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ElizabethPisani_2010-_性交，毒品，hiv——让我们理智起来_
'"People do stupid things. “人会干傻事。
That's what spreads HIV ." 于是HIV就传播开来。”
HIV:n.艾滋病病毒;
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》。
Guardian:n.[法]监护人,保护人;守护者;adj.守护的;
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？
curious:adj.好奇的,有求知欲的;古怪的;爱挑剔的;
Well, one or two brave souls. 哦,有一两位勇士。
This is actually a direct quote from an epidemiologist who's been in field of HIV for 15 years, worked on four continents , and you're looking at her. 这句话实际上出自一位流行病学家之口 她研究HIV已有15年, 足迹遍布四大洲, 你们现在正看着她。
quote:v.引用;报价;举例说明;开价;为(企业的股份)上市;n.引用; epidemiologist:n.流行病学家; continents:n.[地理]大陆,大洲(continent复数);
And I am now going to argue that this is only half true. 我现在想说明 这句话只说对了一半。
People do get HIV because they do stupid things, but most of them are doing stupid things for perfectly rational reasons. 有些人确实是因为做了傻事感染了HIV, 但是其中的大多数人虽然做这些傻事 却有完全合乎理智的原因。
rational:n.理性;人类;合理的事物;[数]有理数;adj.合理的;理性的;明智的;理智的;
Now, "rational" is the dominant paradigm in public health, and if you put your public health nerd glasses on, you'll see that if we give people the information that they need “理智”是公共卫生的 首要准则。 现在你戴上公共卫生怪胎眼镜, 你便会知道如果你提供给人们必要的信息
dominant:adj.显性的;占优势的;支配的,统治的;n.显性; paradigm:n.范例;词形变化表; nerd:n.呆子;讨厌的人;
about what's good for them and what's bad for them, if you give them the services that they can use to act on that information, and a little bit of motivation , people will make rational decisions and live long and healthy lives. 告诉他们什么对他们好,什么不好, 如果你给他们必要的服务 使他们能对上述信息做出反应, 再加上一丁点的鼓励, 人们就会做出理智的决定 从此健康长寿。
motivation:n.动机;积极性;推动;
Wonderful. 好极了。
That's slightly problematic for me because I work in HIV, and although I'm sure you all know that HIV is about poverty and gender inequality, and if you were at TED '07 it's about coffee prices ... 但对于像我这样研究HIV的人,有一点小麻烦, 虽然我确信大家都知道 HIV与贫穷和两性不平等有紧密的联系。 如果你参加了TED*07, 就知道HIV与咖啡的价格紧紧相关;
slightly:adv.些微地,轻微地;纤细地; problematic:adj.问题的;有疑问的;不确定的; poverty:n.贫困;困难;缺少;低劣; gender:n.性别;
Actually, HIV's about sex and drugs, and if there are two things that make human beings a little bit irrational , they are erections and addiction . 实际上,HIV和性交,毒品脱不了干系。 如果说世上有两样东西 使人类丧失理智, 那就是勃起和上瘾。
irrational:adj.不合理的;无理性的;荒谬的;n.[数]无理数; erections:n.勃起;建造;建筑物;直立; addiction:n.瘾;嗜好;入迷;
(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。
Indonesian:n.印尼人;印尼语群;印度尼西亚语;adj.印尼的; Frankie:n.弗兰基(姓名);
We were having lunch and he was telling me about when he was in jail in Bali for a drug injection . 我们一起吃午餐,他跟我讲 他在巴里岛监狱里注射毒品的经历。
jail:n.监狱;监牢;拘留所;v.监禁;下狱; injection:n.注射;大量资金的投入;(液体的)注入;
It was someone's birthday, and they had very kindly smuggled some heroin into jail, and he was very generously sharing it out with all of his colleagues . 那天是一个人的生日,他们偷偷将一些海洛因 弄进了监狱, 他非常大方地邀请牢房里的兄弟们 一起享用。
smuggled:v.走私;私运;偷运(smuggle的过去分词和过去式) heroin:n.[药][毒物]海洛因,吗啡; generously:adv.慷慨地;宽大地;丰盛地; colleagues:n.同事;同行(colleague的复数);
And so everyone lined up, all the smackheads in a row, and the guy whose birthday it was filled up the fit, and he went down and started injecting people. 于是每个人都排好队, 所有瘾君子排成一排。 过生日的那个人 准备好注射器, 蹲下身,开始给兄弟们注射海洛因。
smackheads:n.吸海洛因者,海洛因瘾君子; injecting:v.(给…)注射(药物等);(给…)添加,增加(某品质);(inject的现在分词)
So he injects the first guy, and then he's wiping the needle on his shirt, and he injects the next guy. 他给第一个兄弟注射后, 顺手用衣服擦擦针管, 再注射下一个。
injects:vt.注入;注射; needle:n.针;针头;指针;缝针;v.穿过;刺激;拿针缝;拿针穿;
And Frankie says, "I'm number 22 in line, and I can see the needle coming down towards me, and there is blood all over the place. Frankie说:“我是第22个, 我看见针管离我越来越近, 地上到处都是血。
It's getting blunter and blunter. 针管越来越钝。
blunter:adj.(刀等)钝; (blunt的比较级)
And a small part of my brain is thinking, 'That is so gross and really dangerous,' but most of my brain is thinking, 'Please let there be some smack left by the time it gets to me. 我脑子里在想, “真是恶心死了 太危险了,” 但是我更关心的是, 拜托,拜托到我的时候 针管里还有点海洛因。
gross:adj.总共的;粗野的;恶劣的;显而易见的;v.总共收入;n.总额,总数;
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, "You know ... God, drugs really make you stupid." Frankie说: “你知道,天, 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,
accuracy:n.[数]精确度,准确性;
But, actually, Frankie, at that time, was a heroin addict and he was in jail. 但是Frankie那时, 是个瘾君子,而且他被关在监狱。
So his choice was either to accept that dirty needle or not to get high. 所以他只能选择 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, it's when you're in jail. 如果真有什么地方你确实很想过过瘾, 那就是监狱。
But I'm a scientist and I don't like to make data out of anecdotes , so let's look at some data. 但现在我是位科学家, 我不会用八卦故事当数据, 所以现在来看看数据。
anecdotes:n.奇闻轶事(anecdote的复数);
We talked to 600 drug addicts in three cities in Indonesia, and we said, "Well, do you know how you get HIV?" 我们采访在印尼的三座城市的 600名瘾君子, 我们问他们:“你知道你怎么感染HIV的吗？”
addicts:有瘾的人;对...入迷的人(addict的复数);
'"Oh yeah, by sharing needles ." “哦,当然知道。共用一个针头。”
needles:n.针数,千针本;[印刷]折页顶针(needle复数形式);
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 at a price you can afford to avoid that?" 我们又问:“你知道在哪可以买到 干净又便宜的针头吗？”
afford:v.给予,提供;买得起;
'"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, in the places where they're hanging out and taking drugs. 我们采访的那些地方就在街上, 瘾君子们聚集在一起服毒。
interviewing:v.对(某人)进行面试;(媒体)采访,访问;(interview的现在分词)
'"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。
maximum:n.最大限度;最大量;最高限度;adj.最高的;最多的;最大极限的;
So no surprises then that the proportion that actually used clean needles every time they injected in the last week is just about one in 10, and the other nine in 10 are sharing. 所以也难怪 在上周每次注射时真正 使用干净针头的比例 只有十分之一。 另外十分之九共用一个针头。
proportion:n.比例;部分;份额;均衡;v.摊派;使相称; injected:v.(给…)注射(药物等); (inject的过去分词和过去式)
So you've got this massive mismatch; everyone knows that if they share they're going to get HIV, but they're all sharing anyway. 你看,这前后矛盾。 每个人都知道 共用针头会感染HIV, 但是他们还是用一个针头。
massive:adj.大量的;巨大的,厚重的;魁伟的;
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？
junkie:n.有毒瘾者;废旧品商人;
You don't want to share a needle anymore than you want to share a toothbrush even with someone you're sleeping with. 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, 就算他是你的情人也不行。
toothbrush:n.牙刷;
There's just kind of an ick factor there. 这是因为,你知道,ick的原因。
factor:n.因素;要素;[物]因数;代理人;v.做代理商;v.把…作为因素计入;
'"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, if you were carrying a needle and the cops rounded you up, they could put you into jail. 现在,在印尼 如果你被逮到藏有针头,就会被警察抓走, 丢进监狱.
cops:n.警察;v.遭受;忍受;注意到;(cop的第三人称单数和复数)
And that changes the equation slightly, doesn't it? 这样看的话,情况就不一样了,对吗？
equation:n.方程式,等式;相等;[化学]反应式;
Because your choice now is either 因为这时你的选择就是,
I use my own needle now, or I could share a needle now and get a disease that's going to possibly kill me 10 years from now, or I could use my own needle now and go to jail tomorrow. 要么用现在自己的针头, 要么现在和别人用一个针头 感染上病 过个十年因此而死, 或者我可以现在用自己的针头 明天就去蹲监狱。
disease:n.病,[医]疾病;弊病;vt.传染;使…有病;
And while junkies think that it's a really bad idea to expose themselves to HIV, they think it's a much worse idea to spend the next year in jail where they'll probably end up in Frankie's situation and expose themselves to HIV anyway. 虽然瘾君子们认为 置身于感染HIV的危险中绝不是什么好事, 但是在监狱里过一年 更加糟糕, 你很可能在监狱里遇上Frankie所说的情况 最终还是可能感染HIV。
junkies:n.毒品贩子;吸毒者(junky的复数); expose:v.揭露,揭发;使曝光;显示;
So, suddenly it becomes perfectly rational to share needles. 这样,突然间,共用针头 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。
policy:n.政策,方针;保险单; point of view:观点;见地;立场;
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。
incentives:n.激励;奖励;诱因(incentive的复数形式);奖励措施; aligned:adj.对齐的;均衡的;v.结盟(align的过去式);使成一直线;
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 -- and junkies want to use clean needles. 我们希望瘾君子用干净的针头, 瘾君子也想用干净的针头。
So we could make this problem go away simply by making clean needles universally available and taking away the fear of arrest. 所以我们只用使瘾君子们能随时拿到针头 同时让他们不必担心被逮捕 就能解决这个问题。
universally:adv.普遍地;人人;到处;
Now, the first person to figure that out and do something about it on a national scale was that well-known , bleeding heart liberal 而第一个想出这一招 并在全国执行的人 就是大名鼎鼎的“铁娘子”
scale:n.规模;比例;鳞;刻度;天平;数值范围;v.衡量;攀登;剥落;生水垢; well-known:adj.著名的;众所周知的;清楚明白的; bleeding heart:荷包牡丹; liberal:adj.宽宏大度的; n.理解且尊重他人意见的人;
Margaret Thatcher . 英国首相撒切尔夫人。
Thatcher:n.盖屋匠;
And she put in the world's first national needle exchange program, and other countries followed suit: Australia, The Netherlands and few others. 她推行了全球第一项 国家针头交换计划 其他国家竞相效仿,澳大利亚,荷兰和一小部分其他国家,
exchange:n.交换;交流;交易所;兑换;v.交换;交易;兑换;
And in all of those countries, you can see, not more than four percent of injectors ever became infected with HIV. 在这些国家里,你们可以看到, 低于百分之四的吸毒人员 曾因注射而感染HIV。
injectors:n.注射器;注射者;注水器; infected:adj.带菌的; v.传染; (infect的过去分词和过去式)
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 -- we're talking, at its peak , one in two injectors infected with this fatal disease. 莫斯科,雅加达, 在峰值时, 每两个注射毒品的人中 就有一个感染了这种致命疾病。
Jakarta:n.雅加达(印尼首都,等于Djakarta); peak:n.高峰; v.达到高峰; adj.最高度的; fatal:adj.致命的;灾难性的;毁灭性的;导致失败的;
Now, Margaret Thatcher didn't do this because she has any great love for junkies. 撒切尔首相做这些 不是因为她对瘾君子有恻隐之心,
She did it because she ran a country that had a national health service . 她这样做是她执政的国家 有国家免费医疗系统。
national health service:n.(英国)国民医疗服务体系;
So, if she didn't invest in effective prevention , she was going to have pick up the costs of treatment later on, and obviously those are much higher. 所以,如果她不在有效疾病预防方面投资, 她以后就必须为疾病的治疗 付出昂贵的费用, 而且治疗的费用昂贵的多。
invest:v.投资;(把资金)投入;投入(时间、精力等);授予; effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象; prevention:n.预防;阻止;妨碍; treatment:n.治疗;疗法;对待;处理;讨论;
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。
politically:adv.政治上;
Now, if I take out my public health nerd glasses here and look at these data, it seems like a no-brainer , doesn't it? 现在,如果我带上我 公共卫生怪胎的眼镜, 再看看这些数据, 这完全不合逻辑。
no-brainer:不需对其动脑筋的事物;
But in this country, where the government apparently does not feel compelled to provide health care for citizens, (Laughter) 但是在这个国家, 政府显然不认为他们必须 为公民提供免费医疗,
apparently:adv.显然地;似乎,表面上; compelled:v.强迫;迫使;使必须;引起(反应);(compel的过去分词和过去式) health care:n.卫生保健;
we've taken a very different approach . 我们于是采取了大相径庭的解决方法。
approach:n.方法;路径;v.接近;建议;着手处理;
So what we've been doing in the United States is reviewing the data -- endlessly reviewing the data. 在美国,我们一直在做的事情是 验证数据,不断地验证。
United:adj.联合的; v.联合,团结; (unite的过去分词和过去式) reviewing:v.复查;重新考虑;反思;评论;(review的现在分词) endlessly:adv.不断地;无穷尽地;
So, these are reviews of hundreds of studies by all the big muckety-mucks of the scientific pantheon in the United States, and these are the studies that show needle programs are effective -- quite a lot of them. 于是上百个研究的数据 被大型的muckety-mucks 美国科学界圣人验证, 而大量的研究表明 针头计划是有效的。
reviews:n.综述; v.回顾; scientific:adj.科学的,系统的; pantheon:n.万神殿;名流群;
Now, the ones that show that needle programs aren't effective -- you think that's one of these annoying dynamic slides and I'm going to press my dongle and the rest of it's going to come up, but no -- that's the whole slide. 再看,这些表明针头计划无效的研究 你们认为在这张烦人的幻灯片上, 我按一下手中的遥控器,剩下的数据就会出现, 但是,没有,这张幻灯片上就这么多内容。
annoying:adj.烦人的;使生气的;使烦恼的;v.使生气;打扰;骚扰;(annoy的现在分词) dynamic:n.动力; adj.充满活力的; dongle:n.电子狗;软件狗;
(Laughter) （笑声）
There is nothing on the other side . 另外一栏什么也没有。
on the other side:另一面;在另一边;
So, completely irrational, you would think. 那么,这完完全全没有道理。 你肯定这样想,
Except that, wait a minute, politicians are rational, too, and they're responding to what they think the voters want. 只是,等下,不对,政客们也是理智的, 而且他们所做的事情是他们认为选民们想做的。
politicians:n.政治家;(蔑)政客;(美)政治贩;(politician的复数) responding:v.响应;作出反应;反应灵敏;(respond的现在分词)
So what we see is that voters respond very well to things like this and not quite so well to things like this. 我们看到的是选民们都 十分愿意回应这种情况 而不愿意回应这种情况。
(Laughter) （笑声）
So it becomes quite rational to deny services to injectors. 所以拒绝向瘾君子提供服务 就显得很有道理。
deny:v.否定,否认;拒绝给予;拒绝…的要求;
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 the clearly irrational positions of people like the Catholic Church, who think somehow that if you give out condoms , everyone's going to run out and have sex. 呃,我根本不会去评论 天主教徒们那些 完全不和逻辑的想法。 以为只要你免费发保险套, 人们就会出去找乐子。
Catholic:adj.天主教的;宽宏大量的;n.天主教徒;罗马天主教; somehow:adv.以某种方法;莫名其妙地; condoms:n.避孕套,安全套;(condom的复数)
I don't know if Pope Benedict watches TEDTalks online, but if you do, I've got news for you Benedict -- 我不知道本尼迪克特教皇 是否会在线看TED的演讲, 但是教皇,您看的话,我有话要跟您讲。
Pope:n.教皇,罗马教皇;权威,大师; Benedict:n.本尼迪克特(男子名);
I carry condoms all the time and I never get laid. 我随身带着保险套, 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 to transmit sexually . HIV不是很容易 通过性交传染。
transmit:v.传送;发射;播送;传播;传染; sexually:adv.性,性欲
So, it depends on how much virus there is in your blood and in your body fluids . 是否传染取决于你血液和体液所含的 病毒数量
fluids:n.液体;流体;液;(fluid的复数)
And what we've got is a very, very high level of virus right at the beginning when you're first infected, then you start making antibodies , and then it bumps along at quite low levels for a long time -- 10 or 12 years -- you have spikes if you get another sexually transmitted infection . 当某人感染HIV后,在感染最初期 病毒含量非常,非常高, 然后你的身体开始产生抗体, 之后很长的一段时间内 10年或12年,病毒的含量都保持在相当低的水平, 如果你有与他人发生关系而受到感染,you have spikes ,
at the beginning:首先;从一开始;起初;从头开始; antibodies:n.[免疫]抗体(antibody的复数); bumps:碰撞(bump的第三人称单数);碰撞(bump的复数); spikes:n.钉鞋(spike的复数);v.把…钉牢(spike的第三人称单数); transmitted:v.传送;输送;发射;播送;传播;传染;(transmit的过去分词和过去式) infection:n.感染;传染;(身体某部位的)感染;传染病;
But basically , nothing much is going on until you start to get symptomatic AIDS, and by that stage, you're not looking great, you're not feeling great, you're not having that much sex. 但一般而言,在你开始出现艾滋病的 症状之前,不会发生什么。 而到了那一阶段,这里, 你会看起来很糟,感觉很不好, 不会发生很多性交。
basically:adv.主要地,基本上; symptomatic:adj.有症状的;症候的;
So the sexual transmission of HIV is essentially determined by how many partners you have in these very short spaces of time when you have peak viremia. 所以通过性交感染HIV基本取决于 当你体内的病毒达到高潮时 的那一段非常短的时间段内 你有多少位同伴。
transmission:n.传输;传染;播送;发射;广播;传动装置; essentially:adv.本质上;本来; determined:adj.决定了的:v.决定;(determine的过去分词和过去式)
Now, this makes people crazy because it means that you have to talk about some groups having more sexual partners in shorter spaces of time than other groups, and that's considered stigmatizing . 这一来人们就要发疯了 因为这意味着你必须谈论 有些人在较短的时间内 比另外一些人有更多的同伴, 这样就太侮辱人了。
stigmatizing:vt.诬蔑;玷污;给…打上烙印;
I've always been a bit curious about that because I think stigma is a bad thing, whereas lots of sex is quite a good thing, but we'll leave that be. 我一直都对此很好奇 因为我认为侮辱是件很不好的事情, 而然性交频繁却是件很好的事, 不过这事就这样吧。
whereas:conj.然而;鉴于;反之;
The truth is that 20 years of very good research have shown us that there are groups that are more likely to turnover large numbers of partners in a short space of time. 事实是20年来 很出色的研究 告诉我们 有一些人更倾向于 在短时期内有很多伙伴,
turnover:n.翻覆;[贸易]营业额;流通量;半圆卷饼;失误;adj.翻过来的;可翻转的;
And those groups are, globally, people who sell sex and their more regular partners. 而基本上这些人, 都是出卖色情,有更多的同伴,
They are gay men on the party scene who have, on average, three times more partners than straight people on the party scene. 在派对上的同性恋拥有的伙伴数量 平均比派对上的异性恋 多出两倍,
And they are heterosexuals who come from countries that have traditions of polygamy and relatively high levels of female autonomy , and almost all of those countries are in east or southern Africa. 还有些异性恋 他们来自的国家 有一妻多夫的传统 女性有较强的自主权, 大多数此类国家都在南部非洲的东部。
heterosexuals:n.异性恋者(heterosexual的复数); polygamy:n.一夫多妻,一妻多夫,多配偶; relatively:adv.相当程度上;相当地;相对地; female:adj.女性的;雌性的;柔弱的,柔和的;n.女人;[动]雌性动物; autonomy:n.自治,自治权;
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。
reflected:adj.反射的;得自他人的;v.反射;思考;(reflect的过去式和过去分词) epidemic:n.流行病;蔓延;adj.传染病;流行性的;
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。
horrifying:adj.令人极其震惊的;v.惊吓;使厌恶;(horrify的现在分词)
These are all countries in southern Africa where between one in seven, and one in three of all adults, are infected with HIV. 这些全部是南部非洲的国家 七分之一 到三分之一 的成年人 都感染了HIV。
Now, in the rest of the world, we've got basically nothing going on in the general population -- very, very low levels -- but we have extraordinarily high levels of HIV 而在世界其他国家, 基本上普通大众平安无事, 非常低的比率, 但是HIV携带率
in the general:通常,一般; extraordinarily:adv.非常;格外地;非凡地;
in these other populations who are at highest risk: drug injectors, sex workers and gay men. 在高危人群中的比率异常的高, 像注射毒品的瘾君子,性工作者, 男同性恋。
And you'll note, that's the local data from Los Angeles: 25 percent prevalence among gay men. 大家注意看旧金山的地方数据。 有25%的同性恋感染了HIV。
prevalence:n.流行;普遍;广泛;
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。
unprotected:adj.无保护的;未设防的;v.无保护;(unprotect的过去式和过去分词);
You can only HIV by having unprotected sex with a positive person. 你只有和在传染期的携带者 发生无预防措施的性交才会染病。
positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片;
In most of the world, these few prevention failures notwithstanding , we are actually doing quite well these days in commercial sex: condom use rates are between 80 and 100 percent in commercial sex in most countries. 在世界大多数地方, 有些预防措施失效了 但不多, 在性交易行业里 实际上,我们（预防措施）做的很不错。 在大多数国家性性交易行业 安全套的使用率在80%到100%。
notwithstanding:adv.尽管,仍然;prep.尽管,虽然;conj.虽然; commercial:adj.贸易的;商业的;赢利的;以获利为目的的;n.(电台或电视播放的)广告;
And, again, it's because of an alignment of the incentives. 正是因为形成了这些鼓励措施
alignment:n.队列,成直线;校准;结盟;
What's rational for public health is also rational for individual sex workers because it's really bad for business to have another STI. 对公共卫生讲这是理智的行为 对个体性工作者也是理智的。 因为染上病会影响生意。
individual:n.个人;有个性的人;adj.单独的;个别的;
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。
clients:n.委托人;当事人;客户机;(client的复数) drip:n.滴落;滴落(的液体);水滴;v.(液体)滴下;
So essentially, you're able to achieve quite high rates of condom use in commercial sex. 所以最终,你可以在性交易行业 达到高安全套使用率。
But in " intimate " relations it's much more difficult because, with your wife or your boyfriend or someone that you hope might turn into one of those things, we have this illusion of romance and trust and intimacy , and nothing is quite so unromantic as the, "My condom or yours, darling?" question. 但是在“亲密”关系中, 就困难的多了 因为也许你的妻子或男友, 或你想进一步发展成为恋人或配偶的那个人, 因为某种浪漫的幻想 信任和亲密, 没有什么比“亲爱的,用你的安全套还是我的” 这样的问题,更让人扫兴的了。
intimate:n.知己; v.暗示; adj.亲密的; illusion:n.幻觉,错觉;错误的观念或信仰; romance:n.爱情;恋爱;风流韵事;传奇故事; intimacy:n.亲密;密切;关系密切;性行为; unromantic:adj.平淡无奇的;
So in the face of that, you really need quite a strong incentive to use condoms. 所以,在那种情况下, 你需要有强大的意愿 才会使用安全套。
in the face of:面对;
This, for example, this gentleman is called Joseph . 就像这位先生,他叫Joseph。
Joseph:n.连帽大氅;
He's from Haiti and he has AIDS. 来自海地,患有艾滋,
Haiti:n.海地;
And he's probably not having a lot of sex right now, but he is a reminder in the population, of why you might want to be using condoms. 现在他大概没有什么性交, 但是他提醒着其他的人们, 你为什么想用 安全套。
This is also in Haiti and is a reminder of why you might want to be having sex, perhaps. 这张也在海地,提醒着你 为什么想上床。
Now, funnily enough, this is also Joseph after six months on antiretroviral treatment. 好了,挺好笑,这张还是Joseph。 在进行抗病毒治疗6个月后（的照片）。
funnily:adv.有趣地,滑稽地;古怪的; antiretroviral:adj.抗逆转录病毒的,抗后病毒的;
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 of what's rational in sexual decision-making . 但是这样一来等式两边就不平衡了 在性交时 什么样的决定才是理智的。
decision-making:n.决策;
So, what we've got -- some people say, "Oh, it doesn't matter very much because, actually, treatment is effective prevention because it lowers your viral load and therefore makes it more difficult to transmit HIV." 我们听到 有些人说:“这没什么要紧的 因为实际上,治疗非常有效 治疗使你体内的病毒减少了 所以就很难传递HIV了。”
So, if you look at the viremia thing again, if you do start treatment when you're sick, well, what happens? Your viral load comes down. 那么,如果大家再看看感染病毒的情况, 如果你在生病时就开始治疗, 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？
compared:adj.比较的,对照的; v.相比; (compare的过去式和过去分词)
Well, you die, so your viral load goes to zero. 那你就会死, 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 -- which are because you couldn't get to the pharmacy , or you ran out of drugs, or you went on a three day party binge and forgot to take your drugs, 这些绿色部分,包括SPIKES, 是因为你没有去看医生 或者你没有药了,或者你去派对狂欢三天 完全忘记吃药,
stuff:n.东西:物品:基本特征:v.填满:装满:标本: pharmacy:n.药房;配药学,药剂学;制药业;一批备用药品; binge:n.狂欢,狂闹;放纵;vt.放纵;vi.狂饮作乐;大吃大喝;
or because you've started to get resistance , or whatever -- all of that is virus that wouldn't be out there, except for treatment. 或者你的身体开始产生抗药性,或者随便别的什么, 这些全部是病毒 不是因为治疗,这些都不会在这里。
resistance:n.电阻;抵抗;阻力;抗力;
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,
strategy:n.策略;行动计划;部署;战略;
Let's just stop treating people." 我们都别给患者治病了吧？
treating:v.以…态度对待;把…看作;处理;讨论;(treat的现在分词)
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。
expand:v.扩张;使膨胀;详述;发展;张开,展开;
But what I am doing is calling into question those people who say that more treatment is all the prevention we need. 但是我要提出一个问题 问那些说只要更多的治疗就足够我们预防艾滋的人 你们凭什么这么说。
That's simply not necessarily true, and I think we can learn a lot from the experience of gay men in rich countries where treatment has been widely available for going on 15 years now. 事实显然并非如此, 在发达国家艾滋病的治疗已经普及了15年, 我们可以在那些国家的男同性恋那里 学到很多教训,
necessarily:adv.必要地;必定地,必然地;
And what we've seen is that, actually, condom use rates, which were very, very high -- the gay community responded very rapidly to HIV, with extremely little help from public health nerds , I would say -- 我们看到 实际上,安全套的使用率 非常,非常高 同性恋群中,对HIV的反应也很迅速, 几乎不需要 公共卫生人员的帮助
community:n.社区;[生态]群落;共同体;团体; responded:v.回答,回应;作出反应;响应;反应灵敏;(respond的过去式和过去分词) extremely:adv.非常,极其;极端地; nerds:n.书呆子;网虫;讨厌鬼(nerd的复数);
that condom use rate has come down dramatically since treatment for two reasons really: 接受治疗后,安全套的使用率开始锐减 主要有两个原因。
dramatically:adv.戏剧地;引人注目地;adv.显著地,剧烈地;
One is the assumption of, "Oh well, if he's infected, he's probably on meds , and his viral load's going to be low, so I'm pretty safe." 有一种想法是:“呃, 要是他感染了,他肯定在吃药, 那他的病毒携带量就很低,所以我安全的很。”
assumption:n.假定;设想;担任;采取; meds:n.药物:
And the other thing is that people are simply not as scared of HIV as they were of AIDS, and rightly so. 另一个原因是人们根本 不像害怕艾滋一样 害怕HIV,这样想也对。
rightly:adv.正确地;恰当地;公正地;合适地;
AIDS was a disfiguring disease that killed you, and HIV is an invisible virus that makes you take a pill every day. 艾滋把你折腾的不像人样,还致你于死命, HIV是看不见摸不着的病毒 害你每天吃片药。
disfiguring:v.损毁…的外形;使变丑;毁容;(disfigure的现在分词) invisible:adj.看不见的;n.看不见的人或物; pill:n.[医]药丸;药品;
And that's boring , but is it as boring as having to use a condom every time you have sex, no matter how drunk you are, no matter how many poppers you've taken, whatever? 真无聊, 就和每次做爱都要用安全套 一样的无聊, 不管你喝的多醉, 不管你和几个瘾君子上床,什么都不管
boring:adj.无聊的;令人厌烦的;n.钻孔;v.使厌烦;钻孔;(bore的现在分词) poppers:n.礼花;爆竹;炮手(popper的复数形式);
If we look at the data, we can see that the answer to that question is, mmm. 看看数据,我们会发现 问题的答案就在 嗯——
So these are data from Scotland. 这些是苏格兰的数据
You see the peak in drug injectors before they started the national needle exchange program. 你看毒品注射者这些峰值 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 -- and in drug users, you've really got nothing much going on after treatment begins, and that's because of that alignment of incentives that I talked about earlier. 不管是异性恋,大多数是性工作者 还是瘾君子, 在开始治疗之后,基本上没有出现任何状况, 这要归功于我先前提到的 那些鼓励政策
But in gay men, you've got quite a dramatic rise starting three or four years after treatment became widely available. 但是男同性恋中, 在治疗广泛推行的 三四年内 数量却急剧上升。
This is of new infections . 这些是新增的感染者。
infections:n.传染病;口腔病害(infection复数形式);
What does that mean? 这意味着什么？
It means that the combined effect of being less worried and having more virus out there in the population -- more people living longer, healthier lives, more likely to be getting laid with HIV -- is outweighing the effects of lower viral load, and that's a very worrisome thing. 这意味着一方面人们不再那么害怕（HIV） 而另一方面,病毒携带者的数量增加了, 更多人活的更长,更健康, 更可能身为HIV携带者依然进行性交 这些综合因素的影响 已超过了低病毒携带的影响, 这让我很担心。
worrisome:adj.令人烦恼的,令人不安的;麻烦的;
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。
compassion:n.同情;怜悯; conundrum:n.难题;谜语;
We've talked a lot about compassion the last couple of days, and what's happening really is that people are unable quite to bring themselves to put in good sexual and reproductive health services for sex workers, unable quite to be giving out needles to junkies. 这两天我们常常讨论同情心。 现在的情况是人们 很难做到 为性工作者提供高质量的性和生育健康服务, 很难给瘾君子发针头,
reproductive:adj.生殖的;再生的;复制的;
But once they've gone from being transgressive people whose behaviors we don't want to condone to being AIDS victims, we come over all compassionate and buy them incredibly expensive drugs for the rest of their lives. 但是一旦他们不再是不可饶恕的 瘾君子或性工作者, 而成为了艾滋病人, 我们会抛开一切情绪 为他们买昂贵的药物,直到他们生命终结的那天。
transgressive:超亲的;海浸的;逾越的; condone:vt.宽恕;赦免; compassionate:adj.慈悲的;富于同情心的;vt.同情;怜悯; incredibly:adv.难以置信地;非常地;
It doesn't make any sense from a public health point of view. 从公共卫生的角度讲 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:abbr.国际核事件分级表(InternationalNuclearEventScale);
Ines is a a transgender hooker on the streets of Jakarta; she's a chick with a dick . Ines是为变性人,她在雅加达的街上当妓女。 她是有小鸡鸡的女生。
transgender:n.跨性别;跨性别者; hooker:n.(橄榄球并列争球时的)钩球队员;卖淫者;妓女; dick:n.阴茎,鸡巴;侦探;誓言;
Why does she do that job? 她为什么当妓女？
Well, of course, because she's forced into it because she doesn't have any better option , etc., etc. 当然是因为她被逼无奈 别无选择,等等等等,
option:n.选择;可选择的东西;
And if we could just teach her to sew and get her a nice job in a factory, all would be well. 但是如果我们教她缝纫 给她在工厂里提供一份好工作,事情就圆满了。
sew:v.缝;缝制;缝补;做针线活;
This is what factory workers earn in an hour in Indonesia: on average, 20 cents. 在印尼,工厂工人平均一个小时 赚20美分。
It varies a bit province to province. 每个省份的情况稍微有点不同。
varies:n.多重复合;v.使不同;改变;违背(vary的三单形式);
I do speak to sex workers, 15,000 of them for this particular slide, and this is what sex workers say they earn in an hour. 这张幻灯片上的数据 来自我在和15000名性工作者的谈话。 这是性工作者自报的 每小时的薪水。
So it's not a great job, but for a lot of people it really is quite a rational choice. 这个工作不怎么样,但是对很对人而言 确实很明智的选择。
Okay, Ines. OK,Ines。
We've got the tools, the knowledge and the cash, and commitment to preventing HIV too. 我们也有方法,知识,现金, 以及决心,防治HIV。
commitment:n.承诺;投入;保证;许诺;
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。
politics:n.政治;钩心斗角;政治观点;v.(贬)从事政治活动;(politic的第三人称单数)
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 , politicians are making no sense. 从性工作者的角度看, 政客们完全没有道理。
sex worker:n.性工作者(对以性行为换取金钱者的委婉说法);
From the point of view of a public health nerd, junkies are doing dumb things. 从公共卫生怪胎的角度看, 瘾君子们在做蠢事。
dumb:adj.哑的,无说话能力的;不说话的,无声音的;
The truth is that everyone has a different rationale . 每个人都有自己的一套逻辑。
rationale:n.基本原理;原理的阐述;
There are as many different ways of being rational as there are human beings on the planet, and that's one of the glories of human existence. 世上有多少个人 就有多少种逻辑。 这是人类的闪光点之一。
But those ways of being rational are not independent of one another, so it's rational for a drug injector to share needles because of a stupid decision that's made by a politician, and it's rational for a politician to make that stupid decision because they're responding to what they think the voters want. 但是种种不同的逻辑 并不是单存于世。 所以瘾君子们 共用针头很理性 因为政治家的一个愚蠢的决定, 政治家做了愚蠢的决定 也很理智 因为他们是以他们认为的 投票者赞同的方式行动。
independent of:不依赖…的;不受…支配的;
But here's the thing: we are the voters. 但问题是: 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, and everyone who's watching this out there on the web, 每个在这间房间的人, 每个在网站上看这些视频的人,
I think, has a duty to demand of their politicians that we make policy based on scientific evidence and on common sense . 都有义务要求政客们 在科学证据和常识的基础上 指定政策。
evidence:n.证据,证明;迹象;明显;v.证明; common sense:adj.常识的;有生活经验得来的;
It's going to be really hard for us to individually affect what's rational for every Frankie and every Ines out there, but you can at least use your vote to stop politicians doing stupid things that spread HIV. 我们很难 单独地去影响 世界上每个Frankie和Ines的决定。 但是你至少能利用手中的投票权 去阻止政客们做蠢事 加剧HIV的传播。
individually:adv.个别地,单独地;
Thank you. 谢谢。
(Applause) （掌声）