(Applous) Vigs is in 1981 ontdek; die virus -- 1983. Hierdie Gapminder borrels wys hoe die virus in 1983 wêreldwyd versprei was, of hoe ons benader dit was. Wat ons hier wys is -- op dié as dui ek die persentasie besmette volwassenes aan. En hier, inkomste in dollar per persoon. En die grootte van die borrels hier wys hoeveel besmet is in elke land, en die kleur is die vasteland.
(Applause) AIDS was discovered 1981; the virus, 1983. These Gapminder bubbles show you how the spread of the virus was in 1983 in the world, or how we estimate that it was. What we are showing here is -- on this axis here, I'm showing percent of infected adults. And on this axis, I'm showing dollars per person in income. And the size of these bubbles, the size of the bubbles here, that shows how many are infected in each country, and the color is the continent.
Julle kan sien die VSA het, in 1983, ’n baie lae persentasie infeksies gehad, maar a.g.v. die groot bevolking, is dit steeds ’n wesenlike borrel. Nogal heelwat mense was besmet in die VSA. En, hier bo, sien julle Uganda. Hulle't amper vyf persent gehad, en nogal ’n groot borrel, al was dit toe nog ’n klein land. En hulle was waarskynlik die mees besmette land ter wêreld. Nou, wat het gebeur? Nou dat julle die grafiek verstaan, en nou, in die volgende 60 sekondes, sal ons die MIV-epidemie oor die wêreld afspeel.
Now, you can see United States, in 1983, had a very low percentage infected, but due to the big population, still a sizable bubble. There were quite many people infected in the United States. And, up there, you see Uganda. They had almost five percent infected, and quite a big bubble in spite of being a small country, then. And they were probably the most infected country in the world. Now, what has happened? Now you have understood the graph and now, in the next 60 seconds, we will play the HIV epidemic in the world.
Maar eers, het ek ’n nuwe uitvinding hier. (Gelag) Ek het die straal van die laserwyser gesoliedifiseer.
But first, I have a new invention here. (Laughter) I have solidified the beam of the laser pointer.
(Gelag)
(Laughter)
(Applous)
(Applause)
So, op julle merke, gereed, weg! Eerste, het ons die vinnige styging in Uganda en Zimbabwe. Hulle't opgegaan soos dit. In Asië, was Thailand die eerste erg besmette land. Hulle't een tot twee persent bereik. Toe het Uganda begin terugdraai, terwyl Zimbabwe uitgeskiet het, en so paar jaar later het Suid-Afrika ’n vreeslike styging in MIV-frekwensie. Kyk, Indië het baie besmet gehad, maar met ’n lae vlak. En omtrent dieselfde gebeur hier. Sien, Uganda kom af, Zimbabwe kom af, Rusland gaan tot by een persent.
So, ready, steady, go! First, we have the fast rise in Uganda and Zimbabwe. They went upwards like this. In Asia, the first country to be heavily infected was Thailand -- they reached one to two percent. Then, Uganda started to turn back, whereas Zimbabwe skyrocketed, and some years later South Africa had a terrible rise of HIV frequency. Look, India got many infected, but had a low level. And almost the same happens here. See, Uganda coming down, Zimbabwe coming down, Russia went to one percent.
In die laaste twee tot drie jaar, het ons ’n bestendige toestand in die wêreld se MIV-epidemie bereik. Dit het 25 jaar geneem. Maar, bestendigheid beteken nie dat dinge beter word nie, dit het net ophou erger word. Die bestendige toestand is, min of meer, een persent van die volwasse wêreldbevolking wat MIV-besmet is. Dit beteken 30 tot 40 miljoen mense, die hele Kalifornië, elke persoon, is min of meer wat ons het in die wêreld vandag.
In the last two to three years, we have reached a steady state of HIV epidemic in the world. 25 years it took. But, steady state doesn't mean that things are getting better, it's just that they have stopped getting worse. And it has -- the steady state is, more or less, one percent of the adult world population is HIV-infected. It means 30 to 40 million people, the whole of California -- every person, that's more or less what we have today in the world.
Laat ek Botswana weer ’n keer vinnig deurspeel. Botswana -- hoër-middelinkomste land in suider-Afrika, demokratiese regering, goeie ekonomie, en dis wat daar gebeur het. Hulle't laag begin, toe uitgeskiet, hulle't daar bo gepiek in 2003, en nou is hulle af. Maar hulle val net stadig-stadig, want in Botswana, met ’n goeie ekonomie en regering, kan hulle dit bybring om mense te behandel. En as besmette mense behandel word, sterf hulle nie aan vigs nie. Hierdie persentasies sal nie daal nie, want mense kan oorleef vir 10 tot 20 jaar. So daar's nou ’n probleem met hierdie maatstawwe. Maar die armer lande in Afrika, die lae-inkomste lande hier onder, daar val die infeksiekoers vinniger, want mense sterf steeds. Ten spyte van die vrygewige PEPFAR, word almal nie deur behandeling bereik nie, en van dié wat wel bereik word in die arm lande, ontvang slegs 60 persent ná twee jaar steeds behandeling. Lewenslange behandeling is nie realisties vir almal in die armste lande nie. Maar dis baie goed dat wat gedoen word, wel gedoen word.
Now, let me make a fast replay of Botswana. Botswana -- upper middle-income country in southern Africa, democratic government, good economy, and this is what happened there. They started low, they skyrocketed, they peaked up there in 2003, and now they are down. But they are falling only slowly, because in Botswana, with good economy and governance, they can manage to treat people. And if people who are infected are treated, they don't die of AIDS. These percentages won't come down because people can survive 10 to 20 years. So there's some problem with these metrics now. But the poorer countries in Africa, the low-income countries down here, there the rates fall faster, of the percentage infected, because people still die. In spite of PEPFAR, the generous PEPFAR, all people are not reached by treatment, and of those who are reached by treatment in the poor countries, only 60 percent are left on treatment after two years. It's not realistic with lifelong treatment for everyone in the poorest countries. But it's very good that what is done is being done.
Maar die fokus is nou terug op voorkoming. Slegs deur oordrag stop te sit sal die wêreld dit kan baasraak. Medisyne is te duur -- met die entstof, of wanneer ons dit kry, dis iets meer effektief -- maar die medisyne is baie duur vir armes. Nie die medisyne self nie, maar die behandeling en die sorg wat daar rondom nodig is. So, as ons na die patroon kyk, kom een ding duidelik na vore: julle sien die blou borrels en mense sê MIV is baie hoog in Afrika. Ek sou sê, MIV is baie ánders in Afrika. ’n Mens sal die hoogste MIV-koers ter wêreld in Afrikalande kry, en tog het Senegal, hier onder, dieselfde koers as die VSA. En julle sal Madagaskar kry, en baie Afrikalande kry wat omtrent so laag is soos die res van die wêreld. Dis hierdie vreeslike vereenvoudiging dat daar een Afrika is, en dat dinge op een manier werk in Afrika. Ons moet ophou daarmee. Dis nie respekvol nie, en dis nie baie slim om so te dink nie.
But focus now is back on prevention. It is only by stopping the transmission that the world will be able to deal with it. Drugs is too costly -- had we had the vaccine, or when we will get the vaccine, that's something more effective -- but the drugs are very costly for the poor. Not the drug in itself, but the treatment and the care which is needed around it. So, when we look at the pattern, one thing comes out very clearly: you see the blue bubbles and people say HIV is very high in Africa. I would say, HIV is very different in Africa. You'll find the highest HIV rate in the world in African countries, and yet you'll find Senegal, down here -- the same rate as United States. And you'll find Madagascar, and you'll find a lot of African countries about as low as the rest of the world. It's this terrible simplification that there's one Africa and things go on in one way in Africa. We have to stop that. It's not respectful, and it's not very clever to think that way.
(Applous)
(Applause)
Ek was bevooreg om vir ’n ruk in die VSA te woon en werk. Ek het agtergekom dat Salt Lake City en San Francisco baie verskillend is. (Gelag) En so is dit in Afrika -- daar's baie verskille. So, hoekom is dit so hoog? Is dit oorlog? Nee, dis nie. Kyk hier. Die oorloggeteisterde Kongo is hier onder -- twee, drie, vier persent. En hierdie is vreedsame Zambië, naburige land -- 15 persent. Daar's goeie studies van die vlugtelinge uit die Kongo -- twee, drie persent is besmet, en vreedsame Zambië -- baie hoër. Daar's nou studies wat duidelik aandui dat die oorloë aaklig is, dat verkragtings aaklig is, maar dis nie die dryfkrag vir die hoë vlakke in Afrika nie.
I had the fortune to live and work for a time in the United States. I found out that Salt Lake City and San Francisco were different. (Laughter) And so it is in Africa -- it's a lot of difference. So, why is it so high? Is it war? No, it's not. Look here. War-torn Congo is down there -- two, three, four percent. And this is peaceful Zambia, neighboring country -- 15 percent. And there's good studies of the refugees coming out of Congo -- they have two, three percent infected, and peaceful Zambia -- much higher. There are now studies clearly showing that the wars are terrible, that rapes are terrible, but this is not the driving force for the high levels in Africa.
So, is dit armoede? Wel, as ’n mens kyk op die makrovlak, blyk dit meer geld, meer MIV. Maar dis baie simplisties, so kom ons gaan af en kyk na Tanzanië. Ek deel Tanzanië in vyf inkomstegroepe op, van die hoogste na die laagste inkomste, en hier gaan ons. Dié met die hoogste inkomste, ek sou wel nie sê ryk nie, hulle't hoër MIV. Die verskil gaan van 11 persent af tot by vier persent, en dis selfs groter onder vroue. Daar's baie dinge wat ons gedink het wat nou, deur navorsing, van Afrika-instansies en -navorsers saam met internasionale navorsers, wys dat dit nie die geval is nie. Dis die verskil binne Tanzanië.
So, is it poverty? Well if you look at the macro level, it seems more money, more HIV. But that's very simplistic, so let's go down and look at Tanzania. I will split Tanzania in five income groups, from the highest income to the lowest income, and here we go. The ones with the highest income, the better off -- I wouldn't say rich -- they have higher HIV. The difference goes from 11 percent down to four percent, and it is even bigger among women. There's a lot of things that we thought, that now, good research, done by African institutions and researchers together with the international researchers, show that that's not the case. So, this is the difference within Tanzania.
En, ek moet Kenia wys. Kyk hier. Ek het Kenia in provinsies opgedeel. Hier gaan dit. Kyk die verskil binne een Afrikaland -- dit gaan van ’n baie lae tot by ’n baie hoë vlak, en die meeste van die provinsies in Kenia is betreklik beskeie.
And, I can't avoid showing Kenya. Look here at Kenya. I've split Kenya in its provinces. Here it goes. See the difference within one African country -- it goes from very low level to very high level, and most of the provinces in Kenya is quite modest.
So, wat is dit dan? Hoekom sien ons sulke uiters hoë vlakke in sommige lande? Wel, dis meer algemeen met meer as een seksmaat, kondoomgebruik is minder algemeen, en daar is ouderdom-disparate seks -- dit is, ouer mans is geneig om met jonger vroue seks te hê. Ons sien ’n hoër koers in jonger vroue as jonger mans in baie van die erg geaffekteerde lande.
So, what is it then? Why do we see this extremely high levels in some countries? Well, it is more common with multiple partners, there is less condom use, and there is age-disparate sex -- that is, older men tend to have sex with younger women. We see higher rates in younger women than younger men in many of these highly affected countries.
Maar waar is hulle geleë? Ek sit die borrels op ’n kaart. Kyk, die hoogs geïnfekteerdes is vier persent van die hele bevolking en hulle hou 50 persent van die MIV-geïnfekteerdes. MIV bestaan regoor die wêreld. Daar's borrels regoor die wêreld hier. Brasilië het baie MIV-geïnfekteerdes. Arabiese lande nie so veel nie, maar Iran is nogal hoog. Hulle het heroïnverslawing en ook prostitusie in Iran. Indië het baie want daar is baie. Suid-oos Asië, en so aan. Maar, daar is een deel van Afrika -- en die moeilike ding is, terselftertyd, om nie ’n eenvormige uitspraak oor Afrika te maak nie, om nie met simpel idees voorendag te kom oor hoekom dit so is, aan die een kant.
But where are they situated? I will swap the bubbles to a map. Look, the highly infected are four percent of all population and they hold 50 percent of the HIV-infected. HIV exists all over the world. Look, you have bubbles all over the world here. Brazil has many HIV-infected. Arab countries not so much, but Iran is quite high. They have heroin addiction and also prostitution in Iran. India has many because they are many. Southeast Asia, and so on. But, there is one part of Africa -- and the difficult thing is, at the same time, not to make a uniform statement about Africa, not to come to simple ideas of why it is like this, on one hand.
Aan die ander kant, om te erken dat dit ’n ernstige geval is, want daar is nou wetenskaplike konsensus oor hierdie patroon. VNVIGS het, uiteindelik, goeie data beskikbaar gestel, oor die verspreiding van MIV. Dit kan samelopendheid wees. Dit kan sekere virustipes wees. Dit kan wees dat daar ander dinge is wat oordrag teen ’n hoër frekwensie laat voorkom. As jy immers heeltemal gesond is en jy hê heteroseksuele seks, is die infeksierisiko tydens een omgang een in ’n 1000. Moenie oorhaastig raak met julle gedrag vanaand nie. (Gelag) Maar as jy in ’n ongunstige situasie is, meer seksueeloordraaglike siektes, kan dit een in ’n 100 wees.
On the other hand, try to say that this is not the case, because there is a scientific consensus about this pattern now. UNAIDS have done good data available, finally, about the spread of HIV. It could be concurrency. It could be some virus types. It could be that there is other things which makes transmission occur in a higher frequency. After all, if you are completely healthy and you have heterosexual sex, the risk of infection in one intercourse is one in 1,000. Don't jump to conclusions now on how to behave tonight and so on. (Laughter) But -- and if you are in an unfavorable situation, more sexually transmitted diseases, it can be one in 100.
Maar wat ons dink dit kan wees, is samelopendheid. En wat is dit? In Swede het ons geen samelopendheid nie. Ons het reeks-monogamie. Vodka, Oujaarsaand -- ’n nuwe maat vir die lente. Vodka, Midsomersaand -- ’n nuwe maat vir die herfs. Vodka -- en so gaan dit aan, julle weet? En jy versamel ’n groot aantal ekse. En ons het ’n vreeslike chlamidia-epidemie -- ’n vreeslike chlamidia-epidemie wat vir baie jare rondhang. MIV bereik drie tot ses weke na infeksie ’n piek en dus, is om meer as een seksmaat in een maand te hê baie meer gevaarlik in MIV-oordrag as met ander infeksies. Waarskynlik, is dit ’n kombinasie hiervan.
But what we think is that it could be concurrency. And what is concurrency? In Sweden, we have no concurrency. We have serial monogamy. Vodka, New Year's Eve -- new partner for the spring. Vodka, Midsummer's Eve -- new partner for the fall. Vodka -- and it goes on like this, you know? And you collect a big number of exes. And we have a terrible chlamydia epidemic -- terrible chlamydia epidemic which sticks around for many years. HIV has a peak three to six weeks after infection and therefore, having more than one partner in the same month is much more dangerous for HIV than others. Probably, it's a combination of this.
En wat my so gelukkig maak is dat ons nou in die rigting van feite beweeg wanneer ons hierna kyk. Julle kry dié grafiek, pasella. Ons't VNVIGS data op Gapminder.org opgelaai. En ons hoop dat wanneer ons in die toekoms op globale probleme reageer ons nie net die hart sal hê nie, nie net die geld sal hê nie, maar dat ons ook die brein sal inspan.
And what makes me so happy is that we are moving now towards fact when we look at this. You can get this chart, free. We have uploaded UNAIDS data on the Gapminder site. And we hope that when we act on global problems in the future we will not only have the heart, we will not only have the money, but we will also use the brain.
Baie dankie.
Thank you very much.
(Applous)
(Applause)