人员: Elena YAN 校对人员: Chunlei Chang

"People do stupid things.

“人会干傻事。

That's what spreads HIV."

于是HIV就传播开来。”

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

这句话是一家英国报纸的头条，

The Guardian, not that long ago.

不久之前出版的《卫报》。

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

我很好奇，请大家举个手，谁同意这句话？

Well, one or two brave souls.

哦，有一两位勇士。

This is actually a direct quote from an epidemiologist

这句话实际上出自一位流行病学家之口

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

她研究HIV已有15年，

worked on four continents,

足迹遍布四大洲，

and you're looking at her.

你们现在正看着她。

And I am now going to argue

我现在想说明

that this is only half true.

这句话只说对了一半。

People do get HIV because they do stupid things,

有些人确实是因为做了傻事感染了HIV，

but most of them are doing stupid things

但是其中的大多数人虽然做这些傻事

for perfectly rational reasons.

却有完全合乎理智的原因。

Now, "rational" is the dominant paradigm

“理智”是公共卫生的

in public health,

首要准则。

and if you put your public health nerd glasses on,

现在你戴上公共卫生怪胎眼镜，

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

你便会知道如果你提供给人们必要的信息

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

告诉他们什么对他们好，什么不好，

if you give them the services

如果你给他们必要的服务

that they can use to act on that information,

使他们能对上述信息做出反应，

and a little bit of motivation,

再加上一丁点的鼓励，

people will make rational decisions

人们就会做出理智的决定

and live long and healthy lives.

从此健康长寿。

Wonderful.

好极了。

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

但对于像我这样研究HIV的人，有一点小麻烦，

and although I'm sure you all know

虽然我确信大家都知道

that HIV is about poverty and gender inequality,

HIV与贫穷和两性不平等有紧密的联系。

and if you were at TED '07

如果你参加了TED'07，

it's about coffee prices ...

就知道HIV与咖啡的价格紧紧相关；

Actually, HIV's about sex and drugs,

实际上，HIV和性交，毒品脱不了干系。

and if there are two things that make

如果说世上有两样东西

human beings a little bit irrational,

使人类丧失理智，

they are erections and addiction.

那就是勃起和上瘾。

(Laughter)

（笑声）

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

那么，我们先说说瘾君子认为什么不和逻辑。

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

我曾经和一位印尼的朋友，Fankie，聊天。

We were having lunch and he was telling me

我们一起吃午餐，他跟我讲

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

他在巴里岛监狱里注射毒品的经历。

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

那天是一个人的生日，他们偷偷将一些海洛因

smuggled some heroin into jail,

弄进了监狱，

and he was very generously sharing it out

他非常大方地邀请牢房里的兄弟们

with all of his colleagues.

一起享用。

And so everyone lined up,

于是每个人都排好队，

all the smackheads in a row,

所有瘾君子排成一排。

and the guy whose birthday it was

过生日的那个人

filled up the fit,

准备好注射器，

and he went down and started injecting people.

蹲下身，开始给兄弟们注射海洛因。

So he injects the first guy,

他给第一个兄弟注射后，

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

顺手用衣服擦擦针管，

and he injects the next guy.

再注射下一个。

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

Frankie说：“我是第22个，

and I can see the needle coming down towards me,

我看见针管离我越来越近，

and there is blood all over the place.

地上到处都是血。

It's getting blunter and blunter.

针管越来越钝。

And a small part of my brain is thinking,

我脑子里在想，

'That is so gross

“真是恶心死了

and really dangerous,'

太危险了，”

but most of my brain is thinking,

但是我更关心的是，

'Please let there be some smack left

拜托，拜托到我的时候

by the time it gets to me.

针管里还有点海洛因。

Please let there be some left.'"

拜托给我留一点。”

And then, telling me this story,

故事讲完后，

Frankie said,

Frankie说：

"You know ... God,

“你知道，天，

drugs really make you stupid."

毒品真能让你蠢到极点。”

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

而且，你知道，他这句话你挑不出一点毛病，

But, actually, Frankie, at that time,

但是Frankie那时，

was a heroin addict and he was in jail.

是个瘾君子，而且他被关在监狱。

So his choice was either

所以他只能选择

to accept that dirty needle or not to get high.

要么接受那血迹斑斑的针头，要么就没法过瘾。

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

如果真有什么地方你确实很想过过瘾，

it's when you're in jail.

那就是监狱。

But I'm a scientist

但现在我是位科学家，

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

我不会用八卦故事当数据，

so let's look at some data.

所以现在来看看数据。

We talked to 600 drug addicts

我们采访在印尼的三座城市的

in three cities in Indonesia,

600名瘾君子，

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

我们问他们：“你知道你怎么感染HIV的吗？”

"Oh yeah, by sharing needles."

“哦，当然知道。共用一个针头。”

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

我是说，差不多100%，对，都是共用针头害的。

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

我们又问：“你知道在哪可以买到

at a price you can afford to avoid that?"

干净又便宜的针头吗？”

"Oh yeah." Hundred percent.

100%的人都答道：“哦，知道。”

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

“我们吸毒，我们当然知道上哪儿去弄干净的针头。”

"So are you carrying a needle?"

“那你们会带着针头吗？”

We're actually interviewing people on the street,

我们采访的那些地方就在街上，

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

瘾君子们聚集在一起服毒。

"Are you carrying clean needles?"

“你们带着干净的针头吗？”

One in four, maximum.

最多四分之一的人带着。

So no surprises then that

所以也难怪

the proportion that actually used clean needles

在上周每次注射时真正

every time they injected in the last week

使用干净针头的比例

is just about one in 10,

只有十分之一。

and the other nine in 10 are sharing.

另外十分之九共用一个针头。

So you've got this massive mismatch;

你看，这前后矛盾。

everyone knows that

每个人都知道

if they share they're going to get HIV,

共用针头会感染HIV，

but they're all sharing anyway.

但是他们还是用一个针头。

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

这是为什么呢？是共用针头让你更过瘾吗？

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

我们这样问他们，他们说：“你疯了？

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

你当然不会愿意和别人共用针头，就像你绝不愿意共一把牙刷，

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

就算他是你的情人也不行。

There's just kind of an ick factor there.

这是因为，你知道，ick的原因。

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

不是，不是。我们共用针头因为我们不想进监狱。”

So, in Indonesia at this time,

现在，在印尼

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

如果你被逮到藏有针头，就会被警察抓走，

they could put you into jail.

丢进监狱.

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

这样看的话，情况就不一样了，对吗？

Because your choice now is either

因为这时你的选择就是，

I use my own needle now,

要么用现在自己的针头，

or I could share a needle now

要么现在和别人用一个针头

and get a disease that's going to

感染上病

possibly kill me 10 years from now,

过个十年因此而死，

or I could use my own needle now

或者我可以现在用自己的针头

and go to jail tomorrow.

明天就去蹲监狱。

And while junkies think that

虽然瘾君子们认为

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

置身于感染HIV的危险中绝不是什么好事，

they think it's a much worse idea

但是在监狱里过一年

to spend the next year in jail

更加糟糕，

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

你很可能在监狱里遇上Frankie所说的情况

and expose themselves to HIV anyway.

最终还是可能感染HIV。

So, suddenly it becomes perfectly rational

这样，突然间，共用针头

to share needles.

就变得非常有道理了。

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

现在我们从政策决策者的角度看看这个问题。

This is a really easy problem.

实际上非常简单。

For once, your incentives are aligned.

终于有一次，大家达成了一致意见。

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

从公共卫生角度，我们得出了理性的答案。

You want people to use clean needles --

我们希望瘾君子用干净的针头，

and junkies want to use clean needles.

瘾君子也想用干净的针头。

So we could make this problem go away

所以我们只用使瘾君子们能随时拿到针头

simply by making clean needles universally available

同时让他们不必担心被逮捕

and taking away the fear of arrest.

就能解决这个问题。

Now, the first person to figure that out

而第一个想出这一招

and do something about it on a national scale

并在全国执行的人

was that well-known, bleeding heart liberal

就是大名鼎鼎的“铁娘子”

Margaret Thatcher.

英国首相撒切尔夫人。

And she put in the world's first

她推行了全球第一项

national needle exchange program,

国家针头交换计划

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

其他国家竞相效仿，澳大利亚，荷兰和一小部分其他国家，

And in all of those countries, you can see,

在这些国家里，你们可以看到，

not more than four percent of injectors

低于百分之四的吸毒人员

ever became infected with HIV.

曾因注射而感染HIV。

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

再看，没有实行这一政策的国家，比如纽约，

Moscow, Jakarta --

莫斯科，雅加达，

we're talking, at its peak,

在峰值时，

one in two injectors

每两个注射毒品的人中

infected with this fatal disease.

就有一个感染了这种致命疾病。

Now, Margaret Thatcher didn't do this

撒切尔首相做这些

because she has any great love for junkies.

不是因为她对瘾君子有恻隐之心，

She did it because she ran a country

她这样做是她执政的国家

that had a national health service.

有国家免费医疗系统。

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

所以，如果她不在有效疾病预防方面投资，

she was going to have pick up the costs

她以后就必须为疾病的治疗

of treatment later on,

付出昂贵的费用，

and obviously those are much higher.

而且治疗的费用昂贵的多。

So she was making a politically rational decision.

所以她做出了一个政治上很理智的决定。

Now, if I take out my

现在，如果我带上我

public health nerd glasses here

公共卫生怪胎的眼镜，

and look at these data,

再看看这些数据，

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

这完全不合逻辑。

But in this country,

但是在这个国家，

where the government apparently does not feel compelled

政府显然不认为他们必须

to provide health care for citizens, (Laughter)

为公民提供免费医疗，

we've taken a very different approach.

我们于是采取了大相径庭的解决方法。

So what we've been doing in the United States

在美国，我们一直在做的事情是

is reviewing the data -- endlessly reviewing the data.

验证数据，不断地验证。

So, these are reviews of hundreds of studies

于是上百个研究的数据

by all the big muckety-mucks

被大型的muckety-mucks

of the scientific pantheon in the United States,

美国科学界圣人验证，

and these are the studies that show

而大量的研究表明

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

针头计划是有效的。

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

再看，这些表明针头计划无效的研究

you think that's one of these annoying dynamic slides

你们认为在这张烦人的幻灯片上，

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

我按一下手中的遥控器，剩下的数据就会出现，

but no -- that's the whole slide.

但是，没有，这张幻灯片上就这么多内容。

(Laughter)

（笑声）

There is nothing on the other side.

另外一栏什么也没有。

So, completely irrational,

那么，这完完全全没有道理。

you would think.

你肯定这样想，

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

只是，等下，不对，政客们也是理智的，

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

而且他们所做的事情是他们认为选民们想做的。

So what we see is that voters respond

我们看到的是选民们都

very well to things like this

十分愿意回应这种情况

and not quite so well to things like this.

而不愿意回应这种情况。

(Laughter)

（笑声）

So it becomes quite rational

所以拒绝向瘾君子提供服务

to deny services to injectors.

就显得很有道理。

Now let's talk about sex.

现在来说说性交。

Are we any more rational about sex?

我们在性交上更理智吗？

Well, I'm not even going to address

呃，我根本不会去评论

the clearly irrational positions

天主教徒们那些

of people like the Catholic Church,

完全不和逻辑的想法。

who think somehow that if you give out condoms,

以为只要你免费发保险套，

everyone's going to run out and have sex.

人们就会出去找乐子。

I don't know if Pope Benedict

我不知道本尼迪克特教皇

watches TEDTalks online,

是否会在线看TED的演讲，

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

但是教皇，您看的话，我有话要跟您讲。

I carry condoms all the time

我随身带着保险套，

and I never get laid.

但从来没机会用。

(Laughter) (Applause)

（笑声）

It's not that easy!

这种机会可不容易找。

Here, maybe you'll have better luck.

接着，也许你的运气好一点。

(Applause)

（掌声）

Okay, seriously,

OK，严格地说，

HIV is actually not that easy

HIV不是很容易

to transmit sexually.

通过性交传染。

So, it depends on how much virus there is

是否传染取决于你血液和体液所含的

in your blood and in your body fluids.

病毒数量

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

当某人感染HIV后，在感染最初期

right at the beginning when you're first infected,

病毒含量非常，非常高，

then you start making antibodies,

然后你的身体开始产生抗体，

and then it bumps along at quite low levels

之后很长的一段时间内

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

10年或12年，病毒的含量都保持在相当低的水平，

you have spikes if you get another sexually transmitted infection.

如果你有与他人发生关系而受到感染，you have spikes ，

But basically, nothing much is going on

但一般而言，在你开始出现艾滋病的

until you start to get symptomatic AIDS,

症状之前，不会发生什么。

and by that stage,

而到了那一阶段，这里，

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

你会看起来很糟，感觉很不好，

you're not having that much sex.

不会发生很多性交。

So the sexual transmission of HIV

所以通过性交感染HIV基本取决于

is essentially determined by how many partners you have

当你体内的病毒达到高潮时

in these very short spaces of time

的那一段非常短的时间段内

when you have peak viremia.

你有多少位同伴。

Now, this makes people crazy

这一来人们就要发疯了

because it means that you have to talk about

因为这意味着你必须谈论

some groups having more sexual partners

有些人在较短的时间内

in shorter spaces of time than other groups,

比另外一些人有更多的同伴，

and that's considered stigmatizing.

这样就太侮辱人了。

I've always been a bit curious about that

我一直都对此很好奇

because I think stigma is a bad thing,

因为我认为侮辱是件很不好的事情，

whereas lots of sex is quite a good thing,

而然性交频繁却是件很好的事，

but we'll leave that be.

不过这事就这样吧。

The truth is that 20 years

事实是20年来

of very good research

很出色的研究

have shown us that

告诉我们

there are groups that are more likely to turnover

有一些人更倾向于

large numbers of partners in a short space of time.

在短时期内有很多伙伴，

And those groups are, globally,

而基本上这些人，

people who sell sex and their more regular partners.

都是出卖色情，有更多的同伴，

They are gay men on the party scene

在派对上的同性恋拥有的伙伴数量

who have, on average, three times more partners

平均比派对上的异性恋

than straight people on the party scene.

多出两倍，

And they are heterosexuals

还有些异性恋

who come from countries that have

他们来自的国家

traditions of polygamy

有一妻多夫的传统

and relatively high levels of female autonomy,

女性有较强的自主权，

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

大多数此类国家都在南部非洲的东部。

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

这些都反映在现在大范围流行的疾病上。

You can see these horrifying figures from Africa.

大家看来自非洲的这些数据，让人不寒而栗。

These are all countries in southern Africa

这些全部是南部非洲的国家

where between one in seven,

七分之一

and one in three

到三分之一

of all adults,

的成年人

are infected with HIV.

都感染了HIV。

Now, in the rest of the world,

而在世界其他国家，

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

基本上普通大众平安无事，

very, very low levels --

非常低的比率，

but we have extraordinarily high levels of HIV

但是HIV携带率

in these other populations who are at highest risk:

在高危人群中的比率异常的高，

drug injectors, sex workers

像注射毒品的瘾君子，性工作者，

and gay men.

男同性恋。

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

大家注意看旧金山的地方数据。

25 percent prevalence among gay men.

有25%的同性恋感染了HIV。

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

当然，如果只进行无预防措施的性交不会染上HIV。

You can only HIV by having unprotected sex

你只有和在传染期的携带者

with a positive person.

发生无预防措施的性交才会染病。

In most of the world,

在世界大多数地方，

these few prevention failures

有些预防措施失效了

notwithstanding,

但不多，

we are actually doing quite well these days

在性交易行业里

in commercial sex:

实际上，我们（预防措施）做的很不错。

condom use rates are between 80 and 100 percent

在大多数国家性性交易行业

in commercial sex in most countries.

安全套的使用率在80%到100%。

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

正是因为形成了这些鼓励措施

What's rational for public health

对公共卫生讲这是理智的行为

is also rational for individual sex workers

对个体性工作者也是理智的。

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

因为染上病会影响生意。

No one wants it.

没人希望如此。

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

而且，也没有哪个顾客想带病回家。

So essentially, you're able to achieve

所以最终，你可以在性交易行业

quite high rates of condom use in commercial sex.

达到高安全套使用率。

But in "intimate" relations

但是在“亲密”关系中，

it's much more difficult because,

就困难的多了

with your wife or your boyfriend

因为也许你的妻子或男友，

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

或你想进一步发展成为恋人或配偶的那个人，

we have this illusion of romance

因为某种浪漫的幻想

and trust and intimacy,

信任和亲密，

and nothing is quite so unromantic

没有什么比“亲爱的，用你的安全套还是我的”

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

这样的问题，更让人扫兴的了。

So in the face of that,

所以，在那种情况下，

you really need quite a strong incentive

你需要有强大的意愿

to use condoms.

才会使用安全套。

This, for example, this gentleman is called Joseph.

就像这位先生，他叫Joseph。

He's from Haiti and he has AIDS.

来自海地，患有艾滋，

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

现在他大概没有什么性交，

but he is a reminder in the population,

但是他提醒着其他的人们，

of why you might want to be

你为什么想用

using condoms.

安全套。

This is also in Haiti and is a reminder

这张也在海地，提醒着你

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

为什么想上床。

Now, funnily enough, this is also Joseph

好了，挺好笑，这张还是Joseph。

after six months on antiretroviral treatment.

在进行抗病毒治疗6个月后（的照片）。

Not for nothing do we call it the Lazarus Effect.

这就是为什么我们称之为拉撒路效应。

But it is changing the equation

但是这样一来等式两边就不平衡了

of what's rational

在性交时

in sexual decision-making.

什么样的决定才是理智的。

So, what we've got --

我们听到

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

有些人说：“这没什么要紧的

because, actually, treatment is effective prevention

因为实际上，治疗非常有效

because it lowers your viral load and therefore

治疗使你体内的病毒减少了

makes it more difficult to transmit HIV."

所以就很难传递HIV了。”

So, if you look at the viremia thing again,

那么，如果大家再看看感染病毒的情况，

if you do start treatment when you're sick,

如果你在生病时就开始治疗，

well, what happens? Your viral load comes down.

你体内的病毒携带量就会下降。

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

但是这跟怎么比呢？如果你没有接受治疗呢？

Well, you die,

那你就会死，

so your viral load goes to zero.

这样你体内的病毒携带量变成了零。

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

这些绿色部分，包括SPIKES，

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

是因为你没有去看医生

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

或者你没有药了，或者你去派对狂欢三天

and forgot to take your drugs,

完全忘记吃药，

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

或者你的身体开始产生抗药性，或者随便别的什么，

all of that is virus

这些全部是病毒

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

不是因为治疗，这些都不会在这里。

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

那我的意思是，好啊，多棒的预防策略啊，

Let's just stop treating people."

我们都别给患者治病了吧？

Of course not, of course not.

当然不是，当然不是，

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

我们必须尽量让更多的人接受抗病毒的治疗。

But what I am doing is calling into question

但是我要提出一个问题

those people who say that more treatment

问那些说只要更多的治疗就足够我们预防艾滋的人

is all the prevention we need.

你们凭什么这么说。

That's simply not necessarily true,

事实显然并非如此，

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

在发达国家艾滋病的治疗已经普及了15年，

in rich countries where treatment has been widely available

我们可以在那些国家的男同性恋那里

for going on 15 years now.

学到很多教训，

And what we've seen is

我们看到

that, actually, condom use rates,

实际上，安全套的使用率

which were very, very high --

非常，非常高

the gay community responded very rapidly to HIV,

同性恋群中，对HIV的反应也很迅速，

with extremely little help

几乎不需要

from public health nerds, I would say --

公共卫生人员的帮助

that condom use rate has come down dramatically since treatment

接受治疗后，安全套的使用率开始锐减

for two reasons really:

主要有两个原因。

One is the assumption of, "Oh well,

有一种想法是：“呃，

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

要是他感染了，他肯定在吃药，

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

那他的病毒携带量就很低，所以我安全的很。”

And the other thing is that people are simply

另一个原因是人们根本

not as scared of HIV

不像害怕艾滋一样

as they were of AIDS, and rightly so.

害怕HIV，这样想也对。

AIDS was a disfiguring disease that killed you,

艾滋把你折腾的不像人样，还致你于死命，

and HIV is an invisible virus

HIV是看不见摸不着的病毒

that makes you take a pill every day.

害你每天吃片药。

And that's boring,

真无聊，

but is it as boring as

就和每次做爱都要用安全套

having to use a condom every time you have sex,

一样的无聊，

no matter how drunk you are,

不管你喝的多醉，

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

不管你和几个瘾君子上床，什么都不管

If we look at the data, we can see that

看看数据，我们会发现

the answer to that question

问题的答案就在

is, mmm.

嗯——

So these are data from Scotland.

这些是苏格兰的数据

You see the peak in drug injectors

你看毒品注射者这些峰值

before they started the national needle exchange program.

是在苏格兰全国针头交换计划实施之前

Then it came way down.

之后人数下降了

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

不管是异性恋，大多数是性工作者

and in drug users,

还是瘾君子，

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

在开始治疗之后，基本上没有出现任何状况，

and that's because of that alignment of incentives

这要归功于我先前提到的

that I talked about earlier.

那些鼓励政策

But in gay men,

但是男同性恋中，

you've got quite a dramatic rise

在治疗广泛推行的

starting three or four years

三四年内

after treatment became widely available.

数量却急剧上升。

This is of new infections.

这些是新增的感染者。

What does that mean?

这意味着什么？

It means that the combined effect of being less worried

这意味着一方面人们不再那么害怕（HIV）

and having more virus out there in the population --

而另一方面，病毒携带者的数量增加了，

more people living longer, healthier lives,

更多人活的更长，更健康，

more likely to be getting laid

更可能身为HIV携带者依然进行性交

with HIV --

这些综合因素的影响

is outweighing the effects of lower viral load,

已超过了低病毒携带的影响，

and that's a very worrisome thing.

这让我很担心。

What does it mean?

这意味着什么？

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

这意味着医疗方法越进步，我们越要加强预防力度。

Is that what's happening?

实际情况时这样的吗？

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

不，我把这种情况称作同情难题。

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

这两天我们常常讨论同情心。

and what's happening really is that people are

现在的情况是人们

unable quite to bring themselves to put in

很难做到

good sexual and reproductive health services for sex workers,

为性工作者提供高质量的性和生育健康服务，

unable quite to be giving out needles to junkies.

很难给瘾君子发针头，

But once they've gone from being

但是一旦他们不再是不可饶恕的

transgressive people whose behaviors we don't want to condone

瘾君子或性工作者，

to being AIDS victims,

而成为了艾滋病人，

we come over all compassionate

我们会抛开一切情绪

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

为他们买昂贵的药物，直到他们生命终结的那天。

It doesn't make any sense

从公共卫生的角度讲

from a public health point of view.

这完全没有道理。

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

我想对Ines说几句离别的话。

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

Ines是为变性人，她在雅加达的街上当妓女。

she's a chick with a dick.

她是有小鸡鸡的女生。

Why does she do that job?

她为什么当妓女？

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

当然是因为她被逼无奈

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

别无选择，等等等等，

And if we could just teach her to sew

但是如果我们教她缝纫

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

给她在工厂里提供一份好工作，事情就圆满了。

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

在印尼，工厂工人平均一个小时

on average, 20 cents.

赚20美分。

It varies a bit province to province.

每个省份的情况稍微有点不同。

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

这张幻灯片上的数据

for this particular slide,

来自我在和15000名性工作者的谈话。

and this is what sex workers

这是性工作者自报的

say they earn in an hour.

每小时的薪水。

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

这个工作不怎么样，但是对很对人而言

it really is quite a rational choice.

确实很明智的选择。

Okay, Ines.

OK，Ines。

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

我们也有方法，知识，现金，

and commitment to preventing HIV too.

以及决心，防治HIV。

Ines: So why is prevalence still rising?

Ines：那为什么HIV的携带者数量还在上升？

It's all politics.

都是因为政治原因。

When you get to politics, nothing makes sense.

当政治介入后，一切都变得毫无道理。

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

Elizabeth Pisani：“当政治介入后，一切都变得毫无道理。”

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

从性工作者的角度看，

politicians are making no sense.

政客们完全没有道理。

From the point of view of a public health nerd,

从公共卫生怪胎的角度看，

junkies are doing dumb things.

瘾君子们在做蠢事。

The truth is that everyone has a different rationale.

每个人都有自己的一套逻辑。

There are as many different ways of being rational

世上有多少个人

as there are human beings on the planet,

就有多少种逻辑。

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

这是人类的闪光点之一。

But those ways of being rational

但是种种不同的逻辑

are not independent of one another,

并不是单存于世。

so it's rational for

所以瘾君子们

a drug injector to share needles

共用针头很理性

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

因为政治家的一个愚蠢的决定，

and it's rational for a politician

政治家做了愚蠢的决定

to make that stupid decision

也很理智

because they're responding to

因为他们是以他们认为的

what they think the voters want.

投票者赞同的方式行动。

But here's the thing:

但问题是：

we are the voters.

我们才是投票者。

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

当然不止我们这些人，但是TED是一个有见解的领军人物的集聚地，

And everyone who's in this room,

每个在这间房间的人，

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

每个在网站上看这些视频的人，

I think, has a duty to demand of their politicians

都有义务要求政客们

that we make policy based on scientific evidence

在科学证据和常识的基础上

and on common sense.

指定政策。

It's going to be really hard for us

我们很难

to individually affect what's rational

单独地去影响

for every Frankie and every Ines out there,

世界上每个Frankie和Ines的决定。

but you can at least use your vote

但是你至少能利用手中的投票权

to stop politicians doing stupid things

去阻止政客们做蠢事

that spread HIV.

加剧HIV的传播。

Thank you.

谢谢。

(Applause)

（掌声）