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  • I want you to take a trip with me.

    譯者: Adrienne Lin 審譯者: Geoff Chen

  • Picture yourself driving

    請各位與我一起

  • down a small road in Africa,

    想像你們開著車

  • and as you drive along, you look off to the side,

    開在非洲的一條小路上

  • and this is what you see:

    邊開邊注意到路邊的景象

  • you see a field of graves.

    你會發現到的是這個

  • And you stop, and you get out of your car and you take a picture.

    一片墓地

  • And you go into the town,

    然後你會停下來,下車,拍下照片

  • and you inquire, "What's going on here?"

    繼續往城鎮開

  • and people are initially reluctant to tell you.

    然後你會問:「這裡發生了什麼事?」

  • And then someone says,

    居民一開始會不願意回答你

  • "These are the recent AIDS deaths in our community."

    之後有人會向你坦白

  • HIV isn't like other medical conditions;

    「這些是我們社區,最近因愛滋而死亡的人」

  • it's stigmatizing.

    愛滋不像其他醫療疾病

  • People are reluctant to talk about it --

    得愛滋是種恥辱

  • there's a fear associated with it.

    人們不願意多談

  • And I'm going to talk about HIV today,

    提到愛滋就一陣惶恐

  • about the deaths,

    我今天要談的是,關於愛滋、

  • about the stigma.

    關於死亡、

  • It's a medical story, but more than that, it's a social story.

    關於恥辱的故事

  • This map depicts the global distribution of HIV.

    這是關於醫療的故事,但更重要的,是關於人們的故事

  • And as you can see,

    這張地圖是全球愛滋分布圖

  • Africa has a disproportionate share of the infection.

    各位可以看到

  • There are 33 million people

    非洲的愛滋感染分佈極不相稱

  • living with HIV in the world today.

    現今有3300萬人

  • Of these, two-thirds, 22 million

    感染愛滋病

  • are living in sub-Saharan Africa.

    這當中有三分之二的人

  • There are 1.4 million pregnant women

    2200萬人住在次撒哈拉非洲地區

  • in low- and middle-income countries living with HIV

    現在有140萬個愛滋媽媽

  • and of these, 90 percent

    來自於中低所得國家

  • are in sub-Saharan Africa.

    其中有九成

  • We talk about things in relative terms.

    就住在次撒哈拉非洲地區

  • And I'm going to talk about annual pregnancies

    我們用相對的例子說明

  • and HIV-positive mothers.

    我要談的是每年的懷孕率

  • The United States -- a large country --

    與愛滋媽媽

  • each year, 7,000 mothers with HIV

    美國這麼大一個國家

  • who give birth to a child.

    每年有七千個愛滋媽媽

  • But you go to Rwanda -- a very small country --

    產下子女

  • 8,000 mothers with HIV who are pregnant.

    但你看到盧安達,相對而言很小的國家

  • And then you go to Baragwanath Hospital,

    有8000個懷孕的愛滋媽媽

  • outside of Johannesburg in South Africa,

    當你到巴拉瓜納醫院

  • and 8,000 HIV-positive pregnant women

    就在(南非)約翰尼斯堡附近

  • giving birth --

    醫院裡有約八千名懷孕的愛滋媽媽

  • a hospital the same as a country.

    等著生產

  • And to realize that this is just the tip of an iceberg

    光一家醫院的數量就如此龐大

  • that when you compare

    所以請了解,這只是冰山一角

  • everything here to South Africa, it just pales,

    和南非相比

  • because in South Africa,

    南非的情形可是一片慘澹

  • each year 300,000 mothers with HIV

    因為在南非

  • give birth to children.

    每年有30萬個愛滋媽媽

  • So we talk about PMTCT,

    懷孕生子

  • and we refer to PMTCT, prevention of mother to child transmission.

    所以我要談PMTCT

  • I think there's an assumption amongst most people in the public

    PMTCT代表:母子垂直感染的預防計畫

  • that if a mother is HIV-positive,

    大家對於愛滋的普遍看法是

  • she's going to infect her child.

    當一名母親感染愛滋

  • The reality is really, very different.

    她的孩子也會受感染

  • In resource-rich countries,

    但事實並非如此

  • with all the tests and treatment we currently have,

    在資源豐富的國家

  • less than two percent of babies are born HIV-positive --

    我們已經有許多的測試與療法

  • 98 percent of babies are born HIV-negative.

    愛滋寶寶機率只有不到2%

  • And yet, the reality in resource-poor countries,

    98%的寶寶愛滋病毒會呈現陰性反應

  • in the absence of tests and treatment,

    然而在資源短缺國家

  • 40 percent -- 40 percent of children are infected --

    因為測試與治療的缺乏

  • 40 percent versus two percent --

    愛滋寶寶的機率高達40%

  • an enormous difference.

    40%與2%的差距

  • So these programs --

    是非常驚人的

  • and I'm going to refer to PMTCT though my talk --

    所以這些計畫

  • these prevention programs,

    我接下來演講裡所說的PMTCT

  • simply, they're the tests and the drugs that we give to mothers

    這些預防計畫

  • to prevent them from infecting their babies,

    簡單說,母親能接受檢查與藥物治療

  • and also the medicines we give to mothers

    來預防垂直感染

  • to keep them healthy and alive to raise their children.

    同時也必須服用藥物

  • So it's the test a mother gets when she comes in.

    讓母親們身體健康到能養育嬰兒

  • It's the drugs she receives

    所以一開始的檢查很重要

  • to protect the baby that's inside the uterus and during delivery.

    她要服用的藥很重要

  • It's the guidance she gets around infant feeding

    能讓肚裡的寶寶能健康發育到出生

  • and safer sex.

    嬰兒餵養的指導很重要

  • It's an entire package of services,

    安全性行為也很重要

  • and it works.

    這是關於完善的服務

  • So in the United States,

    而且是有效的

  • since the advent of treatment in the middle of the 1990s,

    在美國

  • there's been an 80-percent decline

    1990年代中期,愛滋的治療出現後

  • in the number of HIV-infected children.

    在愛滋寶寶的數量上

  • Less than 100 babies are born with HIV

    已經降低80%

  • each year in the United States

    美國每年的愛滋寶寶數量

  • and yet, still,

    不到100個

  • over 400,000 children

    然而世界上

  • are born every year in the world today with HIV.

    每年還是有超過40萬名兒童

  • What does that mean?

    一出生就感染愛滋

  • It means 1,100 children infected each day --

    這代表了什麼?

  • 1,100 children each day, infected with HIV.

    這代表每天就有1100個孩子受感染

  • And where do they come from?

    每天有1100個孩子感染愛滋

  • Well, less than one comes from the United States.

    這些寶寶從哪來?

  • One, on average, comes from Europe.

    不到一個是來自美國

  • 100 come from Asia and the Pacific.

    平均歐洲有一個

  • And each day,

    剩下有一百個來自亞洲、太平洋地區

  • a thousand babies -- a thousand babies

    然而每一天

  • are born each day with HIV in Africa.

    有一千個寶寶,一千個愛滋寶寶

  • So again, I look at the globe here

    在非洲出生

  • and the disproportionate share of HIV in Africa.

    所以我們看看全球情況

  • And let's look at another map.

    在非洲,愛滋分布不均的情況

  • And here, again, we see

    我們來看另一個地圖

  • Africa has a disproportionate share of the numbers of doctors.

    可以再次看到

  • That thin sliver you see here, that's Africa.

    在非洲,醫生數量也是分佈不均

  • And it's the same with nurses.

    圖中那條銀色細線,就是非洲

  • The truth is sub-Saharan Africa

    護士也一樣

  • has 24 percent

    事實上,次撒哈拉非洲地區

  • of the global disease burden

    包含了24%的

  • and yet only three percent of the world's health care workers.

    世界疾病數量

  • That means doctors and nurses

    但醫療人員數量卻只有全世界的3%

  • simply don't have the time to take care of patients.

    這表示,這裡的醫生護士

  • A nurse in a busy clinic

    根本沒有時間照顧好每個病人

  • will see 50 to 100 patients in a day,

    較忙的診所裡,每天

  • which leaves her just minutes per patient --

    每位護士要照看50到100位病人

  • minutes per patient.

    一個病人只有幾分鐘時間

  • And so when we look at these PMTCT programs, what does it mean?

    短短幾分鐘

  • Well, back in 2001,

    當我們看看這些PMTCT計畫,代表了什麼?

  • when there was just a simple test

    我們先回到2001年

  • and a single dose of a drug,

    當時要做的檢查很簡單

  • a nurse, in the course of her few minutes with a patient,

    藥也只有一顆

  • would have to counsel for the HIV test, perform the HIV test,

    一位護士可以在幾分鐘內

  • explain the results, dispense a single dose of the drug, Nevirapine,

    提供病人愛滋病諮詢、檢查、

  • explain how to take it, discuss infant feeding options, reinforce infant feeding,

    解釋檢查結果、發藥(因為只有一顆:Nevirapine)、

  • and test the baby -- in minutes.

    解釋服藥方式、討論嬰兒的服藥選擇、加強嬰兒餵食、

  • Well, fortunately since 2001,

    替嬰兒檢查,幾分鐘內就要完成

  • we've got new treatments, new tests,

    幸運的是,從2001以後

  • and we're far more successful,

    我們有了新治療、新測試

  • but we don't have any more nurses.

    能更加成功地對抗愛滋了

  • And so these are the tests

    但護士還是不夠多

  • a nurse now has to do

    這些測試是

  • in those same few minutes.

    現在的護士

  • It's not possible --

    短短幾分鐘內就要完成的

  • it doesn't work.

    這根本不可能

  • And so we need to find

    根本辦不到

  • better ways of providing care.

    所以我們需要的是

  • This is a picture of a maternal health clinic in Africa --

    提供更好的醫療照顧

  • mothers coming, pregnant and with their babies.

    這照片是非洲一家婦產科診所

  • These women are here for care,

    許多的母親來到這,有懷孕的、帶著孩子的

  • but we know that just doing a test,

    這些婦女來這裡接受照顧

  • just giving someone a drug,

    我們都知道只做測試

  • it's not enough.

    給他們藥物吃

  • Meds don't equal medical care.

    是不夠的

  • Doctors and nurses, frankly,

    藥品不等於醫療照顧

  • don't have the time or skills

    老實說,醫生護士們

  • to tell people what to do in ways they understand.

    根本沒有時間、能力

  • I'm a doctor -- I tell people things to do,

    去好好解釋給病人聽

  • and I expect them to follow my guidance --

    我是個醫生,我給病人指示

  • because I'm a doctor; I went to Harvard --

    希望他們能照我說的去做

  • but the reality is,

    因為我是個醫生,我哈佛畢業的

  • if I tell a patient, "You should have safer sex.

    但事實上

  • You should always use a condom,"

    如果跟病人說:「你要有安全的性行為」

  • and yet, in her relationship, she's not empowered --

    「一定要用保險套」

  • what's going to happen?

    但他們的社會裡,女人沒有權利

  • If I tell her to take her medicines every day

    會發生什麼事?

  • and yet, no one in the household knows about her illness, so

    如果我告訴她,每天按時服藥

  • it's just not going to work.

    但她家裡沒人知道她生病了又有什麼用

  • And so we need to do more,

    這是行不通的

  • we need to do it differently,

    所以我們必須做更多

  • we need to do it in ways that are affordable

    必須換種方式

  • and accessible and can be taken to scale,

    這方式要我們能夠負擔

  • which means it can be done everywhere.

    能夠接觸到更多人

  • So, I want to tell you a story --

    所以一定要到處都可行

  • I want to take you on a little trip.

    我分享一個故事給各位

  • Imagine yourself, if you can,

    帶你們來趟旅行

  • you're a young woman in Africa, you're going to the hospital or clinic.

    想想你們自己

  • You go in for a test

    是非洲的一名年輕女性,來到醫院或診所

  • and you find out that you're pregnant, and you're delighted.

    你來做檢查

  • And then they give you another test

    你發現你懷孕了,很開心

  • and they tell you you're HIV-positive, and you're devastated.

    但他們要你做另一項檢查

  • And