"People do stupid things. That's what spreads HIV." This was a headline in a U.K. newspaper, The Guardian, not that long ago. I'm curious, show of hands, who agrees with it? Well, one or two brave souls.
“人会干傻事。 于是HIV就传播开来。” 这句话是一家英国报纸的头条, 不久之前出版的《卫报》。 我很好奇,请大家举个手,谁同意这句话? 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。
And I am now going to argue that this is only half true. People do get HIV because they do stupid things, but most of them are doing stupid things for perfectly rational reasons. 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 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. Wonderful.
我现在想说明 这句话只说对了一半。 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。 “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 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。 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 ... 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.
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; 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。
(Laughter)
(笑声)
So, let's start with what's rational for an addict. Now, I remember speaking to an Indonesian friend of mine, Frankie. We were having lunch and he was telling me about when he was in jail in Bali for a drug injection. 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. 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. So he injects the first guy, and then he's wiping the needle on his shirt, and he injects the next guy. 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. It's getting blunter and blunter. 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. Please let there be some left.'" And then, telling me this story, Frankie said, "You know ... God, drugs really make you stupid."
那么,我们先说说瘾君子认为什么不和逻辑。 我曾经和一位印尼的朋友,Fankie,聊天。 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。 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。 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。 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。 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。 针管越来越钝。 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。 拜托给我留一点。” 故事讲完后, 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. But, actually, Frankie, at that time, was a heroin addict and he was in jail. So his choice was either to accept that dirty needle or not to get high. And if there's one place you really want to get high, it's when you're in jail.
而且,你知道,他这句话你挑不出一点毛病, 但是Frankie那时, 是个瘾君子,而且他被关在监狱。 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。 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. We talked to 600 drug addicts in three cities in Indonesia, and we said, "Well, do you know how you get HIV?" "Oh yeah, by sharing needles." I mean, nearly 100 percent. Yeah, by sharing needles. And, "Do you know where you can get a clean needle at a price you can afford to avoid that?" "Oh yeah." Hundred percent. "We're smackheads; we know where to get clean needles." "So are you carrying a needle?" We're actually interviewing people on the street, in the places where they're hanging out and taking drugs. "Are you carrying clean needles?" One in four, maximum. 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.
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。 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?” “哦,当然知道。共用一个针头。” 我是说,差不多100%,对,都是共用针头害的。 我们又问:“你知道在哪可以买到 干净又便宜的针头吗?” 100%的人都答道:“哦,知道。” “我们吸毒,我们当然知道上哪儿去弄干净的针头。” “那你们会带着针头吗?” 我们采访的那些地方就在街上, 瘾君子们聚集在一起服毒。 “你们带着干净的针头吗?” 最多四分之一的人带着。 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。
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. So what's that about? Is it like you get a better high if you share or something? We asked that to a junkie and they're like, "Are you nuts?" You don't want to share a needle anymore than you want to share a toothbrush even with someone you're sleeping with. There's just kind of an ick factor there. "No, no. We share needles because we don't want to go to jail." So, in Indonesia at this time, if you were carrying a needle and the cops rounded you up, they could put you into jail. And that changes the equation slightly, doesn't it? Because your choice now is either 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. 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. So, suddenly it becomes perfectly rational to share needles.
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。 这是为什么呢?是共用针头让你更过瘾吗? 我们这样问他们,他们说:“你疯了? 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。 这是因为,你知道,ick的原因。 不是,不是。我们共用针头因为我们不想进监狱。” 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. 这样看的话,情况就不一样了,对吗? 因为这时你的选择就是, 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。 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。 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. This is a really easy problem. For once, your incentives are aligned. We've got what's rational for public health. You want people to use clean needles -- and junkies want to use clean needles. So we could make this problem go away simply by making clean needles universally available and taking away the fear of arrest. Now, the first person to figure that out and do something about it on a national scale was that well-known, bleeding heart liberal Margaret Thatcher. And she put in the world's first national needle exchange program, and other countries followed suit: Australia, The Netherlands and few others. And in all of those countries, you can see, not more than four percent of injectors ever became infected with HIV.
现在我们从政策决策者的角度看看这个问题。 实际上非常简单。 终于有一次,大家达成了一致意见。 从公共卫生角度,我们得出了理性的答案。 我们希望瘾君子用干净的针头, 瘾君子也想用干净的针头。 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。 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” 英国首相撒切尔夫人。 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, 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。
Now, places that didn't do this -- New York City for example, Moscow, Jakarta -- we're talking, at its peak, one in two injectors infected with this fatal disease. Now, Margaret Thatcher didn't do this because she has any great love for junkies. She did it because she ran a country that had a national health service. 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. So she was making a politically rational decision. 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? But in this country, where the government apparently does not feel compelled to provide health care for citizens, (Laughter) we've taken a very different approach. So what we've been doing in the United States is reviewing the data -- endlessly reviewing the data. 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. 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,没有实行这一政策的国家,比如纽约, 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。 撒切尔首相做这些 不是因为她对瘾君子有恻隐之心, 她这样做是她执政的国家 有国家免费医疗系统。 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。 所以她做出了一个政治上很理智的决定。 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。 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, 我们于是采取了大相径庭的解决方法。 在美国,我们一直在做的事情是 验证数据,不断地验证。 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。 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。
(Laughter)
(笑声)
There is nothing on the other side. So, completely irrational, you would think. Except that, wait a minute, politicians are rational, too, and they're responding to what they think the voters want. So what we see is that voters respond very well to things like this and not quite so well to things like this.
另外一栏什么也没有。 那么,这完完全全没有道理。 你肯定这样想, 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。 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. Now let's talk about sex. Are we any more rational about sex? 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. I don't know if Pope Benedict watches TEDTalks online, but if you do, I've got news for you Benedict -- I carry condoms all the time and I never get laid. (Laughter) (Applause) It's not that easy! Here, maybe you'll have better luck.
所以拒绝向瘾君子提供服务 就显得很有道理。 现在来说说性交。 我们在性交上更理智吗? 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。 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。 我随身带着保险套, 但从来没机会用。 (笑声) 这种机会可不容易找。 接着,也许你的运气好一点。
(Applause)
(掌声)
Okay, seriously, HIV is actually not that easy to transmit sexually. So, it depends on how much virus there is in your blood and in your body fluids. 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. 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.
OK,严格地说, HIV不是很容易 通过性交传染。 是否传染取决于你血液和体液所含的 病毒数量 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 , 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。
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. 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. 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. 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. And those groups are, globally, people who sell sex and their more regular partners. They are gay men on the party scene who have, on average, three times more partners than straight people on the party scene. 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. And that is reflected in the epidemic that we have today.
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。 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。 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。 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, 而基本上这些人, 都是出卖色情,有更多的同伴, 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, 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。 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. These are all countries in southern Africa where between one in seven, and one in three of all adults, are infected with 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 in these other populations who are at highest risk: drug injectors, sex workers and gay men. And you'll note, that's the local data from Los Angeles: 25 percent prevalence among gay men. Of course, you can't get HIV just by having unprotected sex. You can only HIV by having unprotected sex with a positive person.
大家看来自非洲的这些数据,让人不寒而栗。 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。 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 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。 大家注意看旧金山的地方数据。 有25%的同性恋感染了HIV。 当然,如果只进行无预防措施的性交不会染上HIV。 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。
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. And, again, it's because of an alignment of the incentives. What's rational for public health is also rational for individual sex workers because it's really bad for business to have another STI. No one wants it. And, actually, clients don't want to go home with a drip either. So essentially, you're able to achieve quite high rates of condom use in commercial sex.
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%。 正是因为形成了这些鼓励措施 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。 没人希望如此。 而且,也没有哪个顾客想带病回家。 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. So in the face of that, you really need quite a strong incentive to use condoms.
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。 所以,在那种情况下, 你需要有强大的意愿 才会使用安全套。
This, for example, this gentleman is called Joseph. He's from Haiti and he has AIDS. 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. This is also in Haiti and is a reminder of why you might want to be having sex, perhaps. Now, funnily enough, this is also Joseph after six months on antiretroviral treatment. Not for nothing do we call it the Lazarus Effect. But it is changing the equation of what's rational in sexual decision-making. 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." 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. But compared to what? What happens if you're not on treatment? Well, you die, so your viral load goes to zero. 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, or because you've started to get resistance, or whatever -- all of that is virus that wouldn't be out there, except for treatment.
就像这位先生,他叫Joseph。 来自海地,患有艾滋, 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。 这张也在海地,提醒着你 为什么想上床。 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)。 这就是为什么我们称之为拉撒路效应。 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。 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。” 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。 但是这跟怎么比呢?如果你没有接受治疗呢? 那你就会死, 这样你体内的病毒携带量变成了零。 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, 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。
Now, am I saying, "Oh, well, great prevention strategy. Let's just stop treating people." Of course not, of course not. We need to expand antiretroviral treatment as much as we can. But what I am doing is calling into question those people who say that more treatment is all the prevention we need. 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. 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 -- that condom use rate has come down dramatically since treatment for two reasons really: 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."
那我的意思是,好啊,多棒的预防策略啊, 我们都别给患者治病了吧? 当然不是,当然不是, 我们必须尽量让更多的人接受抗病毒的治疗。 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。 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, 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 接受治疗后,安全套的使用率开始锐减 主要有两个原因。 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。”
And the other thing is that people are simply not as scared of HIV as they were of AIDS, and rightly so. AIDS was a disfiguring disease that killed you, and HIV is an invisible virus that makes you take a pill every day. 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? If we look at the data, we can see that the answer to that question is, mmm.
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。 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。 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 看看数据,我们会发现 问题的答案就在 嗯——
So these are data from Scotland. You see the peak in drug injectors before they started the national needle exchange program. Then it came way down. 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. But in gay men, you've got quite a dramatic rise starting three or four years after treatment became widely available. This is of new infections.
这些是苏格兰的数据 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 之后人数下降了 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 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。 这些是新增的感染者。
What does that mean? 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. What does it mean? It means we need to be doing more prevention the more treatment we have.
这意味着什么? 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。 这意味着什么? 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? No, and I call it the "compassion conundrum." 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. 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. It doesn't make any sense from a public health point of view.
实际情况时这样的吗? 不,我把这种情况称作同情难题。 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, 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。 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. Ines is a a transgender hooker on the streets of Jakarta; she's a chick with a dick. Why does she do that job? Well, of course, because she's forced into it because she doesn't have any better option, etc., etc. And if we could just teach her to sew and get her a nice job in a factory, all would be well. This is what factory workers earn in an hour in Indonesia: on average, 20 cents. It varies a bit province to province. 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. So it's not a great job, but for a lot of people it really is quite a rational choice. Okay, Ines.
我想对Ines说几句离别的话。 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。 她为什么当妓女? 当然是因为她被逼无奈 别无选择,等等等等, 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。 在印尼,工厂工人平均一个小时 赚20美分。 每个省份的情况稍微有点不同。 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。 这个工作不怎么样,但是对很对人而言 确实很明智的选择。 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。
Ines: So why is prevalence still rising? It's all politics. When you get to politics, nothing makes sense.
Ines:那为什么HIV的携带者数量还在上升? 都是因为政治原因。 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." So, from the point of view of a sex worker, politicians are making no sense. From the point of view of a public health nerd, junkies are doing dumb things. The truth is that everyone has a different rationale. 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. 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. But here's the thing: we are the voters. We're not all of them, of course, but TED is a community of opinion leaders. And everyone who's in this room, and everyone who's watching this out there on the web, I think, has a duty to demand of their politicians that we make policy based on scientific evidence and on common sense. 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.
Elizabeth Pisani:“当政治介入后,一切都变得毫无道理。” 从性工作者的角度看, 政客们完全没有道理。 从公共卫生怪胎的角度看, 瘾君子们在做蠢事。 每个人都有自己的一套逻辑。 世上有多少个人 就有多少种逻辑。 这是人类的闪光点之一。 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。 但问题是: 我们才是投票者。 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, 每个在这间房间的人, 每个在网站上看这些视频的人, 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。 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。
Thank you.
谢谢。
(Applause)
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