(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.
(Pljesak) SIDA je otkrivena 1981., a virus, 1983. Ovi Gapminder krugovi vam prikazuju koliko je virus bio raširen 1983. u svijetu, ili koliko procjenjujemo da je bio. Ono što je ovdje prikazano su -- na ovoj osi ovdje, postotak zaraženih odraslih osoba. A na ovoj osi, pokazujem prihode po osobi u dolarima. Veličina ovih krugova, veličina ovih krugova ovdje, pokazuje koliko je zaraženih u svakoj od država, a boja predstavlja kontinent.
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.
Ovdje možete vidjeti da su Sjedinjene Države, 1983. imale vrlo nizak postotak zaraženih, no zbog veličine populacije, to je još uvijek velik krug. Bilo je prilično mnogo zaraženih u Sjedinjenim Državama. A, ovdje gore, vidite Ugandu. Oni su imali skoro pet posto zaraženih, i prilično velik krug bez obzira na to što se radi o maloj državi. Oni su vjerojatno bili najzaraženija država na svijetu. No, što se dogodilo? Sad ste shvatili prikaz, i sad, u sljedećih 60 sekundi, pogledat ćemo epidemiju HIV-a u svijetu.
But first, I have a new invention here. (Laughter) I have solidified the beam of the laser pointer.
Ali prije toga, imam ovdje novi izum. (Smijeh) Učvrsnuo sam snop laser pokazivača.
(Laughter)
(Smijeh)
(Applause)
(Pljesak)
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.
Priprema, pozor, sad! Prvo, imamo brzi porast u Ugandi i Zimbabwe-u. Oni su išli gore ovako. U Aziji, prva zemlja koja je bila teško zahvačena je Tajland -- oni su dosegli jedan do dva posto. Onda, Uganda se počela vraćati natrag, dok je Zimbabve naglo porastao, i nekoliko godina kasnije Južna Afrika je imala grozan porast učestalosti HIV-a. Pogledajte, Indija ima mnogo zaraženih, ali ima nisku razinu. Skoro isto se dogodilo ovdje. Vidite, Uganda se vraća dolje, Zimbabve se spušta, Rusija je otišla na jedan posto.
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.
U zadnje dvije do tri godine, mi smo dosegli stabilno stanje HIV epidemije u svijetu. Za to je trebalo 25 godina. Ali stabilno stanje ne znači da su se stvari poboljšale, samo su se prestale pogoršavati. I jesu -- stabilno stanje je, više ili manje, da je jedan posto odrasle svjetske populacije zaraženo HIV-om. To znači 30 do 40 milijuna ljudi, to je cijela Kalifornija -- svaka osoba, to je više manje ono što danas imamo u svijetu.
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.
Sada ću napraviti brzo ponavljanje Bocvane. Bocvana -- zemlja sa gornje srednjim prihodima u južnoj Africi, ima demokratsku vladu, dobru ekonomiju, i evo što se tamo dogodilo. Oni su počeli nisko, onda su jako brzo porasil, dosegnuli su vrh tamo u 2003., a sada su tu dolje. Ali oni samo padaju polako, zato što u Bocvani, s dobrom ekonomijom i vladom, oni mogu davati ljudima terapiju. I ako osobe koje su zaražene dobivaju terapiju, oni ne umiru od AIDS-a. Ovi postotci neće se spustiti zato što ljudi mogu preživjeti 10 do 20 godina. Tako da sada postoji problem s ovim mjerenjima. Ali siromašnije zemlje u Africi, one s niskim prihodima ovdje, tamo stope brže padaju, postotci zaraženih padaju, zato što ljudi još uvijek umiru. Bez obzira na PEPFAR, velikodušni PEPFAR, nisu svi ljudi pod terapijom, a od onih koji dobivaju terapiju u siromašnijim zemljama, samo 60 posto su i dalje na terapiji nakon dvije godine. Nije realistično imati doživotnu terapiju za sve u najsiromašnijim zemljama. Ali je jako dobro da se radi to što se radi.
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.
Ali je sada fokus opet na prevenciji. Samo ako zaustavimo prenošenje će se svijet moći nositi s HIV-om. Lijekovi su pre skupi -- da imamo cjepivo, ili kada ćemo imati cjepivo, to je nešto što bi bilo puno učinkovitije -- ali lijekovi su jako skupi za siromašne. Ne lijek kao takav, ali terapija i njega koje je potrebna uz to. Kada pogledamo uzorak, jedna stvar je potpuno jasna, vidite plave krugove i ljudi kažu da je HIV čest u Africi. Rekao bih, HIV je drugačiji u Africi. Naći ćete najvišu stopu HIV-a u Africi, a ipak ćete naći Senegal ovdje dolje -- ista stopa kao SAD. I naći ćete Madagaskar, i naći ćete puno afričkih zemalja koje su nisko kao i ostatak svijeta. Ovo strašno pojednostavljivanje da postoji jedna Afrika i da se stvari u Africi događaju na jedan način. To moramo zaustaviti. Nije puno poštovanja, i nije najpametnije razmišljati tako.
(Applause)
(Pljesak)
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.
Imao sam sreće živjeti i raditi neko vrijeme u SAD-u. Utvrdio sam da su Salt Lake City i San Francisco različiti. (Smijeh) Tako je i u Africi -- ima puno raznolikosti. Pa, zašto je tako visoko? Je li to zbog rata? Nije. Pogledajte ovdje. Ratni Kongo je ovdje -- dva, tri, četiri posto. I ovo je mirna Zambija, susjedna zemlja -- 15 posto. I postoje dobra istraživanja izbjeglica koje izlaze iz Konga -- imaju dva, tri posto zaraženih, i mirna Zambija -- puno više. Tu su istraživanja koja jasno pokazuju da je rat užasan, i da se silovanja događaju, ali to nije pokretačka sila visokih razina u Africi.
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.
Dakle, je li to siromaštvo? Ako gledate na makro razini, čini se, više novca, više HIV-a. Ali to je vrlo pojednostavljeno, idemo pogledati Tanzaniju. Podijelit ću Tanzaniju u pet skupina prihoda, od najnižih i najviših prihoda, i evo nas. Oni s najvišim prihodom, kojima je bolje -- ne bih rekao bogati -- više razine HIV-a. Razlika pada od 11 posto do 4, i čak je i veća među ženama. Postoji puno stvari u koje smo vjerovali, koje sad dobro istraživanje, koje rade afričke institucije i istraživači zajedno s međunarodnim istraživačima, pokazuju da to nije slučaj. Ovo je razlika unutar Tanzanije.
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.
I ne mogu izbjeći Keniju. Pogledajte Keniju. Podijelio sam Keniju prema provincijama. Evo ga. Pogledajte razliku unutar jedne Afričke zemlje -- ide od vrlo niske razine do vrlo visoke, i većina provincija u Keniji je poprilično skromna.
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.
Pa, o čemu se radi? Zašto su ovako visoke razine u nekim zemljama? Pa, učestalije je s više partnera, manje se koriste kondomi, i tu je disparitet u snošaju -- to jest, stariji ljudi imaju snošaj s mlađim ženama. Vidimo više razine kod mlađih žena nego mlađih muškaraca u mnogim ovim zemljama s visokim stopama.
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.
Ali gdje su oni smješteni? Zamijenit ću krugove kartom. Pogledajte, visoka stopa od 4 posto čitave populacije, i oni drže 50 posto zaraženih HIV-om. HIV postoji posvuda u svijetu. Imate krugove po čitavom svijetu. Brazil ima mnoge zaražene HIV-om. Arapske zemlje ne toliko, ali Iran je poprilično visok. Imaju ovisnost o heroinu i prostituke u Iranu. Indija ima mnogo jer ih je puno. Jugoistočna Azija i tako dalje. Ali postoji jedan dio Afrike -- i teška stvar je, u isto vrijeme, ne raditi jedinstvenu izjavu o Africi, ne doći do jednostavnih ideja zašto je to tako, s jedne strane.
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.
S druge strane, pokušajte reći da to nije slučaj, jer postoji znanstveni konsenzus o ovom uzorku. UNAIDS je prikazao dobre podatke, napokon, o širenju HIV-a. Moglo bi biti potpomaganje. Mogle bi biti vrste virusa. Moglo bi biti da postoje druge stvari koje uzrokuju učestalije prenošenje. Napokon, ako ste potpuno zdravi i imate heteroseksualne odnose, rizik infekcije u jednom snošaju je jedan nasprama 1.000. Ne zaključujte na prečac kako se ponašati večeras i tako dalje. (Smijeh) Ali -- i ako ste u nepovoljnoj situaciji, više seksualno prenosivih bolesti, može biti 1 naprema 100.
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.
Ali mislimo da bi to moglo biti potpomaganje. A što je to potpomaganje? U Švedskoj, nemamo potpomaganje. Imamo serijsku monogamiju. Vodka, Nova Godina -- novi partner za proljeće. Vodka, Ljetna noć -- novi partner za jesen. Vodka -- i tako dalje, znate? I skupite velik broj bivših. I imamo užasne epidemije klamidije -- užasne epidemije klamidije koje su tu godinama. HIV ima vrhunac tri do šest tjedana nakon infekcije i zato, imati više partnera u jednom mjesecu je puno opasnije za HIV od drugih. Vjerojatno, to je kombinacija ovoga.
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.
I ono što me čini sretnim jest da se krećemo prema činjenicama kada gledamo ovo. Možete dobiti ovaj graf, besplatno. Stavili smo podatke UNAIDSA na Gapminder stranicu. I nadamo se da kada budemo djelovali na globalne probleme u budućnosti nećemo samo imati srca, nećemo samo imati novca, već ćemo koristiti i mozak.
Thank you very much.
Hvala vam puno.
(Applause)
(Pljesak)